Monthly Archives: June 2018

Social care ‘close to collapse’ in most councils. The difference between public and private places, in the same homes, is “covert”, and needs to be routinely exposed.

Whilst Norway has a National Investment fund, which represents joint savings for unforeseen events, the UK has nothing. My pension is not funded from savings, or from my earnings, but from todays younger people in work. The reality of the shortfall for social care, and the difference between the bills paid by private customers as opposed to the state’s, are scandals. Families must ask for the difference between the private and the public funded places when their member first enters a home. Even if they still go ahead and are admitted, the truth is then out in the open. The difference between public and private places, in the same homes, is “covert”, and needs to be routinely exposed.

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Greg Hurst reports in the Times 12th June 2018: Social care ‘close to collapse’ in most councils

Three quarters of local authorities fear that their provision of residential homes and domiciliary care is close to collapse because of rising demand and reduced funding.

A survey found that 78 per cent were concerned that they may be unable to meet their duty to ensure a stable market for social care. Nearly half, 48 per cent, said that providers of home care, which are mainly private companies, had ceased to trade in their area in the past year and 44 councils said that companies had given up contracts because they were losing money.

The survey of 152 councils was by the Association of Directors of Adult Social Services. In addition to arranging adult care they have a duty to stimulate a diverse market for care provision.

The government announced a £2 billion boost for the care system last year. Jeremy Hunt, the health secretary, is to publish plans to reform social care next month.

Comment from the Times:

The welfare state model is going to have to change. People are going to have to save for their retirement (and no, NI is not going to do it for you) like they do other things such as a mortgage and not expect the state (that is other taxpayers) to provide support because you couldn’t be bothered providing for it yourself. Of course there will be means tested exceptions, that it what the state is there for, a social safety net for those in true need who didn’t have the option of preparing for retirement. Being profligate whilst working and expecting others to pick up your bill when retired, doesn’t count!

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NHS will help to find jobs for patients

Just because NHS England is going to do this, it does not mean the other 3 health services will do it. or that it will work. But it is good news, and the right way to think. The comment from the Times online which I have cut and pasted below summarises the “good news”. It will be interesting to see if the service lasts, and if the other Regions take it up.

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Kat Lay reports on the NHS England announcement 12th June in the Times: NHS will help to find jobs for patients

The NHS is to hire 300 employment coaches who will find patients jobs to keep them out of hospital.

Those in work tend to be in better health, visit their GP less and are less likely to need hospital treatment.

The specialists will help people with severe mental illness to seek work and hold down a job. They will offer assistance on CVs and interview techniques and are expected to work with 20,000 people by 2021. Pilot schemes running in Sussex, Bradford, Northampton and some London boroughs suggest that the coaches find work for at least a quarter of users. The scheme is being extended nationwide.

Claire Murdoch, NHS England national mental health director, said: “Tackling severe mental illness is not just about getting medication and treatment right but ensuring people can recover to live independently with their condition, including the reward and satisfaction of getting and keeping a job.”

NHS England is putting £10 million into the scheme over the next two years with further investment planned.

Coaches are urged to build relationships with employers to gain access to the “hidden” labour market of jobs that are never advertised. The specialists, whose support is not time-limited, then act as a link between a patient, their employer and their medical team.

A Centre for Mental Health review calculated that the scheme saved £6,000 per client over 18 months.

Far from being a waste of money this is long overdue. So often adolescents with special needs are let down by CAHMS and then as they mature, adult social services. What they need is an opportunity to contribute to society as they are able and in return receive both a fair wage and a sense of worth. At the moment all they hear is “limited resources”.

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England will lose more than 600 GP practices by 2022 without urgent investment, BMA analysis reveals

BMA News 8th June reports: England will lose more than 600 GP practices by 2022 without urgent investment, BMA analysis reveals

More than 600 GP practices in England will be lost in the next four years if investment is not increased, according to analysis by the British Medical Association.

The BMA has produced two projections based on the rate of practice closures and mergers over both the last six years, and between 2016 and 2017, which estimate that England is set to lose between 618 and 777 practices between now and 2022.

If these projections bear out, millions of patients will need to find a new practice.

According to NHS Digital1, there were 166 fewer practices in 2017 (7,361) compared to 2016 (7,527), while the total has fallen by 963 since 2010, when there were 8,324 practices in England.

While the fall in numbers is partly due to mergers, many will have closed or been forced to merge as the result of the….. continued pressures on general practice, following a decade of underinvestment.

The BMA is now urging the prime minister, as part of her pledge to produce a long-term funding plan for the NHS, to address the historic underfunding of general practice………..

 

NHS using 34‑year‑old equipment

The current crisis of capital  and lack of investment in plant, has left us all subject to old equipment, and inadequate images. Allied with poor purchasing power organisational skills, the health services need to replace their oldest equipment. X ray machines, for example, are much more efficient and use much less radiation and more sensitive plates than 30 years ago.

Chris Smyth reports 11th May 2018 in the Times: NHS using 34‑year‑old equipment

Patients are at risk because they are routinely being treated or diagnosed using equipment that is decades old, including scanners that are past their use-by date, Labour has claimed.

Diagnosis of cancer and other conditions is harder because hospitals have skimped on replacing vital machines, the party says. An x-ray machine from 1984 is being used at a hospital in Leeds, in Oxford staff are using a 1992 ultrasound scanner and an MRI scanner at the Royal Free in London should have been replaced in 2007, according to data from freedom of information requests.

Responses from 93 NHS trusts found that 892 x-ray machines were more than ten years old, including 139 that are beyond their replacement dates. There are 295 ultrasound machines still going after more than a decade, including 134 past replacement age.

Jon Ashworth, shadow health secretary, said: “Tory cuts to capital budgets mean we have among the lowest numbers of CT scanners and MRI scanners per head in the world.”

Theresa May has promised extra money for the health service, but Mr Ashworth said: “It will be a key test of any new funding settlement for the NHS in the coming weeks that it makes up for years of Tory cuts to capital budgets which have left hospitals unable to replace essential equipment and have put patients in danger.”

Phillippa Hentsch, of NHS Providers, said that money to maintain and develop equipment “has been used to prop up day-to-day NHS spending”.

The Department of Health said that the government had “announced £3.9 billion of new capital investment”.

 

There is no need to wait for a decade for a new hospital – but that is how long it takes for a new cohort of doctors.

Chris Smyth in the Times 9th June reports: Flat-pack operating theatres in NHS bid to build new hospital every year

There is no need to wait for a decade for a new hospital – but that is how long it takes for a new cohort of doctors.

Dozens of flat-pack casualty units, operating theatres, maternity wards and MRI suites will be built under plans to increase NHS efficiency through prefabricated hospitals.

Ministers are hoping to spend a significant chunk of a £3.5 billion infrastructure fund on ready-made hospitals that speed up construction and standardise NHS buildings.

With conventional buildings taking the best part of a decade to complete, ministers say that the NHS does not need “bespoke” designs when off-the-shelf can be quicker and cheaper.

So far 21 construction companies have been signed up to a scheme to make it easier for hospitals to buy prefabricated buildings, with officials insisting that modern developments, designed to last 60 to 70 years, could end the traditional prefab image of leaky roofs and wobbly floors.

The scheme will also signal to the Treasury that the NHS is serious about improving productivity, as Philip Hammond, the chancellor, is demanding efficiency in exchange for the extra money promised by Theresa May.

Stephen Barclay, the health minister in charge of finance and procurement, told The Times: “Modular design brings economies of scale, as the more units you have the cheaper they become.” He added that such buildings could be rolled out quicker, giving “a huge performance opportunity for the NHS”.

Mr Barclay is overseeing bids from hospitals for a share of the £3.5 billion promised by Mr Hammond to clear an infrastructure backlog and allow the NHS to implement reform plans designed to join up services and move care closer to home.

The government says the programme promises the equivalent of a new hospital each year, alongside dozens of smaller projects, and Mr Barclay wants to encourage prefab companies to work with the health service.

“We’re looking actively at it because all too often the NHS has built bespoke buildings. There is scope for greater consistency, which is good for staff, considering where staff move and allows us to roll out buildings in a quicker way and to a very high quality,” he said.

Nathan Hodgson of NHS Shared Business Services, an outsourcing company part-owned by the government, argues that standardised buildings could yield savings of 10 to 20 per cent.

While previous projects have not always been cheaper, prefab buildings typically take half the time of traditional construction, with wards functioning within six months, he said. The government hopes that getting new services running quicker will cut delays, cancellations and bed-blocking.

Saffron Cordery, deputy chief executive of the hospitals’ group NHS Providers, said that while they were happy to look at more cost-effective construction, standardised buildings might be a step too far.

“There may be a significant role for modular buildings, but it is important to remember that different services and sites have different needs, and the buildings will need to suit their specific circumstances,” she said.

• Banks have cancelled more than £100 million of funding for a new hospital after the collapse of the construction company Carillion in January. The European Investment Bank had brought in four lenders to co-finance the construction of the Midland Metropolitan Hospital in Smethwick, West Midlands, but has now said it will be pulling the plug on the £107 million funding. The local NHS trust will seek help from the government.

Whay are patients like me denied a new cancer drug? You know the answer – rationing…

Sean O’Neill knows the answer to his question. But he thought, before he was ill, that he never would need to ask this question. After all, politicians deny rationing, and only restriction, priorities, and exclusions. We need not ration at the low volume high cost end (as much) if we charge for the low cost high volume end.

Why are patients like me denied a new cancer drug?

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The cancer cure stories have been coming thick and fast over the past month. We’ve had the “biggest breakthrough since chemotherapy”, a woman cured of breast cancer with an injection of her own cells, a hormone pill that will “liberate thousands of women” from chemotherapy and the notion that artificial intelligence will beat the disease.

After Tessa Jowell’s death from brain cancer last month, Theresa May found a magic money tree to give more patients access to experimental treatments. And Simon Stevens, chief executive of NHS England, was moved to declare that an early diagnosis blood test had placed us “on the cusp of a new era of personalised medicine that will dramatically transform care for cancer”.

Mr Stevens’s lofty words are wedged firmly in my craw, impossible to swallow. I have a cancer, chronic lymphocytic leukaemia, that is already striding into a new era in which doctors feel chemotherapy is largely unnecessary and dangerously counterproductive.

There is a groundbreaking drug available, a once-a-day pill, which stops the growth of cancerous cells without blasting the bone marrow. It’s a drug that allows most patients to get back to a full life — enjoying time with their families, going to work, paying their taxes.

This is no pie-in-the-sky experiment: it’s here now. The National Institute for Health and Care Excellence (Nice) says this drug, ibrutinib, is “innovative and effective” and should be “routinely available” for patients (like me) who have relapsed after a previous course of chemotherapy.

But Mr Stevens is denying us ibrutinib. His bureaucrats overruled Nice and issued doctors with a checklist restricting the prescription of the drug. Instead, Mr Stevens thinks I should endure another six months of debilitating chemotherapy, this time including a drug called bendamustine, derived from mustard gas by East German scientists in the 1960s. So much for a new era.

True to form for Whitehall, Mr Stevens’s communications officers refuse to answer questions about who overruled Nice, why or what other drugs are being restricted like this. Jeremy Hunt, the health secretary, should surely intervene. The health department says the NHS “is legally required to fund” Nice-approved treatments.

If Mr Hunt, who has received dozens of letters from MPs about this issue, has not already called in Mr Stevens to ask him why NHS England appears to be breaking the law by secretly curtailing access to approved drugs, now is the moment.

Sean O’Neill is chief reporter

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The cost of technology is exceeding our ability to pay.

Commissioners and Trust Board directors find themselves in an impossible position. Their political masters will not allow use of the word “rationing”, and yet they are expected to keep up with new treatments, and make them available to all. We rarely hear any “exit interviews” but the resignation of Bob Kerslake following the demoting of KGT to “special measures” should tell the politicians what the professionals already know: the health services are founded on financial sand. The edifice is falling.

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Chris Smyth reports 6th June in the Times: Discount deal opens up new cancer treatment but 

Of course there are numerous other treatments, and much money has been invested to get a return!

Hundreds of lung cancer patients will receive a cutting-edge immunotherapy drug on the NHS after health chiefs boasted of beating down prices.

The deal was the first test of a controversial policy that allows NHS England to restrict or delay medicines that will cost taxpayers more than £20 million a year, even if deemed cost-effective.

Officials said the threat of such measures had been enough to persuade the drugmaker, MSD, to agree a confidential discount. Pembrolizumab costs £84,000 per patient at full price and to get below the threshold would have to be reduced to a fraction of that. About 1,800 patients a year will now be eligible.

Pembrolizumab is one of new class of medicines that boost the body’s own natural defences against cancer. It is used in cancers of the lung, stomach, head and neck, skin and bladder and is being tested in other types such as prostate cancer.….

On the same day Kat Lay reported: Targeting cancer’s genes prolongs life

Treating cancers based on their genes, rather than where they occur in the body, increases a patient’s chance of surviving for a decade six-fold, a study has found.

Data presented at the American Society for Clinical Oncology (Asco) meeting in Chicago showed that 15 per cent of patients given drugs that targeted specific genetic mutations in their tumours survived for three years, compared with 7 per cent of patients who had standard unmatched therapy.

Six per cent of the matched group survived for ten years compared with 1 per cent of the unmatched group.

“All patients should have access to next-generation sequencing and I believe in the next few years we are going to see this approach dramatically improving outcomes,” Apostolia Tsimberidou, who led the research, said. “We need to know what is really causing these diseases so we can treat them properly.”

Researchers from the University of Texas looked at more than 3,000 patients with cancers including breast, lung, gynaecological and stomach tumours. After using a technique called next-generation sequencing, which tested between 20 and 50 genes simultaneously to determine exactly which molecular abnormalities were present in the tumours, they found that 1,307 had at least one genetic change. Some 711 of those patients received drugs matched to the biology of the tumour, for example blocking the function of the mutated or altered gene, sometimes alongside chemotherapy. A further 596 received a drug that was not matched to their tumour’s biology, usually because a matched treatment was not available to that patient at the time.

Those studied had advanced cancer that standard care had failed to halt, with some having tried 16 therapies. While overall survival in the study was small because the patients involved were very ill to start with, Professor Tsimberidou said that the results would probably be even more striking had the technique been used earlier.

In the NHS, many cancer patients receive genetic testing of some type, but next-generation sequencing has yet to be adopted widely. The cost can vary but has declined rapidly in recent years, with some versions costing about £300.

Professor Tsimberidou said that one patient in her clinic had had glioblastoma — the aggressive brain cancer that killed Tessa Jowell, the former cabinet minister, last month — diagnosed in 2011 but was still alive thanks to personalised treatments.

Catherine Diefenbach, an Asco expert, said: “We’ve just scratched the surface. Now with faster and more robust genetic tests we can help even more patients by treating the cancer based on its genetic makeup rather than solely on its location in the body.”

 

Lets make the four health services finacially secure… A new report demands more money, but this alone is not enough..

There is an opportunity afforded by the new report into the health services, and England in particular. Private health care is experiencing a boom as the health Services deteriorate, and loss of personnel (retention) is as bi a problem as recruitment. As the Financial Times reported December 11th, even centres of excellence are being put under “special measures”.   

The long term effects of under resourcing general practice were explained succinctly on Radio 4 today programme on 5th June by Helen Stokes Lampard. (The RCGP chair represents the academic side of General Practice, whereas the BMA is the union.)

Yesterday the Kings Fund and Nuffield Trust, and the Health Foundation published their opinion: An open letter: a long-term funding settlement for the NHS   

Even they however, refuse to agree that health care has to be rationed!

The BBC has announced today “PM to give ‘significant’ cash to the NHS”, but this is NOT enough. The largest drain on resources is staff, and there are just not enough of them. Money may help, but longer term it is more people, and training takes a decade or more. All the professions know that the money may well be wasted.

Dennis Campbell for the Guardian reports today: May to give NHS ‘significant’ cash boost, Jeremy Hunt reveals – Exclusive: health secretary says PM 100% committed to NHS in Guardian

The Telegraph reported 30th July 2017: Nuffield Health sales leap as the NHS comes under strain

The FT December 11th: King’s College Hospital — a ‘canary in the NHS coal mine’? Trust placed in special measures as deficit spirals and chairman quits

After Rachel Sylvester’s article in the Times, todays letters;

Sir, Rachel Sylvester is right: we really do need to listen and act on the unfolding care crisis (“May should stop tinkering and start spending”, June 5). We are a “hospice at home” and last year looked after 1,760 families in their homes. A study of our night service shows that by being responsive we prevented many 111 and 999 calls for help and consequent admissions. A survey of total daily costs for home care from all visits of healthcare professionals and carers over a 308-day period shows that it cost only £75 per patient per day on average, compared with the £250 per day in hospital mentioned in Sylvester’s article.

Despite our competitive costs and the fact that 93 per cent of families are highly satisfied with our care at home, the local clinical commissioning group cut its annual funding contribution for 2018-19 by 15 per cent. It is exasperating and just one example of muddled thinking, given that a very small amount of additional NHS funding would make a huge difference. All that is achieved by this cut is more pressure to raise more charitable funds just to stand still, and an inability to take on more work. If community services are to survive, let alone prosper, we need support and partnership now.
Professor Stephen Spiro

Chairman, Rennie Grove Hospice Care, Tring, Herts

Sir, Rachel Sylvester says that Theresa May needs to take a risk, just like in Monopoly, in order to solve the crisis in the NHS. However, this “risk” involves nothing more than throwing more money at the NHS. Given that almost everyone says this is what she should do, it is hardly a risk.

A real risk, involving true bravery, would be to highlight that the NHS has a worse record on cancer survival rates and avoidable deaths than most countries in Europe, and is on a par with Slovenia or the Czech Republic. The NHS has issues with productivity, efficiency, and wasteful spending. It also lags behind other healthcare systems on innovation.

Mrs May needs to insist that the NHS makes dramatic improvements in the above areas before it receives an extra penny. After all, it is not Monopoly money that will foot the bill but an increased tax burden, one that will place additional pressure on households already struggling with the cost of living.
John O’Connell

CEO, TaxPayers’ Alliance

We need tax and fiscal policies that upset some!..”The role of a leader is to persuade voters of the need for reform, rather than just to follow public opinion.” but we have no leadership, and no honest debate ..

We need tax and fiscal policies that upset some!..”The role of a leader is to persuade voters of the need for reform, rather than just to follow public opinion.” but we have no leadership, and no honest debate .. The media find health too complex, and in a media led society this is part of the collusion of anonymity and denial. Where the author mentions priorities – rad rationing.

June 5th in the Times: Theresa May should stop tinkering and start spending

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To solve the crisis in health and social care, the PM must come up with tax-raising policies that risk upsetting people

Politics is a bit like playing Monopoly. Leaders start the game with a pot of political capital that is gradually eroded by power. As they go around the board dealing with events, they spend more to build up a property empire of popular support. There must be an element of risk-taking and ruthlessness, as well as responsibility. Luck is required, but also the wisdom to know that you must create your own good fortune. The winner is the person with the most capital left when the country goes to the polls, even if everyone is almost bankrupt.

……There is a chance for the prime minister to play a winning hand on the NHS in the year of its 70th anniversary but it will require a courage that she has so far lacked. Jeremy Hunt, who yesterday became Britain’s longest-serving health secretary having fought off No 10’s attempts to move him at the last reshuffle, is pushing hard for more money and he knows reform is also required. Boris Johnson is piling in with demands for a “Brexit dividend” for the NHS, while Sajid Javid wants to overturn the “hostile environment” of immigration and relax visa restrictions on foreign doctors. Philip Hammond understands the need for resources to cope with an ageing population. If the settlement is to be more than a sticking plaster that falls off at the first hint of rain, however, leadership from the prime minister is needed to win some difficult arguments.

The NHS crisis is also a social care crisis in which nearly one in ten hospital beds are taken up by patients who are well enough to go home, a situation that is traumatic for families and damaging to the health service. There needs to be much greater integration between the health and social care systems, with budgets reallocated people in the community. That will mean closing hospitals or reducing the number of wards — a political taboo for many MPs — but if Mrs May is serious about reform it is a row worth having.

It costs about £250 a day to keep somebody in hospital and only £100 for a domiciliary care package, so rebalancing the system would save money and be better for patients. In six areas where the NHS is piloting a scheme to send doctors and nurses into care homes, emergency hospital admissions have fallen. Wakefield reduced ambulance callouts by 9 per cent and the number of days spent in hospital by care home residents by 26 per cent, while in Sutton there was an 18 per cent drop in bed days.

The prime minister also needs to make the case for tax rises, including on the elderly. According to the Institute for Fiscal Studies, spending on healthcare will have to increase by an average of 3.3 per cent a year over the next 15 years, and social care funding by 3.9 per cent, just to maintain current provision. In other words, the NHS needs an extra £2,000 from every household to continue functioning properly. On top of that, the government must introduce a cap on care costs to end the unfairness that some people who have to spend years in residential care end up with crippling bills while others pay nothing. That would cost about £6 billion a year. Such sums cannot be raised by trimming budgets or cutting costs — there needs to be a public debate about priorities.

Mrs May is understandably nervous about engaging in this discussion after the fiasco over the “dementia tax” during the last general election campaign. That policy, however, was fatally flawed because it increased the amount that many people would have to pay for social care without spreading the risk. It therefore created a political problem without solving the policy dilemma.

There is growing cross-party support among MPs for working pensioners to pay national insurance. At the moment a 64 year old and a 66 year old doing the same job take home different amounts because pensioners are exempt from the deductions, which is illogical and unfair. The levy could be turned into a dedicated health and social care tax, which could be put up or down each year in line with demand. Billions more could be raised by scrapping the planned cut in corporation tax and abandoning the now-annual fuel duty freeze. There may also need to be adjustments to property taxes to ensure those with the greatest assets contribute more. None of this will be popular with everyone but the role of a leader is to persuade voters of the need for reform, rather than just to follow public opinion.

The rumour in Whitehall is that the government is heading towards a promise of a 3 per cent boost for the NHS. Tory MPs have been told it is “not helpful” to ask for more than that. As one senior backbencher puts it: “That would be treated with dismay because it doesn’t even keep the health service at standstill.”

To govern is to choose. If she wants to have a legacy beyond Brexit, Mrs May should approve a proper funding settlement for health and social care, involving radical reform, rather than tinkering around the edges with a package that pleases no one.

One senior Conservative MP says that the prime minister has “to a quite extraordinary extent no leadership in her DNA”. It is time to break with the habit of a lifetime and roll the dice if she wants to get another chance to pass Go on the political Monopoly board and collect £200.

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High Tech advances hit NHS funding. A proper debate wont happen however.

The state is not able to keep up with the advance of technology. This means we HAVE to ration care. It’s just a choice of rationing covertly and differently by post code/region, or doing  it overtly. Our cowardly political masters know this, but refuse to speak out. The media thinks health is too complex for a sustained debate that their readers will appreciate. So, in a media led society,  it won’t happen.

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HI-TECH ADVANCES HIT NHS FUNDING
Nye Bevan did not foresee, and your leader neglects, the effects of medical advances on both NHS funding requirements and patient demand (“Higher tax is not the only solution to an ailing NHS”, Editorial, last week).

New investigations and treatments create “wants”, which change to “needs” as they become familiar. Such advances have been dramatic and are often expensive: if they extend life beyond what was previously possible, patients survive to require more clinical management for longer. Thus the costs are not limited to the treatments themselves, but to the longevity they facilitate.

No country, whatever its healthcare model, can provide the funding that could potentially be absorbed as technology advances. We have to recognise this and use funding wisely. A mature debate is long overdue.
Dr Vernon Needham, provost, Wessex Faculty, Royal College of General Practitioners

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Red-tape waste
Your editorial is correct. Huge sums are being wasted through the present complex system of commissioning healthcare. The internal market process has been estimated to consume 14% of the total NHS budget and has not been shown to improve outcomes.

About 200 clinical commissioning groups (CCGs), each with its own infrastructure, have to negotiate with multiple providers. Recent changes were meant to reduce bureaucracy, but my experience on the governing body of a CCG leads me to believe the opposite has happened. The system is divisive and wasteful.
Professor Robert Elkeles, Northwood, London

A bus-load of cash awaits
It shouldn’t be difficult to find more funds for the NHS. As those of us who followed the EU referendum can attest, Boris Johnson and Michael Gove know where to find an extra £350m a week.
Stephen Ball, Littleborough, Greater Manchester