Monthly Archives: October 2014

NHS Scotland finding it ‘difficult to cope’

BBC Scotland news report 30th October 2014: NHS Scotland finding it ‘difficult to cope’ – The Scots have cheaper care for the elderly, but their whole system is likely to fold under the financial pressure..

The NHS in Scotland is finding it “increasingly difficult to cope” with the “significant pressures” being placed on it, according to a watchdog.

Audit Scotland said NHS budgets were tightening at the same time as demand for health services was increasing.

And it said the NHS had not met waiting time targets, and may not be able to do so in the future.

Health Secretary Alex Neil said the Scottish government’s long-term vision for the NHS would be “refreshed”.

This was to ensure it “reflects the increasing demands from patients and the new way services will be delivered under health and social care integration”, he said.

The Audit Scotland report said progress towards the Scottish government’s vision of a more community-based health system by 2020 had been “slow”.

‘Rising expectations’

Organisations which represent doctors and nurses in Scotland called for an “honest debate” about the future of the NHS after Audit Scotland said the health service could not continue to provide its existing level of service.

In its report, Audit Scotland said NHS boards’ revenue budgets increased by just over 1% in real terms in 2013-14, and smaller real terms increases were planned from 2014-15 onwards.

It said: “Cost pressures, such as staff pay costs, the growing costs of drugs and other health technologies and rising pension costs, exacerbate this tight financial situation.

“At the same time, the demands on the NHS are increasing as a result of demographic change, particularly the growing population of elderly and very elderly people; the number of people with long-term health conditions; and people’s rising expectations of healthcare.”

The report said the NHS had made good progress in a number of areas, including improving outcomes for people with cancer or heart disease and reducing healthcare-associated infections….‘Not sustainable’

The report said the NHS may have to focus on other targets in order to cope with the pressures of an ageing population.

Overall, NHS boards in Scotland delivered a small surplus of £23.4m against an overall budget of £11.1bn.

But although all boards met their financial targets, Highland, Orkney, Tayside and NHS 24 required financial bail-outs from the Scottish government in order to break even, while a further five had to rely on high levels of non-recurring savings…..

Dr Peter Bennie, chairman of the BMA in Scotland, said: “An honest, public debate about what needs to change to make the NHS sustainable in the long-term is urgently required and politicians must have the confidence and determination to make the difficult and perhaps unpopular decisions that may follow.”

Theresa Fyffe, director of the Royal College on Nursing in Scotland, said: “When patient care suffers because health boards are trying to make ends meet, it’s obvious something is going wrong.

“People are being moved from ward to inappropriate ward because of a lack of space or shortage of care available at home or are waiting longer for treatment and turning to A&E just to gain access to the healthcare they need. On top of this, vacancy rates across the NHS are on the rise.

“The Scottish government needs to look at the consequences of requiring health boards to meet financial targets on an annual basis and allow them to take a more long term approach which doesn’t put at risk standards in patient care.”

NHS bungles ‘need air-crash investigators’

Kat Lay in the Times 31st October 2014 reports: NHS bungles ‘need air-crash investigators’

The NHS needs an aviation-style independent safety investigation agency to make sure it learns from its mistakes, experts have said.

Academics have criticised a “smorgasbord” of approaches to investigating incidents that might put patients’ lives at risk “with little apparent consistency, logic or strategy underlying their design or execution”.

The report, published in the Journal of the Royal Society of Medicine, says that large public inquiries — such as the Francis report into the scandal at Mid Staffordshire hospitals — also had drawbacks.

Carl Macrae of Imperial College London, the lead author, said: “Inquiries can have considerable impact and provide much-needed public explanation after terrible events.

“However, each investigation starts anew and struggles to develop a methodology and approach.”

The report concludes that the NHS needs a permanent organisation similar to the US national aviation safety watchdog.

Jeremy Hunt, the health secretary, has already introduced new safety procedures for the health service based on the “airline model”, which urges pilots to report mistakes. Last week, officials unveiled a safety advice video and information card for hospital patients.

Give patients tax cuts for going private

Chris Smyth in The Times 31st October reports: Give patients tax cuts for going private  (The Institute of Economic Affairs) This is an inevitable request from economists when a system is failing, and it increases inequalities – officially rather than covertly. Would it apply across the UK? What happens if a patient in one Region decides to go privately in another? The frontier issues become determining… and embarrassing for government. What would be the differences between the tax management of insured health premiums (prospective), against paying outright (retrospective)? If there was a private option for General Practice in some areas, it would not exist in others (such as the North East and Wales), so patients in these areas would be unwise to get comprehensive private cover – an approved post-code lottery.

Patients should be allowed to opt out of the NHS in exchange for a tax rebate to buy private cover, a free market think-tank has urged.

The Institute of Economic Affairs said that this would drive up standards by encouraging competition and would let patients unhappy with their NHS care take their custom elsewhere.

Unions condemned the idea, saying that it would undermine the principle of a universal free health service.

Kristian Niemietz, the author of the report, said: “The public is very attached to [the NHS] and rather than saying ‘break it up’, we’re saying ‘keep it but let people go outside it if they want’.”

Dr Niemietz praised the Blairite reforms of the early 2000s that let patients have NHS treatment in private hospitals and said this ought to be extended by allowing them to plan their care completely outside the NHS.

People choosing to opt out would renounce their right to NHS treatment in exchange for a rebate equivalent to how much their healthcare was likely to cost. For example, a young healthy person might get £700 while someone over 85 would get £3,750. This would mean that the rich and healthy were still subsidising the poor and sick, Dr Niemietz argued.

“I don’t see why it would be the wealthy opting out. It could be anyone who is unhappy with what they’re getting,” Dr Niemietz said. “You would move closer to a continental European social insurance system and they generally have better health outcomes across a range of indicators.”

Dr Niemietz said that people would be forced by law to buy insurance with a minimum level of cover to stop them falling back on the NHS. Emergency care for people who had opted out could be provided by the NHS but reimbursed by private insurers.

Simon Stevens, head of NHS England, is a fan of personal budgets, which lets people with long-term conditions buy their own care with NHS funds, and Dr Niemietz said that opt-outs worked on a similar principle.

Mark Littlewood, director-general of the Institute of Economic Affairs, said: “Although the reforms of the last government opened up the UK health service to much needed competition, comparative studies show how much more must be done to catch up with our neighbours.

“Allowing complete freedom of choice and empowering people to choose private commissioners and providers will promote competition across the health sector. This will see hospitals, as well as GP surgeries and commissioning groups, competing to look after the health care of all Britons, as their livelihood will depend on it.”

A spokesman for the British Medical Association said: “It is important that we maintain a universally available healthcare system where care is delivered on the basis of clinical need, not on financial incentives or the size of an individual’s wealth.”

NHS trusts borrowing heavily from state bailout fund

 BBC Radio 4 30th October reporter Jon Manel says: NHS trusts borrowing heavily from state bailout fund Instead of rationing overtly, and facing reality, the politicians have one rule “there is no rationing”. Thus the professions are disengaged as the debate has not been begun with the obvious truth… We are in “fossilisation” period until the election. Denial will continue, but NHSreality feels the first party to speak out honestly will win the reluctant regard of the most voters…

Some NHS hospital trusts in England are still counting on large government bailouts, the BBC has found.

And a senior health analyst believes there will be a “significant increase” in the number requiring help this year.

But he warns the “interim support” – which totalled more than £500m to 31 trusts last year – could run out.

The government said any “interim financial support” depended on trusts “sticking to a strong recovery plan”.

Nigel Edwards, chief executive of the Nuffield Trust – an independent research group on healthcare in the UK – said despite an expected rise in demand for the money, a lack of “spare cash” in the health system was likely to prevent such funding being distributed to the same extent in the future.

Mr Edwards told Radio 4’s PM programme that the NHS had had the means to provide the “bailouts” because it had been “under-spending its budget”.

But with the extra finances now “almost completely spent”, he said there could be a case for rationing future bailouts.

The government says its financial support to trusts is factored into “planning for how the overall budget is used”.

Recent figures from regulators show NHS trusts in England ran up a combined deficit of £467m in the first quarter of 2014-15.

Last week, NHS England’s chief executive, Simon Stevens, repeated his warning of a £30bn annual deficit by 2020. By then, the NHS will need an extra £8bn a year, according to a new five-year plan.

Reliant on support

Caroline Walker, finance director at the Peterborough and Stamford Hospitals NHS Foundation Trust, explained that it was having to rely on “interim support” from the Department of Health.

She said: “If this hospital was a private company, we would have not been trading for three years now.”

The trust’s financial situation is now “stable” – it is not deteriorating – but it is not getting any better, either, which is largely the consequence of a Private Finance Initiative project to build Peterborough City Hospital.

Ms Walker explained the trust had received just over £40m in interim support during the last financial year – a “significant” percentage of its turnover and a figure it would almost certainly need “this year, next year, and the year after that”.

She rejected the idea that the support – which hospitals in deficit are not required to pay back – was rewarding failure. “Management changes have been made [in the past], so failure has been recognised,” she said.

“Monitor, our regulator, has supported the trust in the conclusion that the management or the board of this hospital can’t save £40m [per year].”

Ms Walker said trusts had to go through stringent checks before receiving assistance.

“We have had to submit our annual plans and our monthly and weekly cash-flow forecasts many, many times to clear this funding,” she explained.

More of same

The BBC contacted some of the trusts which had received some of the larger pay-outs during the last financial year. Most said they would – or hoped they would – receive this same support or other kinds of permanent financial help again this year.

Some other trusts, which did not receive any interim support in 2013/14 but have fallen into deficit, told the BBC they were hoping to get some this time round.

Derby Hospitals NHS Foundation Trust said it had already received more than £12.1m since April and would be given a further £16.7m over the next five months.

The government says it has increased the NHS budget by billions of pounds and expects NHS trusts to have a strong grip on their finances. It says when it provides help, the aid is dependent on the organisations developing and keeping to a strong recovery plan.

So far in this financial year, the government says it has paid around £36m of interim support to four trusts, but with experts saying more than ever will require help, trusts might worry whether there will be enough bailout money available to go around.

Listen to PM from 17:00 BST on BBC Radio 4, Monday to Saturday each week.

Overt (deserts based) rationing? – “NHS to ‘ration’ routine operations for obese people and smokers”.

Funding Black Hole NHSAndrew Gregory in The Mirror reports 27th October 2014: NHS to ‘ration’ routine operations for obese people and smokers 

They could be turned down for ops such as hip or knee replacements following the Government’s drive to slash £20bn in health costs by 2015

Smokers and the overweight will be denied routine surgery on the NHS unless they quit lighting up or lose weight.

Plans to restrict procedures like hip or knee replacements are a desperate bid to save cash, following the Government’s drive to slash £20billion in health costs by 2015.

Obese patients can already be denied weight loss surgery if they fail to shed pounds. But this is the first time they could be turned down for routine operations.

Experts say the obese and smokers cost extra because they are more likely to get complications, take longer to recover with a higher risk of dying under anaesthetic.

One in five adults smoke in England and two thirds are overweight or obese, one of the highest rates in western Europe.

Northern, Eastern and Western Devon Clinical Commissioning Group has warned services will “suffer” if it does not bring in the restrictions immediately.

NEW Devon is the largest of the 211 CCGs introduced last year during the Tory-led Coalition’s hated NHS reforms. It fears it will miss a target to keep its deficit under £14.5million for 2014/15 if it doesn’t act.

Its dramatic proposals will be voted on next week. Other CCGs could follow suit.

Chief officer Rebecca Harriott told local medics: “We must protect essential services… demand is outstripping what we can afford.”

Ex-Labour Health Minister and Devon MP Ben Bradshaw said: “This shows the unsustainable pressure NHS funds are under.

“Devon is not alone in suffering this huge financial deficit. Implications for services are horrendous.”

As well as requiring smokers to quit at least six weeks before routine surgery and the morbidly obese to lose weight, the CCG plans to cut unnecessary referrals, suspend treatments where there is poor evidence of outcomes and raise the threshold for certain operations.

Dr Louise Irvine, who is standing against Health Secretary Jeremy Hunt at next year’s election said: “To make treatment conditional sounds like rationing.”

The GP in Lewisham, South East London, added: “This highlights the squeeze facing CCGs as a result of this Government’s constant
cost-cuts and underlines the need for an immediate cash injection.”

Labour’s Shadow Health Minister Jamie Reed said: “David Cameron wasted billions on a reorganisation nobody wanted, now the NHS is forced to this.”

Self Harm. Deprived areas in the UK: most are far from Tertiary care. They will have lower life expectancy.

Rosemary Bennett in The Times 29th October 2014 reports: Coastal towns awash with deprivation: most are far from Tertiary care, but not in S. Wales or Scotland. Patients in the rural/coastal areas will have lower life expectancy….. and will be treated more slowly and with less advanced therapies than those nearer to the tertiary centres. Below are maps of deprivation from all the UK regions. Unfortunately not comparable between regions…There is a covert rationing of services to these areas, and NHSreality wonders what would happen if their populations were well informed and assertive…..? Civil unrest?

The scale of deprivation in Britain’s main seaside towns has been revealed by official statistics that show high rates of unemployment and poor health, with only a few places bucking the trend.

Those that are thriving are largely doing so by embracing new technology as part of a home-working revolution, the report by the Office for National Statistics shows.

The prospect of superfast broadband has particularly helped remote parts of Devon, Cornwall and Somerset, which now have among the highest employment rates in the country.

Overall, the data shows that a fifth of those living in coastal towns are aged 65 or over, compared with 16 per cent in England and Wales as a whole.

Among the working age population, 7 per cent have a long-term health problem which limits their activities, well above the national average.

Unemployment is high and more people work part-time than elsewhere. Seaside towns also suffer more than inland towns from having far more residents who commute elsewhere to do their job, making the towns feel empty during working hours.

They are also the least ethnically diverse, with 95.4 per cent of the population white compared with 86 per cent in the rest of the country….

Disability in England and Wales, 2011 and Comparison with 2001

Wales deprivationWales deprivation areas

Jenni Russel reports in The Times 30th October 2014: The lower your status, the shorter you’ll live and says “avoid loneliness or relationships with bitter and destructive people”…

BBC News 30th October reports: A deal for Wales to receive £2bn in European aid between 2014 and 2020 has been formally agreed. (Deprived area of Europe, for the third time in a row! 

Figure 8. Scottish Index of Multiple Deprivation 2012: Overall Rank

Indices of multiple deprivation: the worst places

Update 30th October 2014 BBC News : No link between tough penalties and drug use – report. In a separate report on “legal highs” the government statistics say there are 60 deaths a year from these licensed drugs… Mother warns over legal highs after son’s death

1: 10 of us with stroke or hip replacement will be readmitted! NHS fails to stop sending home sick patients

Kat Lay and Chris Smyth report 29th October 2014: NHS fails to stop sending home sick patients

Trust sand Hospitals are incentivised to send patients home as early as possible. Early complications is a result of the Perverse nature of the incentives. It is false rationing and the rate of return to private hospitals is much lower…

The scandal of patients sent home from hospital when they are too sick to care for themselves is continuing despite years of promises from NHS chiefs, the health watchdog has warned.

Dame Julie Mellor said she was increasingly concerned about vulnerable people being abruptly discharged from hospital and sent back to empty houses without vital support.

The Times highlighted two years ago the plight of nearly 3,000 patients a week who were discharged between 11pm and 6am to relieve pressure on wards. At the time, Sir Bruce Keogh, the medical director of the NHS, said: “Patients should only be discharged when it’s clinically appropriate, safe and convenient for them and their families.”

The Parliamentary and Health Service ombudsman raised the alarm over the discharging of patients again yesterday as she published details of 126 health complaints investigated over the summer.

Dame Julie said: “These investigations highlight the devastating impact failures in public services can have on the lives of individuals and their families. We are increasingly concerned about patients being discharged unsafely from hospital. Unplanned admissions and readmissions are a massive cost to the NHS.”

More than one in ten patients with conditions such as strokes and hip fractures have to be taken back to hospital within a month of being discharged, a rate that has increased by more than a quarter in the past decade. Last week the need to avoid unnecessary readmissions was highlighted in analysis which found that unsafe care wasted up to £2.5 billion a year.

The ombudsman highlighted a case in Kent where an 84-year-old woman was admitted to hospital because of a urine infection. Despite her consultant saying that she should be monitored in hospital for three more days, she was discharged the same day to an empty house, in a confused state, with no medication and a catheter still in place. An ambulance returned her to hospital. Other complaints included the case of a day-old baby who suffered brain damage during a blood transfusion.

Simon Stevens, the head of NHS England, has promised to stop patients being passed “from pillar to post”. It emerged this year that up to 300,000 people in the past two years have been discharged from wards from 11pm-6am.

The figures came after an investigation by The Times in 2012, which found that patients with no way of getting home were being woken and removed from their beds, some night clothes and without medication.

Roger Goss, of Patient Concern, said that the cases highlighted were almost certainly the “tip of the iceberg”. He blamed targets for putting pressure on doctors. “We have daily horror stories on our helpline,” he said. “I have been reduced to tears.”

NHS England said: “It is important that all patients ready to leave hospital are able to do so at the earliest opportunity. It also important that follow-up care is in place . . . Unfortunately this can, in some cases, cause delays.”