Monthly Archives: November 2017

Those “five giants” are getting larger. The ghost of Beveridge haunts the country…

In the last decades, and especially in the devolved parts of the UK, the “five Giants” which Beveridge described have been growing. Post code unfairness in treatments and outcomes is a regular matter in the media, and the public have become immune – until they themselves fall victim.  Then it’s too late. Dead patients don’t vote, but their families do become cynical and restive… If readers wish to be reminded of the altruism which set up the original NHS read here: In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear Neglect, short termism, and denial are the cause. In a media led society this is such a shame, but reflects the poverty of debate on ideological issues.

The Telegraph thinks the “hard” Brexit deal will be expensive for the Health Services: £500m?

Nick Triggle, while welcoming the pay rises for NHS staff says: NHS pay rise: Are there strings attached?

NHSreality has already commented upon the rationing of hearing aids, and that the delay in proper treatment may be linked to dementia

The Mail is on about lack of evidence for masks, and rationing robotic treatments… and that Rationing is cutting lives short.

Andrew Grice for the Independent sums up the current situation and dilemma for the politicians: NHS England is rationing its services – Hammond’s Budget didn’t go far enough – The Budget’s gaping hole was on social care; it is close to collapse and putting ever-increasing pressure on hospitals through bed-blocking, but got no extra cash

A debate about rationing the care provided by the National Health Service will be launched tomorrow, when NHS England begins a conversation about what it can and cannot afford to do.

Although there will not be a hit list of cuts at this stage, the implications will be clear enough: the Government has not provided enough money to meet goals including the 18-week target for elective operations; cancer treatment; mental health; public health and obesity and for a creaking social care system. In short, something’s gotta give.

NHS England’s gloomy prognosis will come at a bad time for the Government. Theresa May has made mental health a personal priority. A green paper soon about expanding help for children will generate some headlines, but without money and staff there will be little or no difference on the frontline until 2021.

Similarly, ministers’ hopes that Budget headlines about a “£2.8bn boost for the NHS” would buy some political credit will prove short-lived when the continuing cash crisis is laid bare. Philip Hammond’s injection was less generous than it looked: £1.6bn for next year, well short of the £4bn a year prescribed by three independent think tanks – the King’s Fund, the Health Foundation and Nuffield Trust…..

The Local Government Association estimates a £1.3bn funding gap between what care providers need and what councils pay. Although May acknowledged the problem during this year’s election, she got her fingers burnt with her so-called “dementia tax” and the issue has now been kicked into the long grass. We won’t get a green paper until next summer. That is woeful, given the additional pressure the demographic timebomb will put on health and social care.

While the debate over NHS rationing is inevitable, we need a much wider one about the state’s priorities. The 2010 and 2015 elections were followed by a government-wide spending review. There’s no sign of one now – another example of the reduced capacity of a government consumed by Brexit.….

Appropriately enough, the new statesman celebrates the 75th anniversary of the Beveridge report: Slaying the Five Giants: the 75th anniversary of the Beveridge Report

The flock of geese that laid golden eggs has been culled. It takes years to rebuild, and the fox is at the door.

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Mark Smith for Walesonline 13th June 2017 reports: A GP recruitment drive has led to a ‘significant’ drop in vacant posts in Wales  – But the British Medical Association say they are concerned about the number of practices ‘at risk’ of closure

but Mark is not being critical enough. His article is a parody of government thinking short term promotion of false good news can negate the reality of the long term rationing of medical training places. The Reality was evident and reported truthfully by Abby Bolter on 8th November: Doctor shortage forces GP out-of-hours centre to close for 16 hours – Some patients were sent to A&E

On 22nd September Mark Smith reported on the biggest complaints about an underfunded and unrealistic service, without choice and with declining standards: These are the biggest complaints people had about GP services in Wales – Inspectors visited 27 GP surgeries in 2016-17 and this is what they found

Martin Shipton on 5th September reported: ‘GP surgeries will close and low-cost staff will replace doctors’ – A campaigning GP is warning that more and more practices will shut

David Williamson resents the lack of Welsh Speaking doctors on 27th November: Struggle to recruit GPs means you may not be able to see a Welsh-speaker even in a heartland area – The BMA says ‘unprecedented’ recruitment challenge makes bilingual GP services in all Welsh-speaking areas ‘unlikely’ but this is a minority issue in Wales as a whole, where almost every Welsh speaker also speaks English. Only 20% maximum are preferential Welsh speakers, but in an ideal world this would be a choice available to patients. We are not in an ideal world. Pragmatic rationing is everywhere, but it is post coded and covert.

Mental Health is the worst provision of all…

The reality of recruitment and staffing shortages is exposed by Tony Ursell in letters on 21st November in Walesonline:

Congratulations but there’s still a deficit

I would like to congratulate the Health Secretary Mr Gething on the latest news that 144 places have been filled for GP training.

It’s a pity that also in the news are the following facts, that in the last 10 months 187 doctors have left the NHS. and 287 nurses and health visitors have also left in the same period.

Oops! That’s still a deficit. It’s no wonder my local GP practice has just closed and left my family and myself looking for a new practice after 27 years of using the same one.

Tony Ursell

GP shortage is a National Issue and trying to pretend otherwise is false news. GPs are highly trained (10 years minimum) and potentially a mobile workforce. There is an issue with poor recruitment from the shires, including rural Wales, where education has been in the steepest decline in the EU. Disengagement and lack of aspiration are a real problem in peripheral UK and it is this lack of opportunity that partly led to the Brexit vote. Bribes on £20k are all well and good, but short term solutions to a long term problem. The flock of geese that laid golden eggs has been culled. It takes years to rebuild, and the fox is at the door.

Junior doctors offered £20,000 ‘golden hello’ to train as a GP – Telegraph

Public Finance office reported by Emily Twinch 12th October 2017: GPs to be offered £20,000 inducement to work in rural areas

In Scotland Kingdom FM reported 27tth November 2017: GP Shortages in Fife highlighted at Holyrood.

The Horse has bolted but “play it again Sam”… “GPs to receive ‘golden hellos’ in hiring drive”….

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

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Policy transplant Is this the end of the NHS’s internal market? Three decades of market-based reforms are being

The Economist November 4th 2017 reports as if the “thinkers” have finally realised that the current system is not founded on a rock, and sustainable into the next generations. It’s a pity that the Political parties are not allowed to acknowledge this, and are all in denial.. (With apologies to the Economist for reproducing an important article.) Integrating health and social care does not put more money into the system, It may make it more efficient in an ideal world, but we still need to ration health care I  a fair and open manner.

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Policy transplant. Is this the end of the NHS’s internal market? – Three decades of market-based reforms are being rethought

CLAIRE MORRIS used to work as an ambulance paramedic in Lancaster, in north-west England. But as part of recent changes in the National Health Service, last year she moved 50 miles away to Millom, a town of 8,500 people that has struggled since the closure of its ironworks half a century ago. There she became part of a new system that continues to handle 999 calls, but now also liaises with other health workers to ensure vulnerable residents receive good enough care that they do not have to call the emergency services in the first place.

Such an approach may seem like common sense, but it is far from the norm. Despite its name, the NHS it not a single service. It is a mish-mash that involves nearly 7,500 general practices (clinics of GPs, or family doctors, which are independent contractors); 233 “trusts”, as hospitals and other direct providers of care are known; and some 850 companies and charities that provide care on behalf of the NHS. All of these entities have their own contracts, budgets, employees and incentives. None is responsible for social care, the residential support for elderly or disabled folk that is mostly left to local authorities.

The project in Millom and its surrounding area of Morecambe Bay is one of 50 experimental “vanguard” sites set up by the NHS in England to piece together this fragmented system, which is increasingly struggling to cope with growing numbers of elderly people with multiple chronic conditions. Although the scope of each vanguard varies, all aim to break down silos by combining budgets and having staff from different parts of the health service work more closely together. Simon Stevens, head of NHS England, wants these sites to be models for the rest of the service.

At last, almost unnoticed, the NHS is starting to change at its core. It is a shift that indicates the end of an era of thinking about health care. In 1990 Ken Clarke, then Conservative health secretary, created an “internal market” by separating the parts of the NHS that pay for services from those that provide them. From 1997 Labour added a vast set of targets and a tariff for each procedure, to reward the most active hospitals. The Tory-led coalition of 2010-15 devolved more of the NHS budget to local groups of clinicians; today two-thirds of its spending is done via 207 “clinical commissioning groups”, which buy services from trusts and other providers.

Vanguards deliberately undermine this history. In February Mr Stevens told MPs that the reforms would “effectively end the purchaser-provider split,” adding for those parliamentarians unfamiliar with NHS-speak: “This is pretty big stuff.”

In Millom the stuff seems to be working. Between 2014 and 2016 the town reduced emergency admissions to hospital by 23% and elective admissions by 16%. Emergency admissions from care homes were cut by 10%. Between April 2015 and December 2016, the whole Morecambe Bay region saw small drops in emergency hospital admissions and occupancy rates, even as most of the country saw increases.

Those running the vanguard ascribe the results to co-operation. The NHS is “a bit like ‘Game of Thrones’,” says John Howarth, one of the vanguard’s clinical leaders. “We’re a set of tribes who are often at war…We need to rejoin the tribes into one NHS tribe.” Millom’s one GP practice is in the same building as the community hospital and the ambulance service but, until Ms Morris started there, they barely spoke and never shared data. Now they are in constant touch, with workers going through phone logs to identify pensioners who call 999 because they do not know what else to do, then liaising across the services to work out how best to care for them at home.

Morecambe and wise

GPs in Millom can now phone or videolink with specialists at regional hospitals. Though this takes a specialist’s time (which under the usual NHS model means the hospital billing for a consultation fee under the NHS tariff), it can save more time and money later. In Morecambe Bay, this change avoided 1,400 unnecessary outpatient referrals in the 11 months to February 2017—no small achievement, since a bus journey from Millom to Lancaster can take more than two hours.

A scheme allowing people with minor eye conditions to see a local optometrist avoided 1,600 unnecessary referrals in its first 18 weeks. Some GP practices are hiring nurses and paramedics to screen patients who need not see a doctor. Other vanguards have GPs in their emergency departments to filter those who do not need urgent treatment. Morecambe runs weekly drop-in “café” clinics: the Airways Café for respiratory diseases; the Serenity Café for mental-health problems; and the self-explanatory Leg Ulcer Café (Professor Howarth concedes it may need a new name).

Before the general election in June was announced, Mr Stevens updated his five-year blueprint for the NHS. He announced that the models of care in the vanguard areas would be imitated throughout the system, via 44 similar local agreements known as Sustainability and Transformation Plans (STPs). A pioneering eight areas will go further still, becoming what he termed Accountable Care Systems (ACSs). These bodies are based on Accountable Care Organisations, an increasingly common way of organising care in America, where most involve one or more health-care providers signing a contract with a health-care payer (such as Medicare, the public scheme for retirees) to deliver specific health outcomes for a defined population over a number of years. ACSs are ersatz versions of this model. They largely formalise what the vanguards are already doing: joining providers in one area together, with the aim of coming under one integrated budget which pays hospitals and clinics for how healthy they keep people, not how many procedures they carry out.

“This is a complete reversal of the Health and Social Care Act of 2012 and the reforms under Andrew Lansley [the health secretary in 2010-12],” says Ben Collins of the King’s Fund, a think-tank. If the experiment were expanded, he says, it could in effect lead to the end of the internal market, since it blurs the line between provider and buyer. “We are finally building a model of care based on the actual needs of the population,” says Ranjit Gill, clinical leader of a vanguard in Stockport.

Vanguards and STPs are “workarounds”, in the words of one doctor. Though he supports them, Andrew Haldenby of Reform, another think-tank, says that STPs have “mad geography, no executive authority and inconsistent vision”. To change this would require new legislation, which is beyond the paralysed government. So the NHS is pushing on, trying to prove the plans’ worth before any legal changes are required. It is betting that the benefits of integration will exceed the costs of eroding the internal market.

Will they? True, the current system wastes millions of pounds on an unwieldy commissioning process. And fragmentation is an incentive for employees to optimise their own performance with little thought for the rest of the system. Nevertheless, the imperfect market-based reforms of the past 30 years have helped to cut waiting times, give patients more choice and instil financial discipline.

Three challenges face the NHS as it makes the case for change. The first is that although integration may help patients, it does not always mean savings for the system, since the overall budget is predetermined. Reducing hospital occupancy rates from 95% to 93% is great, says Professor Howarth, but it does not save money. The second, articulated by many doctors, is that the reforms will not be given time to work. The Labour Party is sceptical of STPs, which it sees as vehicles for cutting spending. It wants to halt the plans and give local areas more money before asking them to figure out how to proceed.

The final issue, says Mr Collins of the King’s Fund, is accountability. “The whole reason the purchaser-provider split was introduced was because of unaccountable local monopolies,” he notes. Although the internal market brought only imperfect accountability, what if the new models fail to deliver improvement? “We could find ourselves back in the 1970s,” he warns.




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The cost of care is so great that we may end up exporting our elderly….

Denial and our big “blind spot”. Its infectious….


The Minister must be “off his trolley”. Waiting for goddo,…… and coat hangers to survive.

The first duty of government is the defence and internal security of the realm, and the institute of law. After this individual health and social care ranks very high, especially amongst the elderly and voters. Successive governments are reducing expenditure in all these areas, and we all know the reasons why. Better to come clean and ration overtly than to pretend …. Despite the Observer recommendation, it appears civil unrest is preferred to a fair, overtly rationed, health service. Unrest is likely to become a reality… In areas without a tertiary centre, and where an underfunded DGH is the only option, standards are falling. Private care is thriving, and the health divide is widening. Image result for nhs trolley cartoon

The Observer 11th November reports: Long Waits in A&E have increased by 557% in seven years….Demand for extra funding grows as figures reveal number of “trolley waits” longer than four hours now exceeds 45,000 per month

Sarah Kate-Templeton in the Sunday Times 26th November 2017 reports: Coat hangers to be drip stands in make-do NHS – Doctors fear the backbone of the service is about to be broken as they warn of running out of equipment and having to make do

Hospitals will be so short of beds this ­winter that doctors will have to resort to making drip stands out of coat hangers, the president of the Society for Acute Medicine has warned.

Dr Nick Scriven, who represents ­doctors working on wards where patients are admitted from A&E or referred as emergencies by their GP, said NHS England bosses had admitted that only 1,000 of the 2,000-3,000 extra beds needed this winter had been freed up.

Scriven said: “NHS England estimated that it needed to free up 2,400 beds this winter, but current estimates are that less than 1,000 of these have been achieved.

“In some places it will mean boarding on the wrong ward. If you are on the wrong ward and things get delayed, you will be in hospital longer. If you are on a trolley in a corridor, waiting for treatment, you are at risk of being ignored. Most hospitals don’t have enough nurses to staff corridors.

“Hospitals will run out of things like drip stands, so they will be putting bags of fluids above the beds, hanging them on coat hangers and that sort of thing.”

Scriven said hospital doctors are ­bracing themselves to “patch together safe care . . . but there is a real sense of foreboding that this may be the winter that finally breaks the backbone of the service”.

He added that Britain did not have a big flu outbreak last year, and that if the levels of infection experienced in Australasia this year are repeated here, “the system will be swamped as never before”.

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Scriven does not believe the extra £2.8bn for the NHS announced in the budget will make a significant difference to overcrowding in hospitals this winter.

Last week Dr Helen Stokes-Lampard, chairwoman of the Royal College of ­General Practitioners, warned that for every patient queuing in A&E, hundreds more will be unable to get a GP appointment when they need it.

Stokes-Lampard told The Sunday Times: “However unpleasant it is to be left on a trolley, for every patient left on a trolley there will be hundreds struggling to get an appointment with their GP.

“A patient struggling to get a GP appointment will go unnoticed, whereas those queuing out the doors in A&E are a very visible symbol of the problem.

“GPs will do everything they can to ­prioritise the urgent care, but what gets pushed back is the chronic disease. ­Conditions that could wait a few days but that are waiting weeks may start bringing in additional risks.”

NHS England said: “Latest data shows more beds were available in September than in the same month last year due to the action taken to reduce delayed transfers of care. In the coming weeks, all local NHS bodies need to continue with this progress, focusing on ensuring patients do not wait unnecessarily in hospital.”


Broken pen
When Pauline Larwood choked on her steak in an American restaurant, Dr Royce Johnson tried the Heimlich manoeuvre — without success. He then performed an emergency tracheotomy, using a steak knife to make a hole in her throat, and a pen that he broke in two, inserting the cylinder as a breathing tube.

Toothpicks and spoon
Dr Tian Yu was on a flight in China when an epileptic passenger was found unconscious and foaming at the mouth. Dr Yu used a spoon and towel to stop the man biting his tongue and toothpicks to press acupuncture points. The patient regained consciousness.

Australian doctors plugged a poisoned Italian tourist into a vodka drip after running out of the medicinal alcohol they needed to save his life. He fully recovered.

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Brexit effects: Pharma may leave, and the severity of the financial rationing is evident, and will get worse. The fears of the Kings’ fund and the Nuffield Trust are not reduced… Listen …

The Nuffield Trust and the Kings fund were urging the chancellor “to address the critical state of health and social care” in the autumn budget. They have comment on the Budget and it’s implications for the Health Services in the UK. The impact of severe financial rationing on commissioners will lead to more post code and covert rationing.

“With the budget this week committing around £2 billion extra for the NHS next year, Nigel Edwards said it will bring respite for patients and staff, but is only around half of what’s needed. In a Q&A about the budget live on Facebook, John Appleby appeared with Anita Charlesworth (Health Foundation) and Siva Anandaciva (King’s Fund) to discuss what it all means for the NHS and social care. You can watch here.”

The economist November 18th reports: Withdrawal symptoms – Pharmaceutical firms trigger contingency plans for a no-deal Brexit – An industry with long production timelines cannot afford to wait any longer

ONE of the first tangible consequences of Britain’s exit from the European Union will be made clear on November 20th, when the EU announces the new home of its drug regulator, the European Medicines Agency, which is currently based in London. The agency will have less than 17 months to pack its bags before Britain leaves the EU in March 2019, whereas by its own reckoning it needs a transition period of at least two to three years.

The agency’s relocation is not the only worry facing one of Britain’s most important and most globalised industries. Pharmaceutical firms on both sides of the English Channel warn that time is running out for the EU and Britain to reach an agreement that allows them to continue operating without a hitch after 2019. Companies would need several years to adjust if such a deal were not made. Even agreement on a transition period, to smooth the first years after Brexit, may come too late to be of use to an industry with long production timelines. Firms are thus already preparing for an outcome in which Britain operates outside the EU’s medicines regulations. Some in the industry say they are arriving at an “accidental no-deal”.

Britain has some reasons to be optimistic about the future of its science industry. The pharma business depends more than most on research and development (see chart), which in turn depends on centres of academic excellence such as Cambridge, Oxford and London, which are not going

nywhere for now. Britain still ranks ahead of other European countries for the amount of biotech venture-capital investment that it receives.

Yet its contribution to manufacturing supply chains could dwindle. The Association of the British Pharmaceutical Industry, a trade group, says that if progress on post-Brexit arrangements is not made by December, an increasing number of pharma firms will activate costly “no deal” contingency plans to avert problems in the supply of medicines. AstraZeneca, an Anglo-Swedish company, and Eisai, a Japanese one, have already started to duplicate their testing and approval procedures elsewhere in Europe, in order to ensure access to the EU market after 2019.

Eisai says the work is costing many millions of pounds—money that it notes will offer “no gain” to patients. Pascal Soriot, the boss of AstraZeneca, says his company has an entire team working on Brexit contingency plans. Another large European pharmaceutical business with facilities in Britain says it is “on the cusp” of making a decision to move activities out of the country. GlaxoSmithKline, Britain’s largest pharma firm, will start spending on contingency plans from the end of the year.

Some companies based outside Britain are looking at ways to avoid passing their products through the country, in order to sidestep the costs and delays they might encounter should Britain leave the EU’s single market and customs union. Many drugs sold in continental Europe are primarily made in Ireland and then sent through Britain, where they are packed, tested, given marketing authorisation and released. Tommy Fanning, head of biopharmaceuticals at IDA Ireland, which promotes foreign investment in the country, believes that this British “bridge” to Europe could collapse if no deal is struck.

Continental Europe, too, has cause for concern. On November 9th the European Federation of Pharmaceutical Industries and Associations, a trade group, issued a warning to Brexit negotiators. Just under half the group’s member firms expect delays in the trade of medicines if Britain and the EU fall back to trading according to the rules of the World Trade Organisation. Over 2,600 medicines are at least partly manufactured in Britain, which supplies 45m packs of medicine to other EU countries every month, while 37m come in the other direction. Any Brexit settlement which disrupted these flows would be a bad prescription for patients on both sides of the channel.

This article appeared in the Britain section of the print edition under the headline “Withdrawal symptoms”


Sam Coates in The Times reports: Budget 2017: Hammond’s NHS boost ‘far less generous than it looks’

Philip Hammond’s cash injection for the NHS is far less generous than it looks and will be cancelled out by the growing and ageing population, says a leading financial think tank.

Health chiefs at NHS England are heading for a confrontation with ministers after declaring that the chancellor’s £2.8 billion boost in Wednesday’s budget was insufficient.

They are holding a board meeting next week to decide whether to step up rationing of services. One Whitehall source expressed surprise that NHS England was mounting what they viewed as an overtly political campaign to challenge the Treasury.

The Institute for Fiscal Studies (IFS) said that the NHS was in the middle of the toughest decade since its creation. “Real spending is essentially unchanged between 2009-10 and 2022-23 after accounting for population growth and ageing,” it added.

Carl Emmerson, the IFS deputy director, said: “The increase in spending does not mean good times for the NHS. The increases are far, far below what it is used to in previous years.”

He said that the £1.6 billion extra allocated for 2019-20 should be seen in the context of the total £125 billion budget. “So if we adjust not just for population but also age, we can see the increases look far less generous and pretty flat even if manifesto commitments are delivered,” he added.

YouGov polling for The Times suggests that increasing money for the NHS was the most popular measure in the budget. Some 62 per cent supported it as a top priority, against 23 per cent for the housing package and 18 per cent for the abolition of stamp duty for first-time buyers on properties of less than £300,000.

Mr Hammond said that the NHS needed to do more to cut waste so more was available for the front line. His aide, the Tory MP Kwasi Kwarteng, complicated the issue by saying that the NHS could receive the extra £350 million per week promised by Leave campaigners during the referendum. “I think actually that we could deliver that. That’s my own view,” he told the BBC.

The IFS also said that the £44 billion housebuilding package could not be relied upon to deliver a big impact.

Mr Hammond told the Commons he wanted the UK to build 300,000 homes a year, although this will largely be done by the private sector rather than a big public housebuilding programme preferred by some cabinet ministers.

The IFS said: “It is impossible to say with confidence how many houses it will deliver.” It questioned the chancellor’s claim that £44 billion was being spent on housing, saying “we haven’t worked out how that’s calculated”.

A former permanent secretary to the Treasury has said that the government’s stamp duty break for first-time buyers was a naked attempt to shore up support and would do little to help young people on to the housing ladder.

Lord Macpherson of Earl’s Court described the measure as a “relieving tax” for the government’s core supporters.

“The vast majority of young people can’t afford to buy any house and probably won’t for many years to come but the proportion of the population who can, no doubt with help from their parents, is the classic sweet spot of Tory middle England,” he said. “People who claim it is bad value for money get it wrong, this is all about shoring up political support.”

The IFS also said that Mr Hammond’s increase in duty on high-strength cider would only affect 9 per cent of the market. “Cider is still the most tax efficient way to get drunk,” said Helen Miller, associate director of the IFS.

There is also an income effect generator in the Times


Brexit NHS pledge could still be met claims Hammond aide – as experts warn winter boost will be spent in a day

Laura Donelly reports in the Telegraph 22nd November 2017: Brexit NHS Boost could still be met claims Hammond – aid as experts warn boost will be spent in one day


The NHS could still get the £350m a week funding boost promised on the Brexit bus, the Chancellor’s aide has claimed – amid warnings that the latest cash boost will be spent in one day.

Health officials will meet next week to discuss rationing measures, after expressing disappointment at the funds awarded in Wednesday’s budget.

The health service will receive an immediate cash boost of £350m to tide it through the winter, as part of a £2.8bn boost to revenue funding over three years.

NHS chiefs say the funding is not enough, and compares poorly to the pledge of an extra £350m a week made by the Vote Leave campaign.

n Thursday, Kwasi Kwarteng, Philip Hammond’s parliamentary private secretary, insisted that pledge could still be met, after Britain leaves the EU.

The MP said he believed that the promise on the side of the Vote Leave buses, to deliver £350m a week for the NHS, still held good.

“That’s what was said on the side of the bus.  And I think actually that we could deliver that.  That’s my own view.  That’s a personal view,” he said, in a BBC Radio 5 Live interview.

“We spend £350m a week now for our EU contributions.  Now when that ends, we will have that money.  And it would be possible, if you were a Chancellor or someone leading a government, to use that money on the NHS.  All those things are incontestable.  That is the truth,” he told Emma Barnett.

Health chiefs will meet next week to discuss the introduction of deeper rationing measures having already warned of an “inevitable” lengthening in waiting lists.

But think tanks suggested the immediate cash injection, aimed at averting an NHS crisis this winter, may do little to help it withstand growing pressures.

Prof John Appleby from the Nuffield Trust told a BMJ debate:”£350 million sounds like a lot, but is a day’s running costs for the NHS.”

And Siva Anandaciva, chief analyst for the King’s Fund, suggested the funding had come so late that the NHS would be forced to pay bumper rates for extra help.

“It’s already November; it’s hard to see how you are going spend that money in a value for money way.” he said.

“You can buy extra capacity for operations from the independent sector, you can get more staff on temporary contracts at premium payment; but all of this would have been more effective if the money had been given the earlier in the financial year,” he said.

On Thursday a report by the European Commission said hospitals in the UK are working at “near-full capacity” with the second highest levels of bed occupancy in Europe, with only Ireland having higher levels of crowding. The study also shows Britain has the third lowest number of beds and doctors in the EU, compared with its population. The analysis of Organisation for Economic Co-operation and Development data also warned of a sharp drop in nursing levels, and said average length of stay is now a full day shorter than the EU average.

Earlier in the day Mr Hammond suggested NHS leaders complaining about the funding should focus on cutting waste in the NHS.

The Chancellor said the Treasury would work closely with Simon Stevens, head of the NHS, to improve health service productivity.

“Simon Stevens set out a five-year plan for the NHS in 2014 which we funded in full and that five-year plan has not yet been delivered,” he told ITV’s Good Morning Britain.

“The NHS have come back and said, ‘look, demand has been higher than we expected, we need some more money’, and we have put some more money in.

“We will continue to work closely with the NHS management and the Department for Health to make sure that we cut out waste in the service, that we focus the money that is available on the frontline on delivering for patients and we get the outcomes that the NHS five-year plan said it could deliver over that period of time,” he said.


Why is the NHS under so much pressure?

  • An ageing population. There are one million more people over the age of 65 than five years ago. This has caused a surge in demand for medical care
  • Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years. This has caused record levels of “bedblocking”; people with no medical need to be in hospital are stuck there because they can’t be supported at home
  • Staff shortages. While hospital doctor and nurse numbers have risen over the last decade, they have not kept pace with the rise in demand. Meanwhile 2016 saw record numbers of GP practices close, displacing patients on to A&E departments as they seek medical advice
  • Lifestyle factors. Drinking too much alcohol, smoking, a poor diet with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and needing to rely on our health services. Growing numbers of overweight children show this problem is currently set to continue


Children attempting suicide in order to access mental health care

A minority of non-voters who don’t count politically have been deprived of appropriate care by rationing. Not enough money and not enough people for decades has led to this shameful situation.. The successive ministers should feel guilty, The parents of these children need a scapegoat… And in many cases the private option will not be possible.

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Kat Lay in The Times 22nd November 2017: Children attempting suicide in order to access mental health care

Desperate pupils are attempting suicide to get mental health treatment, the children’s commissioner has warned.

Anne Longfield told the Commons health select committee that children as young as 13 felt they could only access support in the most extreme circumstances. “Visiting a school quite recently, they told me that actually they had had five occasions of either attempted or threatened suicide in this year alone, and that was something that they would never have had five or six years ago,” she said.

The committee is conducting an investigation into the availability of child and adolescent mental health services. Statistics suggest that on average the services are turning away nearly a quarter of children referred to them.

NHS England insists that it is putting more resources into the sector.

Mrs Longfield said she had been “really shocked . . . when 13-year-olds told me that they understood that feeling suicidal wouldn’t get them treatment”. Instead, she said, they thought that they would “have to have attempted suicide”. She added: “In my slight naivety, I thought that was quite shocking, but as I asked others it seemed to be the norm.”

The Times has demanded urgent action over child mental health as part of its Time to Mind campaign, which calls for early intervention to stop youngsters ending up in hospital.

Disgraceful post-code differentials in the care of children. We are losing our humanity because we fail to address the rationing issue..

“..a brutal and potentially fatal form of healthcare rationing”. It should be the politicians with “an inability to face the outside world” rather than the patients..

The Busted flush in Mental Health: Children and young people denied mental healthcare

NHSreality wants scapegoats – and suggests the successive ministers of health (for England). Allyson Pollock might agree..

Tommy Stubbington: NHS cash crisis reveals the fractures in our finances in the Times 5th November 2017 – before the budget