Monthly Archives: February 2017

Drug companies propped up NHS with £250m after cabinet’s threat

This figure of £250m is about the same as we spend on overseas patients who take advantage of the UKs 4 health services. The amount is small beer – and a distraction from the real issue. How do we ration health care overtly and pragmatically so that it is of a high quality with short waiting lists for everyone? If the quality or the waiting is poor, we have a two tier system…. as is developing by neglect. Big Pharma will do whatever is needed to continue their profits – even selling on line antibiotics into a market where superbug resistance is rising.

The Times’ Chris Smyth and Oliver Wright on 17th Feb 2017 report: Drug companies propped up NHS with £250m after cabinet’s threat – Sir Jeremy Heywood, the cabinet secretary, threatened to impose statutory price caps on drugs in an attempt to raise money to plug a £500 million hole in the NHS budget

Britain’s top civil servant forced the big pharmaceutical companies into a £250 million bailout to help to plug a £500 million hole in the NHS budget.

In the latest sign of panic over NHS finances, Sir Jeremy Heywood, the cabinet secretary, threatened to impose statutory price caps on drugs in an “aggressive” attempt to raise more money.

The pharmaceutical industry then agreed to cover part of a shortfall in an attempt to win government goodwill in talks over medicines regulation and avoid an “acrimonious” row.

Opposition MPs say that ministers must come clean on the gap in the NHS budget and explain why they were spending money that they had yet to receive. The bailout stems from an agreement in 2014 which capped NHS spending on branded medicines at about £8 billion, with any costs above that level refunded by drugs companies.

The pharmaceutical industry had hoped that this would free doctors and hospitals from worrying about the cost of medicines and encourage them to change Britain’s traditional reluctance to use new drugs.

However, instead of funnelling rebates back to areas that spent the most, ministers opted to use the money to prop up the central NHS budget. As a result the Department of Health was caught short when rebates were less than predicted, having already allocated the expected refunds to NHS budgets for 2017-18.

At a meeting in November, Sir Jeremy told the industry that the scheme was failing and threatened statutory price cuts to medicines unless they stumped up more money.

The Association of the British Pharmaceutical Industry said that while it “fundamentally disagree[d]” with the government’s approach, it felt that it was best to agree some sort of deal.

“At best even if the government does not end the scheme early, there would be a significantly more acrimonious relationship going into the next negotiations. There would be significant immediate impact on industry ability to influence and shape the UK commercial environment now and in the future,” industry minutes say.

David Watson of the association told The Times that goodwill with ministers was crucial as the industry approached talks on the shape of the economy and how drugs would be approved once Britain left the EU.

“We are aware that we’ve got a new industrial strategy coming along and there is a lot up for grabs about regulation after Brexit that we want to be working on as partners with the government,” he said.

“Having allocated that money in advance, they found there was a gap in their budget for 2017-18 of £400-£500 million. We agreed to meet them halfway.”

Jonathan Ashworth, the shadow health secretary, said: “It’s embarrassing that ministers have had to go cap in hand to big pharmaceutical industry to plug gaps in the NHS finances. Yet again it exposes the reality that the NHS simply hasn’t been given the investment it needs. With Brexit and the consequent upcoming negotiations over the future of medicine regulation it’s crucial that all transactions between government and the pharmaceutical industry are totally transparent.”

Norman Lamb, the Liberal Democrat health spokesman, said: “What these arrangements expose is the government’s appalling financial planning for the NHS. They have scraped around to find ways of claiming that funding for the NHS has been increased, and now resort to these emergency deals which will inevitably raise eyebrows.”

A spokeswoman for the Department of Health said: ”The successful agreement between government and the pharmaceutical industry on the PPRS payment percentage demonstrates that we can work together effectively and reflects the importance to both sides of ensuring stability for industry and the NHS.”

She added: “Last year saw the fastest growth in spend [on medicines] of any of the last 10 years, and a higher level of spending than previously forecast, as we seek to secure fast access to new medicines for patients.”

Online market in antibiotics fuels rise of superbugs


What a pity that mental health stats are not universal and comparative. The limitations of the smaller mutuals (Wales Scotland and N Ireland) are exposed…. What can save theservices?

James Gallagher for the BBC news 25th Feb reports: Maps reveal schizophrenia ‘hotspots’ in England

GP prescriptions

Maps have revealed “hotspots” of schizophrenia and other psychotic illnesses in England, based on the amount of medication prescribed by GPs.

What is the state of mental health in England and Wales? What a pity that this mapping is not universal.  The limitations of the smaller mutual: (Wales Scotland and N Ireland) are exposed. One measure of a society being civilised is how it looks after mental health and disability. A two tier system is arriving, and Andrew Holdenby in The Telegraph seems to support it being official.

Around 16% of adults have a common mental disorder. Find out more about how these conditions are affecting England and Wales

Almost one in four people are subject to some sort of psychiatric disorder

The Adult Psychiatric Morbidity Survey (APMS) in 2007 was the most comprehensive look at how many people were suffering from mental health issues at that time in England and Wales.

Although the data is relatively old it is the latest government-backed comprehensive national study of mental health available. NatCen is currently putting together a newer edition.

23% of adults screened positive for at least one of the conditions under study. Of those that did 19.1% had two conditions while 12.2% had three or more.

Psychiatric disorders in this case applies to things like generalised anxiety disorder, mixed anxiety and depressive disorder, and obsessive and compulsive disorder.

In the week before the survey, 16.2% of adults had a common mental disorder (CMD)

The list of CMDs includes several types of depression and anxiety. These are ones that cause distress and problems for people in their daily lives but do not affect their ability to think rationally.

Women were more likely than men to have a CMD at 19.7% and 12.5% respectively. Only for panic disorders and obsessive compulsive disorder do women not have significantly higher rates than men.

Out of the adults tested, 7.5% had CMDs of such a level of severity that the person required treatment.

Nearly 1.6m people in contact with specialist mental health services in England during 2012/13

The latest mental health service bulletin from HSCIC showed that approximately one adult in every 27 in England was in contact with these services. When breaking the users down by gender 705,000 of them were male while 885,000 were female, which is a 44:56 split.

The largest age group in 10 year bands was 40-49 year olds, who make up 16% of the total number of mental health service users.

Self-harm in 2012/13: 96,900 inpatient care episodes………

The last mental health bulletin was the first to include data on self-harm. In 2012/13 there were 96,900 instances where someone received care in hospital (inpatient care).

Only blasphemers who do not worship at the altar of our sacred NHS can save it – Andrew Haldenby in The Telegraph 27th Feb 2017

Every one of us benefits from the work of the MPs on the Public Accounts Committee even if, as I suspect, few of us have ever heard of it. There is nothing in British public life quite like the PAC, which inspires a healthy fear among ministers and senior civil servants because they know it is one of the very few bodies that will hold them to account for their decisions.

Its job is to measure how government spends money on our behalf. Its current inquiries, for example, will tell the taxpayer how much foreign aid is lost to fraud and by how much the Ministry of Defence will overspend its budget for military kit and equipment. Sometimes, however, we need the committee to be braver. On some questions, it needs to go beyond asking whether a policy is succeeding in its own terms. It needs to ask whether government needs an entirely new approach. ……


When bickering means a real row, and the “emperor fiddles while Rome burns”..

On 27th February the news on the Health Services hots up. Bickering means a real row, and the “emperor(s) (Politicians) fiddle while Rome burns”..

Image result for emperor fidlles cartoon

The Mail reports: Patients suffer as NHS chiefs bicker with ministers, say MPs: Public rows over cash crisis mean no progress can be made

and Laura Donelly in the Telegraph opines: Bickering between Theresa May and NHS chiefs is ‘an insult to taxpayers’ 

Aol reports: Government ‘must act to avoid catastrophic failure’ in NHS

Public “bickering” between Theresa May and the NHS over funding at a time when the health service is facing severe financial problems is an “insult to taxpayers”, an influential parliamentary committee has said.

Few NHS trusts feel they have a plan for meeting financial targets set by the Government, which must now take “targeted action” to avoid a “catastrophic failure” in the service, the Public Accounts Committee (PAC) said.

Amid the strain, the Prime Minister and NHS England boss Simon Stevens are publicly falling out over funding and must find a way to work together “in the best interests of patients”, alongside the Department of Health (DH).

The intervention comes after Mr Stevens went into battle with Mrs May over NHS funding, telling the committee in January an extra £10 billion was being made available to NHS England over six years, but overall it had “got less” than set out in its five-year plan.

The comments by Mr Stevens, who is due to appear before the committee again on Monday, contradicted those of the Prime Minister, who has insisted the NHS got all it wanted in the funding settlement.
PAC chairwoman Meg Hillier said: “The NHS as we know it is under threat from growing and unsustainable financial pressures.

“Few trusts feel they have a credible plan for meeting the financial targets they have been set by Government.

“At the same time, the Government seems unable to get its own house in order, plundering NHS investment funds to plug holes elsewhere, and falling out in public over its longer-term strategy.

“Contradictory statements about funding from the Prime Minister and head of NHS England are an insult to taxpayers who deserve an honest, grown-up conversation about future finance and service provision.

“Government’s rigid adherence to a set of stock lines about funding, in the face of mounting evidence its plan isn’t up to the job, is not it.

“It is inconceivable the Government would allow a catastrophic failure in the NHS and we expect it to take targeted action now to support NHS bodies facing severe financialproblems.”

An NHS England spokeswoman said that while the PAC is right to highlight the pressures, there is now a “fundamental agreement” on the action needed.

“To that end, the NHS delivery plan being published at the end of March will clearly set out the NHS’s realistic and agreed game plan for the next two years,” she added.

The committee’s report comes after NHS trusts reported a deficit of £886 million in the first nine months of the financial year.

While the sum owed by NHS trusts is down from the record overspend of £2.45 billion in 2015/16, the health service is not on track to meet a year-end deficit target of £580 million.

The committee warned that action being taken to restore financial stability is affecting patients’ access to services.

NHS performance is declining against the four hour waiting time target for accident and emergency (A&E), ambulance response time targets, and the target to be treated within 18 weeks of referral, it said.

“Repeated raids” on long-term investment funds to meet day-to-day spending also risk long-term stability, with £950 million taken out of a separate £4.5 billion capital budget in 2016-16 to pay for everyday activities.

The committee called on the DH, NHS England and NHS Improvement to set out a “clear and transparent recovery plan” immediately.

Among other recommendations, the committee called on the Government to publish an assessment of whether the NHS has capacity “to deliver everything they are expected to within the agreed time frames”.

By July, ministers should also report back on what they have done to understand the link between financial performance and the impact on patient care.

And they should analyse the impact “extreme” financial pressure in social care is having on the NHS and publish their findings, the committee said.

A Department of Health spokeswoman said: “We are united behind the ambition to make the NHS the safest, highest-quality healthcare system in the world – which also means ensuring financial sustainability for the future, and the hospital sector’s financial position has now improved by £1.3 billion compared to this time last year, with 44 fewer trusts in deficit.”

Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, said: “This is a critical report which highlights the fact that money allocated by the NHS isn’t getting to the front line.

“We know from talking to mental health trust commissioners that there is genuine concern about the future of some services in their area, with some saying that cuts to services will be inevitable.

“NHS leaders have a difficult choice, clearing the deficit or investing in services to help their patients.”

No party is offering a credible alternative….. the future of the 4 UK Health Services may lie in social media

Richard Vize in The Guardian 25th Feb 2017 offers: “The NHS is struggling. Labour must offer a credible health policy” , but as we know from NHSreality’s 4 years, none of the political parties is prepared to talk and answer questions honestly. There are occasional managed releases of “good news”, ( Portsmouth News 19th Feb 2017: Cancer charity welcomes NHS pledge on stem cell treatment ) whenever possible, but these are mere distractions. Management at the top recognises this, and hence is demoralised and allows errors such as letter, note, and data loss. It appears this was manual records, and IT systems could be much safer, as long as such were not managed and designed internally..Breach of security in national diagnostic indexes may follow…  No politician or party is offering a credible alternative to the current rules of the game: Everything for everyone for ever…..Therefore the future of the 4 UK Health Services may lie in the pressure built up by social media.

Image result for dishonest politics cartoon…and the perverse incentives may make patients lie as well. The post-truth medical world is really here in the UK today.

Image result for health lies cartoon

….The manner of Labour’s defeat in Copeland is instructive. It took the most emotionally charged line possible, on an issue of great local sensitivity, on its signature issue of the National Health Service, and lost to the government.

Yet the defeat came as evidence mounts that all three of the drivers of current NHS policy – quality and efficiency improvements under the Five Year Forward View, reconfiguration of local health systems under the Sustainability and Transformation Plan (STP) process, and devolution, are in difficulty.

NHS accused of covering up huge data loss that put thousands at risk – Exclusive: More than 500,000 pieces of patient data between GPs and hospitals went undelivered between 2011 and 2016

Pithed politicians collude in unsafe care, ministers told

NHS data-sharing project scrapped – another opportunity missed..

Health service ‘at risk of sudden collapse’ – and the honest debate has yet to occur

Happy 2017: …politicians’ ‘persistent, blinkered denial’ – Say no to a post-truth health service

Image result for dishonest politics cartoon

Nurses and pharmacists to replace GPs for 1 in 4 visits

The highest risk situations in General Practice are when seeing patients without records, when complex elderly people who may have communication difficulties are seen alone, and when there is no chaperone and /or a language/communication problem. Telephone triage may weed out the most risky cases, and reserve these for the GP, notes may be available on a portable computer, but there will be a temptation for “drift” and for those untrained in diagnosis to be over extended. The risk may be more than the insurers will accept. Expect mistakes, and premiums to rise, or for even more pressure on A&E as more patients are referred …. (defensive medicine).

Chris Smyth reports 16ht Feb 2017: Nurses and pharmacists to replace GPs for 1 in 4 visits

One in four GP appointments will be conducted by pharmacists or nurses under plans to relieve pressure on family doctors.

Health chiefs in the South West have said that by 2020 they want doctors to cut their appointments by 27 per cent by drafting in other health professionals and by getting patients to manage their own conditions.

Simon Stevens, head of NHS England, has said that he wants patients across the country to be treated by pharmacists, counsellors and physiotherapist to ease the pressure on GPs. For the first time, health chiefs have now estimated how many doctors’ appointments this could avoid.

The sustainability and transformation plan for Bristol, North Somerset and South Gloucestershire has set a goal to “reduce the number of consultations conducted by GPs by up to 27 per cent through diversion of work to more appropriate multidisciplinary team members and non-clinical services”.

Health chiefs in the area said that the figure was a rough estimate that aimed to show how big a change was needed to keep pace with an older, sicker population when cash and doctors were both in short supply.

They also want to use online consultation and monitoring services to reduce surgery visits by 15 per cent by helping people to look after themselves at home.

Medical leaders have backed the plan as a way to deal with routine problems when waits for appointments are lengthening, but warned that it must not become a way to stop patients seeing a GP.

Richard Vautrey, of the British Medical Association’s GP committee, said: “Nurses, pharmacists and other healthcare professionals could play a vital role in supporting GPs to deliver care in the community.

“This is needed particularly at present as the government has so far failed completely to deliver the much-needed 5,000 new GPs they promised.”

However, he added: “While expanded teams can be beneficial, they should not be seen as a replacement for GPs, as it remains essential that patients can access a GP when they need to.”

Mr Stevens announced plans last year to hire 1,500 in-surgery pharmacists to carry out blood pressure checks, to treat for minor ailments, and conduct routine follow-ups and medicine reviews for older people.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “These highly trained healthcare professionals can provide much-needed support to GPs and our existing teams at a time when the profession is under intense resource and workforce pressures, and they will be instrumental in freeing up GPs’ time to deal with complex patients who really need the expert skills of a family doctor who considers the physical, psychological and social context during the consultation.”

A spokesman for the plan said that the figures “reflect a blended assessment of the scale of the challenge we are trying to address with changes to the way we plan, organise and deliver services both in community and in hospital. What we do want to do is to reduce demand for GP appointments.”

Image result for pharmacist cartoon

Pithed politicians collude in unsafe care, ministers told

Politicians in Pembrokeshire were hoodwinked into supporting SWAT (Save Withybush Action Team) and now the money has been spent elsewhere. Some areas have still got a chance (Maryport) and should consider their options carefully. Think: If you would elect to have your care elsewhere, given the means and permissions, should you be fighting for services to stay exactly the same? All the doctors and nurses who supported SWAT in 2006 would now vote for a new hospital covering three counties (Pembroke, Ceredigion and Carmarthen) – if they had the option. Pithed Politicians don’t deserve our support, and are part of the democratic deficit in their short termism, lack of depth and altruism.. Compounding the reduction of standards is over-occupancy, which leads to increased cross infections and sepsis. (ITV News: Sepsis costing NHS ‘billions’ more than thought due to ‘crippling’ lack of data )

Kat Lay reports in the Times 21st Feb 2017: Close hospitals or collude in unsafe care, ministers told

Politicians who oppose necessary hospital closures are “colluding in unsafe care”, a leading think tank has warned. A report by the King’s Fund health charity said that the government should throw its weight behind plans that could lead to the closure of some hospitals and services.

In late 2015, NHS England split the country into 44 areas, asking each to produce a blueprint detailing how they would improve care and deal with their share of a £22 billion black hole in the health service budget by 2020. Several regions said that they would look to close or downgrade entire hospitals, while others suggested closing casualty or maternity departments, or merging services. All aimed to stem rising hospital admissions by providing more care in the community and to give greater priority to preventing people becoming unwell.

The King’s Fund said that where evidence showed that such changes would deliver better care, the plans deserved politicians’ backing — but such support was “uncertain”. Chris Ham, the fund’s chief executive, said: “If you’re not willing to go through that process and support plans of this kind, essentially you are colluding as politicians in the continuation of unsafe services.”

He added: “Where there is a very clear evidence-based case that local hospitals cannot continue providing safe high quality care . . . then a reluctance to engage in albeit difficult conversations with the public, with local politicians, about why the case for change is compelling . . . means that the public will continue to access services of a lower standard and a lower quality than they have every right to expect. So politicians need to step up to the plate and be brave.”

Theresa May refused four times to condemn the closure of a maternity unit at West Cumberland Hospital when she was visiting Copeland last week, before Thursday’s by-election.

While some of the “sustainability and transformation plans” talk about closing beds, Professor Ham said that was “simply not credible” after the winter crisis during which hospitals have operated at more than 95 per cent capacity. A safe level is considered to be about 85 per cent. However, he added that the plans were the best chance to stabilise the NHS, both financially and in terms of performance.

Mark Porter, chairman of the British Medical Association’s council, said: “Improving patient care must be the No 1 priority for these plans. Given the scale of the savings required in each area, there is a real risk that these transformation plans will be used as a cover for delivering cuts.”

Southwest London

One of St Helier, St George’s, Epsom, Croydon or Kingston hospitals could be downgraded.

Northwest London

Major hospitals may be cut from nine to five.

Leicester, Leicestershire and Rutland

Hospitals providing acute care could be cut from three to two.


Bournemouth or Poole A&E could become an urgent care centre.


Darlington or North Tees in Stockton could lose its A&E department.

The Times leader: Caring for the Community -A realistic debate is needed between politicians and the public about the NHS

Few subjects are as politically toxic as hospital closures. Under plans drawn up by the NHS, many may shut their doors. Others will be downgraded or lose specialist cardiac or maternity units. Fearful of their constituents’ wrath, MPs have begun lobbying to ensure that their local hospitals are spared. However, a report by the King’s Fund, a charity that scrutinises the NHS, argues that if the 44 plans are to be implemented successfully it is vital that politicians endorse them.

The arguments for the closure of some hospitals and units, the creation of specialist centres of excellence, and for improving the provision and funding of social care are compelling on grounds of both health and cost. If MPs reject those arguments, the report states, they are colluding in the provision of inadequate healthcare to the very constituents they seek to protect.

Under the proposals, three community hospitals may be closed in Leicestershire, four in Devon and three in Dorset. Four hospitals in Liverpool may be merged, and two in London downgraded. Nineteen A&E departments and 12 maternity units are under threat. If the NHS is to meet its many challenges, finite resources must be allocated in a more strategic manner. This is not simply a cost-cutting exercise. There is strong evidence that centralised and specialist services are the safest and most efficient way of assisting patients. Centralising trauma care has seen the chances of surviving an accident improve by 50 per cent. When the stroke units of some London hospitals were closed in 2010, and resources concentrated in eight specialist centres, the lives of an extra 100 people a year were saved.

Mark Porter, chairman of the British Medical Association, is correct to point out that demand for care is growing. However, hospitals are not always the best places to deliver it. In the first week of January, three quarters of NHS trusts had occupancy levels of 95 per cent on at least one day. Any rate above 85 per cent raises concerns for patient safety. The solution is not more money for more beds, but increased funding for community care in the form of clinics, nursing associates, home care and improved GP services. Of the almost 200,000 patients whose discharge from hospital was delayed last year, 36 per cent were attributable to inadequate social care. Iris Sibley, 89, recently spent six months on an NHS hospital ward, at a cost of £80,000, for lack of a place in a nursing home. Most of the £1 million an hour that it costs the NHS to treat diabetes is spent on the hospital treatment of avoidable complications.

By focusing resources on illness prevention and the improved integration of services, the plans offer a chance to stabilise the NHS after a winter marked by almost permanent crisis. Katherine Murphy, of the Patients Association, warns that the public will be unhappy if services are shut down secretively. Health chiefs and MPs must be open about the plans and persuasive of their merits. The emotional pull of a community hospital is strong. The reality is that the best hospital is not necessarily the nearest. Too often, discussion of the health service is characterised not by reason, but by emotion. Hospital closures, as Ken Clarke noted in his recent memoirs, provoke the most bitter battles. Politicians do their constituents a disservice if they do not point out that they can also be for the best.

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

Pithed Politicians?

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

Hospitals must shrink or shut, doctors warn


NHS trusts post ‘unsustainable’ £886m third-quarter deficit

Of course we can go on in deficit whilst the world bank and others are willing to give us credit…

Haroon Siddique reports in The Guardian 20th Feb 2017: NHS trusts post ‘unsustainable’ £886m third-quarter deficit

Shortfall in England, attributed to extra pressure on NHS over winter, is £300m over target for end of financial year


NHS trusts in England posted a deficit of £886m at the end of the third quarter, £300m more than the target for the end of this financial year.

NHS Improvement (NHSI), which published the figures on Monday, predicts a year-end deficit of £750m-£850m, much higher than the £580m previously described as the highest figure the health service could afford without risking major financial problems.

After the first six months of the financial year, the deficit was £648m, but at that stage NHSI was clinging to the possibility that it could hit the end of year target. But on Monday it acknowledged this would not happen, blaming “one of the most challenging winters on record” with 5.34 million patients attending A&E units between October and December – 200,000 more than the same period in 2015 – and a 3.5% increase in the number of patients requiring major further in-hospital treatment.

Lost bed days, when medically fit patients cannot be discharged due to constraints on community or social care, were also up on Q3 2015-16, to 390,392, a 28% rise, meaning providers lost income from elective operations because of a lack of capacity.

The NHS Confederation, which represents health service organisations, called the deficit “a tragedy”.

NHS Providers, which represents trusts, warned that, as bad as the figures were, they would have been much worse were if not for a series of one-off savings, which were unlikely to be repeatable.

The NHS Providers chief executive, Chris Hopson, said: “Despite doing everything they possibly can, NHS trusts are £300m behind the target of reducing the provider sector deficit to £580m by the end of March. This is largely because of winter pressures.

“Trusts spent more than they planned and they lost income from cancelled operations – both were needed to create the extra bed capacity to meet record emergency winter demand. This shows the danger of planning with no margin for unexpected extra demand. We can’t expect to run NHS finances on wafer thin margins year after year and keep getting away with it.

“We shouldn’t kid ourselves. The NHS’s underlying financial position is not sustainable.”

A survey by NHS Providers was also published on Monday. The poll completed by finance directors from 99 hospital, mental health, community and ambulance trusts – more than 40% of the NHS provider sector – found that two-thirds said they were only staying on track as a result of one-off savings that may not be achievable next year and beyond.

Those one-off savings totalled £340m but modelling by NHS Providers suggests they could amount to as much as £1bn across the sector.

NHSI said that the overspend was £1.3bn better than at the same point last year with 44 fewer providers (135 in total) ending the quarter in deficit, compared with the same period in 2015-16.

However, this year’s figures have been boosted by a substantial injection of emergency cash from the government. In total, £1.8bn of sustainability and transformation funding has been earmarked for trusts, although not all of it has been paid out yet.

The NHSI chief executive, Jim Mackey, said providers had worked hard to improve their finances in the face of record demand. “However, the job is not done yet and we need each and every organisation to play its part,” he said.

“We will be working very closely with those providers off plan to bring them as close as possible back to plan this year, potentially through the extension of financial special measures.”

The NHS Confederation chief executive, Niall Dickson, said: “This is a tragedy – the NHS had made huge strides to treat and care for patients promptly but the latest figures show a further deterioration – and behind those figures lie real suffering for patients and exhausted staff.” He said the immediate priority was additional funding for social care.

Health analysts warned that the dire figures were a straightforward consequence of failing to increase NHS and social care funding in the face of rising patient demand.

Nick Triggle for BBC news reports 18th Feb 2017: NHS £8bn budget plan ‘not enough’, say hospital bosses

Reporting Chris Hopson of NHSproviders:

….Mr Hopson criticised the way the current spending plans had been structured.

He pointed out the rise in spending was actually £4.5bn rather than £8bn when cuts to other budgets, including those for training staff and money for public health schemes such as stop smoking services, was taken into account.

He also said the extra demands being placed on hospitals, GPs and council-run care services had been underestimated, while the target to save £22bn in efficiencies by 2020 was “too ambitious”.

Graph showing how NHS budget is increasing in England
Chart showing spending rise from 2014/15-2021/22

“For all these reasons, there is now a clear and widening gap between what is being asked of the NHS and the funding available to deliver it,” Mr Hopson said.

“We are therefore asking for a new plan for the rest of the parliament to finalise or confirm the NHS budget and honestly and realistically set out what can be delivered.

“If there are no changes to the money available we will need to set out what the NHS stops doing. Right now the service cannot deliver what is being asked of it on the current budget.”

Charities call for NHS to stop rationing critical care

The knee jerk response of commissioners to the “rules of the game” is to hit the softest targets. Those who don’t or wont speak out, the psychiatrically ill, those with limited prognosis and rare diseases. They hope that their votes, and those of their family won’t be significant  compared to the majority who live on demanding Everything for everyone for ever. Unfortunately the future means this will get worse… And these are of course post coded inequalities as a result of covert decision making.

NHS Emperor naked

Rowena Mason reports in the Guardian/Observer 18th Feb 2017 : Charities call for NHS to stop rationing critical care 

Theresa May has been urged by charity chiefs to stop the NHS rationing treatment for seriously ill patients and to find more money for their care in the budget next month.

About 30 health charities, including the Teenage Cancer Trust, National AIDS Trust and Motor Neurone Disease Association, have raised the alarm about NHS England “restricting and rationing treatment” because of underfunding, especially for patients with rare and complex conditions. The groups from the Specialised Healthcare Alliance said this rationing is taking place without sufficient public scrutiny.

In a letter to the prime minister, they said NHS England is “choosing to restrict and ration treatments that patients with rare and complex conditions need – often without proper consultation with patients”. “We hope that you will take action to ensure full patient involvement in these decisions, and to ensure that any decision to ration treatment is overseen by democratically elected politicians,” they added.

The warning comes after health thinktank the King’s Fund said that politicians would be escaping culpability for rationing decisions, as plans due to come into force from April mean that even cost-effective treatments could be denied to patients.

Nicholas Timmins, a policy adviser at the organisation, wrote: “If the NHS can no longer fund new and cost-effective treatments, ministers should announce that decision case by case, and be held accountable for so doing”.

It emerged last month that cancer, diabetes and asthma patients could all be hit by the new affordability criteria, which means that drugs which cost the NHS more than £20m in total each year could be subject to restrictions.

The charity chiefs also raised wider concerns about funding for the NHS, which medics have said is under huge pressure this winter because of cuts to adult social care provided by councils.

Philip Hammond, the chancellor, is facing calls to give more money to the NHS next month after resisting an emergency bailout at the autumn statement. Instead, the government has launched a long-term review of social care and will allow councils to raise more through a local ‘precept’ (an extra charge to council tax bills which can only be used for adult social services) in the next couple of years.

No 10 and the Treasury appear to remain firmly against repeated calls from medics and the opposition for more cash for the NHS, indicating they are not prepared to change tack at the budget. But the charities say: “Our charities – and the patients we represent – are deeply concerned by the recent statements of Simon Stevens concerning the NHS’s relative underfunding. We urge you to ensure that this year’s budget provides the NHS with the funding it needs to deliver the standards of care patients expect.”

The charities issued their warning ahead of a Lords debate on the medical supplies bill this week, which Labour’s shadow health minister Lord Philip Hunt has described as a missed opportunity to “get rid of many of the restrictions on NHS patients using innovative new medicines”. A government spokesman said blanket restrictions on treatment are unacceptable and that the clinical needs of a patient, and the urgency with which they require treatment, must come first.

“The government is responding to the needs of the NHS by investing more money – £4bn this year – to fund its own plans for the future”.

Inside Health – What (Who) has to give?

As part of an attempt to start a conversation about unpleasant and pragmatic issues around the failing health service, the BBC’s “Inside Health” on Valentine’s day 14th Feb 2017 was honourable. However, there were many issues ducked: the most obvious being that the WHO does not accept that the UK has one system any longer.  Members of the medical professions will welcome the transparency and honesty of the participants, and their questioning of the “market”. The first question was on co-payments, and the last on depoliticising  health, and in the middle rationing service(s) was up for debate. However, in view of the morale and gagging issues in the organisation, it was a pity that the power of exit interviews was never mentioned. On co-payments no one challenged Nick Black: “…is it to raise money or is it to deter demand”. The other good reason is to encourage self sufficiency. On Money and co-payments nobody challenged the 90% exemptions.. perhaps we could pragmatically agree that everyone pays something, whatever their means.
In the middle we heard criticism of spending on prevention without evidence, and a call for decommissioning of non evidence based prevention and screening. Post code differences, particularly in fertility treatments, were decried. When the panel called for a discussion of what was worth retaining they did not address need to be honest about what would not be available, so the issue of “overt” as opposed to “covert” rationing did not arise. Mark Britnell’s book was mentioned, but not to say how helpful it could be: Mark would take something good out of many systems, but does not hold up one as the best. Comparisons with other countries, particularly those who changed from a UK style (Everything for everyone for ever) to a rationing by co-payments and other methods was not mentioned (N.Z.) The idea that the health service is funded by those in work, and that when waiting lists are long the workers need to be treated first was not aired. The poor manpower planning and restriction of places at medical school, and the immoral enticement of doctors from poorer countries never arose. However, the panel did acknowledge the short termism of health ministers and politician’s posturing in general. They admitted psychiatry got a bad deal, but did not have time to split off the dementia component.

Image result for hippo and cub pic cartoonGPs listening might feel the panel is “out of touch” with grass roots feelings, and NHSreality would agree.

The panel was:

Clare Marx, President of the Royal College of Surgeons

Chris Hopson, Chief Executive of NHS Providers

David Haslam, Chair of NICE

Professor Sir Nick Black, London School of Hygiene and Tropical Medicine

Margaret McCartney, Glasgow GP

Programme Transcript – Inside Health from the BBC

Listen to the original conversation.

What would the world’s best health system look like?

Books on the NHS, and others pertinent …..

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

What would the world’s best health system look like? Mark Britnell

Inside Health changed from 7th to 14th Feb BBC Radio 4 21.00 – listen to questions and answers in a public debate


Excess deaths in 2015 (30,000) may be linked to failures in health and social care

A recent paper published in the Journal of the Royal Society has claimed that a recent rise in the number of deaths in January of 2015  may be down to cuts in health and social care funding . With the current level of funding the NHS and social care in the UK is on a trajectory towards catastrophic failure , perhaps that is all part of the envisaged endgame of  Tory health policy. Abandonment of the health and social safety net and the return of fear ? Conspiracy or neglect? Denial either way…

Image result for death by neglect cartoon

Reporting their analysis in the Journal of the Royal Society of Medicine, Professor Danny Dorling, and colleagues from the London School of Hygiene and Tropical Medicine…….

“The year 2015 saw an unprecedented rise in mortality in England and Wales – the greatest rise for almost 50 years – with a particularly large spike seen in January. Explanations presented up until now do not conclusively explain that rise, but do provide serious cause for concern, with the deaths occurring in the context of massive disinvestment in both health and social care, and almost all NHS performance markers falling below their targets. The possibility that the cuts to health and social care are implicated in almost 30,000 excess deaths is one that needs further exploration. Given the relentless nature of the cuts, and potential link to rising mortality, we ask why is the search for a cause not being pursued with more urgency? Rising mortality is concentrated amongst those groups most reliant on such spending.”