Latest post of the previous page:Hospitals may require patients to show passports for NHS treatment
Pity about those who don't have a passport. Or homeless.
But there'll be a solution just around the corner. ID cards...
Latest post of the previous page:Hospitals may require patients to show passports for NHS treatment
Dalton says that the private sector can help the NHS. Well, up to a point, Lord Copper. The private sector has always been there, but as a peripheral presence and not competing with the NHS. The compulsory competition introduced by Andrew Lansley has been a very costly failure. The private sector is expensive, unaccountable, and will walk away when it can’t make a profit. By cherrypicking profitable services it destabilises the local NHS, which can’t drop the expensive work or turn away patients with complex problems. And its ethos is questionable, leading, for example, to profits being sent offshore with no tax paid.
The nonsense which party politics expects – from futile “health checks”, to private sector treatment centres, to the millions spent to open GP surgeries on Sunday afternoons only to be greeted by empty waiting rooms – are the death knells to an NHS free at the point of use
Dr Damian Roland, a consultant in paediatrics at University Hospitals of Leicester NHS trust, said that his unit was full on Saturday morning, and expressed his frustration at the lack of resources, although he appealed to parents not to panic. Roland, speaking as a senior member of the Royal College of Paediatrics and Child Health, said: “The hospital is at capacity but we are always able to make provision for the patients that need care.
“We know that at this time of the year children will develop viral or other serious illnesses that cause them to need intensive care. There is some frustration though that the system as a whole doesn’t always have the ability to deal with these predictable issues. This is another symptom of the challenge we are facing in operating a sustainable health system that continues to provide the care that patients expect. All of us in paediatrics and child health would like an honest discussion about how the system is funded,” Dr Roland added.
In London, all 90 of the beds available in the seven hospitals that provide paediatric intensive care are occupied. Three children had to be taken out of the capital for treatment because there were no beds available.
An email to units from Will Huxter, NHS regional director of specialised commissioning (London), said: “The demand for emergency beds over the last week has been increasing ... There have been periods where there have been no beds available ... I am therefore asking you to review the requirement to proceed with non-urgent elective operating lists.”
Misters show no inclination to raise the revenue required.
This was the week that the social care crisis finally acquired the prominence it deserves. After being lambasted by Jeremy Corbyn at yesterday's PMQs, Theresa May promised a "long-term solution". But today's announcement by Sajid Javid did little to advance that aim. Though the Communities Secretary boasted of £900m extra for social care, the reality undermines the rhetoric.
Local authorities, as expected, will now be permitted to raise council tax by 3 per cent next year and the year after (rather than by 2 per cent). But since the maximum increase is still capped at 6 per cent by 2019-20, the money has merely been frontloaded, rather than increased. As Labour and others have noted, it is also a regressive response that will widen geographical disparities. Wealthy areas will raise far more by increasing council tax than poorer ones.
Javid also announced a new £240m social care "support fund". But even this is not the bounty it appears. The money is drawn from the New Homes Bonus, which is intended to compensate councils for housebuilding. The government is robbing housing Paul to pay social care Peter. Even were the £900m new money it would remain inadequate. The social care funding gap is forecast to be £2.6bn by 2020 and £4.6bn was cut in the last parliament.
"Winter is already here and there is not a penny more for the 1.2 million elderly people who are living without the care they need," said the shadow communities secretary Teresa Pearce. "What is clear is that the government have no new ideas on how to fund social care, and are just passing the buck to overstretched local authorities and council tax payers."
But it is not only Labour that is unimpressed. Sarah Wollaston, the Conservative chair of the health select committee, said: "I'm not convinced that the local government settlement is new money, it brings some of it forward but doesn't grasp the seriousness of the shortfall. Rising unmet need for social care will not be resolved without genuine cross-party working to find a long-term solution to funding."
Today, however, Javid merely promised a new "policy framework" on integrating health and social care (as experts have long urged). Ministers show no inclination to raise the revenue required, either through tax increases or through cuts elsewhere. As it contends with the epic task of Brexit, May's government is unlikely to succeed where others have failed.
Applications for nursing degrees have fallen sharply since the government withdrew their funding via bursaries and forced students to pay for their courses with loans.
Universities said last night that applications for nursing, midwifery and allied health courses were down by about 20 per cent compared with this stage last year. In some institutions applications have halved.
Shortfalls in applications were worse in London and the southeast, among mature candidates and in specialist fields such as learning disability nursing, occupational therapy and podiatry. There are fears that some small courses may become too expensive to run if numbers dip too low.
It is too soon to judge if the fall will mean fewer student nurses starting in September next year but universities are considering contingency plans to avert a shortfall in nursing graduates, including accelerated two-year postgraduate nursing courses.
Vice-chancellors are planning a campaign with health bodies to encourage more people to train as nurses, which is likely to run well beyond the normal deadline for university course applications next month to encourage candidates to make late submissions or apply through clearing in the summer.
Hospitals in England have been advised to halt elective surgery over Christmas to ensure enough beds are free for patients who need emergency treatment at the end of the year.
In a sign of the intense pressures on NHS resources over the winter months, the regulator NHS Improvement said all hospitals should make more beds available between now and mid-January.
Jim Mackey, the chief executive of NHS Improvement, said the focus needed to be on emergency patients at what he called a critical time for the health service. Many hospitals take steps to wind down the number of operations they perform over the Christmas period, but a letter obtained by the Health Service Journal states that operations may need to be postponed “beyond any current plans”.
In the letter to NHS trusts, the regulator says: “Given the level of risk facing the system, it is clear that having sufficient bed capacity going into Christmas is critical, and we know most organisations will already have this in hand as part of local planning arrangements.
“In preparing for managing winter pressures, it is recommended that all providers pace their elective work by introducing elective breaks where trusts cease most in-patient elective activity and focus on treating emergence activity and non-admitted patients.”
Highlighting how much spare capacity is thought to be necessary, hospitals are being advised to reduce their bed occupancy to 85%. The rate currently stands at 95% across NHS England.
• Investigation on the association between outsourcing cleaning services and HAI.
• Data on 126 English acute hospital Trust during 2010–2014 were used.
• Outsourcing cleaning services was associated with greater incidence of MRSA.
• Outsourcing was also associated with lower economic costs.
There has been extensive outsourcing of hospital cleaning services in the NHS in England, in part because of the potential to reduce costs. Yet some argue that this leads to lower hygiene standards and more infections, such as MRSA and, perhaps because of this, the Scottish, Welsh, and Northern Irish health services have rejected outsourcing. This study evaluates whether contracting out cleaning services in English acute hospital Trusts (legal authorities that run one or more hospitals) is associated with risks of hospital-borne MRSA infection and lower economic costs.
By linking data on MRSA incidence per 100,000 hospital bed-days with surveys of cleanliness among patient and staff in 126 English acute hospital Trusts during 2010–2014, we find that outsourcing cleaning services was associated with greater incidence of MRSA, fewer cleaning staff per hospital bed, worse patient perceptions of cleanliness and staff perceptions of availability of handwashing facilities. However, outsourcing was also associated with lower economic costs (without accounting for additional costs associated with treatment of hospital acquired infections).
And, seemingly admitting that GPs had been given little choice in the matter, Mr Stevens said: 'My reading is that GPs are not crying wolf. Actually they have been systematically under-supported and under-invested in, relative to the rising workloads and demands that we are placing on them.
These recent studies suggest that patients admitted during weekends are at no greater risk of dying than those admitted during the week.
Britain’s top GP has said surgeries will have to stop seeing patients during the week unless ministers abandon their drive to guarantee access to family doctors at weekends.
Dr Helen Stokes-Lampard condemned the policy, a key Conservative pledge, as unrealistic and said it was ignoring the lack of demand among patients to see GPs at weekends and a serious shortage of family doctors.
The government has promised to ensure that people in every part of England will be able to see a GP from 8am to 8pm every day of the week by 2020 as a key element of its push to create a “truly seven-day NHS” by the end of the current parliament.
“It’s unrealistic in the current climate. We haven’t got the people, we haven’t got the resources. If you give people access on a Sunday afternoon they’re not going to have access on a Tuesday morning. They can’t have it all”, the chair of the Royal College of GPs said in an interview.
Sarah Wollaston, chair, House of Commons health select committee
The current pressures in the NHS can be traced back to 2009 and what became known as the Nicholson challenge. In the aftermath of the economic crash this ushered in an unprecedented period of efficiency savings against a headwind of rapidly rising demand and costs. The incoming coalition government then imposed a disruptive and demoralising reorganisation that distracted from the key challenges. Rather than seizing the opportunity to integrate health and social care and to design a sustainable long term financial settlement, the Health and Social Care Act 2012 led to greater fragmentation at a time when our demographic changes demanded a different approach.
In the decade to 2015, the number of people living to age 85 and beyond increased by 31%.1 That is a cause for celebration, but there has been a striking failure to plan for what this means for health and social care. The same is true for the rapidly rising cost of preventable conditions and expensive new drugs and technologies.
Over the last parliament, funding for the NHS increased annually by an average of just 1.1%, far below the actual increase in costs or the long term average of around 3.8% since 1978-79.2 The real terms increase in Department of Health spending for the current review period is just £4.5bn3 (€5.3bn; $5.5bn) and will result in reduced spending per person.2 The accompanying cuts to social care combined with a serious workforce shortfall have left more than a million older people going without the personal care that they need to live with dignity in their own homes.4 It is no surprise that so many are ending up in more expensive settings in an already overstretched NHS.
The political response to a health and care system in severe distress, and more importantly to the people it serves, has been dismal. No one listening to the yah boo of debate in the Commons would be filled with optimism. There has been a failure to grasp the scale of the financial challenge facing both health and social care and the consequences and inefficiency of their continuing separation. A serious shortfall in capital, as a result of ongoing raids to plug deficits, is undermining the prospects for the transformational changes necessary to produce future savings.
Likewise, area based joint commissioning is at risk if the financial squeeze is so unrealistic that health and social care retreat to protect their own budgets. Sustainability and transformation plans hold the possibility of moving away from a competition based approach to one based on integrated commissioning but they must be realistic and supported by the funds to deliver.
There have also been missed opportunities in public health. In her first speech on the steps of Downing Street, the prime minister, Theresa May, spoke compellingly of tackling the burning injustice of health inequality. That ambition now needs to be matched by effective cross government policies across the wider determinants of health. It will also require investment in public health in order to achieve the radical upgrade in prevention which underpinned the Five Year Forward View.5
At her recent appearance before the Liaison Committee of all select committee chairs, Theresa May confirmed that the government is working on a new settlement for social care but also that this doesn’t currently include the NHS or involve other political parties. She should urgently revise her terms of reference to include them both.
The public has repeatedly made clear the value it places on our NHS and that it wants to see it properly funded. The financial challenge of providing sufficient funding for health and social care to cope with inexorably rising demand will be the same for whichever party is in power over the coming decades. It is in all our interests for them to work together to agree a way forward compatible with the founding principles of the NHS. Political instincts, however, have tended to focus on division and to duck the problem through arguments about data.
The most remembered statistic of the EU referendum campaign was the £350m a week for the NHS—a cynically deployed and rapidly disavowed non-fact for which no one can be held to account. Misleading data have consequences. If the chancellor believes that the NHS is receiving an extra £10bn, it is easier to see why he and the prime minister might resist the calls for more, especially having overseen far reaching cuts to the Ministry of Defence and the Home Office in their former roles.
The public has a right to expect accurate and consistent figures on total health spending, and it matters that we correctly insist on the true figure of £4.5bn. It also matters to keep setting out the facts on rising demand as well as the efficiency, fairness, and value of our NHS.
I often meet health professionals who think that politicians have no grasp of the scale of the problems they are facing. Never underestimate the impact you can make during a personal visit to MPs’ surgeries or through an invitation to your workplace. We need as many MPs as possible to understand the urgency that they work together to find a sustainable long term settlement and the consequences for their constituents of political failure.
Jeremy Hunt has been accused of “hiding” from the public eye after the British Red Cross was called in to deal with a “humanitarian crisis” in overstretched NHS hospitals.
At the time of publication the Health Secretary had issued no comment on the unfolding health service crisis, following calls by the charity for an emergency cash injection to deal with unprecedented pressures on the under-funded health service.
When contacted by The Independent on Saturday the Department of Health said it was leaving it to NHS England, a non-departmental public body that oversees the NHS day-to-day, to comment on the response to the unfolding winter crisis.
The last press release issued on the Department of Health’s website dates from last year, and refers to the New Year’s Honours list. The Government and Mr Hunt’s Department would have to sanction any additional spending on the NHS as requested by the British Red Cross.
The Liberal Democrats’ shadow health secretary Norman Lamb said Mr Hunt should “stop hiding” while Labour’s shadow health minister Justin Madders said the Mr Hunt was “refusing to acknowledge” the seriousness of the situation.
“This Government should be ashamed. It ignored calls for extra cash to support health and care services through the winter, and now it is patients who are paying the price,” Mr Lamb said.
“Jeremy Hunt must stop hiding and announce immediate measures to alleviate this crisis, including emergency funding to plug gaps across services that are putting patient safety at risk.
“The truth is that the Prime Minister and Chancellor are failing to provide the investment needed to deliver an effective, modern health and care system.
That last sentence needs unpacking. 40% actually sounds quite reasonable: it means that 60% are there necessarily. But where does he get that figure from? I suspect it includes all those who have turned up at A&E and who, after triage and examination, it is decided by staff that a trip to A&E wasn't really necessary. No doubt it includes those who go with a slight cold or with a broken fingernail (or whatever nonsense the Daily Mail claims), but are the really trivial, obvious, cases that great in number? I suspect many go because they've had an injury or are worried it's something serious but it turns out - after expert medical examination - that it's not. Perhaps it's Jeremy 'liar' Hunt who needs to have an 'honest discussion'?Doctors have said Jeremy Hunt’s proposals to alleviate pressures on the NHS by shifting some of the emergency care burden on to GPs are “pie in the sky”.
The Health Secretary urged patients to visit their GP instead of heading to A&E for minor illnesses and outlined plans to temporarily release time for family doctors to support urgent care work.
He said around 40 per cent of A&E patients were in hospital unnecessarily and called for a “honest discussion with the public about the purpose of A&E departments”.
Members of the Council of the Royal College of Physicians (RCP) have today written to the prime minister, Theresa May MP, to set out their concerns about the capacity and resources needed to meet the demands on the NHS.
The letter was signed by RCP president Professor Jane Dacre and 49 members of Council, representing 33,000 doctors across 30 specialties as well as 750 physician associates.
The signatories are fully committed to the NHS and want to work with the government to build on the health service's achievements. However, they say in their letter that the increase in patient need is outpacing the resources available, that services are ‘too often paralysed by spiralling demand to transform and modernise’, hospitals are ‘over-full, with too few qualified staff’ and services are ‘struggling or failing to cope’, and there are ‘increasing reports of staff contemplating the sad decision to leave the NHS’.
The Council members say that ‘current investment levels are not sufficient to meet current or future patient needs’ and the immediate actions needed are 'the reinvigoration of social care services and urgent capital investment in infrastructure'.
For further information and to arrange interviews please contact Linda Cuthbertson, head of PR and public affairs: +44 (0)20 3075 1254 / +44 (0)7748 777919.
You can download the full letter below.
Letter to the prime minister, Rt Hon Theresa May MP
Publication date: 11 January 2017
Responding to a letter sent to Prime Minister Theresa May by the Royal College of Physicians, Professor Helen Stokes-Lampard, Chair of the RCGP, said:
“We stand in solidarity with our colleagues at the Royal College of Physicians. General practice is also struggling to cope with intense pressures brought on by soaring patient demand, a decade of under-investment in our service, and too few GPs.
“GPs and our teams continue to keep the NHS afloat with a combination of professionalism, resilience and goodwill as we make the majority of first contacts with patients, and strive to deliver the best possible patient care to our growing and ageing population.
“The NHS is full of hard working, dedicated healthcare professionals from primary, community and social care, right through to hospitals – this is why our health service is the envy of the world. We want to keep it that way, but increasing patient demand must be matched with resource.
“The first step for the government must be to urgently implement the pledges in the GP Forward View in England, including more investment in general practice and more GPs – and for equivalent pledges to be made by government’s in Scotland, Wales and Northern Ireland. This will give us the resources we need to deliver the care our patients deserve and alleviate pressures right across the NHS, to the benefit of colleagues right across the health service.”
he NHS and social care are seriously underfunded. That was the unequivocal message from the boss of NHS England, Simon Stevens, in evidence to the Public Accounts Committee on Wednesday.
In a combative performance in which he took several thinly disguised swipes at the Prime Minister’s advisers who had briefed against him before his appearance, Stevens left no one in any doubt that more money is needed if the public’s expectations are to be met. His evidence brought to the boil debates that have been simmering for some time. Stevens challenged the government either to find more money for the NHS and social care, or be honest with the public about the consequences.
Theresa May and her ministers have resisted calls for additional funding so far by arguing that the NHS has received financial protection when other budgets have been cut, and by claiming that the NHS has been given more money than it asked for. While the first part of this argument is true, the second is misleading. The Department of Health’s budget will increase by just over £4 billion during this parliament, a long way short of the £10 billion ministers claim has been provided "to back the NHS plan". And while social care funding will increase later in the parliament, this follows years of funding cuts which new measures to allow local authorities to increase council tax will do little to reverse.We got less than we asked for. It would be stretching it to say we got more than we asked for
The Barker Commission proposed that spending on health and social care should rise to around 12 per cent of GDP by 2025 to create a sustainable system. In fact, on current plans, spending as a share of GDP is set to fall by the end of this parliament, and NHS spending per person will also decline. As Stevens pointed out in his evidence to the committee, health care spending in countries such as Germany is higher than in the UK, enabling them to pay for more doctors and nurses.
It is hard to take seriously the sincerity of the Prime Minister’s pledges this week to improve Mental Health standards when England has lost over 70% of its mental health beds in less than 30 years.
The decline has been over successive Tory and Labour governments, undeniably, but it should be noted the cuts and bed losses have been far more savage while the Conservatives have resided in Number 10.
In 2014 the UK had 273 hospital beds per 100,000 population. Compare this to Germany (823 beds per 100,000 population) and even Greece (424 per 100,000) one immediately begins to realise the absolute unremitting pressure on the system, and how frustrating and maddening it is when Mr Hunt and Mrs May refuse to acknowledge the issues staring them squarely in the face.
How can we deliver the level of care we strive to give when we are up against this day in, day out? It is surely an embarrassment that the sixth wealthiest nation in the world offers its citizens healthcare free at the point of access but increasingly devoid of any dignity or human touch.
Jeremy Hunt has time and again proven he does not have the leadership skills or trust to take the NHS forward. He now commands no respect, and this is now a critical issue in the wider NHS argument.
Can anyone see any teeny little problems with this?GPs in England must keep their surgeries open for longer to meet demand from patients, or risk losing funding, Downing Street has warned.
It said many patients were going to under-pressure A&E departments because they could not get appointments.
The government wants to see surgeries open between 08:00 and 20:00, seven days a week, unless they can prove the demand is not there.
The British Medical Association accused ministers of "scapegoating" doctors.
Downing Street said surgeries should do more to ensure they offer appointments in the evening and at weekends.
It said: "Most GPs do a fantastic job, and have their patients' interests firmly at heart.
"However, it is increasingly clear that a large number of surgeries are not providing the access that patients need - and that patients are suffering as a result because they are then forced to go to A&E to seek care.