N Ireland the first Health Region to crack – and admit that the system is broken..

N Ireland Physiotherapists in the MCSP journal are reported: Northern Ireland politicians accept that NHS must find new ways of working, Just as the politicians are attempting to combine Heath and Social Care, Councils ‘don’t pay fair price for care, and many care home operators are dropping their Health Service agreements. (contracts) , Everything has been short term, including the staff training and manpower planning capability. Just as we are short of physiotherapists, we are short of all staff, and it’s going to get worse. The temptation to go “private” will steadily increase.

N Ireland the first Health Region to crack – and admit that the system is broken.. and try to turn a negative into a positive.. The Health service foundations are being washed away.

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Northern Ireland’s health committee has responded positively to evidence of how GP surgeries elsewhere in the UK have benefited from self-referral to physiotherapy and having physios as a first point of contact…..

CSP senior negotiating officer Claire Ronald told the committee that these changes had saved time for GPs and resulted in fewer referrals for interventions, such as MRI or CT scans.

She attended the hearing on 6 October, as part of a delegation from the Irish Congress of Trade Unions.

Northern Ireland has been ‘very poor at transforming how we deliver healthcare’, Ms Ronald warned the meeting.

‘We are only just piloting self-referral to physiotherapy at South Eastern Trust, and it was a battle to get that pilot running.’

Extended scope practitioners and physiotherapists who have qualified as independent prescribers are under-utilised, she said.

Workforce planning

‘It comes back to workforce planning,’ she said. ‘But if you don’t engage with trade unions and professional bodies until you are implementing, then we are at the door saying “that is not going to work”, or “if you had done it this way it would be better”.’

Following Ms Ronald’s evidence, committee chair Paula Bradley said the MLAs recognised that the health system did not fully utilise a range of health professionals.

‘We will have to look at different ways of working, especially when we look at what’s happening within GP services at the moment,’ she said.

Speaking to Frontline after the hearing, Ms Ronald said the committee would launch an inquiry into the roles that allied health professionals and pharmacists could have in primary care, adding that her evidence met with a positive reception from the MLAs.

Marie-Louise Connolly reports 25th October for BBC: Bengoa review: Ambitious health care shake-up unveiled – Its 3rd sentence reveals that it is biased… and this because it is recommended by a government appointed panel unable to speak the truth: we have to ration health care somehow…

An ambitious plan to make Northern Ireland’s health and social care system fit for the 21st Century has been unveiled.

Health Minister Michelle O’Neill said the 10-year plan would improve a system at “breaking point”.

Its 18 time-specific action points are based on recommendations from a government-appointed panel.

Hospital closures are not mentioned, but services will have to meet criteria to prove they are viable, she said.

Opposition politicians have questioned the lack of details in the plan, which is not costed.

Belfast Telegraph: Fewer GPs in Northern Ireland now than in 1950s and (GPs) Bedrock of NHS is on life support and fading fast

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World class cancer care (and Mental Health care) is possible, if we ration the high volume low cost treatments…

Nick Triggle for the BBC asks “Cancer care: Is world class status a distant dream?” on 25th October 2016.  Not only is current care well below world class, but it is getting embarrassing to discuss waiting times and cancer access comparisons with friends in other countries. World class cancer care (and Mental Health care) is possible, if we ration the high volume low cost treatments… It is good news that we are investing and trying to correct the deficit.. it is bad news if some citizens are denied access that others can avail… Linear Accelerators are one form of External Beam Therapy. Machines over 10 years old are unreliable and start to leak. The demographics of old age mean that more treatment centres will be needed around the country..

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Linear accelerators are wonderful machines. They deliver high-energy radiation to a tumour, helping to destroy cancer cells while sparing the normal tissue which surrounds them.

About four in 10 cancer patients get treated with one. So news that NHS bosses are launching a £130m investment to upgrade or replace half of England’s stock in the next two years is understandably being welcomed.

NHS England chief executive Simon Stevens hailed as the “biggest single upgrade” in cancer treatment for the past 15 years that will benefit “hundreds of thousands” of patients.

It is just one of a number of steps NHS England is flagging in the update of the five-year cancer plan on Tuesday.

The strategy was launched in the summer of 2015, promising to create “world class” cancer care by 2020.

Alongside the linear accelerator investment, work has begun on how to ensure cancer patients get earlier diagnosis, which is seen as key to improving survival rates.

This includes piloting multi-disciplinary diagnosis clinics that house a range of specialists and tests under one roof, to try to avoid the delays and inconvenience caused by the practice of passing patients between specialists before they get a diagnosis.

New genetic diagnostic tests have also been made available on the NHS, while experts are developing a new “quality of life indicator” to track care post-treatment.

But big questions remain about how achievable the goal set out last year really is.

Cancer survival rates have improved dramatically in recent decades. One in two people diagnosed with cancer today can now expect to survive for 10 years – but that still means 30,000 people are dying early every year because we are not as good as the best.

The challenge the NHS faces – like it does in so many other areas – is how it copes with rising demand.

Over the past 40 years, the number of people being diagnosed with the disease has more than doubled, mainly because people are living longer.

But as money has got tighter, the NHS has struggled to keep up. The major waiting time target for cancer is the 62-day goal for treatment to start following an urgent referral.

The numbers being seen within that timeframe are going up, but so are the numbers that have to wait longer. There are simply too many patients.

Cancer graph

Few in the field are confident this is going to change in the foreseeable future – even with the investment being made.

Hence Dr Jeanette Dickson, of the Royal College of Radiologists, said while the funding of the linear accelerators was welcome, “significantly” more money would be needed if services were going to be able to cope with what was being asked of them.

There are other concerns too. Sir Harpal Kumar, the widely-respected chief executive of Cancer Research UK, led the taskforce that drew up the cancer plan.

But this year he was left gobsmacked by the government’s child obesity strategy. He said the report, which was criticised for not being tough enough on the food industry, was “inexcusable” given the number of cancers which are linked to lifestyle.

There may be plenty of things for NHS bosses to shout about today, but there is also a lot they should be worrying over too. World class cancer care is still quite some way off.

Surge in twins linked to obese young mothers: UK is one of the worst places in western Europe to be pregnant and have a baby: a ‘no go’ area for a politician but we should break out of the consensus on the NHS and learn from other countries..

Tim Shipman in The Sunday Times 23rd October 2016 reports the “excess” deaths in the English NHS. You can add 10% if you include the other Health Services: Up to 46,000 die each year as NHS lags behind world’s best (Up to 46,000 die each year as NHS lags behind world’s best)

A perverse incentive epidemic, especially in mental health – both for GP’s pay/workload in UK and increased organ donors in the US, or dying, means that the systems are likely to get worse ..

The cost of poor mental health

National Cancer Therapy

Chris Smyth in The Times 25th October 2016: Deaths blamed on outdated radiotherapy machines

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Fast-track plan cuts wait for newest drugs by years… will cost more in an unrationed service

Whilst always looking for “good news” NHSreality finds it hard to come by these days. Chris Smyth reports in The Times 24th October 2016: Fast-track plan cuts wait for newest drugs by years. It is certainly better than waiting for their patent to be so close to expiring that they are immediately generic on licensing. It will however increase the cost of treating diseases, particularly cancers, and it is imperative that we “make sensible choices” rather than continuing to spend 80% of our individual health budgets in the last year of life. Giving painkillers long after they are needed, and reducing Physiotherapy post hip replacement, in a post-code lottery, to a skeleton service does not help.

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The best new drugs will reach NHS patients up to four years sooner than at present under plans to fast track promising treatments and tests.

Medicines must be conditionally approved for NHS use so that doctors can discover how effective they are in the real world, a review recommends today.

Companies must strike deals with the NHS under which drug prices vary according to how successfully they help patients or save money elsewhere, the review says. Drugs and devices deemed “transformative” will reach clinics sooner as NHS bosses work together to minimise delays caused by bureaucracy.

The NHS is slow to start using new treatments and the review says that patients “often have to wait long periods of time before life-saving therapies are available”. Patients in Britain often wait longer than elsewhere in Europe.

Ministers ordered the review to find ways of speeding up access to new drugs that would also boost the British life-sciences industry. They have welcomed its conclusions, despite being told that more money is needed to ensure that there is a “viable market” for new treatments in the NHS.

Chris Smyth 24th October in The Times: Pointless treatments cost NHS £2bn a year

BBC News: 24th October Doctors name treatments that bring little or no benefit

Emma Force reports 23rd October: Doctors’ leaders call for prescription drug helpline

Chris Smyth 24th October: Hip surgery does not lead to active life

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Surge in twins linked to obese young mothers: UK is one of the worst places in western Europe to be pregnant and have a baby: a ‘no go’ area for a politician but we should break out of the consensus on the NHS and learn from other countries..

The rise in multiple births, older mothers and “first” deliveries as a percentage of the whole, mean that specialist units should become the place of choice for expectant mothers. These will be further apart than the current provision, but the relative inconvenience is worth the better outcomes.. The extra deaths reported by the Institute of Economic affairs can be criticised (how can 3 countries deny having any unnecessary deaths?) but we all need to take notice in the round…

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Kate Gibbons reports in The Times 22nd October: Surge in twins linked to obese young mothers

The number of twins being born in Britain has reached a five-year high, largely due to overweight mothers in their twenties.twinsSource: Institute of Economic Affairs

While rates of twins and triplets has decreased slightly in older women, who are more at risk of multiple births, the number of women under 30 giving birth to more than one baby has increased by 3 per cent in a year.

Figures from the Office for National Statistics showed that last year 13.3 out of every 1,000 births to women aged 25 to 29 were multiple births, up from 12.9 in 2014. Experts said that while high rates of twins and triplets in older women can be explained by age or increased use of fertility treatment, it could be due to weight in the case of younger mothers.

Women with a body mass index (BMI) higher than 30 have significantly increased odds of giving birth to non-identical twins, studies found. The healthy range for BMI is 18.4 to 24.9….

The Mail: Number of twins being born in Britain reaches a five-year high – thanks to overweight mothers in their 20s

iNews: Obesity rates could be behind rise in number of women having multiple births

NHS advice: Overweight and pregnant – Pregnancy and baby guide – NHS

Tim Shipman in The Sunday Times 23rd October 2016 reports the “excess” deaths in the English NHS. You can add 10% if you include the other Health Services: Up to 46,000 die each year as NHS lags behind world’s best (Up to 46,000 die each year as NHS lags behind world’s best)

Extract: ….Even if the UK only matched the 12th-best country for each condition, more than 17,000 lives could be saved.

In a foreword to the report, Paterson described the figures are “shocking” and called for the government to learn lessons from overseas.

“The NHS has become a ‘no go’ area for a politician but we should break out of the consensus on the NHS and learn from other countries,” he said.

“The most alarming finding is that 46,413 people die each year because they were treated on the NHS rather than by the healthcare system with the best health outcomes in the world..

Read Tim Shipman’s full article: up-to-46000-die-early-in-the-uk

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Hunt denies that NHS efficiencies mean inevitable rationing

It is getting more difficult for Mr hunt to deny the patently obvious, but he will continue to do so until he loses his job, or there is an election forced on us. Lets hope for the latter, before Brexit becomes a fact. There are many analogies between the denial of real issues in both the politics of Europe and the Health Services. Have we all allowed ourselves to be ruled by minorities? There is always demand for more money (Labour and the other parties) but no demand for rationing – yet. So it’s going to get worse…

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The BMJ reports: Hunt denies that NHS efficiencies mean inevitable rationing ( Published 21 October 2016) BMJ 2016;355:i5659 )

Tough efficiencies in the health service can be made without damaging patient care, England’s health secretary has said, despite recent warnings that rationing of services will become inevitable without extra money….

Sofia Lind on 19th October reports in Pulse: Stop pretending NHS is ‘awash with cash’, MPs tell health secretary

The Government should stop giving the ‘misleading’ impression that NHS is being given a £10bn cash boost, MPs have suggested.

In a session of the House of Commons Health Committee yesterday, its chair Dr Sarah Wollaston asked health secretary Jeremy Hunt whether he felt people were wrongly given the ‘misleading impression that the NHS is awash with cash’.

She said the committee’s own calculations, based on traditional accounting standards and the Spending Review period, meant the NHS investment was more like £4.5bn than the £10bn the Government is claiming to be adding to the annual NHS budget by 2020/21.….

Inefficiencies in health care provision have been made evident this week. A friend with a possible small heart attack is “waiting” in a hospital bed for 2 weeks because he would not be given the same priority on a list for arteriogram and stent if he went home.. A charitable organisation gets a quote for “equipment” to fund a Health Provision contracted service. The eventual cost is 1/10th of that quoted initially by the Health Service provider. Lets hope the contracts hold up better than they did for private provider Cambrian. ( Daniel Dunkley in The Sunday Times 23rd October 2016: Hospital chain faces break-up). The UK Health Services need to shape up and state psychiatric provision is one area where co-payments and rationing for seriously ill people is an ethical challenge.

Cambian, one of Britain’s biggest psychiatric hospital operators, is set to be broken up in a attempt to pay off its spiralling debts.

The mental healthcare specialist, which runs more than 300 hospitals and care homes, has hired Rothschild to sell its Adult Services division for £300m, sources said……



Failing Trusts, GPs and Regions – Hunt admits failure to prioritise GP workforce

It’s all too little and too late. Even Mr Hunt now acknowledges that he has been wrong to ignore the GP crisis. David Millett reports in GPonLine 20th October 2016: Jeremy Hunt admits failure to prioritise GP workforce in four years as health secretary and the first minister in Wales is trying his best: Train / Work / Live – First Minister of Wales launches major new GP recruitment campaign launched 19th October 2016.

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BBC News 18th October: Sussex NHS mental health trust criticised over killings by patients

BBC News 20th October: A medical director’s failure to protect patients did not amount to misconduct, a tribunal has ruled.

Hugh Pym reports: Let struggling GP surgeries fail, says NHS England letter

Despite the black hole of £700m Wales  Regional Health Service (NHS Wales) is going to find some cash. Welsh budget: Labour promises extra £240m for NHS (BBC News 18th October 2016)

NHS Wales: £700m ‘black hole’ fear as pressures rise

The competition is severe….. And Wales is competing in a world market. An e-mail from a recruitment outfit in Australia reads (Shannon Edwards –Level 13, 135 King Street, Sydney, NSW 2000, Australia)

Sydney and Melbourne based Universities are needing General Practitioners to take over existing patient followings!  

If you hold your FRACGP fellowship and have unrestricted AHPRA registration, we want to hear from you. 3 major University on campus medical practices are looking for part time and permanent doctors to take over existing patient bases and earn well in excess of $300,000 PLUS per year. A high standard of healthcare will be expected at all times in line with the guidelines and standards of the University and its practice.  The University’s stance on mental health is extremely important, it is expected that you will hold up to date knowledge surrounding mental health plans and display empathy towards all patients. You will become very familiar with the practice on-site services to enable appropriate patient referrals when required. 

You will be supported by 11 other general practitioners, earn 70% billings and make well in excess of $250K PLUS. You will receive a share in PIP payments and many more benefits available to successful applicants. The practice opens Monday to Friday, Best Practice medical software and is AGPAL accredited. There are two locations in Melbourne’s eastern suburbs and one in Sydney, sessions are flexible with no weekend or after hour requirements. For more in-depth information, please call me today on 02 9411 7440.

There are rumours that Wales will be the first region to insist on salaried GPs. Good luck to them, but most of us feel that this will only have the potential to make things worse.






Dishonesty in the financial numbers. The Nuffield Trust explains.

Sally Gainsbury and Mark Dyan explain the dishonesty in the financial numbers – The Nuffield Trust 18th October 2016. There is also a commentary on the prospects for the elderly: without “harnessing social action” their prospects do not look good. The Nuffield reports do not suggest or start to think about rationing – which the Kings Fund did in May 2012.

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The state of NHS finances has attracted a lot of attention of late. Numbers have been thrown from all corners – and not all of them add up. Here are five figures you may have heard, and what they really mean.

£22 billion

The annual ‘funding gap’ NHS England says the NHS will face by 2020-21. The figure was calculated by projecting how much NHS England’s budget for 2013-14 would be by 2020-21 if it rose only in line with price rises in the economy. In other words: if spending stayed flat in real terms. That figure (£108 billion by 2020-21) was then compared with what NHS costs would grow to if activity continued to rise by around three per cent a year. That produced a figure of around £137 billion by 2020-21, with a consequent ‘funding gap’ of £30 billion between flat funding increases (£108 billion by 2020-21) and expected cost pressures.

Since the analysis was first published in 2013, the 2015 Spending Review awarded NHS England an ‘extra £8 billion’ of funding over inflation by 2020-21. That reduced the £30 billion gap to around £22 billion. NHS England says the health service will close the gap by being more efficient and by slowing the growth in demand for its services by helping people remain healthy. However, cuts to services and quality are now looking increasingly likely.

£8 billion or £10 billion

The ‘extra’ funding the government claims to have awarded the NHS in England above inflation by 2020-21. While the £8 billion figure relates to the amount the government says NHS spending will grow by between 2015-16 and 2020-21, the higher (and therefore more often-cited) figure measures the increase from a year earlier – which is a peculiar way to count aspending settlement that started in 2016-17.

But an even bigger problem is that the £8 billion figure (£7.6 billion if counted correctly) has been flattered by redefining what counts as ‘the NHS’. In the past, the government used to count NHS spending as the entire Department of Health budget for England. Now it only counts the subset of that spending that comes under the control of the department’s commissioning arm, NHS England. Only ‘NHS England’ is protected with ‘real-terms increases’, while the rest of Department of Health spending will be cut by £3 billion by 2020-21. That £3 billion is now part of the ‘£8 billion extra’ the government claims it is giving the NHS. But it is coming from budgets used to build new hospitals, pay for doctor and nurse training and public health initiatives and so will directly hit frontline NHS services.

The ‘real’ increase in NHS spending above inflation between 2015-16 and 2020-21 is then just over half what the government claims, at £4.5 billion.

But even that figure is a bit of a stretch, as it measures spending increases against inflation in the whole economy. Inflation in the things the NHS actually buys (like doctors, nurses, medical technology and drugs) is currently rising faster than average prices in the whole of the economy. Once that NHS-specific inflation is factored in, the remaining £4.5 billion reduces to just £800 million above NHS inflation by 2020-21.

£2.45 billion

The reported net deficit (or overspend) for the financial year 2015-16 across NHS hospitals, mental health trusts and community services in England – referred to collectively as NHS providers. The £2.45 billion figure is bad enough. But it is still a significant under-statement as it was achieved only after huge pressure was put on organisations to make multiple adjustments to their accounts – all designed to either boost reported levels of income, or reduce reported costs, and so minimise the reported deficit. NHS Improvement indicated in its report at the end of the financial year that those measures had reduced the reported deficit by around £1.2 billion, suggesting a real underlying deficit of nearer £3.7 billion.

Separate analysis by the Nuffield Trust exploring provider income and expenditure alongside inflation and activity levels also found an underlying deficit of £3.7 billion for 2015-16.

The true size of the overspend matters, because it shows that although the government has given the NHS (a little) ‘more money’, the NHS is starting from a position of not having enough. Indeed, when the Spending Review was announced in November last year, the government believed the NHS provider overspend for the year would be around £1.8 billion. In the event, it was double that.

How did providers get into such a mess? The answer is pretty simple. Every year between 2010-11 and 2015-16 the amount hospitals were paid for each treatment they provided was cut, year after year. That meant that by 2015-16, a hospital was paid the equivalent of £820 to treat a patient they would have been paid £1,000 to care for in 2010-11. Hospitals tried to balance their books by cutting their costs by around 13 per cent over the same period. But the amount they were paid was cut even faster – by around 18 per cent, resulting in the expenditure-over-income deficit we see today.

£580 million

The forecast NHS provider deficit for 2016-17. It sounds like quite a turnaround from £3.7 billion (or even £2.45 billion) in 2015-16. But, as ever, things are not quite as they seem. If trusts and other providers do manage to report a net deficit of £580 million in their accounts at the end of next March, it will only be because they will have received an extra £1.8 billion in ‘sustainability’ funds. The underlying deficit for the year then would be £2.4 billion. That would still be a significant improvement from £3.7 billion, and providers will only manage to get there if they cut their costs by 4 per cent this financial year. That would mean slashing costs by around £3 billion in one year – around twice the amount Lord Carter’s report on hospital productivity suggested was possible.

NHS England and NHS Improvement have now tacitly acknowledged how much financial trouble providers are in by admitting they will need £1.8 billion of extra sustainability funds for the next three years running. Luckily, the money is just about there to do that. But it comes from the £2.1 billion to £3.4 billion a year fund the NHS set aside in 2015 to invest in transforming NHS services.

That transformation is necessary because over the last decade, NHS activity has grown by around 3 per cent a year, but the funding set out for it by the government to 2020-21 means that is no longer affordable. NHS England want to slow the rate of growth to nearer 2 per cent a year by investing in public health improvements and by establishing new services that reduce the rate at which demand for acute hospital care is growing.

But after using the investment fund to bail out hospitals, it now looks like just £2.5 billion will be available to invest in transformation over the next three years. That is the equivalent of £4 million a year for each NHS clinical commissioning group area. It is not clear whether that is enough. If it isn’t, the risk is NHS activity either continues to grow at an unaffordable rate – resulting in a £2 billion a year net overspend by 2020-21 – or the NHS resorts to crude ways to reduce the rate of growth, such as rationing and service closure.

£350 million

The sum EU referendum Leave campaigners claimed the UK paid each week to Brussels. Slogans like “give our NHS the £350 million the EU takes every week” implied to many that the health service could expect this cash once it left.

The £350 million figure is based on a weekly breakdown of the £19 billion that the UK pays each year. The problem is that the UK already gets a hefty chunk of that back as a ‘rebate’ – over £4 billion in 2014. That leaves only £282 million a week.

And some of that money is already spoken for. The EU today spends billions on British farming, universities, and regional development. We will need to set aside a large proportion of our annual savings to replace this funding.

The highest-profile specific pledge, backed by Boris Johnson and Gisela Stuart among others, was £100 million a week – an extra £5 billion each year for the health service. Leaving the EU really would free up funding on this scale. In fact, we could spend that amount on the NHS and have a few billion left over.

But there is one last catch: leaving the EU has the potential to give Britain’s economy a nasty knock – potentially wiping out as much as £40 billion from the public finances.

This has the potential to swamp any benefit we might get from cancelling our transfers to the Union.

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