Monthly Archives: August 2016

We can’t do it all, says NHS hospitals chief; NHS needs to “take a reality check” and limit what it funds, hospitals say

Initially posted under the title “We can’t do it all, says NHS hospitals chief”, Laura Donelly’s article 11th August changed to; “NHS needs to “take a reality check” and limit what it funds, hospitals say” on 12th August 2016. Is anyone listening to Mr Stevens or Mr Hopson, or reading Ms Donelly? We cannot have “Everything for everyone for ever” and so we need to decide what are our priorities for full funding, partial funding and no funding. Since we all pay the same taxes NHSreality thinks this needs to be National for the really expensive services. Liberal philosophy has to be modified in the face of National inequity and reasonable fear… Meanwhile even normally altruistic juniors are disengaged and feel no remorse in continued strike action … An NHSreality check if ever there was one

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The NHS needs to take a “reality check” about what it can provide and take national decisions about which treatments and services should be rationed, the leader of England’s hospitals has said.

The call came as official data showed the health service in the grip of the worst bedblocking crisis on record, while waiting lists are the highest for almost a decade, with 3.7 million people awaiting treatment.

Chris Hopson, head of NHS Providers, which represents hospitals, said politicians and health officials needed to face the fact the NHS could no longer meet all the demands on it.

He said an “honest debate with the public” was needed about what the health service could pay for, as it grapples with the worst deficit in its history, in the face of growing demand.

Mr Hopson said the NHS could not meet waiting targets, maintain quality, and balance its books, with latest figures demonstrating that “something has to give”.

We need a systematic and planned approach to this and we need to build a national consensus about what the priorities are,” he said.

“We can no longer do everything with the money that we have. We have to look at all the options – whether it’s restricting access to some treatments, changing the [waiting] targets, reducing the workforce, letting the deficits slide or deciding that we can no longer keep an Accident & Emergency department open, or that we can’t run two hospitals 20 miles away from each other,” he said.

The senior figure said most hospital chief executives opposed NHS charges for treatment, but many felt that greater rationing of free treatment was required, to prioritise the most essential care.

The data from NHS England shows a near doubling in the numbers of elderly patients stuck in hospital, for want of care at home, or help to get them discharged, in the past five years.

Overall, 115,425 bed days were lost to delayed discharges in June – almost 80 per cent more than the same month five years ago.

Just 90.5 per cent of patients who went to Accident & Emergency departments were seen within four hours, against a target of 95 per cent  – the worst June figures on record.

Ambulance response times were also a record low for the time of year, with just 69.2 per cent of the most urgent calls receiving a response within eight minutes, against a target of 75 per cent.

Charities said a funding crisis in social care meant thousands of vulnerable people were being left in hospital, when they should have been cared for in their homes.

Vicky McDermott, chairman of the Care and Support Alliance, which represents 80 charities for the elderly and disabled said: “The Government cannot continue to ignore the crisis that means that patients are stuck in hospital, when they could be at home.

“The funding crisis in social care is heaping needless pressure onto the NHS.”

Earlier this week NHS managers at University Lincolnshire Hospitals NHS trust said they were considering closing an Accident & Emergency (A&E) department at night after reaching “crisis point”.

NHS England defended the performance, pointing out that June saw the highest number of A&E attendances on record, with a 2.1 per cent increase on last year.

Health officials said some aspects of the performance showed an improvement on previous months.

A Department of Health spokesman said: “The NHS had its busiest June ever, but hospitals are performing well with nine out of ten people seen in A&E within four hours – almost 60,000 people per day seen within the standard.

“We are committed to delivering a safer seven day NHS which is why we have invested £10bn to fund the NHS’s own plan to transform services in the future,” he said.

In recent days, senior figures have raised concerns about growing levels of rationing across the NHS.

On Thursday, health officials in Merseyside announced plans to withdraw one of the most controversial proposals – the suspension of all non-urgent surgery for months.

The plans from St Helens clinical commissioning group had provoked a public outcry.

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The Health Services Procurement – inefficient and risky… Centralisation and management control is needed

Wales, Scotland, and N. Ireland could save a great deal if their procurement was aligned with England’s. But that means reverting to a “National” Health service.. There are rumours of gross overcharging for public services, Health and Defence being examples. In New Zealand central control (especially of drugs) has prevented waste and controlled spending, but only through overt and explicit rationing. Of course they don’t have “Big Pharma” home industries to content with…

Andrew Allen has posted in Procurement, Public sector “Supply management” 8th August 2016: New NHS procurement structures may be ‘disastrous’ 

Planned changes to NHS procurement are confusing, are being made without consulting health service buyers and are likely to jeopardise current arrangements that are working well.

This is the view of the Health Care Supplies Association (HCSA), which represents procurement and supply professionals within the NHS.

The organisation has strongly criticised the Department of Health, complaining about a series of ‘top-down’ procurement models emanating from Whitehall over the last 25 years and a ‘vacuum’ in NHS procurement leadership.

HCSA believes the new centrally driven Future Operating Model (FOM) for procurement across the NHS planned to replace collaborative procurement, will have potentially disastrous results.

The current proposed design of the FOM “… is not widely understood by the NHS procurement community and certainly not in sufficient depth”, said the HCSA in a statement released on 3 August.

Part of the proposed FOM is a new ‘tower structure’, which is hard to understand, it claims. The structure will consist of 11 category towers and a new Intelligent Client Coordinator unit formed of more than 200 people.

HCSA is also critical of the lack of involvement from procurement people in the wider system. “HCSA must be engaged in the design of the operating model, and given access to key information, including the strategic options analysis and the short listing process which has led to the current, proposed model,” it said.

The association believes current commercial procurement arrangements with the outsourced service NHS Supply Chain are working well and should be extended.

According to HCSA, some NHS Trusts have achieved price reductions of between 24-63% across a range of healthcare consumables, using a collaborative approach.

“There is an immediate need to urgently evaluate the benefits of a further extension to the NHS Supply Chain contract in order to maintain the momentum of these savings initiatives, at a time when savings are critical to NHS stakeholders,” it said.

Extending the current model would allow the NHS to review its relationship with key supply markets, to rationalise and standardise a national NHS product range, and obtain and maintain true market prices, it added.

The Department of Health has not yet responded to a request for comment.

Meanwhile Sofia Lind in Pulse 10th August reports that:  GPs ‘excluded’ from consultations over secret plans for general practice

New NHS procurement structures may be ‘disastrous’

A pill too hard to swallow: how the NHS is limiting access to high priced drugs

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

Lets see the clearing system overfill our medical schools.

Other political parties have been unable to dare to suggest the re-introduction of “aspiration to excellence”. All credit to the Conservatives for opening up this debate. Shame on the Liberals for not supporting the suggestion. There has been no suggestion to bring back the “direct grant” scheme, which was another method of improving social justice and opportunity. Children are born with unequal opportunities, (see the latest figures on cot deaths, reduced by fewer smokers), and education is always divisive, in all its forms. All government can do is pragmatically address the opportunities for bright and aspiring students to do well. The correspondence in the Times and in The Telegraph in the last two days is revealing. If more students from more schools are given the opportunity to study medicine ,they can always be weeded out as they pass through… Lets see the clearing system (over)fill our medical schools. Stop rationing the places Mr Hunt..

Nicola Woolcock reports in The Times 11th August 2016: Medical schools try new routes for top students

School leavers wanting to be doctors can apply through clearing for the first time at one of Britain’s leading medical schools as universities look for new ways to find the best graduates.

A dwindling population of 18-year-olds and a lifting of the cap on student numbers has created a buyers’ market for potential undergraduates.

Clearing, in which pupils seek a university place after getting their A-level grades, has shed its bargain basement image, the head of the Universities and Colleges Admissions Service (Ucas) said. The route has traditionally been reserved for students who do worse than expected in their exams.

Some teenagers are not even bothering to apply to university through the usual channels, focusing their efforts on clearing instead. Traditionally, this would have been a risky strategy because highly selective establishments would offer nothing and other universities sought only to fill unpopular courses. Last year, however, several institutions from the well respected Russell Group had degrees available through clearing.

St George’s, University of London, is the only establishment dedicated solely to healthcare and medical sciences. It is the first time that it has offered five-year medical degrees through the clearing system. Medicine is usually an oversubscribed undergraduate programme, with an average of 11 applicants for every place, according to the British Medical Association……


NHS cuts threaten hospital closures – expect “eyewateringly extensive cuts” – but not “rationing”.

Shed a tear for the old NHS as it was in 1973 when I qualified.

Image result for eye watering cartoonKate Gibbons reports in The Times 11th August 2016: NHS cuts threaten hospital closures

NHS patients should expect “eyewateringly extensive cuts” in the coming months that go far beyond the rationing of non-emergency surgery, a health expert has warned.

Hospitals will be closed and bed numbers sharply cut as the health service tries to reduce its crippling deficit.

A growing number of NHS trusts are denying patients hip operations, cataract surgery and fertility treatment to try to cut hospital costs. One trust has proposed suspending IVF for two years for those aged under 37. Health finance experts have warned that more severe cuts, including a sharp reduction in the number of hospital beds, are ahead.

The savings made by putting a blanket ban on certain treatments are “just a footnote in the eye-wateringly extensive cuts” due to be announced in October, Nigel Edwards, chief executive of the Nuffield Trust, said. “If you think rationing certain treatments is extreme, wait until what comes next.

“All of these cutbacks are on the margin, when what is needed are measures that deliver tens of millions of pounds in savings. The next few years will see widespread hospital closures.”

The savings made by putting a blanket ban on certain treatments are “just a footnote in the eye-wateringly extensive cuts” due to be announced in October, Nigel Edwards, chief executive of the Nuffield Trust, said. “If you think rationing certain treatments is extreme, wait until what comes next.

“All of these cutbacks are on the margin, when what is needed are measures that deliver tens of millions of pounds in savings. The next few years will see widespread hospital closures.”

Yesterday Grantham and District Hospital in Lincolnshire announced that its accident and emergency unit would be closed at night for the next three months because of a severe shortage of doctors.

Doctors also warned last night that the NHS is rationing statins that can cost just a few pence. Stockport Clinical Commissioning Group in Greater Manchester ordered local GPs to ignore guidance from the National Institute of Health and Care Excellence and restrict the cholesterol-reducing drug, according to The Daily Telegraph

Statins being rationed by NHS in ‘desperate’ bid to save cash. Why shouldn’t everyone buy their statins?

If something costs pennies, such as paracetamol or a skin emollient cream, why should it be free? In a pragmatically and explicitly and overtly rationed health service the solution is for all to buy statins. This would enable more funds to be directed at the technological and expensive services including diabetes/obesity.. Rationing is not acknowledged by the Ministers of Health…

Laura Donelly reports in The Telegraph 11th August 2016: Statins being rationed by NHS in ‘desperate’ bid to save cash

Statins costing just pennies are being rationed by the NHS in measures “born out of desperation,” leading doctors have warned. The decision to restrict the heart drugs was last night attacked by health watchdogs, who said wider prescribing of the medication had been recommended to stop “lives being destroyed…

There is no need for the NHS to be crippled – we just need honesty

We loved our former NHS, but now we no longer have one. The Telegraph and Reform think tank are on the front foot at present, without an effective opposition. There is no need for the NHS to be crippled – we just need honesty about the pragmatic need to ration, and differently for different income groups. Even the duke of Westminster cannot escape the inevitability of death (and taxes).

Laura Donnelly reports in The Telegraph 10th August 2016: Rising numbers could face ‘crippling pain’ as NHS rationing spreads 

Stephen Cannon, Vice President of the Royal College of Surgeons said bans on all but the most urgent treatment would become “commonplace” without major changes to the funding of the health service.

The NHS is in the grip of the worst financial crisis in its history, with increasing restrictions on cataract surgery and lengthening waiting times for hip and knee operations in most areas

Yesterday St Helens clinical commissioning group in Merseyside took the unprecedented step of making plans to suspend all non-urgent treatment for four months, in an attempt to tackle its overspend.

In a letter to The Telegraph, Mr Cannon, an orthopaedic surgeon, said such bans would become widespread without a “realistic” increase in funding…..

In the same paper Andrew Haldenby opines “The NHs needs to take better care of itself” – : Hanldenby - NHS(This article was not on line, but Haldenby is a director of “reform” think tank).

Paul Gallagher in iNews reports: St Helens may become first CCG in the country to freeze NHS operations

Stefan Pidluznyj in the Lincolnite on July 21st reports: Failing Lincoln GP service provider asks NHS to take over four surgeries and today the BBC reports Crisis-hit hospital trust may close Grantham A&E at night

Approximately 12 months ago in the Economist Haldenby opined: Physician, heal thyself – Jeremy Hunt’s battle with junior doctors exposes an awkward truth: Britons do not love the NHS – He was wrong. We loved our former NHS, but now we no longer have one. He talks about apathy, but not about the long term manpower planning which has let us all down, as well as the lack of honesty. His article (above) is opportunistic, and even praises Mr Stevens and Mr Hunt who between them have failed to stop the disintegration.


A pill too hard to swallow: how the NHS is limiting access to high priced drugs

It brings back fear if treatments are good and only available privately. In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear

A pill too hard to swallow: how the NHS is limiting access to high priced drugs

BMJ 2016; 354 doi: (Published 27 July 2016) Cite this as: BMJ 2016;354:i4117