Monthly Archives: March 2014

Pay £10 monthly NHS England charge, says ex-Labour minister

BBC news reports 31st April 2014: Pay £10 monthly NHS England charge, says ex-Labour minister

A former Labour health minister has suggested people in England pay a £10 monthly membership charge to use NHS services.

The plan comes from a report for the Reform think tank, which argued the money was needed to fill a £30bn funding gap, expected by 2020.

Lord Warner told Jo Coburn on the Daily Politics that the government could not go on “shoving more money into the NHS from general taxation with the situation we have got.”

Mark Ferguson, editor of LabourList, said that even though the NHS was “facing a big funding crunch,” the Labour party would never support the idea.

So why not include a membership card, incorporating an identity card, and “pin” access to your medical notes, tax code and any other personal details you wish to include? It is odd that even a labour party member can consider a hypothecated tax for health care. Without addressing the fundamental philosophy, and what conditions patients/citizens should expect to be self sufficient regarding, and what is excluded by Health Service membership, any such scheme will fail.

Norman Warner and Jack O’Sullivan report in The Guardian: £10 each can save the NHS

The NHS no longer meets the country’s needs. Rather than managing decline, politicians and the public must face uncomfortable truths

Ian Johnston for The Independent reports: NHS patients should pay monthly fee, says former Labour minister

The Mail reports: Call for £10 a month fee to use NHS and £20 a night to stay in hospital: Former Labour health minister says out-of-date service needs the cash

Reform report: Solving the NHS care and cash crisis

What a nightmare. Evasion, denial and political cowardice conspire to make the Health service doomed to a downward spiral until a real non-political debate is entered into..

Reducing Inequalities – A possible Welsh Health Budget

The Welsh Government (WG) have decided to reduce inequalities further…..

From April 1st 2014 it is not enough for prescriptions to be free, so chemists will be encouraged to give “cash back” for each prescription. This ensures that the obese diabetics will get more money, and money means extra years of life, thus reducing inequality. More money will be handed out for each increasing prescription, as complex cases with multiple pathologies are disproportionately disadvantaged.

The money spent on this will be raised by a Welsh Tax on capital. Anyone owning a house over the national average valuation will be asked to return an extra 2% of the capital value to the WG each year. Holiday homes will be taxed incrementally to encourage sales. This should depress house prices and reduce inequalities.

The WG realises that it can raise very little by direct taxation. Therefore indirect taxation will be the rule. There is already a thriving UK wide “black market” in Tobacco and Alcohol, so the WG has decided to run this properly, and become import/export facilitators for the UK, and undercut the villains profiting illegally. The scheme may be expanded to include hard drugs and Organs (from Welsh donors).

An Indirect tax on Sugar at £1 per 100g of product, including honey and any other natural sugar products will be introduced.. Thus a £1 mars weighing 100g will cost £2 from tomorrow….. This tax may be extended to Chips, Burghers, Sausages and Lava Bread, depending on the average Body Mass Index of supermarket customers (Overweight seen as the norm, says chief medical officer).. who will be weighed automatically on passing over entry scales and past height assessing lazers, which will then announce the customers weight and BMI publicly. Sugar products should still be be affordable because of the prescription cash back.

With regard to Private Medical Insurance, WG will now insist that once any private consultation is made, that all future care, for the remainder of the patient’s life, will be NHS excluded. To get accurate data Wales will pay UK insurance companies for their data and personal information. Since The insurance companies have already got our NHS data. (Jon Ungoed-Thomas  14th March 2014: NHS sells 1,000,000 records! ) they will be able to cross reference and give information on anyone who pays their insurance premium from outside Wales..

Saving on signage. The Welsh Government has decided dual signage and paperwork will be stopped. A decision has yet to be reached as to which language will be retained, but this decision alone could reduce waiting lists……. and on top of this, the savings will be used to fund special scanners to reduce waiting times throughout the principality.

Since Wales cannot train or recruit enough British graduates, recruitment will be centred on Cuba, where doctors currently earning $40 per month will be encouraged to settle in Wales. (Cuba doubles its doctors’ pay — to £40 per month)

Finally, the WG has decided to raise an NHS tax. Details to follow … but it may be in “Bitcoin”..

Chris Smyth writing in The Times on 15th March reports: The wealthy enjoy an extra 20 years of healthy life 

Since Wales is one of the poorest regions in the UK (We should rage against the dying of Wales) and since waiting times are rising fastest in the UK for tests (Record wait for hospital tests in Wales forces patients to England) you might expect the Welsh Government to review some of its policies.

On 14th February 2012 Kimberly Palmer for Money personal finance confirmed the suspicion: Do Rich People Live Longer?

Wealthier people do live longer, but the reason isn’t as obvious as it seems.

On January 8th in the Times, Daniel Finkelstein opined: A separate NHS tax would rein in spending and Frank Field commented on January 10th: How will we pay for the NHS in future?

Frank Field letter on NHS tax

Read Dewi Evans in the Western Mail 25th February 2014: Letter Western Mail First duty of care is to the patients – Dewi Evans. How similar is Mr Drakeford’s denial to that made in Mid Staffordshire 12 months ago?

The state of Wales: Should we all rage against it’s dying?

Update 1st April.

Chris Smyth in The Times 1st April 2014 reports: Health Chief attacks “like it or lump it” doctors.

Abandoned NHS IT system has cost £10bn so far

Rajeev Syal reported for The Guardian 18th September 2013: Abandoned NHS IT system has cost £10bn so far

An abandoned NHS patient record system has so far cost the taxpayer nearly £10bn, with the final bill for what would have been the world’s largest civilian computer system likely to be several hundreds of millions of pounds higher, according a highly critical report from parliament’s public spending watchdog.

MPs on the public accounts committee said final costs are expected to increase beyond the existing £9.8bn because new regional IT systems for the NHS, introduced to replace the National Programme for IT, are also being poorly managed and are riven with their own contractual wrangles.

When the original plan was abandoned the total bill was expected to be £6.4bn.

Richard Bacon, a Conservative member of the committee, said the report was further evidence of a “systemic failure” in the government’s ability to draw up and manage large IT contracts. “This saga is one of the worst and most expensive contracting fiascos in the history of the public sector.

“Yet, as the much more recent universal credit project shows, there is still a long way to go before government departments can honestly say that they have learned and properly applied the lessons from previous contracting failures.”….

Five ways to fund the NHS that Reform might like to consider

The Guardian reports on Five ways to fund the NHS that Reform might like to consider

Lord Warner’s suggestion of a £10 a month subscription fee to the NHS hasn’t gone down well – so here are five other ideas from history he could use instead.

Invest in more nuns

Destroy the Protestant Work Ethic/Smash Capitalism

Sell Bodies

Support the Co-operative

Elect a Liberal Government

An NHS free from day-to-day political interference is far from reality

Dennis Campbell in The Guardian reports 27th March 2014: An NHS free from day-to-day political interference is far from reality

Jeremy Hunt’s approach to overseeing NHS is far cry from previous health secretary’s attempts to cut political meddling

At noon on Mondays, Jeremy Hunt‘s office on the fourth floor of the Department of Health’s Whitehall headquarters fills up. Always hosted by the health secretary himself, the midday meeting focuses on what the department calls “NHS delivery” – that is, how the NHS is performing its vital role.

There are usually 25-30 in Hunt’s room, with a few having to stand because there is not enough space around the table. Top brass from the three key NHS bodies charged with overseeing the health service are always present. There’s also one or more of Hunt’s ministerial team: Earl Howe is a regular while Norman Lamb and Dr Daniel Poulter are semi-regulars, along with Hunt’s permanent secretary, Una O’Brien, and sometimes the prime minister’s health adviser, Nick Seddon.

Those meetings began shortly after Hunt was appointed in September 2012 and have taken place almost every week since.

But last October, amid gathering fears that the impending winter would be very tough for the NHS, he instituted a second regular weekly meeting in his office, on Thursday afternoons, which looks at how the service is coping.

Fewer people attend the Thursday gathering, though the three key organisations – the department’s arm’s-length bodies (ALBs) – always do. They are NHS England; Monitor, which regulates semi-independent foundation trust (FTs) hospitals; and the Trust Development Authority (TDA), an arm of the health department that looks after non-FTs. Civil servants jokingly refer to it as “the meeting of the three Davids” because the three bodies are headed by, respectively, David Nicholson (although he steps down at the end of March to be replaced by Simon Stevens), David Bennett and David Flory.

These meetings are unusual – indeed, unprecedented – and controversial. Until now, their existence had not been reported, nor the concern and annoyance that senior NHS figures feel about them. Some of them see them as evidence of Hunt’s “control freakery” and an opportunity for him to call the organisations together to give them their “orders” for the week.

Such is the health secretary’s modus operandi that Professor Chris Ham, chief executive of the King’s Fund health thinktank, says: “Effectively Jeremy Hunt has become the executive chairman of the NHS.”

Hunt can seek a detailed report into one hospital’s failing finances, ask to be briefed on the planned reorganisation of hospital services somewhere in England – the potential political fallout from the rundown of any hospital so close to the election is a priority –or demand improvements in a hospital’s A&E performance if it is not treating the required 95% of patients within four hours.

There is widespread concern at senior levels of the NHS that Hunt’s tendency to routinely ask the bosses of the ALBs to look into things, take action and then report back on progress takes up much of their week and amounts to unjustified direction and interference in their work. There is an “understated threat in his approach”, according to one NHS insider.

“He’s tasking the people who turn up very hard,” said another senior NHS source.

“You are tied up for many hours after that, especially in producing information on issues he has asked about,” said another, who lamented the “industry of information Hunt has created, going backwards and forwards between the DH and the ALBs”. No wonder, as a senior source said, “the bosses who go feel leaned on”.

An ally of Hunt admits that “Jeremy is very directing at these meetings with the NHS leaders – much more hands-on than Andrew Lansley. He identifies a problem, agrees with them a way of dealing with it and then comes back to them a week or two later to check if what was agreed has actually been done.”

No previous health secretary has held such management meetings. But then, Hunt only needs to hold them because his own government’s radical restructuring of the NHS in England last year dispersed power among a clutch of mainly new bodies, each responsible for certain things, leaving – in theory – no one person or body in overall control.

Until last year, that person was the NHS chief executive, who did his or her best to help keep the service on-track for whoever happened to be the health secretary at the time. Nicholson served five in his eight years. The health secretary was responsible to parliament, but the NHS chief executive used his or her command and control to make things happen.

Things are more complicated now. The highly contentious Health and Social Care Act was meant to make good coalition promises to set up an independent board to run the NHS in England – NHS England – and let it get on with the job of running the service, albeit within parameters set by ministers. On 1 April 2013 Nicholson and other senior civil servants ceased working for the DH and transferred to NHS England, which gets its £95.6bn budget from the DH.

The coalition agreement of May 2010 said that “we want to free NHS staff from political micromanagement”. The then health secretary Andrew Lansley’s NHS reform white paper two months later, subtitled “Liberating the NHS”, pledged that the new independent NHS board would be “free from day-to-day political interference” and that the legislation would “limit the ability of the secretary of state to micromanage and intervene”.

While Lansley believed all that, Hunt appears to think otherwise. “He’s controlling the NHS by controlling all of the key NHS bodies, and controlling the NHS almost despite the legislation,” said one of the NHS’s most experienced powerbrokers.

Professor Ham says Hunt is responding to the fact that Number Ten and the Treasury are very interested in its performance, both clinically and financially in the run up the election. However, he adds: “Senior NHS leaders have expressed concerns about Jeremy Hunt’s very close involvement in the running of the NHS.”

One NHS insider said: “Hunt has completely reversed Lansley’s philosophy that problems in the NHS were nothing to do with him or with politics. Instigating the Thursday meetings showed he wanted to do everything he could to avoid a crisis. His approach is, ‘if there’s a problem in the NHS, we get in there and sort it out’.”

The outgoing Nicholson’s second ever tweet, when he finally joined Twitter on 30 January, was an in-joke to fellow NHS leaders. Responding to a spoof tweeter called Jeremy_Twunt, he wrote: “Hello, Jeremy. Any instructions for the weekend?” After initially attending the Monday meeting some weeks, Nicholson declined to continue. His deputy, Dame Barbara Hakin, usually goes instead.

Well-placed NHS sources say that she is the one among the senior regular attenders who enjoys pursuing Hunt’s concerns. “Barbara loves it. She has no problem with being tasked. She loves to see herself as Hunt’s right-hand woman – his deliverer.”

Unusually, while notes are taken at these meetings, no minutes are made or circulated. However, a series of “action points” – specific tasks the ALBs must now pursue – are agreed instead.

Hunt’s highly interventionist style has created resentment and led to rows. “There was a sense that this was direct operational interference by the secretary of state in the operational management of the NHS, which is unprecedented,” said one senior source.

NHS patients ‘face more treatment rationing since coalition restructuring’

Denis Campbell, Health correspondent  for the Guardian 31st March 2014 reports: NHS patients ‘face more treatment rationing since coalition restructuring’

Doctors say restrictions on access to healthcare have increased since creation of NHS clinical commissioning groups

Patients are facing growing rationing of treatments such as counselling, cataract removal and IVF since the coalition restructured the NHS last year, GPs say.

In a survey of 315 family doctors, GP magazine found that 71% believed that restrictions on access to treatment in their area had increased since April 2013, when the controversial shake-up of the NHS in England began.

That led to the creation of 211 GP-led clinical commissioning groups (CCGs), which control the budget for healthcare in an area and decide who can receive what treatment. GPs said patients were encountering growing difficulty in receiving care from community nurses, counselling, cataract surgery and fertility treatment. Rationing has increased significantly in the past nine months, doctors responding to the survey said.

One family doctor, a partner in a surgery, told the magazine: “We have huge cost pressures and this is resulting in increased rationing and fragmentation of services to reduce costs.”

However, access to weight-loss surgery has improved, although patients can face what Dr David Haslam, a GP and chair of the National Obesity Forum, called a “torturous” path to getting it. And some obese patients are expected to attend weight-loss programmes for at least a year before they will be considered for surgery.

Some CCGs aim to scrap rationing policies inherited from their predecessor primary care trusts once their finances are in the black. For example, six which have previously refused to offer women IVF treatment as recommended by the National Institute of Health and Care Excellence hope to start doing so…….”

The PostCode lottery in cancer – revisited

Marc Macaskill reports in The Sunday Times 30th March 2014: Scots seeking cancer drugs still face ‘postcode lottery’ As the smaller Mutuals (Wales, Scotland and N Ireland) are seen to fail relative to the larger English Mutual, frontier issues will arise more and more. Instead of being issues relating to free prescriptions or choice of specialist, they could be between life and death… 

FRESH concerns have been raised that cancer patients in Scotland are being denied potentially life-extending drugs because of where they live.

Consultants warn that a postcode lottery in treatments still exists despite attempts by the Scottish government to ensure that newly licensed medicines which have not been recommended for general use by NHS Scotland are available to patients on a case- by-case basis.

Dr Noelle O’Rourke, chair of the consultants’ committee at the renowned Beatson West of Scotland Cancer Centre, said patients with colorectal cancer are among the worst affected, with those in the west of Scotland being denied access to drugs that are available to patients in Edinburgh.

In a letter to the Scottish parliament’s health and sport committee, which is investigating access to medicines, she warns that drugs for breast, gynaecological, and urological cancers “have also been difficult to access”…..

Sarah-Kate Templeton and Jon Ungoed-Thomas   report 30th March 2014: Wait for cancer test can be 4 or 40 days

….Data from NHS England reveals that patients at some hospitals are waiting more than 13 weeks for tests that can diagnose cancer. There can be further delays of three weeks or more for the results……

If only they’d sent Jake for a scan – He was only 24 when he died on Christmas Eve. Jake McCarthy’s mother is urging GPs to learn the vital lessons of a family tragedy

Cap on doctors’ hours costs NHS £750m

Jack Grimston, reporting in The Sunday Times on 30th March reports: Cap on doctors’ hours costs NHS £750m The nightmare of inadequate training due to lack of exposure to sufficient clinical exposure is imminent…. Enforcing the EUWTD (European working time directive) is attractive to government as it seems to cut down on costs… at the expense of inadequate training.

RULES from the European Union limiting the number of hours that doctors can work are costing the NHS £750m a year, an inquiry by the president of the Royal College of Surgeons (RCS) has found.

Jeremy Hunt, the health secretary, is seeking to build an alliance of countries to back demands for a renegotiation of the 48-hours-a-week cap on doctors. Germany and Holland are among at least four countries understood to be sympathetic.

The report into the effect of the EU working-time directive on the health service, commissioned from Professor Norman Williams, found:
■ The NHS is spending an extra £750m a year on locum doctors because the regulations mean there are fewer staff doctors available
■ Hospitals are being “stretched too thin, particularly at nights and weekends, with … patient safety being put at risk”
■ 280,000 hours of surgical training are lost every month because of time limits
■ Patients are being seen by up to five different teams of doctors in a single day because of strict rota systems imposed by the rules
■ Doctors starting courses today will lose the equivalent of 128 days of training compared with those who studied before 2009. For some specialisms, including obstetrics and gynaecology, the situation is even worse
■ The rules are “undermining professionalism” by “promoting a culture of clock-watching”.

The report, expected to be sent to Hunt this week, is understood to include
findings from the Royal College of Physicians that nearly 60% of trainees believe that working-time rules worsen the quality of care.

A source close to Hunt said: “Ministers are concerned about the way the directive has interfered with continuity of patient care and the ability of doctors to learn.”

The directive is expected to be one of the areas targeted by David Cameron as he seeks to renegotiate Britain’s EU membership before his planned in-out referendum.

Charlotte Leslie, the Tory MP who co-authored a separate report on the directive for Fresh Start, a group that campaigns for EU reform, said: “Anyone on the ground, particularly in surgery, knows how devastating the directive is but the outside world, particularly politics, hasn’t twigged yet.

“Nearly every EU state is having massive issues with this. They are all trying to find ways to weave around this failing legislation.”

The RCS declined to comment on the report.

Additional reporting: Laura Hughes

Half of (our) MPs fear for future of free NHS – but have insufficient political will to change it!

Richard for in The Times 31st March 2014 reports: Half of (our) MPs fear for future of free NHS after a report commissioned by the NHS confederation was made public. The latest member survey and the thoughts of Rob Webster who commissioned the report are here.

and follows it up with Sonia Elks : Patients should pay £10 monthly fee for NHS, says ex-Health Minister

A £10 monthly “membership fee” should be introduced to use NHS services, according to a report co-authored by a former Labour Health Minister.

Patients would also have to pay hotel-style charges of £20 a night for hospital stays under sweeping changes to the model’s funding system proposed by Lord Warner, who was minister for health reform under Tony Blair.The Labour leadership swiftly rejected the plan.

“Even with major changes to care, it is now irresponsible to pretend to the public that current forms of taxation alone will be sufficient to provide a good quality health and care system”, said the report, which was published by the centre-Right think-tank Reform.

It comes as a poll found that more than half of MPs fear that a free NHS could be scrapped in the future. Senior health leaders have said they are concerned at the impact on the provision of services of an ageing population and an increase in long-term health conditions.

The paper suggests that cash could be brought in for the health service by raising the cost of prescriptions and vaccinations. Patients would also receive “telecare products” to “help people meet their own care using their own resources”, it said.

In return for the new monthly charge, patients would be offered an annual “health MOT” of basic health checks and be given targeted health goals. Those receiving free prescriptions would be exempt from the charges, the report suggests.

Higher “sin” taxes could also be introduced on products such as cigarettes, alcohol, and high-sugar foods to deal with the associated costs brought on by unhealthy lifestyles.

Lord Warner said that £6 billion a year could be raised by the changes, and argued that the health service should not get above-inflation funding increases from the general tax income pot to avoid starving other services of cash.

“We can no longer pay homage to an out-of-date and unaffordable NHS that’s unfit for today’s and tomorrow’s care needs,” he said.

“It should have no more hand-outs at the expense of other public services. It faces a hard slog of doing more with less and a tough conversation with the public about how we change services and accept new ways of funding the NHS.”

The report’s proposals were rejected by the campaign group Patient Concern.

A spokesman for Department of Health said: “The founding principles of the NHS make it universally free at point of use and we are clear that it will continue to be so.

“This Government doesn’t support the introduction of membership fees or anything like them. But we know that with an ageing population there’s more pressure on the NHS, which is why we need changes to services that focus far more on health prevention out of hospitals.”

The report comes as a separate poll found that half of British politicians think that a free NHS could be consigned to history unless challenges are tackled to ensure that it meets future patient needs.

More than 80 per cent of the respondents — 39 Conservative, 48 Labour and five Liberal Democrat MPs, plus five from other parties — said that in their constituency the NHS had to change. Yet almost two thirds said there was insufficient political will to do so……….”

An extra tax for the Regional Health Services would focus minds. Rationing by co-payments is just one of many options, but politicians are afraid to discuss any of them.. Who will be the first bold and honest politician, and where will he come from?

Richard Johnstone also comments in Public Finance 31st March 2014.


Hywel Dda Health Board chief executive Trevor Purt to leave his post

The Milford Mercury 25th March reports on a change of CEO (and Chairman) in the next few weeks: Hywel Dda Health Board chief executive Trevor Purt to leave his post There has been a lot of controversy over plans to centralise services in West Wales. The next CEO and Chairman will have to come from outside of the area, because whatever they do they will be pariahs to the locals. The 6 years ago offer of a new hospital, rejected by the media and the professions at the time, would be welcomed with open arms now….

Professor Trevor Purt, the Chief Executive of Hywel Dda University Health Board, is to leave his post.

He will take up the role of Chief Executive of Betsi Cadwaladr University Health Board in June.

During his time in west Wales, Mr Purt has overseen significant new developments including the new Urgent Care Centre and Renal Unit at Withybush Hospital.

But he is likely to be best remembered for the hugely controversial ongoing service changes which threaten the Special Care baby Unit at Withybush Hospital as well as maternity services, and has prompted several large demonstrations from angry campaigners.

Mr Purt joined Hywel Dda University Health Board in September 2009. He said: “I am sad to leave as I have thoroughly enjoyed my time in the University Health Board but feel the time is right for new challenges in North Wales. “We have come a long way in the last 4½ years and there is still more to do to ensure that Hywel Dda has the right services in the right place to provide the very best healthcare.

“I have full faith in my executive directors, the wider management and clinical teams and Karen Howell who will be interim chief executive officer to move forward to ensure our services continue to develop.

“These have not been the easiest of times and I want to personally thank all staff for their dedication and commitment – you are the university health board’s greatest asset.”

Chris Martin, Chair of the University Health Board, who is also to leave the organisation this year, said: “Trevor was the first chief executive officer of the new integrated health board and has successfully lead the organisation through some difficult times. During his time we have seen a significant improvement in quality and performance due in no small measure to his leadership. We are sorry to see him leave but wish him well in his new role.”