Monthly Archives: October 2015

Care Crash? NCA Questions Vision of NHS-run Care Homes

Covert rationing is endemic in care provision. Different rules apply if different jurisdictions.. An e-mail gives the text below but not the website..

NCA (National Care Association) Questions Vision of NHS-run Care Homes

Reports of the Government’s latest announcement on the ongoing Carter Review on Operational Productivity in NHS Providers have sparked debate in the Care Sector. According to reports, Lord Carter suggests hospitals should build their own care homes to look after elderly patients after they have been treated to make it easier to discharge patients and prevent ‘bed-blocking’.

The National Care Association points out that it has, at length, reminded the government that patients requiring care homes are needlessly being kept in hospitals at greater expense while the care homes sector remains underfunded.    National Care Association Chairman Nadra Ahmed OBE, has responded to the Review by identifying continuing disparities in the current approach: ‘Long-stay geriatric wards can cost as much as £2,000 a week per patient, yet local authorities are unwilling to pay the private care sector somewhat less than a third of that sum for a similar standard of care due to rigid adherence by councils to chronic underfunding. Words are not deeds,’ Mrs Ahmed reminds Lord Carter. ‘While the Review’s recommendations are laudable, getting an “ideal” put into practice is quite another matter, given the reluctance by Local Authorities to fulfil the Government’s Manifesto Pledge that vowed “to give councils more flexibility to support local services.”      ‘The standardisation of practices that Lord Carter proposes for the NHS should, in our view, extend to local authority funding of social care provided by the care homes sector. There remains a critical shortfall in average council funding of about 8% for a typical care home placement. So until our sector is granted realistic funding there exists a strong probability that the independent social care market will continue to shrink, a UK support service which remains essential to local government and NHS care provision.’   ENDS

 

Editorial note: Lord Patrick Carter is advising Health Secretary Jeremy Hunt on how hospital budgets can be better spent, identifying a number of measures that could, the Review suggests, save £5bn a year by 2019-20.

. . . and the facts behind the crisis in care, which point to an imminent major market crash that the National Care Association believes will spell the end of the road for many independent care homes unless increased funding from local councils reflects the true cost of care.

 

Care Crash! Residential care provision crash warning.

 

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Decision making in Orthopaedics. A reflection by proxy from Mrs Charnley. It is decentralisation that is leading to irrational decision making….

Centralisation of supply and decision making means that the larger mutual is considered before the local Single Interest Pressure Groups. This is a feature of the old National Health Service which has been destroyed by devolution, decentralisation and regional health services, and was an appropriate utilitarian response. Now we have many people (not doctors or GPs) on boards who do not have the high level ability to analyse the evidence…. It is decentralisation that is leading to irrational decision making, and post code rationing. Bear this in mind as the Welsh election debate builds up..

In 2011 James Meek in The London Review of Books wrote an essay entitled: “It’s already happened”.

Wrightington Hospital, in the countryside near Wigan, is an accretion of postwar buildings of different eras clustered round an 18th-century mansion. It was sold to Lancashire County Council in 1920 after the death of its last resident, a spendthrift, according to one writer, ‘with a fanatical attachment to blood sports’. The hospital promotes itself as ‘a centre of orthopaedic excellence’. National Health Service hospitals have to promote themselves these days. Earlier this year it survived a brush with closure. It’s neat and scrubbed and slightly worn at the edges, unable to justify to itself that few per cent of the budget the private sector sets aside for corporate sheen, although it does have a museum dedicated to John Charnley, who, almost half a century ago, pioneered the popular benchmark of the NHS’s success or failure, the hip replacement operation.

They still do hips at Wrightington, and knees, and elbows, and shoulders. They deal with joint problems that are too tricky for general hospitals. There’s a sort of blazer and brogues testosterone in the corridors, where the surgeons have a habit of cuffing one another’s faces affectionately. At the end of a hallway lined with untidy stacks of case notes in wrinkled cardboard folders Martyn Porter, a senior surgeon and the hospital’s clinical chairman, waited in his office to be called to the operating theatre. He fixed me with an intense, tired, humorous gaze. ‘The problem with politicians is they can’t be honest,’ he said. ‘If they said, “We’re going to privatise the NHS,” they’d be kicked out the next day.’

The Conservative Party’s 2010 manifesto promised: ‘We are stopping the top-down reconfigurations of NHS services, imposed from Whitehall.’ Two months later, the new health secretary, the Conservative Andrew Lansley, announced his plans for a top-down reconfiguration of England’s NHS services, imposed from Whitehall.

The patient whom Porter was about to operate on was a 60-year-old woman from the Wirral with a complex prosthesis in one leg, running from her knee to her hip. She’d had a fracture and Porter had had a special device made at a workshop in another part of the NHS, the Royal National Orthopaedic Hospital in Stanmore in Middlesex. The idea was for the device to slide over the femoral spur of the knee joint, essentially replacing her whole leg down to the ankle. ‘The case we’re doing this morning, we’re going to make a loss of about £5000. The private sector wouldn’t do it,’ he said. ‘How do we deal with that? Some procedures the ebitda is about 8 per cent. If you make an ebitda of 12 per cent you’re making a real profit.’ You expect medical jargon from surgeons, but I was surprised to hear the word ‘ebitda’ from Porter. It’s an accountancy term meaning ‘earnings before interest, taxation, depreciation and amortisation’.

‘Last year we did about 1400 hip replacements,’ he said. ‘The worrying thing for us is we lost a million pounds doing that. What we worked out is that our length of stay’ – the time patients spend in hospital after an operation – ‘was six days. If we can get it down to five days we break even and if it’s four, we make a million pound profit.’

I felt as if I’d somehow jumped forwards in time. Lansley has not yet, supposedly, shaken up the NHS. He’d barely been in power a year when I talked to Porter. But here was a leading surgeon in an NHS hospital, about to perform a challenging operation on an NHS patient, telling me exactly how much money the hospital was going to lose by operating on her, and chatting easily about profit and loss, as if he’d been living in Lansleyworld for years. Had the NHS been privatised one day while I was sleeping?

When the NHS was created in 1948, it had three core principles. It was to be universal: anyone and everyone would receive medical treatment whenever they needed it. It was to be comprehensive, covering all forms of healthcare, from dentistry to cancer. And it was to be ‘free at the point of delivery’: no matter how much the system cost to run, no matter how much or how little any individual had contributed to those costs, no matter how expensive their treatment or how many times they went to the doctor, they’d never be billed for it. Through dozens of reorganisations since then, including the present one, these principles have remained, along with another: that it’s never a bad time for a fresh reorganisation. Otherwise, much has changed.

The source of the money that funds the NHS is still, as in 1948, general taxation, and there are no plans to change this. For the first 30 years, civil servants in Whitehall and the regions doled out annual budgets to hospitals and GPs according to the size of the populations they served and an estimate of the scale of their health problems. Money flowed down from the Treasury, but it didn’t flow horizontally between the different parts of the NHS. Each element got its overall allowance, paid its staff, obtained its equipment and supplies, and co-operated, sometimes well, sometimes not, with the other elements, according to an overarching plan. The aim was fairness, an even spread of care across the country. In a monopoly healthcare system, competition had no place; on the contrary, it seemed sensible to the planners to avoid duplication of services. It was patriarchal and democratic, innovative and hidebound, cumbersome and cheap. For the majority without private insurance, if you were ill, you knew you’d always be cared for; if you were cared for carelessly, you had nowhere else to go.

It’s objectively hard to describe how money flows through the NHS now……..

…the weakness of the British authorities in the face of the ASR hip, and the ease with which DePuy salespeople persuaded British surgeons to use the ASR implant when tried and tested alternatives were available, doesn’t make one confident that the people who run our health system have a clear idea of the difference between ‘choice’ and ‘marketing’.

In 1993, an op-ed piece by three surgeons in the BMJ pointed out that a significant cause of long waiting lists for hip replacements was that hospitals blew their orthopaedic budgets on expensive new kinds of joint implant whose increased cost couldn’t possibly be justified on medical grounds. Much of the cost of the latest medical devices, like the cost of a can of Coca-Cola, goes towards the marketing propaganda without which it would never occur to you to buy them. The article’s parting barb – ‘the implant industry remains a haven for all the excesses of free enterprise’ – still applies. A recent report by Audit Scotland (where the NHS more closely resembles its pre-Enthoven form) noted that in Lothian, the average cost of a hip implant was £858. In neighbouring Forth Valley, NHS joint buyers were paying more than twice as much. In the US, a basic Charnley-style hip implant will now set you back $10,000, or £6100. Another type of hip has gone up in price there by 242 per cent since 1991, when inflation has been only 60 per cent. The authors of Transatlantic History point out that some of the cheaper hips used in Britain aren’t sold in the US, even though they’re made there. Many surgeons and consumers want the best, they say, ‘but when that which is properly known to be “the best” is ipso facto old technology, the best may come to mean “the latest”, and the latest may be prove to be expensive failures.’

‘There is no reason,’ Aneurin Bevan wrote to doctors as the NHS came into being, ‘why the whole of the doctor-patient relationship should not be freed from what most of us feel should be irrelevant to it, the money factor, the collection of fees or thinking how to pay fees – an aspect of practice already distasteful to many practitioners.’….

…..Jill Charnley, now in her eighties, is the contented recipient of two artificial knees. They’ve lengthened her life, she says. Her shoulder gives her trouble and she could, if she wished, have a prosthesis put in for that, too, but she’s made the choice not to. She’s drawn the line, partly because of the physiotherapy involved and partly because she knows there’s a limit to what medicine can achieve. ‘We are all getting old,’ she said, ‘and bits of us wear out.’

There is only money in more, or in getting something. There is no money in less, or in getting nothing, even though less and nothing is everyone’s eventual fate, and may be desirable long before that. The NHS can’t avoid dealing with the financial consequences of its own success in enabling people to be old for longer and longer. But it can avoid becoming a victim of marketing.

In The Charterhouse of Parma, Stendhal wrote: ‘The lover thinks more often of reaching his mistress than the husband of guarding his wife; the prisoner thinks more often of escaping than the jailer of shutting his door; and so, whatever the obstacles may be, the lover and the prisoner ought to succeed.’ In the governance of Britain, it is as if the marketeers have internalised a modern version of this. The salesman thinks more often of making a sale than the consumer thinks he is being sold to; the lobbyist thinks more often of his loophole than the politician thinks of closing it; and so, whatever the obstacles may be, the salesman and the lobbyist are bound to succeed.

What sort of evidence do Trust Boards and CCGs listen to? The Single Interest Pressure Group and levels of evidence. Do Commissioners and Trusts have policies to cope with them? Case studies are not valid evidence.

Devolution of health to Wales was a mistake?

Jeremy Hunt the most disliked Health Minister of all time ?

Jeremy-Hunt-NHS-alien-cartoonBMJ editor-in-chief joins criticism of Hunt – The article, published in the BMJ 2nd September 2015, reported an excess of 11,000 deaths within 30 days of hospital admission on Friday, Saturday, Sunday or Monday, as compared to admission on any other day of the week. The study authors had noted in the paper that ‘it is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.’ The undercapacity due to long term rationing of professionals in training is evident…. previous NHSreality posts listed below. The first weekend after changeover in August must be the worst in the year… Interesting that Wales is not going down the same line..

Dr Fiona Godlee said: ‘I am writing to register my concern about the way in which you have publicly misrepresented an academic article published in The BMJ.’  She emphasized that ‘what it does not do is apportion any cause for that excess, nor does it take a view on what proportion of those deaths might be avoidable.’

Dr Godlee noted that Mr Hunt has, on a number of occasions, told MPs and the public that excess deaths following weekend admissions to hospital were due to low staffing levels over weekend periods, implying that the excess deaths were indeed avoidable.

Two academic lecturers, Antonio de Marvao and Palak J Trivedi, recently wrote to the Cabinet Office requesting an investigation of Mr Hunt’s claims. Their letter attracted signatures from thousands of other doctors and medical students. However, Dr de Marvao said that the letter had had no effect.

A Department of Health spokesperson said: ‘There is clear independent clinical evidence of a “weekend effect” in hospitals, evidence supported by the Academy of Medical Royal Colleges and NHS England’s medical director, Professor Sir Bruce Keogh.’

August comes around again – don’t get ill in August

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

NHS Weekend: Action demanded over death risk – shocking increase in risk of death…

retired GP.

GPs reject MBAs. It’s no wonder… GP recruitment scheme offering MBAs scrapped after it attracts no GPs…

My own experience in having an MBA is not good. Whilst the degree was of great help personally, and I could see that Trust Boards had need of GPs with such qualifications, the operational aspects are not seen as important to most board members or disengaged physicians, and nobody is interested to hear the strategic views of the profession… Politicians and the bulk of the administrators feel that we are biased..  Since health boards have excluded GPs (until recently), and ignore their advice anyway, strategic influence is denied the MBA GP. As for “regional influence” or “national influence” this has always been denied. Operational management at practice level is enhanced by an MBA, and in a small self employed business this is an advantage. As the rules of the game are used to lever GPs into ever bigger organisations a GP with an MBA would be useful – but are larger practices what patients want? Most young doctors chose to do medicine to care, be practical and active, solve a diagnosis,  and avoid paper shuffling, bottom sitting jobs… General Practice has become the latter, even without an MBA!

See below some of the posts which reveal how the rules of the game are made… and Pulse’s related articles. It is no wonder, with so many retirements due, and after so little strategic influence, that GPs are favouring a salaried service. Government will then get the culture, the illness and absenteeism rates it deserves..

Sofia Lind reports for Pulse 28th October 2015: GP recruitment scheme offering MBAs scrapped after it attracts no GPs

A radical recruitment scheme offering sabbaticals and MBAs to GPs willing to come and work in under-staffed practices has been scrapped after failing to recruit a single new GP in a year, Pulse can reveal.

The scheme, launched in October last year by NHS Hull CCG, offered a package of incentives aimed at keeping GPs in the area for six years, as it was particularly hit by the national recruitment crisis.

Although it is not funded by Government’s 10-point plan for relieving the GP recruitment crisis, NHS England followed NHS Hull CCG’s lead and offered GP trainees ’an additional flexible year of training, where they can… get an MBA in leadership skills or another academic pursuit’.

GP leaders said the similarity of the schemes meant this was what they might ‘expect to see’ nationally.

Hull’s scheme, for which the CCG, Hull City Council, Hull and East Yorkshire Hospitals NHS Trust and the Hull York Medical School had made available £600,000 has so far only spent £5,000 – all on advertising costs – as no new GPs have joined.

As part of the deal, the CCG promised to find overseas placements for trainee and qualified GPs, to fund an MBA or a Master’s degree in education or leadership. In return it expected GPs to work across multiple under-staffed practices and remain in Hull for a minimum of six years.

Responding to a Pulse FOI request, NHS Hull CCG said: ‘The CCG has not recruited any GPs as a result of the scheme.’

The FOI response further revealed that the scheme was ‘amended and re-launched in May 2015’ to reduce the time applicants needed to spend in Hull to three years, give more flexibility in terms of sessions worked and scrap the idea of rotation between practices.

It added: ’We received five applicants to the second offer, all of which were shortlisted. However four withdrew prior to interview and the final candidate was not appointed.’

An NHS Hull CCG spokesperson said: ‘The scheme, following two unsuccessful recruitment attempts, is not still on offer. However the CCG is looking at various other ways to support general practice and address workforce issues.’

Dr Susie Bayley, vice chair of GP Survival, said: ‘The innovative scheme run by Hull CCG is similar to what we are expecting to see nationally, as CCGs use money from the 10 point recruitment plan to tie GPs into longer term salaried posts [but] there are several problems with this.’

She said the problems included doctors being ‘hesitant to commit themselves to long-term schemes’, while there was still ‘a great deal of mistrust’ between GPs and the Department of Health regarding its ‘long-term vision’ for general practice, and as such schemes would need to offer a more ‘considerable incentive’.

Dr Russell Walshaw, chief executive of the Humberside Group of LMCs, said: ‘Maybe CCGs aren’t the best [organisations] for recruiting for GP practices. It may be better for practices to recruit their own doctors.’

One of NHS England’s ten points to tackle the recruitment crisis said: ’Offering GP trainees an additional ‘flexible’ year of training where they can train in a special interest, get an MBA in leadership skills or another academic pursuit.’

This is the latest proposal for relieving the pressures in Hull, previously including a suggestion of moving to a wholly salaried model of general practice which the CCG said was ‘never a plan’.

Meanwhile, NHS Hull CCG has also set out plans for all of its 55 GP practices to come together by geography and merge into eight super practices by April 2017.

The CCG spokesperson said: ’We hope that by practices working together collaboratively and developing new models of care they will be in a better position to deliver an expanded range of services which will make working in Hull as a GP potentially a more attractive proposition.

North Wales is shamed by WG rules of the game in health – and no applicants for Welsh Health Trusts, which now need to change their names.

Post-coded rules? 25 vital cancer drugs deemed ‘too expensive’ for the NHS will have to be rationed within weeks unless drastic changes are made

Private member’s bill aims to repeal competition rules in NHS

Dame Barbara has her gong and Gary Walker does not…. It should be the other way around. Whistleblowers not valued..

Shameful, inexcusable, unacceptable – and symptomatic of a wider malaise. Does this represent our modern “civilization”?

Power to the people as Manchester takes control of £6bn health budget

The Overt Rationing News – just for the last few days

Trying to defuse some of the invective against NHS managers.

Mid Staffordshire NHS trust fined for ‘avoidable and tragic death’ – we may all need an advocate..

Rurality and Utilitarian decision making: Wales is let down by its inept politicians.

Imploding NHS

The media does publish “good news” – but far too early, raising expectations unreasonably…. Do you know what is not covered in your Regional Health service?

Care Homes

Wales is the first Region to crack on questioning current philosophy

Knee Jerk responses and short-term actions are not in the long term interest of health.. In a “free market” politicians threaten to cap agency/locum fees.

Fewer than half the population know who runs Welsh NHS, says poll

The Any Qualified Provider decision

Related Articles:

Neurology services underfunded and post-code rationed…..

If removal of “fear” is a reason to value a health care system, then the opinion of Arlene Wilkie on the Neurology Services in the UK (Neurological Alliance) is important. Whilst government spends money on small items which patients should have responsibility to provide for themselves, the bigger things are being post-code rationed, with large variations in provision. 20% of the population have no service and 40% have difficulty accessing services… These services were provided as a result of the original large NHS mutual….. Breaking up the market into small financial entities brings a perverse incentive not to commission these services which affect a small % of the population. (if commissioner scan get away with it!)

A letter in the Times 26th October shows how she feels:

Today the House of Commons public accounts committee will hear evidence from the Department of Health and NHS England on the state of services for the millions of people who live with neurological conditions such as migraine, epilepsy, multiple sclerosis and Huntington’s disease.

From a patient perspective, this scrutiny is long overdue. For far too long, neurology services have suffered from huge regional and local variations in service access and quality. More than a fifth of local commissioning groups provide no neurology services whatsoever within their local area. Services that are available are often fragmented and under-resourced, with patients routinely waiting for more than a year from the first onset of symptoms to see a specialist capable of making a diagnosis. According to a recent survey by the Neurological Alliance, almost 40 per cent of people with neurological conditions have difficulty accessing the services they require.

This situation cannot be acceptable in today’s NHS. I call on the PAC to obtain clear commitments from NHS England and the Department of Health to bring neurology services up to the standards expected of a modern health service.

Arlene Wilkie

Chief executive, Neurological Alliance

Moving to Canada to work as a GP was the best decision I’ve ever made. From being underpaid and overworked I became well-paid and respected. Why would I want to return to practise in the UK?

The Guardian 27th October 2015 reports the opinion of a Dr PK: Moving to Canada to work as a GP was the best decision I’ve ever made – From being underpaid and overworked I became well-paid and respected. Why would I want to return to practise in the UK? – When will the debate on rationing begin to take place?

nhs cut throat by Blair

When I read the British newspapers, in which GPs are denigrated on a daily basis, I smile at the articles that used to make me cry.

Having practised in Canada for more than a year, and having regularly discussed life with colleagues who have fled to Australia and the unfortunate ones who remain in the UK, I can say with certainty that the grass is greener for GPs on the other side.

In the UK, GPs are underpaid and overworked. After indemnity, taxes, increasingly unattractive pension contributions, national insurance and student loan repayments, most full-time GPs take home between £3,000 and £4,500 a month. While this may be significantly higher than the average salary, it is not enough to attract skilled and educated individuals into the profession, or retain current GPs. It is ludicrous that the salary of a GP should be compared with the average worker in the first place.

In Canada, and most other countries in the world, it is accepted that doctors should be paid well, command respect and be deemed essential members of the community.

At dinner parties in England, I would fear telling strangers my profession because of the inevitable barrage of abuse that would ensue. They would ask why they could never get through to their GP when they called, or why it took a week for their doctor to see them. Or worse, they would ask what GPs do in their three-hour lunch break and joke that we all just play golf.

I would bite my tongue for the most part when really my blood was boiling and the answers were on the tip of my tongue: “The phone lines and the appointments are mostly taken up by ignorant ingrates who lie about having severe symptoms to get urgent appointments because they want to be seen immediately for their minor and self-limiting ailments, for which we can do nothing anyway.

“And as for the three-hour lunch breaks, between the four home visits for patients who couldn’t possibly make their way to the practice yet are somehow able to pick up their own prescriptions, piles of paperwork, business meetings, staff meetings and checking blood and test results, I don’t have much time for golf.”

Now when I’m asked my profession at a dinner party, I proudly reply with the truth. I usually get thanked for moving to Canada and the only question I ever get asked is whether I will accept their family as my patients.

Here, I choose my hours and my patients, and I get paid fairly for the work I do. I have complete freedom to open and close my list as I see fit. Until there is a similar standard of life for GPs in the UK, those who have left will not return. Why would they?

Meanwhile, the chair of the Royal College of General Practioners, Dr Maureen Baker, has vowed to increase the recruitment and retention of GPs, and also to attract overseas doctors back to the NHS by streamlining the return process.

The RCGP has stopped overseas recruiters attending their conferences; there have been NHS adverts in the Australian industry press trying to tempt GPs and offering golden hellos of up to £20,000 for GPs to work in Leicestershire.

But so far all these efforts have proven fruitless.

There is an ongoing national GP recruitment crisis, with more than 400 training places going unfilled this year. Newly graduated doctors can see that general practice is an unattractive option and even medical school deans are warning undergraduates against second-class careers as GPs.

By freezing pay, which means a pay decrease in real terms, and promising seven-day extended hours access to GPs, the government has simultaneously scuppered its promise of creating 5,000 extra GPs by 2020 and decimated the RCGP’s drive on recruitment, retention and returners.

At a time when GP morale is at rock bottom, workload is increasing, recruitment is dropping and the exodus from the UK continues at an alarming rate, one would have thought that the career should be made more attractive, not less so.

The UK is an excellent place to learn the trade, but not to apply it. UK doctors are coveted and respected worldwide but not at home. It leads me to ask, “Why on earth would GPs return to work in the UK?”

When will the debate on rationing take place ?

 

Public attitudes to the NHS

A report by the Health Foundation summarises its findings in a survey from 2014. So do the British public really  “love” the NHS or is this a politically driven myth. Link to the original report here.

The survey took place in late summer/early autumn 2014 and 2,878 adults from across Great Britain were surveyed.

Key findings

  • There is strong support for the principles of the NHS across all sections of British society. Of those surveyed, 89% agree that the government should support a national health system that is tax funded, free at the point of use and provides comprehensive care for all citizens.
  • 43% of respondents think the NHS has neither improved nor deteriorated over the five years of the current parliament, while 26% think it has got better and 28% that it has got worse. UKIP supporters are most likely to believe that the NHS has deteriorated (41%), compared with 24-28% of supporters of the other three main political parties.
  • While people support the funding principles of the NHS, they are much less attached to the idea of the NHS as their preferred provider of care. 39% of respondents prefer their care to be delivered by an NHS organisation, but even more people (43%) do not have a preference between receiving NHS-funded care from an NHS organisation, a private company, or a non-profit body such as a charity or social enterprise. However, responses vary markedly between generations, with younger generations less committed to the idea of the NHS as a provider of care than the older ones.
  • Labour supporters are most likely to have a preference for NHS provision of their care but even then, more than half (52%) either do not have a preference or would prefer a private or non-profit provider. Conservative supporters (23%) are more likely than Labour supporters (13%) to prefer private provision, while Liberal Democrats (55%) are most likely not to have a preference.
  • Among those who say that they would prefer to be treated by a private or non-profit provider for their NHS-funded care (18%), around half would still have this preference even if it meant their local NHS hospital or clinic was at risk of being closed as a result of people using non-NHS providers.
  • Just over half of the respondents (51%) think the NHS wastes money and (perhaps as a result) a majority (58%) would not support further cuts to other public services in order to provide additional funding for the NHS. Older generations are much more likely to think that the NHS wastes money (62% for those born before 1945 and 65% for those born between 1945 and 1965, compared to 51% for those born between 1966 and 1979 and just 31% for those born after 1980).
  • Most people are willing to travel further away from home for higher quality specialist and complex care (86%). However, only 42% are willing to travel further for higher quality A&E services.