If anyone was in doubt about the reduction of standards, here is evidence from the Nursing world. Equally damning evidence would be available from retiring consultants, if only they had exit interviews. The obsessive use of private providers is dumbing down the training of doctors. The irony in Linda Holland’s statement is self evident. Good communication, both in consulting with patients and in the written/computerised notes is essential in medicine. Rationing their pay, and the number of places, and insisting on degree academic courses, rather than practical skills based training for nurses is the cause.
Whilst Student nurses face tougher tests for course places – 31 May 2011: Sarah Calkin in the Nursing Times the result has been a shortage. Now, to fill the gap Catherine Read reports in The Mirror: “English Language Test for Nurses is made easier as only 4% pass exam”.
In the Times (Not on line) the report reads “Easier test for nurses”.
The score needed to pass language tests for foreign nurses working in Brritish Hospitals has been lowered after only 8 out of 220 Filipina nurses passed at the Royal Wolverhampton NHS Trust. The Trust blamed the “painful” English test for an acute shortage of nurses. Under the new system more than half the nurses would have passed. Linda Holland, from the Trust, stressed “We will never compromise patient safety in any way”.
If you want to get “redundancy” get to the top in the Health Services. By constantly moving on, and leaving your wrecks behind, you climb the greasy pole to a point where it pays to be made redundant…
Ministers are to press ahead with plans to cap public sector “golden goodbyes” that the government claims will save the taxpayer £250 million a year.
Under the proposals, no civil servant, health service manager or other public sector worker will be allowed to claim more than £95,000 in redundancy pay.
There will also be a “claw back” clause in severance contacts allowing the government to reclaim the redundancy payments if an employee gets another job in the public sector shortly afterwards.
The move, which will be announced today following a consultation, comes after a series on controversies over so-called “fat…
With no disincentive to make a claim, and all political parties remaining in denial, all of us in the professions know the answer to the rhetorical question. When the media and the politicians come on board something can and will be done. Until then covert post code rationing gets worse.. As the news comes thicker and faster public discontent will rise, and civil unrest is a real possibility because of the long lead-in time for reconstruction and renewal.
With the NHS facing a virtual freeze in its spending to 2014/15 and prospects for little or no real funding increases for some years after, what does the long-term future hold for the NHS?
The publication of the Office for Budget Responsibility’s (OBR) 2012 Fiscal Sustainability report provided a timely basis for examining and debating possible trajectories of spending in the future and the implications for NHS policy.
Robert Chote, Chairman of the Office for Budget Responsibility (OBR), shares the results of the OBR’s 2012 Fiscal Sustainability report, with a focus on health care spending.
Paul Johnson, Director, Institute of Fiscal Studies, gives a background to economic growth in the UK and discusses what future NHS spending could look like.
John Appleby, Chief Economist at The King’s Fund, looks at UK and US health care spending projections and the share of wealth we might want to devote to health care in the future.
Kate Gibbon in The Times 22nd September reports: Mental health funding cut to prop up other NHS services and this is the reality of current decision making by knee jerk and “what we might get away with”.
Rupert Neate in New York reports for The Guardian 21st September, on the opportunism of the Pharmaceutical Industry when there is poor procurement control: US drug company hiked price of acne cream by 3,900% in less than 18 months
The Belfast Telegraph on 22nd September reveals how little accurate information the UK Health Services have, and how cancellations affect the services. Thousands of cancelled operations not included in official figures and the BBC ‘Thousands’ hit by late-cancelled operations
And in June John Appleby asked: “Is the UK spending more than we thought on health care (and much less on social care)?”
in 2015 the BMJ published “John Appleby: Hoping for the “Appleby paradox” ( BMJ 2015;350:h107 )
The “phoney war” preceding hostilities in the second world war allowed people to discuss and agree on survival strategies. Citizens were fearful but at least all were in it together and treated equally. The denial, which is highlighted by the Nuffield Trust and the Kings Fund, is not allowing the discussion. Politicians (mainly) and the Media (slightly) are to blame.
Increasing numbers of patients will be left to endure “crippling pain” as rationing spreads across the NHS, one of Britain’s most senior surgeons has warned.
Stephen Cannon, Vice President of the Royal College of Surgeons said bans on all but the most urgent treatment would become “commonplace” without major changes to the funding of the health service.
The NHS is in the grip of the worst financial crisis in its history, with increasing restrictions on cataract surgery and lengthening waiting times for hip and knee operations in most areas.
Yesterday St Helens clinical commissioning group in Merseyside took the unprecedented step of making plans to suspend all non-urgent treatment for four months, in an attempt to tackle its overspend.
In a letter to The Telegraph, Mr Cannon, an orthopaedic surgeon, said such bans would become widespread without a “realistic” increase in funding.
He also called for changes in the way existing funds are spent, to divert more money away from bureaucracy towards front-line care.
“This is not a one-off, this is a growing problem across the NHS,” he said. “We are deeply concerned. It is bad enough having to put up with crippling arthritis as waiting times get longer, but these sorts of delays can mean the hip crumbling away so the patient can’t even take a step. It also means that when patients do have surgery, it is infinitely more complex,” the surgeon said.
“I am concerned that we could end up going back to the days when patients waited two or three years for operations,” he added, warning that many patients were being left in “severe discomfort and pain”.
Mr Cannon called for extra funding for the NHS to cope with rising demand from an ageing population. But he also said too much money was being spent on bureaucracy – including on long wrangles over which patients would be funded.
“We are seeing decisions now being made purely on a financial basis, when these should be clinical judgements, made in the interests of patients,” he said.
“These rationing processes are often adding in an extra layer of bureaucracy, which is using up more resources,” he said.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s GP committee, said blanket suspensions of “non-urgent” treatment risked lives.
Diseases such as cancer were often only detected when doctors investigated ailments which had not been identified as urgent, he said.
“This is an unacceptable decision which highlights the incredible financial pressure facing general practice and its impact on patient care,” he said.
“What apparently may not be urgent at first presentation and is therefore not referred could turn out to be very serious in the long term. Many cases of cancer are subsequently diagnosed following routine referrals of patients who have undifferentiated symptoms early on in their illness.”
Geoffrey Appleton, lay chairman of St Helens CCG said: “We would prefer not to be in this position but we are by no means alone as an increasing number of CCG’s are reporting similar financial challenges. Our funding gap is so large we know these measures alone will not bring a resolution and we are faced with the prospect of proposing to suspend, reduce or withdraw certain services.”
Its proposals will now go to public consultation. Because the CCG was recently rated “inadequate” by NHS England, any plans will have to be agreed by its local health officials.
Last week, a think-tank said “unpalatable” decisions about rationing lie ahead unless the NHS achieves unprecedented levels of efficiency savings, or receives a funding boost.
Three in four CCGs are now operating restrictions on cataract surgery, limiting them to those in most desperate need, using criteria such as whether the patient has suffered falls as a result of their vision loss.
Earlier this year the NHS declared a deficit of £2.45bn – the worst in its history.
As the NHS finances have deteriorated, health trusts have spent record sums on “turnaround” managers employed on “off-payroll” deals.
Earlier this month, an investigation by The Telegraph revealed that such managers have been paid rates of up to £60,000 a month by cash-strapped trusts.
An NHS England spokesman said: “Decisions when prioritising resources are always very difficult for commissioners but it is up to CCGS to make the best decisions for their area and work with hospitals to plan and manage demand over winter. St Helens CCG is actively engaging with its local population on the best way to ensure patients have their care prioritised over the busy months for the NHS. The 18 week target is a national objective which all CCGs and hospitals should be striving to meet.”
Grantham and District Hospital is considering plans to restrict its A&E hours after becoming “seriously affected” by a “national shortage of appropriately trained doctors to work in A&Es”.
In a statement it said: “We have reached a crisis point and we may put patients at risk if we don’t act.”
Dr Clifford Mann, president of the Royal College of Emergency Medicine, said there were too few A&E doctors in the country to meet patient demand.
“The wider picture is there is a real crisis in emergency medicine as our workforce numbers are not growing fast enough to keep pace with rising numbers of patients attending A&E Departments,” he said.
Meanwhile NHS managers at University Lincolnshire Hospitals NHS trust are considering closing an Accident & Emergency department at night after reaching “crisis point”.
Aside from the fact that there is no “N” HS but rather 4/5 regional services, Dr Mark Porter shows his own denial by his e-mail as quoted in the penultimate paragraph of this post. Whilst Politicians and Doctors in the public eye conspire in a collusion of anonymity and denial we can only get a worse service.
RATIONING ‘ALREADY WIDESPREAD IN THE NHS FOR A VARIETY OF TREATMENTS’
Rationing is rife across the NHS, with patients suffering cutbacks to treatment and expensive drugs, a major survey of doctors has found.
The research, for the Press Association and ITV, found cuts to cancer treatments, costly medicines, mental health services and knee and hip replacements.
Some patients have been left to develop complications before getting the treatment they need, while others are being forced into re-mortgaging to pay for private care.
BBC STARS EARNING MORE THAN £150K TO BE NAMED UNDER NEW REFORMS
BBC stars earning more than £150,000 a year will be named under government reforms to make it clearer how the licence fee is spent.
More than 100 of the corporation’s best known faces are set to have their pay packets disclosed by next summer.
But the BBC raised fears it would be harder to hold on to its biggest names and pointed out that it already paid less than other broadcasters.
PROSTATE CANCER SURVIVAL RATES VERY HIGH REGARDLESS OF TREATMENT, STUDY FINDS
Regular monitoring of prostate cancer as a treatment option offers the same chances of survival 10 years after diagnosis as surgery or radiotherapy, a major study into the disease has discovered.
The decade-long trial, which examined men with localised prostate cancer, found survival rates were extremely high, approximately 99%, irrespective of the treatment administered.
There was no spread of the disease in around 80% of men who were actively monitored during the UK-wide study.
The Express and Star: Rationing ‘already widespread in the NHS for a variety of treatments’
The Guernsey Press: Rationing NHS care ’causes delay and distress’
Selina McKee in The Pharma Times: Care rationing widespread in NHS, survey finds
The majority of doctors taking part in a survey for ITV News have admitted to rationing care on the NHS because of financial constraints.
In the survey of 1,000 doctors, undertaken by healthcare data and intelligence provider Wilmington Healthcare, more than two-thirds said they had been forced to ration care as a direct result of the cash crisis. Moreover, 90 percent said further rationing is inevitable.
Services and treatments spanning all aspects of care – from child mental health, hip and knee replacements, and cancer drugs are being restricted to save money, while patients in need of varicose vein removal and cataract surgery are either being denied or made to wait, the news channel said.
According to its research, some patients ended up in accident and emergency departments because they had been refused treatment through normal channels.
However, more than three-quarters of responders believe the NHS should be rationing treatments, citing arguments such as ‘it is necessary for the NHS to survive financially’ and that ‘not all treatments should be available on the NHS’.
In an emailed statement, Dr Mark Porter, council chair of the British Medical Association, said: “The rationing of vital health care not only causes delay and distress to patients, but can ends up costing the NHS more money in the long run. This is especially true in the area of public health spending.
“Inevitably, it will be patients who suffer as the NHS, its doctors, nurses and other staff, are forced to choose between which patients to treat and the type of treatment they receive. The government must realise that the answer lies not in rationing essential services but in addressing the funding shortfall and investing in the future of the NHS.”
Bed-blocking is at a record high as NHS decline continues, official figures show.
Hospitals predicted a “winter of discontent” as they struggled to cope even in summer, warning patients to get used to long delays.
More than 200,000 patients waited in excess of four hours in A&E in July and the target to see 95 per cent within this time has not been met for a year.
Cliff Mann, president of the Royal College of Emergency Medicine, said: “The system is in crisis — the pressures departments experience in winter are being felt almost all year round.”
Health chiefs said that junior doctors’ strikes planned for the autumn posed “obvious risks to patients”. Targets are also being missed for emergency ambulance call-outs, routine operations, diagnostic tests and cancer treatment.
Siva Anandaciva of NHS Providers, which represents hospitals, said: “We are becoming increasingly worried about this continuing deterioration in performance. The summer is usually a quieter time. We are heading towards a winter of discontent, with this relentless cycle of record high A&E attendances, increasing emergency admissions and greater numbers of patients who cannot be discharged because the services they need in the community are not being properly resourced.”
Patients were stuck in hospital when fit to go home for a record 184,188 days in July, a bed-blocking rate 25 per cent higher than last year. On a sample day 6,364 patients fit to leave were still in hospital, the highest number on record and up almost 50 per cent on last year.
Vicky McDermott, chairwoman of the Care and Support Alliance of charities, said: “More people are being kept in hospital unnecessarily because of failures in the health and social care system.” She blamed cuts to council social care services.
Nigel Edwards, chief executive of the Nuffield Trust health think-tank, said: “There’s a general feeling that we’re managing gradual decline and the question is when do we get to breaking point?”
Julie Mellor, the NHS ombudsman, said: “Health and social care leaders must look at the discharge process as a whole and uncover why ten years of guidance to prevent unsafe discharge is not being followed.”
Targets to carry out routine operations such as hip replacements within 18 weeks are also being missed, with 3.7 million people now on an NHS waiting list.
Matthew Swindells, director of operations at NHS England, said: “As the NHS responds to increasing care needs, hospitals are continuing to look after more than nine out of ten A&E patients within four hours, and more than nine in ten patients are waiting less than 18 weeks for routine operations.”
Aug 13th letters: Solving the NHS bed blocking crisis together
Sir, In November 2013, concerned about bed blocking, I wrote to Jeremy Hunt and David Cameron to offer the aid of our country’s voluntary sector in ensuring that elderly people are supported in the community and not in hospital beds when there is no need for medical interventions (“NHS crisis deepens as bed blocking costs £6bn”, Aug 12).
The work of charities such as the Red Cross and Royal Voluntary Service, working in casualty and on wards helping safe patient discharge, has already been highly effective and could be rolled out to every hospital. Other than a small intervention in 29 hospitals funded by the Cabinet Office, this offer has been spurned by government and the NHS. It is time for a national initiative that galvanises our charities to help out in this crisis.
Sir Stephen Bubb
Director of Charity Futures
Sir, For too long funding for social care has been cut and cut again. A funding gap running to £30bn is predicted for our health service by the end of the decade and for social care that gap is at least £4.3bn, yet within eight years one in five of us will be over 65.
Health and social care are not separate entities. If one area is not functioning, it will impact on the other. The long-term solution is to create a collaborative model where local authorities, the NHS and voluntary agencies work together to put people at the centre of their own care. In the short term, however, there is funding allocated for social care support. The government has set aside extra money to enhance the Better Care Fund, but most of that is being held back until the end of the decade. This money could be helping thousands, including some of the 6,000 people trapped in hospitals across England right now. We urge the government to release this funding.
Director for independent living and crisis response, British Red Cross UK
Sir, What happened to convalescent homes? I remember my grandmother being in one for about six weeks while she recovered from an orthopaedic operation. There were fewer old people and less that medical science could offer then, but the convalescent facilities provided a more homely atmosphere in which to recover and gave patients some breathing space.
Sir, As many as a third of patients do not need to be in NHS beds, and while the significance of joined-up working with social services and community care is important, it is not the whole story. The housing shortage for young starters is but one end of a problem. The other end is the need to ensure an abundant supply and range of housing options for older people and to redesign neighbourhoods to provide supportive environments.
If we get this right, together with good community health and social services, a large proportion of admissions could be avoided and patients who are admitted could be discharged sooner. A good start would be to have a housing sector board member on each NHS trust.
Dr John R Ashton
President of the UK Faculty of Public Health 2013-16
Sir, The current NHS financial challenge has left commissioners, providers and clinicians facing increasingly tough decisions about patient care as they try to prioritise funding and balance their budgets (“NHS cuts threaten hospital closure”, Aug 11).
The scale of savings required cannot be generated by productivity improvements alone and it is inevitable that some organisations will be forced to restrict access to services or dilute the quality of care they provide because of the financial imperative. Politicians need to be honest with the public about what the health service can offer with the funding made available to it.
Chief executive, The King’s Fund
May 26th: Bed-blocking costs NHS £820m a year
The NHS is in terrible shape. Keeping it alive requires medicine both the left and right will find hard to swallow
Nearly everyone born in England after 1948 was delivered into the care of the National Health Service, and most retain an almost filial loyalty to the organisation. The taxpayer-funded service, which provides health care free at the point of use, is so precious in the public imagination that politicians are less likely to talk of improving the NHS than “protecting” it.
Yet this national treasure is looking frail (see article). Nine out of ten of the local trusts which run hospitals are spending beyond their budgets; overall the service faces a funding gap of £20 billion ($27 billion) by the end of the decade. Doctors have gone on strike over a new, less generous contract that the government is imposing on them. And everywhere hospitals are struggling to make ends meet. In recent weeks one trust has abruptly shut an emergency department to children because it was found to be unsafe; another said it was considering delaying all surgery on obese patients.
The diagnosis is simple: rising demand for health care from an ageing population is outstripping supply. But the cure will be hard to stomach for both left and right. Increasing the NHS’s capacity will require a far more ruthless focus on efficiency. Even then, taxpayers will have to get used to forking out more. Managing demand will involve not just uncontroversial measures such as more emphasis on preventive medicine, but toxic ones such as introducing charges for services that have been free. Such is the price Britons must expect to pay for living a decade and a half longer than when the NHS was founded.
Though the NHS is lean by international standards, it still bleeds money through inefficiency. There can be few organisations in England that still use fax machines as often as doctors’ surgeries do. Poor staff planning means that shortages are tackled by expensive overtime. And the English have a romantic attachment to small local hospitals, which are costlier and deliver worse results than big specialist ones. By scaling up, the NHS could offer better care for the same money. In some parts of the country family doctors are leaving their cottage practices to join chains of larger surgeries that share back-office functions such as call centres. Countries such as Germany and Denmark have found that by reducing the number of hospitals that offer particular surgical procedures, they can reduce the incidence of complications.
You may feel some discomfort
Yet even if all such wastefulness can be eliminated, the government’s plan to close the NHS’s entire funding gap through greater efficiency is heroically optimistic. Britain already spends less as a share of its GDP on health care than most other rich countries. It is now on course to shrink that share, from 7.3% to 6.6% by 2021. At a time of steeply rising demand that is unrealistic. Politicians must make plain to voters that if they want to keep the taxpayer-funded model and expect to carry on living into their 80s and beyond, they will have to pay for it.
At the same time as making available more resources, the government needs to rein in demand for NHS services. Patients should, where possible, be diverted from expensive forms of care into cheaper ones. One reason that hospital beds are in such short supply is that budgets for social care have been slashed. It makes no sense to use hospitals as expensive substitutes for old people’s homes. Amalgamating health and social care, as some regions are already doing, would lead to a more sensible allocation of resources. If more doctors dealt with simple queries from their patients by phone or e-mail, they would have more time to devote to tricky ones. Subjecting more services to fees would temper frivolous demand. In-person doctor’s appointments, for instance, could incur a modest charge, as prescriptions and dental work already do.
More fundamentally, the focus must shift away from treating illness and towards preventing it. The NHS was designed with acute conditions in mind; nowadays 70% of its spending is on long-term illnesses. It is cheaper, as well as better for patients, to reduce obesity, say, than to treat diabetes. Yet NHS providers are paid for the procedures they carry out, not for those that they render unnecessary. A better model would be to give health providers a budget based on the population they serve, and pay them according to their ability to meet targets of better public health. This would increase the incentives to use new technology that would give patients more responsibility for their own health. If private outfits can do this with a profit margin to spare, good for them.
Higher taxes, new charges and more rationed services: these are bitter pills for politicians. But the English are ageing, and as long as their leaders promise simply to “protect” the NHS by doing nothing, the service faces only decline.