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Friday 24th October 2014

Guardian

  • NHS boss Simon Stevens defends privatisation.

    The boss of the NHS in England has defended the privatisation of services as a way of helping patients get treatment but insisted that the health service would continue to do most of the work. Simon Stevens, the chief executive of NHS England, said that “sometimes there will be a case” for a patient needing, for example, a hip operation to use a private provider paid by the NHS and stressed that patients should decide themselves who should treat them. He was responding on BBC Radio 4’s Today programme to questions about the NHS put by its listeners, many of which involved the outsourcing of NHS clinical services. Stevens, an ex-Labour government health adviser under Tony Blair, started in the NHS’s top job on 1 April after 10 years working for UnitedHealth, an American private health firm. Pressed as to whether private firms would have an increasing role, Stevens again stressed that patient choice meant private involvement would continue. Recent Department of Health figures showed that non-NHS providers of healthcare, including private firms, received more than £10bn of the NHS’s almost £100bn budget last year. Stevens also defended the NHS’s use of the private finance initiative, pioneered by the last Labour government in which he was a health policy adviser, despite concern that it is adding to some hospital trusts’ money problems and has saddled the NHS with billions of pounds of repayment costs for years to come through expensive long-term contracts. The scheme had given the NHS important new and modernised hospitals, he said. But he backed the idea of other hospitals following the example set recently by Northumbria Healthcare foundation trust in buying itself out of its PFI contract. In the first deal of its kind it borrowed £114m from its local council to pay up and end the contract with the firms that build Hexham general hospital in Northumberland. The move is expected to save the trust an estimated £3.5m a year for the next 19 years. Stevens failed to offer any view on TTIP, the trade deal between Europe and the US being negotiated, despite the fears that it would force NHS services to be opened up to competition and permanently entrench privatisation in the service. The NHS England boss also appeared to defend his organisation paying GPs £55-a-time for diagnosing patients who have dementia, a move that critics have claimed is “putting a bounty” on certain patients and is unethical because, for the first time, it offers doctors financial incentives to diagnose a specific condition. Some GPs have called for family doctors to boycott the payments. Professor Sir Simon Wessely, the president of the Royal College of Psychiatrists, dismissed the scheme. Money for dementia should be spent on improving social care for those with the condition or on research which may yield new treatments that slow its progress. “Until that happens I can see little point in this initiative,” Wessely added.

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  • Two in five fear NHS will soon cease to be free.

    More than two out of five people fear the NHS will cease to be a free service over the next 20 years, a new survey reveals. When asked how likely it was that the NHS by 2034 would still be free at point of use, 44% said it was unlikely and 37% thought it was likely to be the case. Women and the less well-off were the most pessimistic. Among women, 48% believe the free NHS will have disappeared, while 36% do not. More men (40%) share that concern, though almost as many (38%) think free care will survive. The findings, from a survey of 1,030 adults in England by pollsters Populus, come after several thinktanks, groups of health professionals and ex-Labour health minister Lord Warner said the NHS should introduce charges, notably for visiting GPs, as a way of reducing the burden on the taxpayer. The survey, undertaken before NHS England this week sets out its radical plan to save the service, also found low levels of voter trust in political parties to put the NHS’s growing problems ahead of their own self-interest. Labour again emerged as the party that most voters (47%) trust on the NHS, followed by the Conservatives (38%), Liberal Democrats (35%) and Ukip (32%). Fifty-two percent did not trust either the Tories or Lib Dems on the NHS.

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Open Democracy

  • NHS boss Stevens and the TTIP 'trade' lobbyists who threaten our NHS.

    New NHS boss Simon Stevens faced a barrage of crowd-sourced questions on NHS privatisation as he launched the “NHS 5 Year Forward Plan” on Radio 4’s Today Programme. Not all of which he answered - particularly on the controversial TTIP deal that many campaigners see as threatening the NHS. Presenter Sarah Montague read out a question: “People are concerned, not least because of trade talks that are going on which could mean that the NHS is forced to open up under TTIP to American Companies… Does Simon Stevens think he can be unbiased on TTIP given his links to a pro-TTIP lobby group when he was at UnitedHealth” ? Stevens refused to be drawn on his views or lobbying on TTIP - the controversial trade talks currently underway between the EU and the US.After a stint as Tony Blair's health advisor, Simon Stevens was ‘President of Global Affairs’ at American private healthcare giant UnitedHealth until last year. In that role, according to Physicians for a National Health Programme, Stevens was a founder member of The Alliance for Healthcare Competitiveness - a pro-TTIP US lobby group pushing for the inclusion of health in the TTIP treaty. Stevens also acted as a spokesman for the Alliance for Healthcare Competitiveness's pro-TTIP position. In September 2011 - as health industry TTIP lobbying was already underway behind closed doors - the StarTribune reported “A coalition of U.S. health care businesses, including Minnesota-based UnitedHealth Group and Medtronic, proposes to rebuild America’s battered economy by selling the country’s ‘health ecosystem’ internationally. The Alliance for Healthcare Competitiveness (AHC) wants the U.S. government to build its foreign free-trade policy around the health care industry...” The paper quoted Simon Stevens commenting on behalf of the AHC that: “The worldwide need for health care in aging populations will lead to a demand for goods and services that can drive sales of American insurance, medical devices and record-keeping technology”.Although the actual TTIP negotiations are being kept under close wraps, the demands of groups like the AHC seem to be being heard. Cameron and his ministers - though repeatedly pressed - have refused to exclude or exempt healthcare from TTIP, saying it is “unnecessary”.

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Northern Echo

  • Anger over hospital cuts prompts two protests.

    NHS hospital directors were faced with two separate protests when they arrived for a board meeting at a North-East hospital. The demonstrations were held at the University Hospital of North Tees in Stockton over proposals to close two nurseries and downgrade a haematology unit. The North Tees and Hartlepool NHS Foundation Trust directors had to pass more than 20 protesters outside the main entrance of the hospital. They included Unison officials, parent members of the Friends of North Tees Nurseries and nursery staff who are due to be made redundant in December. Waving placards saying “Save Our Nurseries” and blowing whistles, they were calling on the directors to reverse their decision to close two day nurseries - one at the North Tees hospital and one at the University Hospital of Hartlepool. Mark Edmundson, area organiser for Unison, said: “They should have consulted with the unions, parents and the local community before pressing ahead with closure plans. This is a fantastic facility which is well used by staff and local residents.” He warned that Unison was considering legal action over the nursery closure plans, which will make 54 staff redundant. Outside the boardroom the directors were greeted by two leukaemia patients, June Ryder, 56, and Allison White, 37, both from Newton Aycliffe, County Durham, waving “Save Our Haematology Unit” signs. The chairman of the board of directors, Paul Garvin spoke to both sets of demonstrators before the meeting and explained the reasons why the board was backing controversial plans to close the nurseries and downgrade the eight-bedded haematology unit.

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Daily Telegraph

  • The 'Saatchi Bill' is dangerous and will bring nothing but harm.

    The death of Josephine has driven Maurice Saatchi to press forward with his Medical Innovation Bill, which will be debated in the House of Lords. Lord Saatchi believes doctors should be able to experiment when the disease is fatal. We believe, however, that Lord Saatchi's well-intentioned measure would be a terrible mistake. Let’s drown out the sound of the media campaign and ask why it is so many expert bodies believe that Lord Saatchi’s proposals would bring about nothing but harm. The Bill has failed to win the support of The British Medical Association, The Motor Neurone Disease Association, the Royal College of Physicians, the Royal College of Surgeons, the Medical Research Society, the Royal College of Radiologists, The Medical Defence Union, the Academy of Medical Sciences, the Royal College of Pathologists, the Royal College of General Practitioners, the Academy for Healthcare Science, the Wellcome Trust, Action Against Medical Accidents, and patient advocacy charities Health Watch and the Nightingale Collaboration, among others. Conservative MP Sarah Wollaston, a former GP, has "very serious concerns" about it. The PR campaign distorts the facts, exploiting ignorance and desperation to plant false hope in the rich soil of multiple fallacies. The Bill does not apply only to people who "have run out of other options" as Saatchi’s campaign director Dominic Nutt wrote in this paper. It applies to all patients and to any ailment, no matter how trivial, and strips them of existing protections against bad practice. It grants no rights to patients that they do not already have, and it is worth pointing out that the Saatchi Bill was not needed for NHS doctors to swiftly treat an Ebola patient with an un-trialled drug, or to test an un-trialled vaccine on valiant volunteers. If patients don’t benefit from the Bill, and doctors don’t and medical innovation doesn’t, who does ?Pharmaceutical companies stand to profit greatly. They are always looking to expand the market for existing drugs, especially drugs that are out-of-patent and competing with less expensive generic versions. "Innovative" use – i.e., prescribing them for different conditions or types of patients – is much cheaper and faster than developing new drugs. What’s more, the Saatchi Bill has no provision for the collation of results. So if it turns out, for example, that a drug previously taken only by adults is harmful for children, or that a treatment typically prescribed for men over 60 causes an astronomical rise in, say, diabetes when used by women in their 40s, the evidence of this will be blurred and easily hidden. As will evidence of effectiveness. The Bill actually diminishes the chances of serendipitously stumbling across a cure, while hindering research and further reducing the incentive to develop new medicines. Providers of private health insurance will benefit. If you can afford the premiums, you can jump the queue, as the NHS comes under relentless pressure to provide risky, inappropriate, or useless treatments at enormous cost. Quacks will be given free rein. No "treatment" is so loopy (or potentially dangerous) that the Saatchi Bill won’t protect doctors who prescribe or administer it from prosecution. In an article for this paper last May, Lord Saatchi makes the astonishing assertion that: ‘‘In democratic politics, perception is reality. If the people perceive a problem, there is one.’ In other words, there is no such thing as objective reality, so instead of addressing and correcting a misperception, a false solution to a non-existent problem has been concocted, with perhaps the assistance of those who stand to gain. Sadly, this is not those members of the public whose misguided support has been stirred up to lend legitimacy to the whole endeavour. It may be, and one hopes it is, the case that the many peers, cabinet ministers, shadow cabinet ministers, and MPs with financial interests in the health care industry will be entirely uninfluenced by their interests (or plans for future employment) in considering the Bill. And equally unswayed by a penchant for alternative medicine. But the clamour of constituents incited by a powerful media campaign will be hard to resist. The enthusiastic collaboration of so much of the British media in promoting the Saatchi Bill has been troubling. Is it based on scientific ignorance, an inability to think critically or to investigate properly ? A predilection for emotionally charged stories ? The power of vested interests ? Or all of the above ? The propagation of falsehoods and fallacies surrounding and arising from this Bill will have a corrosive effect on medical ethics and society as a whole.
    This is a wretched way to run a country.

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BBC News

  • NHS funding increase tough but possible, Jeremy Hunt says.

    Raising NHS spending in England - as demanded in a report by health bosses - would be tough but was possible within a strong economy, Jeremy Hunt has said. A five-year plan warned the NHS would need an extra £8bn by 2020 along with new arrangements such as letting GP practices offer hospital services. The health secretary said the Tories could "deliver an NHS people want" but it would take "difficult decisions". Labour said a failure to increase NHS budgets risked a "full-blown crisis". It comes as a report - called the NHS Forward View - again highlighted that an annual £30bn shortfall would open up in the next Parliament.

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Thursday 23rd October 2014

Tom Pride

  • Read the suppressed report into botched NHS operations by private company.

    An NHS hospital decided not to release the findings of a report into botched eye operations by a private healthcare provider in case the company sued the hospital for libel. Vanguard Healthcare Solutions, which carried out the botched operations, is owned by investment firm MML Capital – whose founder Rory Brooks is a Conservative Party donor. Which of course has nothing at all to do with the fact that the hospital’s critical report into Vanguard’s botched operations was branded “Strictly Confidential“.

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BBC News

  • NHS needs extra cash and overhaul, say health bosses.

    Drastic changes to services and extra money is needed if the NHS in England is not to suffer, health bosses say. A five-year plan for the NHS - unveiled by six national bodies - once again highlighted that an annual £30bn shortfall would open up by 2020. It said changes, such as GP practices offering hospital services, would help to plug a large chunk of the gap. But health chiefs said the NHS would still need above inflation rises of 1.5% over the coming years. That works out at an extra £8bn a year above inflation by 2020. The current budget stands at £100bn a year. But the plan - called the NHS Forward View - said this would only be enough if the health service became more efficient. To achieve this, the plan called for a rethink about the way services were delivered.These include: Large GP practices to employ hospital doctors to provide extra services, including diagnostics, chemotherapy and hospital outpatient appointments; In areas where GP services are under strain, hospitals could be encouraged to open their own surgeries; Smaller hospitals to work as part of larger chain, sharing back-office and management services; Larger hospitals to open franchises at smaller sites, as Moorfields Eye Hospital has done in London; Hospitals to provide care direct to care homes to prevent emergency admissions; Volunteers could be encouraged to get more involved, by offering council-tax discounts.

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  • Private ambulance spending in London rises 'tenfold'.

    Spending on private ambulances in London grew by 1,000% between 2011 and 2013, the Labour Party has claimed. The NHS spent £8.84m on private ambulances in the capital last year compared to £795,000 in 2011, according to a Freedom of Information request. The London Ambulance Service said it was losing staff due to "pressure on the organisation".

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Belfast Telegraph

  • Pension pot for Health trusts' fat cats tops £50m.

    The annual amount paid out to one of Northern Ireland's senior health chiefs from their pension pot could fund two nurses for a year, a union has said. Seventy-seven managers across the NHS here share pensions worth more than £50m - but 12 have individual funds worth more than £1m each. The gold-plated pension scheme for those at the top has been denounced as unjust at a time when thousands of healthcare staff are campaigning for a 1% pay rise. The highest earner is John Compton, who retired as Health and Social Care Board chief executive last year. He is on a guaranteed pension for life of £75,000 a year from a £1.6m pot. He also received a tax-free lump sum of £205,000.

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ITV News

  • Women 'denied fertility treatment due to NHS cuts'.

    NHS trusts are denying thousands of women across Britain fertility treatment in a bid to cut costs, a health watchdog has warned. The National Institute for Health and Care Excellence (Nice) said couples struggling to conceive are being subjected to unfair "postcode lotteries", causing "widespread inequality". Meanwhile fertility groups have warned many women are having to resort to costly private care because NHS provision is so patchy and hard to access. Nice warned that fewer than one in five commissioning groups are paying for the full number of IVF cycles recommended. And the commissioning group covering mid Essex will not fund IVF treatment unless there are "clinically exceptional circumstances".

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Guardian

  • Simon Stevens: new NHS chief executive with a private past.

    Simon Stevens’s 26-year career in healthcare has been partially defined by questions about the role of private enterprise. The £189,900-a-year NHS chief executive (he volunteered for a 10% pay cut this year in solidarity with wider pay restraint), took up one of the toughest jobs in public life in April after having settled with his American wife and children in Minnesota where he was president of the global health division of UnitedHealth Group, a giant US private healthcare company. Prior to his move across the Atlantic he had been a key player in the direction of the NHS under Tony Blair’s government where, as well as advising on a huge public reinvestment programme, he championed the use of privately-run independent sector treatment centres. Birmingham-born and comprehensive-schooled, Stevens joined the NHS as a graduate in 1988 after studying at Balliol College, Oxford. On his second day as NHS chief executive he angered Unison, which represents 400,000 NHS workers, by praising private health firms and “the innovation value of new providers”.

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Nursing Times

  • NHS five-year plan receives cautious welcome from unions.

    Unions have welcomed elements of NHS England’s plans for “radical” new care delivery options, which could see primary care nurses and midwives take on a stronger leadership role. The Royal College of Nursing said proposals to identify non-medical leaders for new models of care, invest in staff and a focus on prevention and care closer to home were all positive suggestions. It said the five-year plan – written by six NHS leading bodies, including the Care Quality Commission and Health Education England – provided a “rigorous and realistic” assessment of the scale of the challenge facing the country’s health service. However, the union warned that nurses, midwives and healthcare assistants would be “sceptical, if not a little cynical”, that without a clear commitment to increase funding, the NHS workforce would still face similar problems to those it has now. The RCN noted that nurses would be “delighted” with the report’s acknowledgement that nurses should be paid competitive salaries to avoid staff shortages. Meanwhile, the Royal College of Midwives welcomed proposals to review how maternity services were organised and delivered.

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Tuesday 21st October 2014

The Guardian

  • NHS needs bigger budget rises to ward off ‘perfect storm’, says watchdog.

    The NHS must once again start receiving annual multimillion-pound increases in its budget to help it survive a “perfect storm” of pressures, the boss of the service’s economic regulator has warned. The health service will struggle to cope with the ageing and growing population unless it goes back to getting above-inflation annual boosts to its funding, said Dr David Bennett. In an interview with the Guardian, the chief executive of Monitor said the coalition’s policy of giving the NHS “flat-real” budget increases was no longer enough to ensure the service could respond to the growing demand for healthcare. His intervention comes days before Simon Stevens, the chief executive of NHS England, unveils a blueprint for what whoever wins the general election in May should do to help the service. It is expected to make clear that the NHS will need billions of pounds of extra investment every year between 2015 and 2020 to help it radically change how it operates. “We’re not going to be able to continue to run with simple, flat-real funding into the indefinite future,” said Bennett, who helped Stevens draw up the NHS Five Year Forward View. “At some point we are going to have to recognise the impact of things like population growth.” The costs associated with ageing, patients’ growing expectations of high-quality treatment and the need to provide good care in every hospital also help explain why the NHS needs to return to real-terms increases in funding, which was the policy of the Tony Blair and Gordon Brown Labour governments. Bennett is also calling for the next government to inject at least a further £1bn a year into the NHS in the form of a “change fund” so it can continue funding hospitals, which are under unprecedented pressure, while also building up an array of new services outside hospitals.

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The Telegraph

  • Spending on private ambulances has risen by 82% in two years.

    Spending on private ambulances by the National Health Service has almost doubled in just two years, freedom of information requests have disclosed. Labour, which obtained the figures, claimed the surge in expenditure proved that every part of the NHS was at risk of being put up for sale by the Coalition Government. The overall budget for private ambulances in England leapt from £37m in 2011-12 to £67.5m last year, a rise of 82 per cent. The most dramatic increase was in London, where spending was up by 1,000 per cent from £796,000 to more than £8.8m. Accusations of creeping privatisation of the NHS were fuelled by reports that the agency which supplies temporary staff to hospitals faces being sold off. Sky News said ministers were examining the future of NHS Professionals, which has some 40,000 nurses, doctors, midwives and other healthcare workers on its books. It quoted a source as saying the agency’s sale, at an estimated price of between £50m and £100m, was “a very real possibility”. The figures on private ambulances revealed that spending quadrupled in Yorkshire and the North East to reach £3.6m and £2.9m respectively, while it went up by 143 per cent on the South East Coast to reach £13.7m. The statistics only relate to England as health is a devolved issue in both Scotland and Wales.

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Pulse

  • GPC to push for more equitable funding for practices taking on medical students.

    The GPC is to campaign for practices to receive fair funding for taking on medical students after highlighting underexposure in medical school as a major factor in the current workforce crisis, Pulse can reveal. GP leaders have identified boosting the number of high quality placements on offer to undergraduates as a priority, after research found that just 14% of curriculum time is spent in general practice, a proportion which has not increased in over a decade. Health Education England’s own GP Taskforce report on the crisis found that students who had been exposed to general practice in undergraduate education were much more likely to choose it as a specialism. GPC officials told Pulse that the failure to invest properly in GP education and training had led to the current workforce crisis, and this needed to be addressed ‘as soon as possible’. The announcement coincides with a review of the Service Increment for Teaching (SIFT) funding – which funds practices and hospitals to take on undergraduates – being run by Health Education England and the Department of Health. The Society for Academic Primary Care, which represents GP academics in discussions with the DH and HEE, fears the review could exacerbate the disparity between GP and hospital funding. Currently hospitals receive £34,000 per student per year in SIFT payments, but payments for practice placements vary and, unlike hospitals, practices are not paid for premises costs incurred in making treatment rooms available to students.

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HSJ

  • Deputy prime minister puts faith in winter funding.

    The deputy prime minister is pushing for next year’s NHS budget to be topped up with enough winter pressures funding to leave the service in a “healthy state” for the next government. Nick Clegg told HSJ in an exclusive interview he was working with Chief Secretary to the Treasury Danny Alexander to ensure the “right amount” of funding for 2015-16 was built into December’s autumn statement. “We need to make sure as custodians of the NHS that we hand on the NHS in a healthy state to whoever comes into power next,” he said. "That’s why for me and for Danny [Alexander] in our discussions with David Cameron and George Osborne, right at the top of our list of priorities will be to ensure we set aside the right amount of money such that any winter pressures in 2015-16 will be properly catered for. “I think that is an act of basic good governance.”

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Monday 20th October 2014

Open Democracy

  • It won't be the reds, blues, purples, greens or yellows who'll save England's NHS - it will be us.

    This week around half a million members of GMB, Unite, Unison and the Royal College of Midwives took strike action over an Osborne-imposed virtual pay freeze that has seen their purchasing power decline 12% since the election. Picket lines were well attended across the country - including at my local Stroud Maternity hospital, where new mothers and pregnant women dropped by to demonstrate solidarity, and horns sounded as passing drivers showed their support. Unite have hinted at further strikes - and we should all lend our support, union members or not. The NHS strike provides a tentative glimpse of the movement required to defend and rebuild a comprehensive, universal, free health service, owned and run within the public sector. There have been recent victories. Union and public campaigning stopped the sell-off of George Eliot hospital in Nuneaton, though not before £1.78million was wasted on the commissioning process. Cambridge mental health drop-in centre ‘Lifeworks’ was saved from closure after a four month sit-in by patients. Last month NHS Direct Action occupied Conservative Party Headquarters during their party conference, unfurling banners proclaiming “When they sell off the NHS — We Bleed, They Profit”. Nearly 4000 people recently filled a rugby stadium in Whitehaven to protest at threats to West Cumberland Hospital. This Saturday trade unionists from across public and private services march, saying 'Britain needs a pay rise'. On Monday Occupy Democracy will host an NHS day as part of its temporary occupation of Parliament Square. These campaigns might not have produced similar ‘victories’ (yet), but many are nonetheless inspiring. Inspiration is sorely needed. The NHS has been hit with ‘efficiency savings’ (ie, cuts) of £20 billion less than it needs to keep up with demand. £2.7 billion (20%) has been stripped out of adult care services, a back door hit on the NHS left to pick up the pieces. Effectively Osborne has - according to the Telegraph, of all papers - ‘abolished the NHS ring fence’. Money is increasingly being diverted to private providers and PFI repayments, to the consultants, lawyers and contesting contacts.

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The Guardian
Mipim is about more than just housing.

  • Mipim is about more than just housing.

    Now we know the Tories think their NHS “reforms” were a disaster (Report, theguardian.com, 13 October), can a law be passed to prevent any MP or peer from advising or holding a directorship with healthcare companies winning NHS contracts ?

The Guardian

  • NHS staff shortages pose risk to patients, warns watchdog.

    Some A& E departments and maternity units are so short of doctors and nurses that they pose a danger to patients, the NHS care watchdog has warned. Despite the Mid Staffordshire scandal, too much care in too many hospitals is still too poor, inspectors say in a report that identifies lapses in safety, patients having to wait on trolleys in corridors and chronic bed shortages as major problems. Inspectors found examples of children being treated on adult wards, too few staff caring for patients overnight, patients waiting to have their call bells answered, lengthening waits for treatment, and low staffing levels leading to more elderly people falling. In its annual report assessing NHS and social care services, the Care Quality Commission (CQC) said on Friday that while much care is excellent, “the variation in the quality and safety of care in England is too wide and is unacceptable”. It paints a picture of an NHS struggling to deliver consistently high-quality care while hampered by a widespread lack of staff. But, it says, the service’s “mounting financial challenge … should not excuse inadequate care”. CQC inspectors found examples of major improvements to different types of hospital care, some of which was rated outstanding. However, they also encountered “unacceptable inadequate care” in other places, with patient safety a recurring worry, in the visits they undertook at 82 hospitals across England between December 2013 and August 2014. David Behan, the regulator’s chief executive, said that not all hospitals had improved enough since Robert Francis QC’s report into Mid Staffordshire was published in February 2013.

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The Independent

  • Letters: A very personal plea - don’t privatise the NHS.

    I have read with interest your many articles about the NHS. Having received a great deal of treatment from the NHS over the past three years, I thought it was about time I gave my thoughts and experiences. I live in Worcestershire and have access primarily to a superb GP. We have been with this practice for many years and have built up an excellent relationship with all the staff, GPs, practice nurses and ancillary staff. In 2010 I finally decided that problems with arthritis were severely hampering what I could do. Having gone through preliminary procedures we – the GP and I – decided that an operation was needed. My GP was happy to refer me to my hospital of choice: the Royal Orthopaedic Hospital in Birmingham. Over the next 12 months I had two procedures: a right ankle fusion and 12 months later a left knee replacement. During both of these procedures my experience was one of total satisfaction, both with the outcomes of the operations and the care administered by the staff. I am now, thanks to dedicated, committed and highly skilled NHS staff, totally pain-free. I thought that I had done at that point and felt very grateful to a superb health service. I was wrong. I was diagnosed shortly afterwards with bowel cancer. Once again I received first-rate treatment from doctors and surgeons. I am now recovering and, throughout all my experiences of four separate NHS trusts covering six hospitals, I can honestly say that I was treated with kindness, care, respect and some of the most skilful surgery and radiotherapy you could wish for. I have had treatment from the Worcestershire Acute Hospitals Trust, Queen Elizabeth Hospital Birmingham, University Hospital Coventry and Warwickshire, and community support services, as well as the Royal Orthopaedic Hospital and my GP at St John’s Surgery in Bromsgrove.

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HSJ

  • Medical contract negotiations collapse.

    Contract negotiations between the British Medical Association and NHS Employers suddenly collapsed last night. The BMA issued a press release on Twitter at 9.15pm in which it announced the talks had ended, claiming: “The government refused to agree necessary safeguards to protect doctors from working dangerously long hours, compromising patient safety and doctors’ wellbeing.” NHS Employers appeared to have been caught by surprise and issued a statement last night that it was “amazed” at the decision of the BMA as it had agreed with consultants to work towards a deal in the next few days. It is understood an email from the junior doctors committee was sent to NHS Employers moments before the announcement. The 18 month talks had centred on NHS Employer’s proposal that consultants’ ability to refuse to work on weekends and evenings for non-urgent work should be removed. Other proposals included changes to their pay structure and a shake up of the Clinical Execellence Award scheme. The BMA claimed last night that while it was willing to discuss changes NHS Employers had refused to provide necessary safeguards beyond what it called “broad statements of intent.” The junior doctors side of the talks was understood to be seeking an increased hourly rate, with safeguards on the number of hours they would be expected to work without an increase to the overall cost. The BMA said: “For a government that claims to champion patient safety, its failure to agree safeguards, and in the case of junior doctors its desire to remove existing protections in order to save money, shows how they have failed to recognise the damaging impact that unsafe and gruelling working patterns have on patients, doctors and the quality of care in the NHS.”

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Pulse

  • Decline of smaller practice accelerating as rate of mergers doubles.

    The decline of the smaller GP practice is accelerating with double the rate of practice mergers in the first half of this year, compared with last year. Figures obtained by Pulse show 93 practices have been involved in mergers in the first five months of this financial year in England, with a further 76 pending. This compares with 80 overall in 2013/ 14. The figures, supplied by NHS England’s area teams under a Freedom of Information Act request, have confirmed reports from accountants that the number of practices looking to merge is sharply rising. Accountants and LMC leaders have said a merger is often the ‘last option’ for a practice to avoid having to close amid challenges such as squeeze on funding or partners retiring, The news comes at a time when various bodies are developing plans for GPs to work in larger organisations, with the chief executive of NHS England, Simon Stevens, claiming that the ‘corner shop’ model of general practice was finished, and that GPs will form ‘expanded group practices’ which employ - or take on as partners - hospital consultants, pharmacists and social care workers. The Labour Party has also announced plans for every hospital to become an ‘integrated care organisation’ with ‘GPs at the centre’, which GPC warned could lead to the ‘destruction of practices’.

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Friday 17th October 2014

The Cockroach Catcher

  • It is like a game of chess!

    We must predict the next move by Clinical Commissioning Groups (CCGs). Or was it really the DoH ? Looks like endgame though. Enter CCGs. Soon, they may stop or refuse to pay for A& E attendances or their resultant admissions. Hospitals depend on that income. Other hospital referrals could be rationed. Why are privateers so keen on GPs and CCGs. It is about controlling the flow to the hospital. Private patients need the specialist times and there is no better way than to control the flow. If that takes time, help might be there: close some hospitals or what they are allowed to do. An excuse could be found easily. In the new world order, they will fail and be closed or be bought by private companies. We have the regulator called Monitor that will see to it. Is it really that difficult to grasp! When there are not enough specialists to go round in any country money is used to ration care. Rationing of Health Care is unpopular at the best of times and different ways have been tried by the previous governments first through Fund Holding and later PCTs. It would have been very unpopular for PCTs to continue to ration health. They have been doing it one way or another and it has been a costly exercise for some PCTs. It has even caused unnecessary deaths. Like private companies, when one fails change the name, same staff, slight changes in titles. Same with regulators too. Just look around. The current concern for the NHS Reform is perhaps too focused on privatisation. We ignore what CCGs could do at our own peril.

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Independent

  • Thousands of patients at risk from NHS outsourcing.

    The safety of thousands of NHS patients “outsourced” to the private sector has been called into serious doubt by a confidential report revealing how dozens were left in severe pain by botched eye surgery carried out by private contractors. It comes as new figures, seen by The Independent, show that one in every 10 NHS cataract operations is now carried out in the private sector. Private providers also carried out more than one in five NHS knee operations, and one in six hip operations that year. A damning report has today revealed that two patients suffered burns, six lost pigment in their irises and four were left with microscopic shards of metal in their eyes after being operated on at a private facility contracted by an NHS hospital in Somerset. 37 out of 62 cataract patients seen by surgeons working for Vanguard Healthcare Solutions required follow-up care, Musgrove Park Hospital's report said - a complication rate tenfold greater than normal. Vanguard, which subcontracted another private company, The Practice plc, to provide two surgeons, was contracted in May to carry out 400 cataract operations, at a rate of 20 a day – at least six more than NHS consultants at the Musgrove were routinely performing daily. Both surgeons were “comfortable” with the caseload at the start of the contract, but the Trust’s investigation said that “the pressures of operating on 20 patients each day may have contributed to the possible deterioration of surgical quality and reduction of patient experience”. The report also said that the “particular combination of staff, equipment and facilities had not been brought together before” and that staff had not had enough time for “on-site training” before patients began arriving on the first day. The Trust had not intended to publish its report into what went wrong, after being warned by its lawyers that it could be defamatory to the companies and individuals concerned. However, it was released to the media after Freedom of Information requests.

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Thursday 16th October 2014

Hospital Doctor

  • There are no quick fixes for hospitals at risk of financial failure, a report finds.

    The increasing number of hospitals reporting deficits has put the spotlight on what happens when NHS providers are in financial difficulty. A report from The King’s Fund warns that the prolonged slowdown in funding means that the NHS is now facing a period when even the best managed organisations will struggle to avoid financial failure. Against this background, the Health and Social Care Act built on existing arrangements for administrators to take over the management of failed organisations, with the intention of ending the practice of bailing out struggling trusts. However, the report says this system has only been used twice and has already proved controversial. http:/ / www.bbc.co.uk/ news/ health-26531807 Meanwhile bail-outs for struggling trusts have become widespread. Other, older approaches to managing financial failure such as replacing the management, mergers, or bringing in private companies through franchising arrangements have had limited success and were not designed to deal with the wave of financial distress currently spreading across the NHS.

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The Independent

  • Jeremy Hunt accused of blaming nurses for NHS staffing shortages.

    The NHS would be able to afford more nurses if it could deliver safer care, Jeremy Hunt will tell health service staff today. An independent report, commissioned by the Department of Health, has suggested that unsafe care costs the NHS between £1bn and £2.5bn a year in follow-up treatments. The Health Secretary will say that more should be “invested in improving patient care rather than wasted on picking up the pieces when things go wrong”. He will tell nurses that if they play their part in making the NHS “the safest healthcare organisation in the world” then money could be released for additional staff, training and “time to care”. His comments risk angering nurses, who have borne the brunt of the longest spending squeeze in NHS history. The Royal College of Nursing (RCN) said that while Mr Hunt’s proposals were “well-intended”, poor care was caused by a lack of investment and low staffing levels. “Every nurse’s first priority is patient safety, and they are well aware of the effects of poor care,” said Dr Peter Carter, the RCN’s chief executive and general secretary. Falls and preventable conditions such as pressure ulcers happen when there are not enough staff on a ward to care properly for every patient, not because nurses are unaware that these things should be prevented.” Figures from the Department of Health suggest that pressure ulcers cost the NHS £49m a year – the equivalent of 950 ward nurses. Falls cost £36m a year, and urinary tract infections caused by catheters cost £67m.

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HSJ

  • GPs hold only a quarter of accountable CCG roles.

    GPs occupy just a quarter of accountable officer posts in clinical commissioning groups, a comprehensive survey by HSJ has revealed. The finding comes amid warnings that CCGs will struggle to boost the number of GPs in leadership positions or to replace those who leave. The analysis of all 211 CCGs shows one in 10 GPs who took on chair or accountable officer roles when CCGs went live have since left their posts. GPs were far more likely to be chair than to be accountable officer, the research also found. More than eight in 10 CCG chair positions are currently held by GPs. The study also found that a higher proportion of women held top officer positions than led boards. Two-fifths of accountable officer positions were occupied by woman compared with one-fifth for CCG chairs. Vicky Pleydell, chief clinical officer for Hambleton, Richmondshire and Whitby CCG, said there were probably not many GPs with enough management experience to take on the accountable officer role. Dr Pleydell said it could be difficult to balance the workloads of CCG leadership and frontline general practice. She stopped practising as a GP in April last year to focus entirely on commissioning commitments. “You’re accountable 24/ 7 and you need to be available to your organisation every day,” she said.

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  • Troubled CCGs could face 'special measures' regime.

    A ‘special measures’ regime could be introduced for clinical commissioning groups with severe problems under plans being considered by NHS England, HSJ can reveal. The adoption of the term, brought in last year for the most challenged NHS providers, is under consideration as part of an overhaul of the CCG assurance regime. Its use is seen as a way to acknowledge that some CCGs also have major performance, finance or quality problems, and to create greater impetus for them to improve. Commissioning sources estimate there are between 10 and 12 groups that could face “special measures” if the plan is adopted. An NHS England document, seen by HSJ, also floats the possibility of creating a CCG “equivalent” to the NHS provider “administration” regimes, under which failing trusts can be broken up, merged or reconfigured. Under the current assurance framework, CCGs are rated as “assured”, “assured with support” or “not assured”. Only one - Barnet CCG - has been rated “not assured”, while 132 of England’s 211 groups were rated “assured with support” at the end of 2013-14. The ratings do not identify which CCGs have serious problems.

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Roy Lilley's blog

  • The 'I, you, we rule'.

    Monday; a senior Cabinet minister told The Times newspaper, £walled so the link is to the Indy coverage: "We've made three mistakes that I regret, the first being restructuring the NHS. The rest are minor." So, there you have it. It's official. The government have made a Horlicks of the NHS. There was more: One insider said the plans, which were drawn up by Mr Lansley, were "unintelligible gobbledygook" and an ally of Chancellor George Osborne said: "George kicks himself for not having spotted it and stopped it. He had the opportunity then and he didn't take it." It gets better: A former No 10 adviser also told The Times: "No one apart from Lansley had a clue what he was really embarking on, certainly not the Prime Minister. He [Lansley] kept saying his grand plans had the backing of the medical establishment and we trusted him. In retrospect it was a mistake." So, we are stuck with a mess until the election and then, hopefully, someone will have the good sense to unpick all this. MPs can't say they weren't told, warned, petitioned and pleaded with, not to do it. There were plenty of people in the NHS who understood exactly what Lansley was planning, its impact and consequences. Hubris, cronyism, cowardice, call it what you will, sidelined common-sense, experience and know-how. They ploughed on regardless and to make matters worse synchronised it with public sector cuts. No one believes any good has come of this wretched, cat's cradle... except, guess who ? Yes. LaLite, here's what he said: "Andrew's structural changes are saving the NHS more than £1bn a year. Because of that we can employ 7,000 more doctors and 3,500 more nurses." Oh really ? I think many of those doctors and nurses were in training before the last election, before the reforms and before the age of austerity. And, as the NAO pointed out there is considerable confusion about just what the reforms have cost. And, the base line is uncertain as not all SHAs provided cost of change returns. As Prof Kieran Walshe said on the Today Programme; show us yer numbers.

Tuesday 14th October 2014

BBC News

  • NHS strike: Unison leader says more workers to vote on strike action.

    Strike action by NHS staff in Northern Ireland over pay will be stepped up, a union official has said. Patricia McKeown, regional secretary of Unison, said thousands more workers are expected to vote on strike action. "Our people are facing a stark fifth year of pay freeze and that is having a very adverse impact, particularly on the lowest paid of health workers," she told a lunchtime rally at Stormont. More than 4,000 NHS staff in Northern Ireland went on strike on Monday. Members of the unions, Unite and GMB, walked out from 11:00 BST until 14:30 BST. In England, six unions took strike action on Monday from 07:00 BST to 11:00 BST. Those unions have more than 400,000 members in the NHS in England, out of 1.3m staff. The government has given NHS staff a 1% pay rise, but not for those who get automatic progression-in-the-job rises. Those increases are given to about half of all staff members and are worth 3% a year on average. The decision by ministers went against the recommendation of the independent pay review board, which called for an across-the-board rise. In Scotland, a 1% pay rise was given to everyone, while no decision has been made in Northern Ireland.

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  • NHS strikes: What next?

    The strike by health workers in England may have come to an end, but the key question now is whether a resolution can be found to the dispute. On Tuesday, a four-day work-to-rule begins, while next Monday radiographers will go on strike, potentially affecting X-ray and ultrasound services. Both the unions and ministers say they are willing to talk, but at this stage a compromise seems some way off - and unions are already talking about more action in the future. Unison general secretary Dave Prentis spent Monday morning complaining that ministers were "not listening", while workers on many picket lines were vocal in comparing their pay offer with the 10% MPs were awarded earlier this year.Unions have been told that they are free to come up with another solution, but that there is no more money for pay.But to understand the cause of this dispute you really need to go back to 2009. That was the year the then NHS chief executive Sir David Nicholson set the health service an ambitious savings target. The NHS was told to save £20bn by 2014 - later pushed back to 2015. Sir David was adamant, though, it could not simply be achieved through cuts, but rather it had to come from efficiency savings. It works out as a productivity gain of between 4% and 5% a year - something the health service had never done before.Unsurprisingly, it has turned out to be just as difficult as expected. A report by MPs earlier this year showed significant inroads had been made, but the majority of these had not come from efficiency savings. Instead, the NHS had relied on "quick fixes" - namely pay restraint. Over the last four years there have been two years of freezes and two of small rises. That has had a significant impact on the pockets of health workers. Figures from Unison suggest health worker pay has fallen by 10% during this period once inflation is taken into account.

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Financial Times

  • Minister seeks emergency winter funding for NHS.

    Treasury chief secretary Danny Alexander wants to use the Autumn Statement to inject emergency funding into the National Health Service to avoid a winter crisis just months before the next election. One Treasury official said Mr Alexander wanted chancellor George Osborne to release “several hundred million pounds” for the NHS in what is otherwise expected to be a fiscally tight Autumn Statement in December.

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Daily Mirror

  • NHS workers will strike again before Christmas unless Jeremy Hunt gives them pay rise.

    Jeremy Hunt was warned NHS workers will strike again – unless he gives them a pay rise. The threat came after hundreds of thousands of staff walked out for four hours in the health service’s first national strike over wages in 32 years. The Daily Mirror has learned that one option being discussed is a full day’s strike across the NHS before Christmas. Rachael Maskell, head of health at Unite, which represents 100,000 NHS staff, said in a direct warning to the Health
    Secretary: “There will definitely be more industrial action by NHS staff if Jeremy Hunt doesn’t sit down and talk and make more money available.” Striking health workers across England and Northern Ireland warned that “obscene” rates of low pay were damaging morale. Midwives, nurses, paramedics, ambulance staff, cooks, cleaners and porters mounted picket lines between 7am and 11am. They will take other forms of industrial action – including refusing to work unpaid overtime – for the rest of the week. The strike was organised in protest at the Government’s decision to rule out a 1% pay rise – recommended by an independent pay review body – for all NHS staff. Defiant Mr Hunt insisted 55% of health staff will get a pay rise of 3% and claimed that giving all staff a 1% increase would cost 4,000 nursing posts. But Rehana Azam, national officer of the GMB union, said: “He is simply wrong to say that nearly half of the staff will get an automatic 3% pay increase.” The incremental rises only apply to some staff and depend on experience. TUC general secretary Frances O’Grady pointed out that the pay review body had said the 1% pay rise was affordable. The war of words came as senior Tories today admitted for the first time that the Government’s controversial NHS shake-up was its biggest mistake. One senior Cabinet minister, who asked to remain anonymous, conceded: “We’ve made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.” Another Tory insider admitted the plans were “unintelligible gobbledygook”. Dr Mark Porter, chair of the British Medical Association, said the Government had ignored the concerns of patients and staff on “top-down” reorganisation. Labour has pledged to repeal the 2012 Health and Social Care Act, which saw a complete restructuring of how the NHS is funded. Campaigners say it paved the way for private firms to take over running the health service.
    Meanwhile, unions reported “solid” support for today’s action even though many workers, including midwives, went on strike for the first time in their lives.

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Guardian

  • The strike is a symptom of an NHS in intensive care.

    Polly Toynbee writes: Nurses, midwives and others striking on Monday were making only a token gesture, designed to shock, not harm. But their work to rule will push up NHS debt, meaning expensive agency temps must be hired. Though nurses finally snapped after a five-year pay freeze that has meant a 15% cut, pay is only part of the story: the nursing shortage causes intense pressure. Staff are caring for too many patients but get blamed when they can’t care well enough, despite more nurses hired. However pay is also a token of respect – ask any CEO. To deny a below-inflation 1% was a calculated provocation, muddied by a spurious claim that nurses shouldn’t be paid more as they gain experience. Their anger is as much about the £3bn waste of money in a chaotic reorganisation even cabinet ministers now call a disaster. Does the health secretary hope prodding them into a strike will turn public opinion against NHS staff ? Politicians who pit themselves against nurses tend to lose the argument.Peel back the truth about the great nursing shortage and you find another reason why the government’s Health and Social Care Act fragmentation of the NHS makes no sense: it has set trusts to compete fiercely against each other for income, staff and patients in a sham health “market”. Recently I visited Watford general hospital, one of the majority of trusts up to its neck in debt, caught out by flat funding, 8% more patients admitted through A& E last year than the year before and intense pressure on the quality of care. Its website gives a grim summary of its latest Care Quality Commission (CQC) inspection , with a thick X for four out of the five key standards, including not enough nurses. In a hurry, it has hired an extra 160 – and its debts rose to £14m. Last year about 6,000 foreign nurses were imported, a number rising fast. But the NHS lost over 4,000 nurses, as they emigrated to better paid, less stressful work in Australia, the US and New Zealand, all higher health spenders per capita. Britain loses its most experienced nurses in exchange for far less experienced staff who need tuition in clinical English. If you think there must be a shortage of British people willing to nurse, you would be wildly wrong. This was another government madness: nurse training places were cut from 20,829 in 2010 to 17,219 in 2013. There is no lack of applicants: 226,400 applied last year, well over 10 per place, double the number trying for each Oxbridge spot. Peter Carter, head for the Royal College of Nursing, reckons more than half are well-qualified applicants with the right attributes to be good nurses. But training places were cut to save money, despite rising need.

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Monday 13th October 2014

Open Democracy

  • The billions of wasted NHS cash no-one wants to mention.

    Calls to solve the NHS cash crisis by charging patients have mounted this week, with the NHS Confederation calling for £75 a night ‘hotel fees’ for hospital stays, or much longer waiting lists. But there is one pot of money that sits curiously unexamined, glistening and untouched. It’s the cost of the NHS ‘market’ itself. Administering the hugely expensive artificial ‘marketplace’ created by successive governments to allow both NHS and private ‘providers’ to compete with each other to offer services to NHS and other ‘purchasers’. No-one knows the exact cost of this bureaucratic ‘marketplace’. A recent estimate by rebel Lib Dems put the figure as high as £30billion a year. Dr Jacky Davis and other doctors and campaigners including the National Health Action Party have put it at £10billion a year. The Centre of Health & the Public Interest put it at a ‘conservative’ £4.5billion a year. Even the most conservative of these estimates is a yearly amount which would, if re-directed away from useless market activities, fund both the £2billion annual NHS shortfall and free critical social care to everyone, which the Kings Fund’s Barker Commission recently said would cost ‘substantially less’ than £3billion a year. Despite fierce urging from expert MPs to look at what the ‘market’ costs the NHS more closely, the government, mainstream media, think tanks and policy makers have dismissed, ignored and even suppressed this information, with unevidenced assertions that ‘modern healthcare systems’ need vastly expensive bureaucracy, market or no market.

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New Statesman

  • For years now – decades, really, but particularly since the undemocratic introduction of the damaging Health and Social Care Act in 2012 – our healthcare workers have been trying to compensate for cracks in the system.

    Those of us who work for the National Health Service are, almost constitutionally, programmed to "keep calm and carry on"; the kind of people who are not afraid of hard work, and who want to give our patients stellar treatment, no matter what is going on around us. We try to cope, but eventually, we reach our limit – our nurses are sick of being undervalued and threatened with redundancy at every round of cutbacks; our doctors are "burning out" after being made to work like robots; and nearly all of the hundreds of thousands of my colleagues who work so hard to make the health service tick are fed up with underfunding and the introduction of market principles in their beloved NHS. So, there has been a lag, a period of seeming calm, since the Health and Social Care Act began its privatisation agenda in full force. But, inevitably, we are now seeing the vital signs flicker – the first audible cries of a system overstretched, saying: "Stop!" This October is a historic landmark in the history of the NHS, marking the first in what may be a series of strikes by healthcare workers who, as insiders, know first-hand that the system has well and truly decompensated, and now teetering on the brink of collapse. So far, UNISON, UNITE, the Royal College of Midwives, radiographers and some paramedics – together representing about half a million health workers – have all agreed to take part in strike action. Predictably, the BMA (the doctors' union) has been slow on its feet.

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The Independent

  • Government’s reorganisation of the NHS was its biggest 'mistake', say senior Tories.

    The Government’s reorganisation of the NHS was its biggest “mistake”, senior Conservatives have reportedly admitted. Labour has pledged to repeal the “toxic” 2012 Health and Social Care Act, which saw a major restructuring of how the NHS is funded. Some claim the bill was designed to pave the way for private firms to take over much of the running of the health service or even its privatisation. Experts said the reorganisation, which is estimated to have cost about £3bn, had caused “profound and intense” damage to the NHS with one saying former Health Secretary, Andrew Lansley, would be facing disciplinary action if he had been a doctor. A senior Cabinet minister told The Times newspaper: “We’ve made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.” One insider said the plans, which were drawn up by Mr Lansley, were “unintelligible gobbledygook” and an ally of Chancellor George Osborne said: “George kicks himself for not having spotted it and stopped it. He had the opportunity then and he didn’t take it.” A former No 10 adviser also told The Times: “No one apart from Lansley had a clue what he was really embarking on, certainly not the Prime Minister. He [Lansley] kept saying his grand plans had the backing of the medical establishment and we trusted him. In retrospect it was a mistake.” Mark Porter, chairman of the British Medical Association’s governing council, said: “Rather than listening to the concerns of patients, the public and frontline staff who vigorously opposed the top-down reorganisation, politicians shamefully chose to stick their head in the sand and plough on regardless. “The damage done to the NHS has been profound and intense, so this road to Damascus moment is too little too late and will be of no comfort to patients whose care has suffered.” Others said the bill had distracted from the need to find efficiency savings because of a looming £20bn funding gap caused by rising demand.

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Pulse

  • CCGs to take over majority of GP budget, under NHS England proposals.

    GP practices could see the majority of their funding - including global sum, QOF, enhanced services and premises - devolved to CCGs within a year, according to a timetable released by NHS England. CCGs have also been asked to retender co-commissioning bids by 6 January, which more than nine out of ten CCGs submitted an interest in, after complaints their expressions of interest were ‘incorrectly categorised.’ A ‘Proposed next steps towards primary co-commissioning’ overview, released last month gives details on what exactly GP commissioners could take responsibility from April next year. It states that the functions ‘most suitable for full delegation’ by CCGs could include GMS and PMS contracts; enhanced Services (GP and Pharmacy, “LES and DES”); property costs; and QOF (for full delegation only). It states: ‘We have not detected an appetite in CCGs to take on revalidation and performer’s lists, and many CCGs also believe that individual and practice performance management aspects of contract management should not be open for delegation.’ And it calls for feedback on whether further elements should be excluded or added. Under the plans for co-commissioning primary care, announced by NHS chief Simon Stevens in May, CCGs were able to submit plans for taking on added responsibility across three broad categories. This includes giving CCGs greater involvement ‘in NHS England decision making’, and joint commissioning, where legislation was reformed to allow joint CCG, area team with a pooled budget.

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HSJ

  • Warning to NHS over paediatric reconfigurations.

    Hospital trusts should ensure adequate children’s community services are in place before closing in-patient units, a senior leader in paediatrics has warned. This call comes from the Judith Ellis, the new chief executive of the Royal College of Paediatrics and Child Health, who predicts a wave of further consolidations in services as trusts struggle to recruit consultants. The former children’s nurse, who joined the college last month, told HSJ: “If you are trying to get 24/ 7 consultant cover you have to be realistic – you can’t have them spread out across a wide area. “We will get consolidation into fewer areas and the college supports that because there is no choice if you want safe quality care for children. The only way to do that is to consolidate. We get worried that decisions are taken that aren’t thought through fully. The NHS is under pressure and things are happening, but for us every time someone should be saying ‘is this right for children ?’ The college saw danger in NHS trusts pressing ahead with closures without enhancing community paediatric services. If inpatient services are to be centralised “the services out in the community have to be capable, so you have professionals trained to recognise if a child starts to deteriorate they may need to come in [to hospital] quickly”, Professor Ellis said.

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Friday 10th October 2014

Our NHS

  • New law proposed to "stop the NHS becoming simply a memory".

    If we are to stop the NHS in England becoming simply a memory, we need urgent - but entirely possible - changes to the law. That’s the message of a new campaign launched by Professor Allyson Pollock on Saturday at the Liberal Democrat Conference. The “Campaign for an NHS Reinstatement Bill 2015" has produced an “NHS Reinstatement Bill” which sets out the legal steps needed not only to reverse the failings of the Health & Social Care Act 2012, but to fully restore the NHS in England as an accountable public service. Launching the campaign, Professor Pollock - who has co-authored the proposed Bill with lawyer Peter Roderick - called on voters to ask all general election candidates to support the Bill. The Bill would abolish ‘competition’ and the division of the NHS into ‘purchasing’ and ‘providing’ bodies, and restrict the role of commercial companies in the NHS. Two decades of policies which have been intent on moving the NHS towards privatisation have failed to improve services and have instead created costly bureaucracy, contends Pollock - one of the leading academics in this area. A coalition of leading NHS campaign groups including Keep Our NHS Public and Health Emergency have pledged their support to the Bill, alongside OurNHS openDemocracy, which has been supporting the Bill from its very earliest genesis. OurNHS and other experienced NHS experts and campaigners have worked closely with Professor Pollock and Lord Owen to help develop a new version that is a truly comprehensive solution to the privatisation destroying the NHS.

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Hospital Doctor

  • “NHS and social care systems at breaking point”.

    The NHS is buckling under the twin crises of rising demand and flat-lining budgets - and the signs “are everywhere”. So says a letter from medical leaders addressed to the leaders of the Conservatives, Labour and the Liberal Democrats. All three parties have made major NHS pledges in recent days at their annual conferences but the letter suggests that none represent the “comprehensive, fully costed, long-term spending plan” that is required to protect the NHS for future generations. The signs of a buckling system include patients “struggling to get an appointment” due to a shortage of GPs; women not getting the “high-quality care they deserve” due to pressures on maternity services; and, thousands of patients facing “longer and even unacceptable waits to find out whether or not they have cancer”. They add that many families being “crippled” by the cost of social care, with thousands of elderly and vulnerable people not getting the help they need; and, people with long-term progressive conditions such as dementia being “cut adrift, reliant on unpaid and unsupported carers”. David Cameron promised real-terms increases in NHS spending from 2015-20, Ed Miliband promised an extra £2.5bn a year and Nick Clegg pledged £1bn extra in 2016 and 2017. But the letter claims the NHS is facing a £30bn ‘black hole’ by 2020 with flat funding, rising demand and more expensive treatments. The letter says: “While we welcome the fact that the NHS has risen to the top of the political agenda, and some new spending commitments have been made, we need a comprehensive, fully costed, long-term spending plan if an NHS true to its founding principles of universal healthcare, provided according to need not ability to pay, is secured for future generations.

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New Statesman

  • "NHS principles aren’t intact": how the public is trying to protect its health service.

    This conference season, all parties have announced new plans to save the NHS; but how do those members of the public trying to protect their health service feel ? At first it was just a pulsating dot on the horizon. But it kept on coming from around some hidden bend; a trickle, then a stream of people, heading our way. Pretty soon our little huddle was caught up in a flash flood of bustling colour, sound and energy. Campaigners of all stripes filled the square: unions, healthcare workers, pro-NHS groups, the Labour party, the Green party, Women of the World, bearing the tribal colours of a dozen activist groups, together. My fears disintegrated with the clouds. It was an electric moment, one that was to be repeated again and again before the march was through. The organisers, an all-women group of NHS campaigners from Darlington nicknamed the "Darlo Mums", had set off from Jarrow two weeks before, heading all the way to Trafalgar Square to spread the word around the country. I found Rehana Azam, one of the founders of the march, and as I walked along beside her I asked what had spurred her and the others into action. “The principles of the NHS aren’t intact,” she said. “We felt it was our civic duty to bring people’s attention to what’s happening to the NHS. The final straw for us was Clause 119 and the battle for Lewisham before that. If it can happen to one hospital then it can happen to any hospital”. It’s just one of many vivid memories from that strange day in August. I remember the ambiguous mood; a blend of anger and hope. And the people we passed by, showing anything from bemusement to approval to expletive fury at what was unfolding before their eyes. We had a chance encounter with a health care assistant who came out of her house just as we streamed past. Slightly baffled, she walked with us for a while. She told me about her own working conditions at a private health care company not too far away, where she works on a zero-hours contract, without holiday pay, sometimes picking up the full 40 hours per week she needs, sometimes only getting 15.

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The Guardian

  • Advances in NHS care ‘going into reverse’.

    The number of patients forced to wait on trolleys before being admitted to hospital is soaring as “exceptional pressures” on the NHS mean key aspects of care are starting to deteriorate, experts warn on Friday. Two health thinktanks claim that improvements in recent years to vital NHS services such as GP consultations, planned surgery and treatment in A& E – in terms of both quality and access – are “starting to go into reverse”. Their findings will worry ministers, who have pledged to enhance NHS care in the wake of the Mid Staffs scandal and to keep waiting times low, especially with winter and next year’s election looming. Research by the Nuffield Trust and the Health Foundation also found it is getting harder for both children and adults to access mental health services promptly, growing numbers of whom are facing “unacceptably long waits” for treatment. They blame a surge in demand for healthcare coupled with the NHS’s unprecedented financial squeeze for what they say are troubling signs that, by some key measures, care is in decline. Nigel Edwards, chief executive of the Nuffield Trust, said the slippage in standards in some areas is so great that “care providers, policymakers and the public need to keep asking searching questions about the point at which declines in quality are no longer tolerable”.

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Pulse

  • Councils throughout London have written to NHE England chiefs demanding they be given powers to sign off plans that could see CCGs commissioning elements of the GP contract.

    In a letter to NHS England chief executive Simon Stevens, the chair of London Councils mayor Jules Pipe has said that approval from health and wellbeing boards - which include representatives from CCGs and local authorities - should be a minimum requirement before any co-commissioning bids are approved. They also suggest that local authorities and HWBs could play a role in managing conflicts of interest that may arise where GPs on a CCG board may be taking decisions that directly affect them or their colleagues. NHS England is set to approve bids from CCGs for commissioning elements of primary care, which include plans to take control of directed enhanced services and QOF funding locally. But the letter from London Councils dated 25 September says that local authorities should have a say over this. It states: ‘The commissioning of primary care is clearly one important lever for bringing about a transformation of primary care in the capital and we believe local government has a positive role to play in the further development of your plans. ‘For local solutions to be really strong and able to secure widespread local engagement and support, they must be shaped by local authorities as well as CCGs. It adds: ‘Therefore, as a minimum, we believe a condition for the approval of arrangements for co-commissioning should be the approval of the proposed approach by the relevant health and wellbeing board.

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HSJ

  • Cambridgeshire trust could see workforce shrink 40 per cent.

    Cambridgeshire Community Services Trust looks set to lose four in 10 of its workforce after a rival NHS led consortium secured preferred bidder status for an £800m older people’s service contract. The trust had previously been in the running to provide some of the service as members of two other consortia withdrew their bids. Cambridgeshire and Peterborough Clinical Commissioning Group announced Cambridgeshire and Peterborough Foundation Trust’s consortium as its preferred bidder for the integrated care contract on 1 October. The Uniting Care Partnership consortium, which includes foundation trust, is expected to sign the contract later this month, provided losing bidders do not contest the decision. This formal sign off would trigger a process to transfer around 1,400 of the community services trust’s 3,540 strong workforce to the partnership under Transfer of Undertakings (Protection of Employment) regulations ahead of the new arrangements going live in April next year. The trust currently runs the community services element of the work, which accounts for about a third of its £155m revenue in 2013-14. Its chief executive Matthew Winn told HSJ he was confident it would remain viable, despite the substantial loss in revenues and headcount.

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  • Waiting list grows despite £250m government push.

    The NHS waiting list for planned care has grown to over 3 million, despite a drive to admit more patients for treatment over the summer months. It follows several months of intense pressure from government for trusts to treat increased numbers of long waiting patients and to cut lists. It announced a £250m fund to pay for this in June. However, latest data published today shows that despite a marked increase in the number of patients treated, the waiting list jumped from 3.07m in July to 3.13m in August. The waiting list has grown steadily since August 2009 when there were just under 2.5m people waiting for treatment. In August 653 more patients were admitted per working day than in the same month last year. However, this did not bring down the number of patients waiting over 18 weeks, which instead rose by 7 per cent. Only 87.9 per cent of admitted patients began treatment within 18 weeks – against the national target of 90 per cent. The government announced in the summer a “managed breach” of the flagship elective waiting time targets, but officials had hoped they would be met again by September. This now looks highly unlikely to be achieved, and national officials have changed their position to say targets should be met from December. Waiting times expert Rob Findlay told HSJ the increased activity in August had failed to cut the number of patients waiting for long periods of time. He said: “It looks as if admissions did increase but it has not had the desired effect of reducing the number of long waiters on the list.” There were 510 patients who had waited over a year for treatment in August.

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Thursday 9th October 2014

Exeter Express and Echo

  • Parents of popular East Devon student say their child would still be alive if his suicidal tendencies were taken seriously enough by medical staff.

    The mum and dad of a popular and talented East Devon teenager suffering from severe mental illness who committed suicide by standing in front of a high-speed train within hours of being granted home leave from hospital, said they believe their son would still be alive if it weren’t for “incomplete and inaccurate” information used in assessing him. George Werb, 15, from Colyton, died when he was hit by the train at around 6.50am near Seaton Junction on Friday, June 28, last year. The inquest at Exeter’s Coroner’s Court heard that George had left a three page suicide note under his bed which was discovered shortly after the tragedy occurred and his parents, Joanne and Justin Werb, felt his suicidal tendencies were not taken seriously enough by staff at the Priory Hospital in Southampton where he was been a patient for five weeks prior to his death. The court heard that George was prescribed anti-depressants and had talked to staff nurses about feeling suicidal in the days leading up to the day he was allowed leave but no risk assessment had been carried out on his ability to cope. Hours later he walked in front of the train. In a narrative conclusion culminating the two day inquest, before praising George’s family and passing on her condolences, assistant coroner Lydia Brown, said: “George died on the railway track near Seaton Junction. At the time he was on home leave from inpatient care in a children’s psychiatric unit. Before he went on leave he was assessed as having no suicidal risk. The information used in this assessment was incomplete, inaccurate and did not reflect the actual situation. Poor engagement with the family, having to place him in a unit a long distance from home, absent note taking and inadequate internal hospital communication all contributed to this outcome. Doctor Hoyos could not do his job adequately because of the lack of clinical support, and the therapeutic service suffered the same, the community could not place in him locally because there were no beds.” Ms Brown confirmed she would be writing to the commissioners in Devon, NHS England and copying in the Department of Health outlining her concerns. The court heard that after being referred by his GP, George waited around 10 months until his first appointment with a Child and Adolescent Mental Health Services (CAMHS) team member in Exeter. It was a subsequent visit to his GP who referred George back to CAMHS and the consultant child psychiatrist for CAMHS, Doctor Divik Seth diagnosed him as suffering from psychosis involving persistent delusion disorder with depression, which he described to the court as “exceptionally uncommon”. George was initially prescribed anti-psychotic medication which the court heard he refused to take after three doses. George’s father explained that they noticed a “massive” change in their son from the point he started taking the medication. The court heard that George was extremely distressed at having taken the medication, having researched the effects on the internet, a trait that persisted in line with his condition, from then on. He was subsequently advised he needed hospitalisation to ensure his safety and for ongoing assessment and treatment. Dr Seth told the court it was usual for him to have to phone around 20 – 30 units to find out where there is availability for a new patient because of the shortage of psychiatric beds. The closest unit to George was Plymouth but there was no room, so the closest hospital with availability was at Huntercombe Hospital in Maidenhead which George’s parents removed him from after visiting him three weeks later. They said his room was “not fit for a dog”, his bed had no sheets on it, the curtains were too short, he was still living out of his suitcase and he looked dishevelled and unclean, and discovered another patient had threatened to kill George. After returning home for a short period, George was sectioned and admitted to the Priory, where staff were “very kind”. Giving evidence, George’s parents spoke of their dissatisfaction over the lack of communication from hospital staff particularly that, they say, they were not advised that suicidal tendencies could increase as a possible side effect of the anti-depressants he was prescribed. During the ward nurses’ evidence, the court was told that the day after returning from his first period of leave he had told nurses that he felt suicidal and wanted to kill himself, but despite this being a regressive feature, because he was not presenting any accompanying concerning factors, he was assessed as not being a suicide risk and being fit enough to go on leave again three days later. The court heard that the consultant didn’t meet George’s parents until a couple of weeks into his five week stay, but he “wished” he had. And a detailed risk assessment of factors relating to George’s suicidal thoughts and causes of his distress was not made. However Dr Hoyos was adamant that assessment was ongoing by staff members, but there is no official record of a detailed assessment. The court heard that Dr Hoyos did not keep regular written clinical notes, an issue that is being looked into by the General Medical Council, but he said this did not affect patient care. He said he preferred a ‘verbal handover’, but on four occasions references to suicidal thoughts were made in written notes which he hadn’t seen. He admitted that he did not have a risk assessment conversation about George prior to his second leave. It emerged during the hearing that George and his family weren’t offered family therapy sessions due to the distance from the hospital to their home. And Neil Law, the therapy services manager for Southampton said that distance from a hospital impacted on the treatment patients received. He said the issue of the shortage of psychiatric beds was a national problem. He also said there was a difficulty, reflected nationally, to recruit psychology professionals at the ward which, for example, the Priory should have a full time paediatric and adolescent psychotherapist, but the ward has only a sessional part time post.

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Building.co.uk

  • Two bidders for £380m PF2 hospital.

    A joint venture between Laing O’Rourke and Interserve will battle Carillion to win the contract to build the UK’s first PF2 hospital. The £380m hospital for Sandwell and West Birmingham Hospitals NHS Trust is set to be built on a brownfield site in Smethwick in the West Midlands. The winner contractor will be required to design, construct and maintain the 80,000m2 hospital, which will include A& E, maternity, children’s services, critical care, diagnostics and other acute treatment services. Final bids are due to be entered in April 2015 with preferred bidder selected in September 2015.

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West Briton

  • Bidding for children's health services.

    Children's health services in Cornwall are being put up for grabs in a move which campaigners called an indication of the continued privatisation of the NHS. Care commissioners for Cornwall and the Isles of Scilly announced their decision to put £22 million worth of children's services out to tender this month. The commissioners, made up of NHS Kernow, Cornwall Council, NHS England and the Council of the Isles of Scilly, have started the pre-procurement process, which will conclude on or before April 1, 2016. Contracts for 23 services including school nursing, speech and language therapy, health visiting, family nurse partnership and child and adolescent specialist mental health services, will be available to private companies and NHS-linked charities. Currently the services are provided by Cornwall Partnership NHS Foundation Trust, Royal Cornwall Hospitals Trust (RCHT), Peninsula Community Health, and Plymouth Hospitals NHS Trust, some of which have contracts coming to an end at the end of March 2016. Rik Evans, the former vice-chairman of the RCHT board, warned children's health services in Cornwall could be "sacrificed to satisfy short-sighted political dogma". He resigned from his post earlier this year over RCHT's privatisation of 600 hotel services jobs. Mr Evans said: "This lemming-like compulsion for our health care managers to drive more and more of our publicly owned services into the hands of private profit speculators from the private health industry will end in failure." He wants people to challenge NHS Kernow Commissioning Group over the decision to tender.

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  • Staff parking charges discussed.

    Discussions are continuing between Cornwall Council and Royal Cornwall Hospitals Trust (RCHT) to find an alternative to the contentious staff car parking charge hikes. New parking charges for staff working at Treliske, in some cases a fivefold increase for lower paid workers, came into force last week despite causing outrage and petitions signed by hundreds of people. In August the trust agreed to increase parking charges at the site. It said it could no longer justifying spending £40,000 a year, which would rise to £70,000, when it needed to prioritise clinical services. Instead it urged staff to use the park and ride, which also had its concession scrapped and does not run at times conducive to many workers' shift patterns.

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Guardian

  • As NHS strike looms, Guardian survey shows scale of anger on pay.

    Seething unrest over pay threatens to undermine David Cameron’s bid to present the Tories as defenders of the NHS, an exclusive Guardian survey of heathcare professionals has found. Asked: “Do you think that NHS staff are paid appropriately ?”, nearly three-quarters (73%) of respondents answered “no”. Many among the 1,700 Guardian healthcare network members who took part in the survey feel that for the large amounts of stress, responsibility and social value, NHS staff are hugely underpaid. “Pay is now frozen for the next four years – while our MPs get 11%. Is their contribution to society so much greater than someone who works for the NHS ?” one responded. “As a salaried GP, I earn less per hour than a physiotherapist or ultrasonographer, never mind lawyers or IT consultants, many of whom also work for the NHS, earning extraordinary sums,” one doctor wrote. “Most of my friends I went to university with laugh at the level of pay I earn after 25 years in the NHS as a professional, and they are shocked at the level of life and death responsibility I hold for this pay,” agreed another. The findings come ahead of Monday’s industrial action by up to 500,000 NHS workers and reveal the scale of anger clinical and non-clinical staff feel about their remuneration following below-inflation pay rises after two years of pay freezes. “I joined to help those in need, at their hour of need, not for the money. However, I struggle to make ends meet, often monthly,” one participant wrote. NHS staff have seen bigger real-terms pay cuts – where any pay rise is less than the rate of inflation – than the rest of the population. According to the latest figures from the Office for National Statistics, the real-terms average weekly income across the working population is down 4.4% between 2010 and 2013. The Trades Union Congress calculates that public sector workers are on average £2,245 worse off since 2010. This is due to a two-year pay freeze (three years for local government), followed by a 1% pay cap in 2013/ 14 and 2014/ 15. Those earning below £21,000 during the pay freeze received a £250 pay rise (except local government employees). Whereas the rest of the public sector (including the NHS in Scotland) awarded the 1% to all employees, the health secretary, Jeremy Hunt, announced in March that he was cancelling the 1% across the board pay rise to NHS staff in England, even though the independent NHS pay review body had recommended it be awarded to all. Instead, only those who are at the top of their pay bands will get the 1%. Even then, this will not be a consolidated pay rise: as a result salaries will revert to April 2013 levels in 2016. Those below this level – some 600,000 people – will receive no cost-of-living pay rise. The government argues that this is because they will still receive salary “increments” – small payments to progress them up the pay scales. But health trade unions argue that this incremental pay progression is a contractual obligation under the 2004 Agenda for Change pay agreement between unions, NHS employers and the then Labour government. Increments were established to reflect the fact that many staff start on lower salaries than the rate for the job and move up the pay scale as they become more experienced. Since 2013, increments are conditional on NHS workers’ performance and skills.

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BBC News

  • More paramedics quitting NHS jobs.

    Increasing numbers of paramedics are leaving NHS ambulance services, according to figures obtained by the BBC. Senior staff say remaining paramedic crews are under greater pressure than ever before to meet demand. At least 1,015 paramedics left their job in 2013-14, compared with 593 in the same period two years earlier. The Department of Health says it is spending an extra £28m on the ambulance service in England this year. London Ambulance Service saw 223 paramedics leave in 2013-14, four times the number in 2011-12, and the largest increase in the country. An internal document, produced by London Ambulance Service and seen by BBC Radio 4's The Report programme, suggests morale among paramedics is low. It says three-quarters of paramedics surveyed had considered leaving the service in the past 12 months. Anonymous paramedics quoted in the report point to rising workloads as one of their greatest grievances. A London paramedic who wanted to remain anonymous, told the BBC that sometimes there were as many as 200 emergency calls on hold, and that the service "haven't got enough vehicles or staff to cope". Dr Fiona Moore, medical director for London Ambulance Service, estimates there is a shortfall nationally of up to 3,000 paramedics.

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Tuesday 7th October 2014

Nursing Times

  • NHS pay row prompts nurse to give up chance of becoming MP.

    A former mental health nurse and union activist has given up the chance of challenging for a seat in parliament, after becoming disenchanted with the coalition government’s approach to NHS pay. In February David Harding-Price was selected by the Liberal Democrats as their candidate to challenge for the parliamentary seat of Lincoln in the general election next May. However, on 1 October, Mr Harding-Price issued a statement in which he announced his decision to stand down. Among his reasons, he cited the “failure by MPs to support nurses in providing them with a pay rise while continuing to give themselves well above the rate of inflation pay rises”.

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Independent

  • NHS funding crisis: Boss warns of £75-a-night charge for a hospital bed.

    The NHS may have to start charging patients for the “hotel costs” of their hospital stay if the health service’s looming financial crisis is not addressed, senior health service managers have warned. Hospital bosses will need to “think the unthinkable” if future NHS funding fails to keep up with patient demand, said Rob Webster, chief executive of the NHS Confederation, which speaks on behalf of all health service commissioners and providers. “If the NHS cannot afford to fund everything, then it will need to make tough choices about what it does fund,” he told The Independent. “Do we think about increasing our tolerance for longer wait [for care], or do we say ‘NHS funding is only for the health aspects of care and treatment’, which means patients being asked to cover their hotel costs for bed and board ?” NHS managers may also have to raise the thresholds at which some minor conditions are considered for surgery, Mr Webster added. Although detailed plans on charging patients for “bed and board” have not been drawn up, another senior NHS source suggested the fees could be means-tested, and set at around £75 per night. Any such move would mark a major departure from the founding principles of the NHS, and would likely require authorisation from the Department of Health. However, Mr Webster said, if funding did not keep up with patient demand, “unpalatable” changes would be unavoidable. The warnings come as The Independent continues its week-long investigation into the parlous state of the health service’s finances with an in-depth look at over-stretched GP surgeries. Health service managers expect the NHS to go into deficit either this year or next, as patient demand begins to outstrip funding following years of flat health spending.The NHS Confederation has said a “transformation fund” of at least £2bn per year for two years is needed to enable the NHS to maintain current levels of service.

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Thursday 2nd October 2014

BBC News

  • Cambridgeshire's £800m NHS bid process 'unnecessary'.

    Campaigners have attacked the process to award an £800m contract to supply older people's healthcare in Cambridgeshire as "unnecessary". NHS-led consortium UnitingCare Partnership was selected from a shortlist of three organisations. The Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) consultation cost £1m, Stop the NHS Sell-Off claimed. The CCG said the cost should be seen in the context of the five-year contract. UnitingCare is a consortium of Cambridgeshire and Peterborough NHS Foundation Trust with Cambridge University Hospitals NHS Foundation Trust. Martin Booth, from Stop the NHS Sell-Off in Cambridgeshire and Peterborough, said the £1m spent on the process was "both unnecessary and highly wasteful". The campaign group gathered 5,500 signatures from people opposing the transfer of NHS services to a private company.

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City A.M.

  • NHS ambulance workers vote to strike.

    Members of the GMB union of NHS workers have voted overwhelmingly in favour of taking strike action on 13 October. Of the ambulance staff who voted, 78 per cent cast their ballot in favour of a walk-out, which will take place between 7:00am and 11:00am. Furthermore, 91% voted for action short of a strike. The ballot was held in reaction to the government's pay policies. NHS staff have been promised a one per cent rise.

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Financial Times

  • NHS trust becomes first to buy out its PFI contract.

    A National Health Service trust has become the first to buy out its private finance initiative contract, as other debt-laden hospitals explore ways of following suit. Northumbria Healthcare Foundation Trust borrowed £114m from the local council to pay off private contractors who built and ran Hexham General Hospital. The deal – the first of its kind – will save the trust £3.5m a year over the next 19 years. The agreement could prove a trailblazer for other trusts and councils keen to escape PFI deals that require them to pay millions of pounds of interest to private companies. More than 100 PFI hospitals were built under the last Labour government, and the previous Conservative one. About £80bn of debt must be repaid over the life of the contracts. In 2012, the Department of Health gave a £1.5bn bailout to seven trusts, but many are still struggling, with the South London Healthcare NHS Trust put into administration partly because of its PFI obligations. Phil Lobb, a partner at Deloitte who advised Northumbria on its PFI buyback, said he had been approached to conduct about 10 further feasibility studies by hospital trusts around the country keen to shift to cheaper public debt.

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Pulse

  • Half of GPs don't trust any political party with managing the NHS.

    Almost half of GPs do not trust any political party to manage the NHS, with more than a third still undecided about who to vote for in next year’s general election, a Pulse survey has found. In what highlights clear political mistrust amongst the profession, a survey of 552 GPs found that 47% do not trust any party with the health service and support for specific policies from the main political parties is mostly below 20%. Support for the individual parties is also at an all time low, with the vast majority of respondents to the same survey saying they have still not made up their minds about who to vote for, despite the elections being only seven months away.

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  • More than 500 practices at risk of closure, says RCGP.

    More than 500 practices in England could close within a year because of a ‘deepening crisis’ in the recruitment and retention of GPs, the RCGP has said as it calls for a ‘rescue package’ for general practice. In addition 1,000 GPs a year will be leaving the profession by 2020 unless ‘urgent action’ is taken, with 22% of GPs in London alone saying they expect to step back from patient care within five years, the RCGP has revealed ahead of its conference. The warning echoes Pulse’s own call for action through its ‘Stop Practice Closures’ campaign which it launched after learning that more than 100 practices across the UK had either closed or were actively considering closing as a result of funding cuts and a recruitment crisis. The college identified 543 practices that is facing closure in England - potentially rising to 600 across the UK - largely by looking at workforce and recruitment trends which show the number of vacancies has quadrupled in the last three years. It found that more than 90% of doctors at these practices are over the age of 60. In her speech to the RCGP conference today, chair Dr Maureen Baker will argue that if practices continue to close, displaced patients will turn to A& E and swamp other parts of the NHS.

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Local Government Chronicle

  • Berkshire CCGs explore merger.

    Four clinical commissioning groups in west Berkshire are considering merging into a single organisation amid concerns GPs’ time is being ‘wasted’ on board meetings. Newbury and District, North West Reading, South Reading and Wokingham CCGs are discussing the “feasibility and practicalities” of becoming a single organisation, according to papers presented to South Reading CCG’s governing board last month. The merger proposal is being driven by “external financial pressures” in the local health economy, a shortage of GPs joining governing bodies, and a reduction in the statutory requirements necessary for the merger, the papers said. Each CCG’s GP council will vote on the plan, which would see a new single entity cover the same geographic boundaries as the four existing CCGs. Member practices of North and West Reading CCG have already voted “unanimously” in favour of the new arrangement, its latest board documents said.

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The Argus

  • Privatised NHS service decision is under review.

    A decision by health bosses to award a multi-million-pound contract to a private health company is coming under scrutiny. Coastal West Sussex Clinical Commissioning Group (CCG) recently said Bupa was the preferred bidder for a £235 million deal to manage services dealing with bone, muscle and joint problems. Western Sussex Hospitals NHS Trust, which had wanted to continue providing the musculoskeletal (MSK) service, said the move could have an impact on its accident and emergency departments in Worthing and Chichester. This is because its staff who work in MSK care are also responsible for emergency trauma care in A& E and the services are linked. The CCG insists there are no plans to destabilise A& E services and Bupa has already said it wants to work closely with the trust.

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Kilburn Times

  • Northwick Park Hospital struggles with 100 beds shortage.

    A health chief has revealed Northwick Park hospital (NPH) is short of 100 beds as it struggles to cope with an influx of patients following the closure of another casualty unit. The hospital has seen an additional 15 admissions a day, three more than originally predicted, since the accident and emergency department at Central Middlesex hospital (CMH) was axed as part of the controversial Shaping a Healthier Future plan. In addition, only 72.8% of patients were seen within four hours at the unit during the week ending September 21, a figure which significantly falls below the 95% NHS target. A total of 130 patients waited between four and 12 hours to be admitted to a ward.

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Guardian

  • NHS policy: Labour and Conservative plans don’t add up.

    Richard Vize writes: The NHS will be at the centre of the general election campaign. During the party conferences Labour and the Tories each used the same brutal, disingenuous techniques to win the argument – low blows aimed at inducing fear about their opponent’s record followed by promises of more staff and better services built on a financial mirage. There was nothing in Labour leader Ed Miliband’s speech that came close to being a coherent plan for running effective public services while meeting his party’s promise to eliminate the deficit.
    The shadow health secretary, Andy Burnham, also swerved round the growing financial crisis to concentrate on his vision of bringing health and social care into a single service. His big idea is for hospital trusts to evolve into integrated care organisations, meeting virtually all physical, mental and social care needs. This vision has appeal, but the policy is beset by dodgy reasoning to make it add up. It is built on the premise that two services can become one by evolution, without the cost and upheaval of reorganisation. And the sum will, apparently, be cheaper than the parts; he described bringing in social care as “key to unlocking the money”, implying that integration will deliver savings. There is little evidence to support this often-made claim. Miliband promised a £2.5bn a year Time to Care Fund, which he claimed would pay for 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 more midwives. It won’t. Further, the ways he plans to pay for it – a mansion tax, a levy on tobacco firms and a clampdown on hedge fund tax avoidance – are hardly secure and predictable. None of this addresses the health service’s large and growing financial problems. Burnham added physiotherapists, occupational therapists and mental health workers to the list of additional staff and implied that private healthcare firms would be compelled to contribute towards training costs. Again this is hardly a dependable funding source. Among Labour’s promises was the right to die in your own home while being cared for by the NHS. This is unquestionably the right objective, but with around 300,000 people dying in NHS hospitals in England each year (roughly triple the number that die at home) the staffing and cost implications of moving a substantial proportion of these back to their own homes and then supporting them over days or weeks are immense. It would add to the pressures on ambulance crews, GPs, district nurses and many more. These are the realities behind conference slogans. For the Tories, David Cameron promised “eight till eight” and weekend access to GPs for the whole population by the end of the next parliament and said he would continue to ringfence the health budget, keeping pace with inflation. With the chronic shortage of GPs leaving some parts of the country short of cover it is difficult to see how this pledge could be met without moving substantial funding out of acute services. As for the ringfence, it already has holes to support social care. More leakage can be expected to mitigate its impact on other services, notably local government. The desperate struggle for votes is at least forcing the parties to begin to address the funding shortfall and the need for big investment in primary care. But the steady succession of NHS promises that will eventually be broken is surely exactly the sort of behaviour that is losing the big parties the trust of the electorate.

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  • David Cameron pledges to protect the English NHS budget in real terms.

    David Cameron will try to prevent the health service becoming Labour’s election-winning weapon when he guarantees that a majority Conservative government will protect the English NHS budget in real terms from 2015 to 2020. It is the first time the prime minister has pledged to ringfence the health service from spending cuts for the next parliament, but his promise will still leave the NHS under massive cost pressures due to soaring demand for NHS services largely caused by an ageing society. Extending a spending pledge that applies in the current parliament, Cameron will say “The next Conservative government will protect the NHS budget and continue to invest more”. In his closing speech to the Conservative conference in Birmingham, the prime minister will also try to broaden the terms of an NHS debate that often seems unwinnable for the Tories by asserting “you can only have a strong NHS if you have a strong economy”. Cameron’s pledge will be seen as a direct response to Labour’s efforts to raise the political profile of the NHS when Ed Miliband promised last week an additional annual £2.5bn a year “time to care fund” funded by a mansion tax, closing tax loopholes and fees on the tobacco companies. The value of Cameron’s pledge was not yet quantified, but the coalition’s existing pledge to maintain NHS spending in real terms means that the English health service will have received £12.7bn more in cash terms over the current parliament, meaning a similar sum is likely to apply in the next five years. Health analysts, such as the Nuffield Trust, the NHS Confederation and the Kings Fund, have all been calling for greater honesty from all political leaders warning a commitment not to cut NHS spending, or even increase spending by £2.5bn annually does not address the scale of the pressures on the health service. The Nuffield Trust warned in July the NHS was no longer securing the 4% a year efficiency savings required, so increasing the likelihood of a financial crisis before the election. It warned that by 2021 there would be a £30bn spending gap without vast productivity improvements. In his highly political speech to conference the health secretary, Jeremy Hunt, admitted on Tuesday the NHS had been through the biggest squeeze on finances in its history, and possibly faced a difficult winter ahead, but he blamed Labour for wrecking the economy.

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Tuesday 30th September 2014

Daily Mirror

  • Cancer patients’ lives at risk as Tory-led NHS cuts force them to wait for treatment.

    Thousands of cancer patients’ lives are being put at risk because Tory-led NHS cuts are forcing them to wait too long for vital treatment. Guidelines say no one should wait more than 62 days to start care after an urgent referral by their GP for suspected cancer. Hospitals are expected to meet this target in at least 85% of cases but a report found the number of trusts failing to do so has trebled in just a year. Campaigning cancer doctor Clive Peedell said: “These aren’t just figures on a page – these are people’s lives. It’s well-evidenced that delays in referral, diagnosis and ­treatment mean worse outcomes for cancer patients.” The alarming news on waiting times emerged as separate figures today revealed funding for cancer ­services has been slashed by nearly £800million under the Tories.

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Leicester Mercury

  • Private business should not be running the NHS.

    A letter to the editor reads: I was one of those who attended the Arriva public meeting regarding their patient transport service. The Q& A session between Arriva, the clinical commissioning groups (CCGs) and the public was held upstairs in a meeting room. One thing I did notice on the screen was that Arriva claimed to have had over 30 years' experience in patient transport. The Arriva representative then explained the problems his company had come across over the last two years and that they are still trying to come to terms with their service demands. Would it be fair to suggest that Arriva had learnt very little from their 30 years' experience ? He also explained the investment Arriva is making in extra staff, vehicles and training and that this would be ongoing. I wonder if this extra expense was budgeted for in the original tender of December 2011; after all, this company is in business to make a profit. The expansion of Arriva's services, throughout the Midlands, is also a possibility. There was a comment from the CCG that they had given Arriva more than £300,000 extra money to help prevent a crisis. This certainly adds enormous weight to the anti-privatisation lobby. In my opinion no private company should hold an NHS contract unless it is in a position to finance its operation with the funds granted to it by the NHS. The action of the PCT who granted Arriva the contract and the CCG who have upheld the contract must surely now be questioned; especially as the CCG made it quite clear that it would be the very last resort to cancel the contract. The concept of private business running our NHS must be outlawed and it returned to a well-managed and efficient public service.

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Nursing Times

  • 'Francis effect' stalls as nurse numbers begin to fall again.

    The rapid increase in registered nurses employed in the NHS has come to an end with numbers now falling for the first time this year. Data from the Health and Social Care Information Centre shows the number of full-time equivalent qualified nurses, midwives and health visitors reached its highest recorded level of 314,802 in March this year – 4,000 more than in May 2010. But in April it fell for the first time this year by 660 nurses to 314,142. Since August 2013 there has been intense recruitment of registered nurses following the Francis Report into failures at Mid Staffordshire Foundation Trust and new rules on safe staffing by the National Institute for Health and Care Excellence. Overall the “Francis effect” as it has been called has seen more than 8,700 nurses join the NHS since August. In the acute sector, where the majority of nurses have been employed, numbers have begun to level off. In April the number of qualified nurses, midwives and health visitors working in the acute setting rose by just 54 nurses to a record high of 175,204 nurses. Since August 6,155 nurses have joined the acute sector.However the data does reveal declines in the number of nurses working across maternity services, mental health services and community services.

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GP Online

  • David Cameron pledges seven-day access to GPs by 2020.

    Everyone in England should have seven-day access to a GP from 2020, the prime minister has announced, but GP leaders warned that the policy does not address the workforce crisis. The Conservatives have pledged £100m for a further wave of access pilots to be launched in 2015/ 16 following the £50m Challenge Fund launched last year. Prime minister David Cameron said a further £400m would be spent over the next five years to widen access to general practice in evenings and at weekends across the country. The PM is also expected to announce that every patient will have a named GP responsible for out-of-hospital care, which could form part of the next GP contract. But GP leaders warned that the policy did not address the real problems of workforce pressure. GPC chairman Dr Chaand Nagpaul said: ‘GPs naturally wish to improve access to patients. But this announcement does not address the current reality of what patients and GPs are facing; we need immediate solutions to the extreme pressures that GP practices are facing, with inadequate numbers of GPs and practice staff to manage increasing volume of patients, who are already having to wait too long for care.’ Labour leader Ed Miliband promised to fund 8,000 new GPs using a £2.5bn NHS funding injection, and shadow health secretary Andy Burnham announced plans to put GPs at the centre of hospital trust-led integrated care organisations. Labour has pledged £100m funding to guarantee patients a GP appointment within 48 hours.

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BBC News

  • Midwives vote in favour of strike action.

    Midwives will be joining other NHS workers in England in a strike over pay next month. The Royal College of Midwives announced 82% of its members voted in favour - the first time they have ever been balloted on industrial action. They will join other staff, including nurses, healthcare assistants and porters, in the 13 October walk-out. The strike will last four hours, but the RCM said midwives will still be there for women giving birth. Instead, it will be ante-natal and post-natal appointments that will be affected by the strike which starts at 7am. It follows last week's announcement that the members of both Unison and Unite, which represent nearly 400,000 workers between them, had voted in favour of taking action. The walkout - the first in 32 years over pay - will be followed by a period of action short of a strike. This is likely to involve staff refusing to work unpaid overtime. In Scotland, the recommendation was agreed to in full. Wales is doing the same as England, but has given extra money to the lowest paid.

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Thursday 25th September 2014

Gloucestershire Echo

  • NHS hospitals in Gloucestershire see income from private patients drop as recession bites.

    A decline in demand for private healthcare because of the recession has left NHS bosses counting the cost. Gloucestershire Hospitals NHS Foundation Trust, which runs Cheltenham General and Gloucestershire Royal, has seen the amount of income it receives from private patients for healthcare dip by more than £1 million since 2009. In 2009/ 10 private patients from the UK and from overseas paid the trust £4.4 million. But that dropped to £3.2 million in 2013/ 14. The trust has stressed that any money received from private patients is reinvested in hospital services which help NHS patients.

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Staffordshire Newsletter

  • Stafford Hospital protesters brand UHNS plans as 'delusional'.

    Support Stafford Hospital campaigner Cheryl Porter has branded UHNS plans for health services in the area as “delusional”. “There has been no risk assessment done of the transfer of services out of Stafford,” said Mrs Porter, from Brocton. “They are playing Russian roulette with our services. The risk is that the whole system will collapse under pressure, just like A& Es across the country are collapsing now.” She said plans to downgrade Stafford to a midwife-led maternity unit did not answer safety questions about what would happen if a woman suddenly developed complications during labour, such as the availability of ambulances for a transfer to another hospital, and the risks that could pose to mums and babies. Mrs Porter said she was shocked by the NHS England decision to review whether or not maternity services should still be provided at a series of other small hospitals, as well as Stafford. "Removing maternity from local hospitals is dangerous and threatens to take healthcare back to pre-war standards," she said. And she added that proposals to reduce pressure on hospitals by strengthening local community health services did not take account of the increasing shortage of GPs and district nurses. "We know that more GPs are retiring and there is a shortage, while district nurses are under more and more pressure and healthcare assistants are having to do some of their work," Mrs Porter said. "The plans being put forward bear no relation to reality. They are just crazy." Meanwhile Lisa Carter, National Childbirth Trust partnerships manager, said it would be a “dreadful shame” if smaller hospitals like Stafford lost full maternity services.

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Practice Business

  • RCGP Rejects Labour Plans For More Top-Down Reform of the NHS.

    The Royal College of General Practitioners (RCGP) has responded to Shadow Health Secretary Andy Burnham’s speech at the Labour Party conference. Dr Maureen Baker, chair of the RCGP, said: “The College has grave concerns about Andy Burnham’s proposals to create hospital-led integrated care organisations. His plans could destroy everything that is great and that our patients value about general practice and could lead to the demise of family doctoring as we know it. Only yesterday he criticised the expensive and time-consuming top-down reorganisation of the NHS as a result of the Health and Social Care Act. Yet his proposals would be just as disruptive, causing even more upheaval for patients and distracting doctors and managers away from what really matters – delivering excellent patient care. GPs want to work as part of wider clinical teams to ensure that the NHS can provide a single service to each patient, instead of the fragmented approach that too often is experienced by patients today. But it makes no sense for hospitals – organisations that provide acute, intermittent and specialist care – to lead on the delivery of person-centred, continuous and co-ordinated care. The College is positive about integrated care. We are positive about working with colleagues right across the NHS. But the model that Andy Burnham is proposing simply will not work. At a time when general practice is heaving under the strain, the last thing we need is more organisational interference, that will destabilise the NHS, divert millions of pounds away from patient care and distract GPs from caring for patients. We hope that all the political parties will heed our warnings, otherwise the consequences for our patients will be disastrous.”

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IFA Magazine

  • UK health watchdog backs Spire Healthcare complaint.

    A UK health watchdog has backed private hospital operator Spire Healthcare after it complained about its treatment by doctors’ commissioning groups (CCGs) in north-west England. Spire said regulator Monitor had agreed that the clinical commissioning groups in Blackpool were breaking the rules by not providing enough information to support patients and their GPs in choosing hospitals for routine elective care. The decision followed a complaint about two CCGs in the area by the group’s Spire Fylde Coast hospital last September. But Spire said it was disappointed that Monitor did not reach a conclusion on whether the block contract between the CCGs and Blackpool Teaching Hospitals NHS Foundation Trust, which provided the trust with a guaranteed income regardless of the number of patients that chose to use its services, was against patients’ interests. However, that contract has now ended and Monitor is looking at the potential implications for patients of commissioners and providers moving away from standard payment arrangements. Spire shares rose 2.5p or 0.88% to 285p at 08:58 in London.

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GP Online

  • Exclusive: Practices could merge into hospital-led organisations under Labour plans.

    GP practices could be swallowed up by hospital-led integrated care organisations under Labour's plans to transform the NHS, according to shadow health secretary Andy Burnham. The shadow health secretary admitted that as well as employing an army of salaried GPs, traditional practices could also be integrated into Labour's planned hospital-led bodies. Under the proposals, a Labour government would require all hospital trusts and other NHS bodies to ‘evolve’ into integrated care organisations (ICOs), which would provide all health and social care in a local area. Mr Burnham has stressed that GPs would be ‘at the centre’ of new multidisciplinary teams of health and social care professionals within the ICOs. The precise configuration of services would be devolved with council-led health and wellbeing boards controlling pooled commissioning budgets. Mr Burnham has said that while he does not want to sweep away the independent contractor model, which could still be appropriate for some, he would offer a new model of salaried GPs working for ICOs. GP leaders fear this could spell the end for traditional general practice.

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Western Gazette

  • UNISON announces NHS strikes for hospital staff in October.

    Trade union UNISON has confirmed that NHS workers who are members will stage a four-hour stoppage between 7am and 11am on Monday 13 October. This will be followed by four days of action short of strike action between Tuesday 14 and Friday 17 October when members will stop working through their breaks and instead take their breaks. The union reported that 68% voted yes for industrial action and 88% to action short of strike action in a ballot which closed on 18 September. The trade union reported that earlier this year, the government "decided to ignore" the NHS Pay Review Body’s recommendations when it gave a 1 per cent non-consolidated increase to staff at the top of their incremental scale. A spokesman said: "Because the award is non-consolidated it will not count towards pension entitlements or shift pay and will be wiped away at the end of March 2016, meaning wages will go back to their April 2013 level. Jeremy Hunt is persisting in the pretence that he is giving staff a pay rise when in truth he has imposed a continued pay freeze for most NHS staff in England, with a small flat rate sum for around 40 per cent of staff. There are 10 unions balloting in the NHS over pay and our action will be co-ordinated with them."

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Guardian

  • The Guardian view on Labour and the NHS: Good plan, Mr Burnham, but now we need the detail.

    Labour is absolutely right that the NHS must be at the centre of political debate between now and the election, for it is genuinely facing bigger challenges than at any time in its history. The party’s proposals for extra cash from taxes on tobacco and mansions are a welcome, if limited, move. A joined-up health and caring service is the right destination and a single funding body is part of the right answer. Much the same was proposed by the commission set up by the King’s Fund and chaired by Kate Barker. But there was nothing in Mr Burnham’s speech that suggested he has a policy that is worked through in enough detail to allow him to answer the challenge of the sceptical interviewer, nor any recognition that the transformation for which he rightly calls will be made in the teeth of cripplingly tight budgets. First, the funding crisis. It is now widely predicted that NHS acute hospitals will be £1bn in debt by the end of the financial year. Even foundation trusts, whose status depends on their effective management and which have been making surpluses until this year, are starting to report serious overspends. Not only are they struggling to afford the extra nurses recommended by the Francis inquiry after the Mid-Staffordshire scandal, they are also trying to meet £4bn of efficiency savings demanded in this year’s round of the so-called Nicholson challenge, which will take £20bn out of budgets between 2011 and 2014. Key performance indicators expose the impact of the pressure. Waiting times for referral appointments, for treatment and in emergency units have all been exceeded this summer, even though the NHS budget has been ringfenced and extra cash – in total more than £12bn – has been found by the government to try to head off crisis. Yet, even if there is still room for improvement, in international comparisons, the NHS remains remarkably cost-effective. According to the OECD , in 2012 the UK spent just 9.3% of GDP on health. France and Germany, both of which have bigger economies, spent 11.3%, while in the US health expenditure is more than 17% of GDP. While Mr Burnham’s combined health and care service is unquestionably the right direction of travel, it is not a cost-free option. The Barker report estimated that even after introducing a combined service, spending would need to rise to around 11% of GDP to meet demand. An increase on that scale would still leave our health spending trailing the highest European spenders – and it would require double the spending increase that Labour is proposing. And although Mr Burnham denies that there will be more reorganisation, it is not clear how the NHS and local councils can deliver a joint service without shared management. Unavoidably, there would be heavy transitional costs. With Mr Burnham floundering in the face of questions about how the mansion tax will work, and when it will start to bring in the promised cash, it compounds the impression that Labour may be thinking too much about exploiting its reputation among voters as the party of the NHS at the next election, and not enough – or not hard enough – about the severity of the challenges ahead. The way health and care are provided is intensely political. But the less political the NHS itself is, the better.

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  • Labour must do more to protect the NHS.

    A letter signed by President of Keep Our NHS Public Wendy Savage, and KONP Co-Chair John Lipetz, as well as over 100 others reads: If Ed Miliband wants to put the NHS at the heart of his election campaign, he and the Labour party need to take a much stronger stance. Labour must reverse NHS cuts and privatisation, and re-establish a comprehensive public health service providing for all on the basis of need – not a logo above a marketplace of profit-making companies. We welcome Labour’s pledge to repeal the Health and Social Care Act and associated “competition regulations”, and to restore the ministerial duty to provide national health services. We welcome Andy Burnham’s commitment to protect the NHS from international “free trade” agreements. But we need to go further, to undo the damage done by the act, and by years of policies shifting the NHS towards a market system, like the “internal market”, widespread privatisation and outsourcing, and fragmentation into competing units. We want a fight to bring contracts already in private hands back into the NHS. We want an end to the private finance initiative and liberation from crushing PFI debts. We want an end to cash-driven closures, a reversal of cuts, and adequate funding to rebuild the NHS as a genuine public service.

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Independent

  • Labour Party conference: Andy Burnham would integrate social care and NHS.

    Andy Burnham has promised to end the "scandal" of how old and vulnerable people are treated by the state by integrating the NHS and social care. The shadow Health Secretary's ambitious plans energised a rather subdued Labour conference on its final day after he won the warmest reception of any member of Ed Miliband's Shadow Cabinet. Mr Burnham, a passionate advocate of a "national care service", said an incoming Labour Government would ask hospital trusts and other NHS bodies to evolve into NHS integrated care organisations, working from home to hospital to coordinate physical, mental and social care. Tory sources said the Government had already started to "join up" health and social care with a £4bn Better Care Fund. It had invested £400m in breaks for carers and given carers the same rights to support as those they care for.

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