Monthly Archives: July 2015

Making cuts in health services without involving politicians in discussion or debate about why!

As far back as 27th October 1995 the Independent reported; Health bosses ‘agree NHS rationing is inevitable’

The latest cuts have been made by politicians , without making tough choices themselves, and by denial and leaving the interpretation of the philosophy to the minister himself. It is politicians who are responsible for the abdication of any responsibility to discuss what is essential and what is desirable and what could be “self care” – in other words a pragmatic solution to our Regional Health Services, using ethical and educational arguments… We are making cuts in health services without involving politicians in discussion or debate about why!

Julia Hartley-Brewer in the Independent 31st July 2015 opines: The latest NHS cuts aren’t about health. They’re about blame – Tough choices don’t just have to be made by doctors – they have to be made by patients, too

Right, pay attention everybody. We’ve some tough choices to make. The NHS has to make £22bn of efficiency cuts by 2020, so where shall we start?

Do I have any bids for cutting children’s cancer treatment? Anyone? No, I thought not. What about knee surgery for the severely obese, or nicotine patches for smokers, or IVF treatment for infertile couples? Do you think we can get away with cutting those?

These are precisely the sorts of conversations that – like it or not – are going on right now within the health service. Our beloved NHS, created in 1948 to care for us from the cradle to the grave, has become a bottomless money pit. And it’s all our fault.

For a start, we’re all living a lot longer (tut tut, you selfish octogenarians), and many of us are eating too much, and then those pesky scientists among us keep coming up with new and clever ways of keeping us alive. It all costs money: £115bn a year, to be more precise. The £22bn of spending cuts will have to be found from somewhere.

An investigation by Pulse magazine has revealed that, to make the cuts, doctors are now “rationing” treatments such as hip and knee replacements and vasectomy operations – and even the fitting of hearing aids – in a bid to cut costs. A number of NHS Trusts have imposed stricter eligibility requirements for some of the most common operations, insisting that patients lose weight or give up smoking before surgeons will operate, while many trusts already limit access to expensive, non-emergency treatments like IVF. The truth is that these cuts aren’t just about simple pounds and pence. They are about assigning personal responsibility and – yes – blame. The question asked by the NHS is no longer “are you sick?” but “are you the deserving or the undeserving sick?”

What seems cruel and heartless to one is common sense for another. Most of us would probably not put an alcoholic top of the list for a liver transplant over another donor recipient whose liver had failed through no fault of their own. The limitations on hip and knee replacements are no different. After all, the single biggest reason why so many patients need new joints is because they are obese. Their bodies simply weigh too much for their joints to cope. The solution, then, is not expensive surgery but a trip to Weight Watchers.

The issue at the heart of the problem is whether we believe obese people, or alcoholics, or drug addicts, or smokers are to blame for all their ills and therefore not as deserving of free treatment on the NHS as someone who has led a healthy lifestyle but is then, say, diagnosed with leukaemia. While cancer sufferers may be high up on our list of “deserving” patients, 40-a-day smokers who get lung cancer or sun worshippers who get skin cancer are perhaps a little further down. It all comes down to whether it’s your own fault. But where does this end? And what’s next? Do we refuse to treat NHS patients, or charge them, if they cannot prove that they eat their required five fruit and veg a day? If we’re going to play the blame-game, what about people who ride horses or play rugby and get head injuries that could so easily have been avoided?

Making cuts to NHS spending will mean tough choices for politicians and our doctors; it may well mean tough choices for us patients too.

The Independent 31st July 2015: Leading article: The wrong sort of NHS rationing

Tony Yearman in the HSJ 29th July 2014: Removing the NHS ringfence: the next stage for healthcare rationing and in the same journal Crispin Dowler reports 15th Jan 2013: Commissioners have rationed cataract surgery on inferior evidence, Keogh admits

Reality – a word not used by Politicians in Health – is that Hearing aids and vasectomies are rationed as NHS pressures bite

Once “rationing” overtly has been accepted as reasonable in the different Regional Health Services, then we can start to debate exactly how services should and could be rationed. None of the current parties accepts the use of the word “rationing” and their lexicon uses “prioritization”, “restriction” and any other synonym..  The politic of speech hides the truth: in effect lying to all of us.

A first debate in West Wales BMA – on rationing – wins a majority in favour

It’s not about money – it’s about a proper debate on philosophy and overt rationing

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

We are rationing the wrong way – and without a philosophical debate it will get worse

An election debate by pithed, fearful politicians. Impotence and denial ensure no significant change in philosophy.

Laura Donelly reports in The Telegraph reports 30th July 2015: Hearing aids and vasectomies rationed as NHS pressures bite – One in three GPs says NHS rationiing has increased in the last year, as investigation finds hearing aids, vasectomies and hip and knee operations are being restricted

The NHS is increasingly “rationing” hearing aids, hip and knee replacements and vasectomy operations to try and cut costs, an investigation has found.

More than one in three GPs say access to treatment has been restricted in the 12 months, with senior doctors warning of “unacceptable” decisions being taken.

Charities said many of the rationing measures are affecting the most vulnerable, with the decision to restrict hearing aids branded as “cruel”.

The health service is attempting to make £22bn efficiency savings by 2020, in order to close a looming deficit.

Areas with the worst financial problems have been ordered to draw up emergency plans to cut spending.

An investigation by Pulse magazine discloses widespread rationing measures being introduced in a bid to bring costs down.

A survey of 652 GPs found 36 per cent had experienced increased restrictions to services in the last year.

The rationing measures mean NHS North Staffordshire clinical commissioning group will no longer fund hearing aids for those with mild hearing loss.

Charity Action on Hearing Loss said it was “deeply opposed” to such restrictions, which would cut off a lifeline for some of the most vulnerable.

NHS North East Essex CCG is restricting vasectomies, female sterilisation procedure and spinal physiotherapy, as part of efforts to save £1m.

NHS Basildon and Brentwood CCG is considering withdrawing funding for patients with “mild or moderate” hearing loss, and has capped the number of vasectomy referrals it will pay for.

Mid Essex CCG has drawn up plans to save £1m by reducing access to procedures including hip and knee operations.A number of areas have tightened up eligibility for some of the most common operations, including hip and knee replacements.

NHS Great Yarmouth and Waveney CCG says obese patients must lose weight, and smokers give up, before hip and knee replacement procedures. It says such restrictions may be expanded to cover other operations.

Dr James Kingsland, president of the National Association of Primary Care, said such decisions could not be defended.

He said: “The idea of rationing necessary care in a service that is free at the point of use is just unacceptable. Any health commissioning body looking at rationing services need to question whether they are fit for purpose.”

Marcus Warnes, Interim Accountable Officer at North Staffordshire CCG, said: “Our decision to introduce an eligibility criteria for hearing aids for people with mild to moderate hearing loss was not financially driven but clinically-led and based on a significant volume of research and extensive engagement with local people, stakeholders and a variety of national bodies with specialist expertise.”

Dr Gary Sweeney, NHS North East Essex CCG chairman said: “We have no choice other than to stay within budget. If we do not implement these decisions we will have to select other services to restrict.”

A Department of Health spokesman said: “Blanket restrictions on treatment are unacceptable and all decisions on treatment should be made by doctors based on a patient’s individual clinical needs.”

Recruiting foreign nurses ‘frustrating and expensive’: British Nurses should cash in on the bonanza

British nurses with desirable high specialty skills such as A&E and Intensive Care should cash in on their opportunity. Travelling a few miles or even a few hours could boost earnings considerably. The employer benefits from knowledge of training quality, probity, professionalism and communications skills – as this is often absent for long periods if these nurses are not appointed. It also applies to doctors at both consultant and junior level. Are YOU, a potential long term patient (even a politician?)with multiple chronic diseases, confident of YOUR future care, or would you rather bury your head? It is the staff who spend time and identify with you who you really remember. The Health visitor for a mother, the psychologist in depression, the physiotherapist after an injury or stroke. It is not only Nurses, but also the softer specialities of the Health Services that are really thin and unable to sustain quality. A change in funding, philosophy and patient expectation is needed..

 Jane Dreaper in the BBC News team reports 28th July 2015: Recruiting foreign nurses ‘frustrating and expensive’

It is “distracting, frustrating and expensive” to have to recruit large numbers of nurses from overseas, the head of a leading NHS hospital says.

Dr Keith McNeil, who runs Addenbrooke’s Hospital in Cambridge, urged officials to “figure out” what resources were needed and improve UK recruitment.

Around 7,500 nurses from countries such as Spain, Romania and Italy registered to work in the UK last year.

Health Education England said national training places had increased.

Figures from the Nursing and Midwifery Council (NMC) show the recruitment of overseas staff to the UK is growing.

The number of nurses coming here from other parts of the EU has risen steadily during the past six years – now making up the vast majority of new overseas recruits – while the number of foreign nurses from beyond Europe has dropped…..

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Third round of GP trainee recruitment cost £113,000 to fill 72 posts (and now you wonder why locums cost so much!)

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…

Implosion. Cynical – over 20% GPs from overseas, and 100s of places unfilled in GP training. Why not consider why?

Not enough nurses or doctors? Or are we just inefficient? The situation is a disgrace and a scandal, and needs a war like atmosphere of honesty to address it…

Healthcare Alert: “We could fall behind in health” – and yet ” Britain has the chance to be the world’s doctor” – REALLY?

Building from nothing? A workforce for the Regional Health Services and rural areas…

New plan to develop frontline NHS Wales workforce

OOH GP services – A Shameful reduction in standards, and increase in expense

Australia offers free weekends to lure NHS consultants

Why not become a locum? Earn more, Standard hours of your own choice, no administration and control of your own life? Training bribes won’t work: undercapacity controls the rules




Grieving for the NHS. The softer specialities and locums. Ration for higher earners, and where insurance could cover.

As doctors and nurses grieve for the former health service that they knew and were proud to work for, and since “goodwill” is fast disappearing, I wanted to reflect on the softer specialities, and the post-code lottery of provision. The 24/7 service planned by Mr Hunt will need all staff on rotas, and many more of them. Since sickness and absenteeism in the UK Health Services are the worst measured across organisations throughout the world, we need to think what is happening and why when an absent person or persons affect care. Why is it that doctors and nurses have locums, but psychologists, physiotherapists and Occupational Therapists do not? It is the urgency (life saving) and speed and volume of decision making, and turnover of patients that means there have to be locums for medics. If we want the whole service to function properly we need politicians to feel this will gain votes, and we are going to need locums for other staff because we all work in teams… And once we accept this, then we need to appoint enough permanent staff so that locums are not needed and we save money. Rationing out some of the softer services overtly and with due notice, especially for higher earners, would be a sensible option in these stringent times.. Insurance could also cover many more sports.

Grieving has many stages (Kubler-Ross), and the politicians are still in denial. The consultants and GPs are angry but many have moved on to reluctant acceptance of lower standards or retired. The softer specialities have been through bargaining (and failed) and are now in depression. The managers are still bargaining and in disorganisation. The public don’t understand and are in sudden shock (pre-denial) when they need the service!

The NHS culture is sick – and so are its staff – But is there any “quick fix”?

Living through the NHS’s famine years. Quality reversals and increasing deficits are symptomatic of deeper problems

Cornwall and Barnsley have worst morale and absenteeism

Is the NHS going to blow a gasket?

Physiotherapy can transform the NHS and lives of older adults

Rationing and Physiotherapy

This will hurt – hospital flaws inspire new play. Stroke victim has very little physiotherapy: covert rationing and deliberate undercapacity

Professional Contact Sports – should the Health Services cover them fully?

Four in ten stroke patients don’t get specialist treatment in time – so 6/10 do!

Specialisation: Hundreds of lives a year could be saved by closure of local hospital stroke units

‘Let’s add life to years, not just years to life’

Midwives and patients warn of ‘devastating’ staff shortages

Foreign nurses still propping up the NHS: At least 40 trusts actively recruiting from abroad …

Ad then there are those who no longer wish to preserve the NHS, and shed crocodile tears..


Goodwill for the Health Service is fast disappearing, as is the safety net. Fear is returning as pre 1948.

Goodwill for the Health Service is fast disappearing, as is the safety net. Fear is returning as pre 1948. The politicians have burnt the boats, and need to build a new fleet. (In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear)

A letter in The Sunday times explains well:

Doctors’ goodwill a splint for understaffed NHS

AS A junior doctor, I routinely work about 10 extra hours a week. The NHS is propped up by the goodwill of all the staff, and with interventions such as Jeremy Hunt’s, morale sinks even further. We already work seven days a week and support the service. What we need at weekends is better access to diagnostic tests and more members of the whole team, not empty threats from the health secretary.

You have the perfect case study of what happens when you push people beyond the point they are prepared to tolerate in A&E. Punishing rotas make it nearly impossible to maintain a family or social life — hundreds of consultant and training posts are unfilled, and expensive staff have to fill the gap.
Dr Hannah Mitchell, London N1

We have rationed OOH and Weekend care for years. Now the comeuppance…

There is nothing wrong with aspiring to a 24/7 service but the rhetoric that suggests consultants and GPs are at fault is nonsense. The problem is of short termism and undercapacity issues, and standards are falling so far and fast that many altruistic doctors and nurses, especially juniors don’t wish to practice in the UK Regional Health Service systems. It is wrong to print that the doctors union is “resistant” – they are just telling us the feasibility in the short term..(Seven-day NHS service plan must prioritise emergency care, BMA says Priority must be given to urgent and emergency care in plans to boost seven-day hospital services, doctors’ leaders have said. ) More analytical, and less emotional, is Sir Bruce Keogh and his contribution is below. The biggest NHS shake-up for 50 years.

Anecdotal evidence from Jon Ungoed-Thomas and Marie Woolf  in the Sunday Times 26th July 2015 is illustrative:

Ending weekend ‘ghost town’ care comes too late for Millie – After tragedies involving children, the NHS is working to introduce a seven-day service in hospitals despite resistance from the doctors’ union

HSJ: Keogh: New research confirms ‘weekend effect’ on mortality

Sir Bruce Keogh’s thoughts:

The transparent provision of data and information to the public is one of our strongest drivers for promoting quality in healthcare. But the use of data to promote quality also exposes some inconvenient truths. Weekend care is an example.

We have evidence that mortality rates for patients admitted to hospitals are higher at weekends; that those patients tend to be sicker; that our junior doctors and trainee specialists feel clinically exposed and unsupported at weekends because of the complexity and demands of modern medicine; and that hospital chief executives are worried about weekend clinical cover.

It also seems inefficient that in many hospitals at weekends expensive diagnostic machines, laboratory equipment and pathology and imaging facilities are under-used, operating theatres lie fallow and clinics remain empty. Yet access to specialist care is dogged by waiting lists, and GPs and patients must wait for diagnostic results.

It is clear the lack of continuity of many services over seven days undermines our ability to tackle the mortality issue, provide continuous support for people with chronic conditions, achieve our safety ambitions and, frankly, provide a modern patient-centred service.

These concerns have led to calls for different service models in hospitals at the weekend from Health Education England, the Academy of Medical Royal Colleges, the Royal College of Physicians, the Royal College of Surgeons and organisations representing NHS managers and patients, with the aim of not only improving outcomes but also enhancing the training of the next generation of NHS doctors.

We have an ethical obligation to address these issues; but we also have a duty of care to NHS staff to ensure they have a reasonable work/life balance.

Every weekend, many consultants are going in to see their patients in hospitals, but it is not universal, which means our weekend services are fuelled by professionalism and goodwill rather than good NHS design. This is not sustainable. We need to design and organise our NHS to make it easier for clinicians to provide the care their patients deserve. The will is there. This is confirmed by junior doctors who tell me there has been a notable increase in consultant-led care at weekends over the last couple of years. The NHS is moving in the right direction.

The problem of diluted services and poorer outcomes at the weekend is not unique to the NHS.

The issue is complex with no single causative factor or solution. To tackle the problem we have developed 10 clinical standards, based on evidence and consensus.They seek to improve the availability of diagnostic tests at weekends, the availability of senior doctors to interpret and act on those tests and the provision of support services to enable the right treatment in a timely fashion. So this is not just about doctors, it is about teams and facilities.

This is potentially the biggest change in NHS philosophy and design since the advent of district general hospitals over 50 years ago. Some of the ambition can be achieved by offering services in a more networked and collaborative fashion between historically competitive NHS organisations. Some changes will require significant investment. So to get going we propose to focus on those patients requiring urgent or emergency care.

We already have 22 trauma networks in England that ensure we have the flexibility to provide first-class care to people who have had a major accident, whatever time of day or night. This has resulted in a 50% increase in survival over the past three years. Now we have announced how we will build on these networks, starting in the northeast and in West Yorkshire, to extend provision of seven-day services to the full spectrum of urgent and emergency care needs.

Professor Sir Bruce Keogh is medical director of NHS England

Setting up the Health Service to fail. Exhausted nurse sums up what many NHS workers think of Jeremy Hunt

David Burke in The Mirror 25th July 2015 , and the Metro carry a link to a video of Nurse Jacqui Berry telling the truth. Jacqui does not realise there is no NHS, and she may not state that health care is covertly rationed, but she speaks from the heart. NHSreality agrees that staff are working weekends.. and the reason that deaths are higher at weekends and in changeover months (August and February) is that there is not a full compliment of staff and back up services available for patients 24 hours, and the changeover August day is in Holiday time. To counter this should need an increase the budget for Health by approximately 1 or 2/7 or 14%, and a move from August/Feb to September/March or October/April for staff training changeover. The Health Services are too big and cumbersome..


Exhausted nurse sums up what many NHS workers think of Jeremy Hunt

An NHS nurse has left a tearful message for health minister Jeremy Hunt the morning after finishing a 14 and a half hour shift.

Jacqui Berry’s eyes well up as she tells how she took inspiration from a fortune cookie with her Chinese takeaway – which she ordered because she was too exhausted to cook.

Her voice wavers as she said: “Yesterday evening I left the hospital an hour and a half late – 14 and half hours after I first arrived. I’m not complaining that happens sometimes, it was a hard day.

“When I got home I didn’t have the time or the energy to make a healthy, nutritious meal so I got a Chinese takeaway.

“Hopefully this pattern doesn’t cause me to develop a costly and complicated long-term condition like diabetes.

“Anyway I got this fortune cookie which read: ‘Sooner or later those who win are those who think they can.

“We have to fight them [Government] and we have to start thinking we can win.”

Mr Hunt has recently come under attack for his plans to enforce seven-day working for NHS staff.

More than 175,000 people have signed a petition calling for him to be sacked or tweeted messages on #ImInWorkJeremy.

Open letters from medics have gone viral on Facebook, including one from 34-year-old Janis Burns.

She blasted the £7,000 MPs’ pay rise and complained many doctors earn less than the £41,000 for managers in coffee chain Pret a Manger.

One furious nurse on £26,000 told Mirror Online of the horrors of an average shift – comforting a dead patient’s wife as she collapsed screaming in hysterics.

And junior doctor Benjamin Carter blasted Jeremy Hunt as a ‘totalitarian Disney villain’, telling him: “My colleagues have children that they only fleetingly see because of work.”

Anti-austerity campaigner Ms Berry added in her message posted on You Tube: “Last week health minister Jeremy Hunt accused of of being a bunch of 9 to 5-ers which is ironic coming from someone heading off for a seven-week break.

“It may surprise the minister to learn that people don’t become critically ill exclusively within office hours

“The truth is we already have seven day working in the NHS it just this government doesn’t want to pay us for it.”

Is there a future for the NHS? Live Debate – The Guardian

Call for public debate on NHS finances post-Budget – NHS …

Medical leaders call for debate on funding NHS in England …

The PFI hospitals costing NHS £2bn every year

NHS drugs to be stamped ‘Funded by the Taxpayer’ to reduce waste

Lydia Wilgress for Mailonline reports 25th July 2015: ‘I’m in work Jeremy… are you?’: Angry doctors take to Twitter to post pictures of themselves on duty after Jeremy Hunt claimed medics weren’t doing enough weekend shifts 

August comes around again – don’t be ill this month

Dont be Ill in August & particularly on the 11/12th …. A reminder that nothing much has changed and how hard it is to make the change

Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war.

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

Let hospitals go bust, says watchdog – What I believe



Building from nothing? A workforce for the Regional Health Services and rural areas…

Maureen Baker, the Chairman of the RCGP sent around a newsletter last week…

By the time the Roland Commission report is actioned, and makes a difference will we be building from nothing? A workforce for all the Regional Health Services is only possible with deliberate overcapacity and some sort of adverse selection. No mention of the rationing in selection where only 11:2 applicants are accepted to medical school..

Dear colleague,   The long-awaited Roland Commission report into the state of the primary care workforce, which was chaired by Professor Martin Roland of Cambridge University, was released this week and if the recommendations are adopted, it will spell good news for general practice, and our patients.

Particularly welcome is the Commission’s recognition of the severe shortage of GPs and the call to reverse longstanding under-investment in general practice.

The report echoes and supports a lot of the objectives of our Put patients first: Back general practice campaign. It calls for the rapid implementation of the College’s 10-point plan to build the GP workforce, which we launched with NHS England, Health Education England and the BMA earlier this year.

The report also advocates broadening the skill-mix in general practice, something that the College also supports.

We have already secured £15m NHS England funding for a pilot scheme of practice-based pharmacists, an idea we launched jointly with colleagues at the Royal Pharmaceutical Society back in March, and which we know already works in some areas of the country. We now want to see a pilot scheme to see how a new medical assistant role – successful in the US to help relieve the administrative burdens that GPs face in our daily practice – translates to UK general practice.

I understand that ideas about broadening the skill-mix in primary care has led to concerns amongst some of you, so I want to reiterate that this is not about replacing us – that will never happen. If properly piloted, evaluated, and then implemented appropriately, these schemes could provide much-needed support to help us meet intense demand.

New GPs can’t be created overnight and we need to take safe, innovative steps, to make our working lives a bit more manageable, both short-term and long-term.

Another recommendation in the Roland Commission’s report is an emphasis on new models of care, particularly GP federations, which the College pioneered nearly a decade ago now.

We are currently working with the Nuffield Trust to map out where federations and other ‘at-scale’ models of general practice are currently in place, so that we can learn about what works and what doesn’t. Please take a few moments to complete our survey to help shape this important piece of work, being led by Mike Holmes. There are two surveys; one for individuals and the other for Clinical Commissioning Groups.

The Roland Commission report provides further ammunition for us to persuade politicians and decision- makers that backing general practice really is in the best interests of the NHS and our patients, now and in the future.

We must particularly thank Vice Chair Amanda Howe, who sat on the Commission, for her considerable efforts in ensuring that the GP voice has been heard loud and clear.

Government plans inquiry that could mean end of NHS free at point of use – about time

It seems to have slipped under the radar somewhat but when NHSreality looked carefully there were references and comment on the article in the BMJ 21st July 2015 by Ingrid Torjesen (BMJ 2015;351:h3971).: Government plans inquiry that could mean end of NHS free at point of use . No other country in the world tries to pull the wool over it’s voters as much as the UK, and no other country tries to be free and comprehensive and cradle to grave! The The Information Age means that citizens will not be content with covert rationing..

Funding Black Hole NHS

The Department of Health for England is considering an inquiry to look at how the NHS should be funded to ensure its future sustainability, which some doctors fear could put in jeopardy a founding principle of the NHS: that it is free at the point of use.

The inquiry was suggested during a House of Lords debate on the “sustainability of the National Health Service as a public service free at the point of need,” which took place on 9 July.

At the end of the debate the parliamentary undersecretary of state for NHS productivity, David Prior, said that he was interested in meeting Narendra Patel, who moved the Lords debate, and “two or three others” to discuss how an independent inquiry looking into the long term sustainability of the health service might be framed. He did not think that the inquiry would need to be a royal commission but that an organisation such as the health think tank the Nuffield Trust or the King’s Fund could be commissioned to examine the issues.

Commenting on the potential inquiry, Clive Peedell, co-founder and co-leader of the National Health Action Party, said that the proposal seemed to have “slipped by very quietly.”

He said, “Premiums, charges, and, potentially, insurance schemes are obviously completely against the ethos of the NHS, and the public deserves to be involved in the debate, if that is what they want to talk about.

“All the evidence suggests that we should be sticking with a tax funded system—progressive taxation. That’s the fairest way to fund healthcare. If you bring in charging and insurance systems, that just transfers risk from the wealthiest in society to the poorest in society in terms of bearing the burden of healthcare costs.”

In the House of Lords Patel pointed out that close to 9% of gross domestic product was spent on the NHS, that 89% of NHS trusts were forecasting deficits, that outcomes, including those relating to cancer and avoidable deaths, were poor, and that the NHS needed to achieve productivity gains far in excess of the 0.4% year on year that it had attained historically. “In this scenario the NHS will need an annual budget of nearly £200bn [€290bn; $310bn] by 2030 and one fifth of the nation’s entire wealth by 2060,” Patel said.

“The history of the past two and a half decades tells us that political parties will continue to manage the health service according to their ideology—managing scandals and giving a bit more money—but with no long term planning, as there will be no political consensus,” he said. “We need a national consensus that recognises and accepts that individuals, communities—including employers—and the state have a role in health and contributing to it.”

The former Labour health minister and peer Norman Warner backed an inquiry, saying, “Our tax funded, largely free at the point of clinical need NHS is rapidly approaching an existential moment. The voices of dissent and outrage will no doubt be deafening, but a wise government should begin now the process of helping the public engage in a discourse about future funding of the NHS. To do that requires a measure of cross party consensus on some form of authoritative independent inquiry that could produce analysis and a range of options for a way forward.”

The Conservative peer Patrick Cormack added that all forms of funding must be looked at. “We have to have a plurality of funding if we are to have a sustainable NHS. Whether the extra funding comes from compulsory insurances or certain charges matters not, but it has to come,” he said

Prior said that, having looked at many other funding systems around the world, he was “personally convinced” that a tax funded system was the right one. “However, if demand for healthcare outstrips growth in the economy for a prolonged period, of course that premise has to be questioned,” he said.

The health secretary for England, Jeremy Hunt, last week refused to guarantee that the current system of funding would remain. After a speech at the King’s Fund in which he set out a 25 year vision for the NHS,1 Hunt was asked whether the budget would continue to be funded by taxpayers for the next 25 years. He replied, “I am confident, but I don’t have a crystal ball.

”Iacobucci G. Hunt promises more transparency and fewer targets in “more human” NHS. BMJ2015;351:h3885.

The Health Services need a new electoral system – Sudden swings in direction, funding, and organisation are killing health systems..

Rationing a Global Perspective

Rationing and Models

Waiting lists are rising: Marie-Louise Conolly 22nd July 2015: Musgrave Park Hospital’s waiting list rises by 75%

The Budget is under duress: Hugh Pym 22nd July 2015: The health budget – under strain again and care of the elderly is impossible to fund (Nick Triggle 24th July 2015 – Is the cap on care costs doomed?)

Jon Stone in The Independent opines 17th July: The principle of a free, taxpayer-funded NHS ‘must be questioned’, says Tory health minister

and Cory Doctorow in BoingBoing 16th July remains in cloud cookooo land: UK Tories launch quiet inquiry into privatising the NHS

NHS’s financial problems need one solution, not many

No mention of rationing or co-payments… this means the eventual solution will be more knee-jerk and less debated, and NHSreality feels the solution proposed will not be based on philosophical and moral/ethical criteria. Meanwhile denial will continue.. and rural areas will suffer….and the charities will deliver more core services

Image result for financial problems cartoon

Chris Hopson reports 24th July 2015: NHS’s financial problems need one solution, not many – A collaborative approach is needed between local and national systems to ensure the NHS stays within its 2015-16 budget

The latest evidence, such as the King’s Fund Quarterly Monitoring Report (QMR) published last week, shows that the NHS faces a significantly more difficult challenge to stay within its budget this year than it did last year.

There are a number of possible responses from NHS frontline leaders to this problem. One would be, “The only way we can manage 2015-16 without the system crashing is for the government to inject more money and admit the current challenge is undeliverable”. Another might be, “Making the NHS numbers add up is a system level responsibility of the department of health and the arm’s length bodies, not ours”. A third would be, “We can only deliver by forgetting about everyone else and sorting out our own problems”. These responses are understandable and justifiable, but they ignore the risk the NHS runs by missing its 2015-16 targets. The NHS, along with social care, is the only public service to experience 4% increases in demand annually. But it’s also the only one to have the combination of its budget being ring-fenced; an extra £2bn-ish for 2015-16 in the autumn statement; and the promise of real terms growth for the remainder of the parliament. Other Whitehall departments have had to contribute £3bn of in-year savings in 2015-16, admittedly boosted by a £200m raid on public health budgets. So the government has said there is no more money for the NHS in 2015-16.

Failure by the NHS to stay within its 2015-16 budget would risk a crisis of confidence in central government and across Whitehall. We need to be alert to the arguments that others will make. If the NHS can’t deliver financial balance with all these advantages, why put more money in? Why frontload the NHS’s extra £8bn (which we desperately need)? Let the NHS demonstrate appropriate financial discipline first. Why bother investing in an NHS transformation fund if the health service will always be a bottomless money pit that cannot transform? There have already been mutterings of this kind in the national media.

So there is a strong argument for the need for a concerted one NHS solution to a large one NHS problem – a collective responsibility and shared endeavour to ensure the health service stays within its budget. Our members tell us they need a number of things from national system leaders if they are to apply the in-year spending handbrake quickly and sharply.

They note that in many places there is a significant gap between commissioner and provider activity plans and budgets, which suggests that not all the extra autumn statement money is reaching the provider frontline as planned. This needs to be bottomed out quickly. System leaders are placing a lot of reliance on new agency staffing controls to reduce staffing spend but the QMR shows this may be overoptimistic. Our members tell us they need clearer and more obvious signals around the staffing/finance balance if they are to recalibrate in favour of the latter. They need to know that they won’t be at regulatory risk if they make sensible judgments to ensure this recalibration while continuing to deliver the right quality of care.

Our members tell us they could also look at delaying capital expenditure, which could be turned into local revenue. They also say it’s important for system leaders to be role models for the right behaviours – for example, by rapid vacancy control and delaying non-essential spending across the department and its arm’s length bodies.

The Five Year Forward View talks about the importance of a new relationship in which the national NHS system supports local leaders. A collaborative local-national partnership to ensure the NHS delivers its 2015-16 budget would be a great place to start.