Category Archives: Trust Board Directors

The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply

Normally there would be a budgetary report on the English Welsh and Scottish Trusts before the election. Home office staff are arguing that such data is so politically sensitive that it should be kept secret until after the election. What nonsense. Hiding the truth is not a good precedent for something which should be routine. Darlington Hospital is one of many who may not be able to pay their staff. The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply to something routine and pre-planned. BBC News reports 19th May: Reality Check: Why is NHS budget data delayed by purdah? and Will NHS stats spark polling day debate? 

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All the Trusts are bust.

Ben Glaze in the Mirror reports 20th May 2017: Tories accused of ‘blocking damning figures on state of NHS finances’ – Key statistics were due to be released at the end of May but ministers are citing “purdah” rules to hold the information back until after the election

on 19th May in the Northern Echo, Graeme Hetherington reports: Darlington Memorial Hospital trust could run out of money to pay some wages unless plan to solve cash crisis is found

A HOSPITAL trust could run out of money to pay some staff wages unless it comes up with a plan to solve its dire financial predicament by next month.

Concerns over the future of Darlington Memorial Hospital have been raised after details of its financial situation were leaked to The Northern Echo.

Senior management and consultants are being told to tighten their belts as money-saving initiatives are missing their targets and an email sent to some staff has highlighted that the trust could run out of money if drastic action is not imposed.

The County Durham and Darlington NHS Foundation Trust ( CDDFT) introduced cost reduction targets (CRT) in an attempt to balance its books – but is missing its £6.9m savings target by about £1.7m.

The detailed email raises the prospect of the length of operation and appointment waiting times being extended beyond the Government target of 18 weeks, the Trust’s inability to cover staff wages and a reduction in nursing levels.

However, the CDDFT’s consultant surgeon and surgical care group director is reassuring people that patient safety is central to all discussions in the hospital and that there are no plans to reduce staffing levels.

The internal email was sent out to senior staff following a meeting of the Trust’s Financial Stability Programme, which was described as a “maul” after the stark warning was driven home by finance chiefs.

And the news comes just days after it was revealed that maternity services at the hospital could be lost as plans are being investigated to centralise care in Darlington, Durham and North Tees – albeit on a temporary basis.

Today, the full extent of the financial pressures on the hospital’s surgical departments can be revealed.

The email reads: “The three of us have to go back in four working days time with a full plan, costed and developed for a further £1.5m pounds of guaranteed CRT in addition to the already identified as an interim to meeting the full amount. So far in month one we are forecasting to be £350k (April) overspent due to not achieving CRT.

“I do not intend to just pass on this message in the same way. You all work hard and I know you are all very hard pushed for time. However, I need urgent and focused work form every one of you to help the senior triumvirate as yesterday’s is an experience I have not had before and never want to have again.

“I have been asked to ensure that all staff are fully briefed that if by June we do not have a full plan for CRT and are not completely in control of expenditure that we, CDDFT, will run out of cash to pay wages.

“Whist this has been briefed before I chose not to put it in these terms. I have been asked not to sanitise the message.”

But Mr Steve Scott, consultant surgeon and surgical care group director at County Durham & Darlington NHS Foundation Trust, has reassured people that patients’ health will not be put at risk, as the document is not a formal trust plan.

He said: “NHS organisations are working under financial pressure and we regularly review the best way to provide safe efficient patient care. It is worth noting that County Durham & Darlington NHS Foundation Trust ended 2016/17 with a surplus and ahead of our financial plan.

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What and when is “purdah”?

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Perverse outcomes abound in a Media Led society. The utilitarian imperative would be ignored by the press, and will be by shallow politicians.

The rationing of drugs by the four UK Health Services is logical. There may be post code differences but that does not mean it is wrong. It’s logical and ethical and pragmatic rationing. However, once a drug is of proven benefit and is very expensive there must be a level at which NICE disapproves. This is currently £30,000 per year. If we rationed low cost high volume medications (paracetamol etc) we could possibly afford to raise this threshold. If NHSreality was commissioning, it would spend the money on people… especially in Mental Health support care, and reduce the threshold!!

There is a large risk of another perverse outcome in a Media Led society. The utilitarian imperative would be ignored by the press, and will be by shallow politicians.

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Laura Donelly reports in the Telegraph 15th May: Political parties urged to commit to reversing NHS drug rationing plans

More than 30 charities have written to the three party leaders urging them to commit to reversing NHS measures to increase rationing of medicines.

Health officials last month brought in new thresholds which mean access to one in five treatments could be delayed or restricted.

Under the rules, all drugs expected to cost the NHS a total more than £20 million a year will be checked against new “affordability criteria”.

The cost threshold set by NHS England could affect medicines costing as little eight pence a day, if used commonly enough, as well as high cost medicines used for rare diseases.

Rationing body the National Institute for Health and Care Excellence (Nice) has said it is likely to affect around 20 per cent of drugs it assesses, with the process including changes that the head of its rationing body has previously described as “unfair”.

In an open letter to Theresa May, Jeremy Corbyn and Tim Farron, the charities – which include Parkinson’s UK, the Children’s Heart Federation and the MS Society – ask all the parties to commit to reversing the changes.

The signatories – all members of the Specialised Healthcare Alliance – said that the measures “stand to restrict and ration treatments for people with rare and complex conditions, and were implemented without the agreement of Parliament.”

The letter comes as political parties prepare to publish their manifestos for the election.

Caroline Harding, chief executive of Genetic Disorders UK said: “Under these plans, some of the most critically ill patients are being denied access to potentially life-changing treatments.

“Any decision to ration access to medicines should be taken by ministers, not unelected officials.”

Kay Boycott, chief executive, Asthma UK, said: “There is a real risk that these plans will turn the clock back on access to life transforming treatment.”

Sarah Vibert, chief executive, Neurological Alliance, said: “Politicians from all sides should pledge to rethink these damaging proposals.

“It is completely unacceptable that patients with neurological conditions risk being denied access to treatment solely on the basis of cost.

None of the parties have formally published their manifestos. But the draft Labour manifesto, leaked last week, said: “Labour will tackle the growing problem of rationing of services and medicines across England, taking action to address postcode lotteries and making sure that the quality of care you receive does not depend on which part of the country you live in. We will ensure that NHS patients get fast access to the most effective new drugs and treatments.”

Jonathan Ashworth, shadow Health Secretary, said: “There is a real and growing worry that Theresa May’s ongoing underfunding of the NHS means patients just aren’t getting access to new medicines. Patients need fast access to medicines and treatments which are recommended by Nice as being clinically and cost effective. Labour is committed removing the barriers which are being put in place and to ensuring that NHS patients get fast access to the most effective new drugs and treatments.”

A Conservative spokesman said: “NHS spending on medicines and treatments is now second only to staffing costs – in fact, the NHS in England spent more than £15 billion on medicines last year, a rise of nearly 20 per cent since Labour left office. But we can only ensure more patients than ever get outstanding care if we continue to invest in the NHS on the back of a strong economy – something Jeremy Corbyn and the other parties who’d prop him up in Downing Street simply could not do.”

Liberal Democrat Health Spokesperson Norman Lamb said:  “This is a shameful retreat from the core principle of the NHS, that treatment should be available to patients regardless of their ability to pay.

“The rationing of treatments is an inevitable consequences of this government’s chronic underfunding of the NHS. NHS England is caught between a rock and a hard place because they simply don’t have enough resources.

China’s One child policy and pension

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

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, meaning elderly people with no medical need to be in hospital are stuck there. Latest quarterly show occupancy rates are the highest they have ever been at this stage of the year, while days lost to bedblocking are up by one third in a year

Meanwhile rising numbers of patients are turning up in A&E – around four million more in the last decade, partly fuelled by the ageing population

Shortages of GPs mean waiting times to see a doctor have got longer, and many argue that access to doctors since a 2004 contract removed responsibility for out of hours care

 

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Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”.

In the Times this letter from many oranisations on 10th May 2017, under the title “HEALTH REFORMS PLEA” got little publicity because of the Media focus on Brexit. Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”. Is the great thing about a democracy is that the citizens get what they deserve…..  or is it that the uninformed can be led by a right wing press? Governments ration covertly, and it is much more sensible to ration those whose votes count least. Its going to get worse I’m afraid… A Health Tax is a non starter, but so are Sticky Toffee Puddings.
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Sir, We want to see an NHS that provides high-quality care, support and treatment to everyone who needs it — and to ensure that our voice is heard during the general election campaign. In particular, we want all politicians standing for election to know of our deep concern with the reforms to the National Institute for Health and Care Excellence (Nice) that the government and NHS England implemented from April 1. These reforms stand to restrict and ration treatments for people with rare and complex conditions, and were implemented without the agreement of parliament.

With that in mind, we urge political parties to commit in their manifestos to reverse these recent reforms, and to guarantee that any future reforms will be considered by parliament before being implemented. We also ask that any decisions to restrict the availability of Nice-approved treatments are taken by democratically-elected politicians.
Deborah Bent, Charity Manager, Limbless Association; David Bickers, CEO, Douglas Bader Foundation; Kay Boycott, CEO, Asthma UK; Roger Brown, Chair, Waldenstrom’s Macroglobulinemia UK; Nic Bungay, Director of Campaigns, Care and Information, Muscular Dystrophy UK; Liz Carroll, CEO, The Haemophilia Society; Tanya Collin-Histed, CEO, Gauchers Association; Ann Chivers, CEO, Alström Syndrome UK; Genevieve Edwards, Director of External Affairs, MS Society; Sue Farrington, CEO, Scleroderma & Raynaud’s UK; Steve Ford, CEO, Parkinson’s UK; Kye Gbangbola, Chair, Sickle Cell Society; Deborah Gold, CEO, National AIDS Trust; Caroline Harding, CEO, Genetic Disorders UK; Tess Harris, CEO, The Polycystic Kidney Disease Charity; Dr Lesley Kavi, Postural Tachycardia Syndrome UK (PoTS UK); Anne Keatley-Clarke, CEO, Children’s Heart Federation; Caroline Morrice, CEO, GAIN; Allan Muir, Development Director and Type II Co-ordinator, Association for Glycogen Storage Disease (UK); Patricia Osborne, CEO, Brittle Bone Society; Jill Prawer, Founder and Chair, LPLD Alliance; Lynne Regent, CEO, Anaphylaxis Campaign; Richard Rogerson, Niemann-Pick UK; David Ryner, The CML Support Group; Timothy Statham OBE, CEO, National Kidney Federation; Laura Szutowicz, CEO, HAE UK; Paddy Tabor, CEO, British Kidney Patient Association; Jeremy Taylor, CEO, National Voices; Oliver Timmis, CEO, Alkaptonuria (AKU) Society; Gabriel Theophanous, President, UK Thalassaemia Society; Sarah Vibert, CEO, The Neurological Alliance; Dr Susan Walsh, Director, Primary Immunodeficiency UK

Chris Smyth reports a day later, May 11th: Hospital bosses demand another overhaul to sort minister’s mess

….new laws to overhaul the health service are likely to be needed by the end of the next parliament even though they are still struggling to implement the most recent changes…..One STP head said: “It’s a huge problem. Everything takes ages, but the difficulty with legislation is that it’s an implicit recognition that Andrew Lansley f***ed everything up.”…..Niall Dickson, chief executive of the NHS Confederation of senior managers, said: “It’s a no-brainer that you will need at some point a legislative underpinning for the structures….Senior Conservatives regretted the changes almost immediately, with one cabinet minister saying it was the coalition’s biggest mistake. The disruption distracted from the central task of making big financial savings and when Mr Lansley was demoted in 2012, his vision failed to take. Simon Stevens began reversing key elements of the reforms barely two years after they were completed.

Read the full article below..

Hospital bosses demand another overhaul to sort minister’s mess

The debate is puerile. There is no addressing the real issues..

Chris Smyth: Ageing population brings risk of stroke epidemic

Chris Smyth: Saving for dementia bill would take century

Andrew Harrap: This could be the health tax election

Sustainability and transformation (rationing) plans – surely STPs deserve a better acronym…

The Inefficient English Health Service is compared with the German one. Hypothecated Taxation with choice of provider?

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GP leaders to debate future of NHS, industrial action and ‘zombie GPs’. “GPs’ first priority must be their own health”..

The most important word any resilient GP needs to learn is how to say “No”. Our profession is well paid, and the argument is not about pay. The conditions of work, the restriction of choices, and the shape of the job have become so onerous that many feel like zombies. In a national incident such as a train crash the Drs need to ensure they are safe before treating the victims. They need to secure the site. They need to make decisions which perhaps amputate on site, or allow some victims pain killers only, whilst others are saved. The train crash which the UK health services are now having is similar. As Clare Gerada is correct; “we have to look after ourselves  first”.

Nick Bostock reports on GPonline 3rd May 2017: GP leaders to debate future of NHS, industrial action and ‘zombie GPs’

GP leaders at next month’s LMCs conference will discuss whether the NHS can survive chronic underfunding, whether GP contractor status has ‘reached the end of the road, and whether industrial action should be back on the table to defend the profession.

The conference in Edinburgh on 18-19 May could also discuss whether deceased GPs could be resurrected to ease the GP workforce crisis, and call for health secretary Jeremy Hunt to be sacked ‘for presiding over the worst time in the history of the NHS, missing targets, longer waiting lists and low morale’.

Pressure looks to be growing from the profession for a wide-ranging overhaul of GP funding, with LMCs set to warn that overall funding is too low, and that distribution through the Carr-Hill formula and other contract mechanisms is unfair.

Motions put forward by LMCs warn that no funding mechanism will deliver fair funding for GP practices until overall funding is increased. The GPC warned earlier this year that despite pledges to raise funding through NHS England’s GP Forward View, the profession remains underfunded by billions of pounds.

GP funding

But LMCs will question whether the existing funding formula gets the balance right between different priorities, with a motion put forward by Glasgow LMC warning that ‘careful consideration has to be given to the balance of the funding formula between deprived patients, remote and rural patients, elderly patients and those patients not in any of these groups who may face their funding being eroded’.

GP leaders will also call for a list of core GP services to be defined – a step the GPC has long opposed – in part to maintain services as new care models take shape across the NHS. The GPC has consistently argued that it is simpler to define non-core work, for example using its Urgent Prescription document to list services that practices should receive additional funding for.

The conference will also hit out at the rising cost of indemnity, warning that increased fees are driving GPs out of the profession. LMCs will argue for greater transparency from medico-legal organisations about risk criteria that can lead to sharp rises for individual GPs.

GPs will also warn that contract uplifts have not covered rising indemnity costs in full, and that direct reimbursement of costs would be a better option for practices than payments based on list size.

Locum GPs

Plans to improve communication with sessional GPs, with a proposal for a ‘national communications strategy to secure adequate communication of guidelines and patient safety communications to locums’ will also be discussed at the conference.

Broader ‘themed debates’ at the conference will discuss issues such as NHS rationing, independent contractor status, working at scale and workload.

One debate will look at whether the NHS can survive given overall underfunding, and whether co-payments for services should be considered. Another will consider whether independent contractor status has reached the end of the road and how it could be protected.

Further debates will look at whether GPs should remain within the NHS – in Northern Ireland GPs have suggested they will quit the NHS en masse if two thirds of practices hand in resignations – and whether there is ‘still a need to consider appropriate forms of action, and would this be effective or counter-productive’.

Another debate will encourage GPs to discuss whether the QOF has reached the end of its useful life – as NHS England chief executive Simon Stevens has suggested.

A motion put forward by Shropshire LMC, meanwhile, suggests ‘the urgent funding of a bioengineering program designed to immediately triple-clone all UK GPs, including the recently retired, in order to facilitate our prime minister’s glorious vision of a truly 24/7 health service’.

It adds: ‘The project should ideally extend to exploration of the resurrection of deceased general practitioners, though conference acknowledges that some health consumers might find zombie GPs unpalatable at first (assuming they even notice the difference.) However, we believe that public fears about human cloning and the walking dead could be swiftly allayed by the persuasive powers of the undisputedly veracious Mr Jeremy Hunt.’

Alex Matthews-King in Pulse 24th April reports: NHS England asks CCGs for rationing heads-up following media scrutiny

Isabella Laws on 2nd May reports Clare Gerada: GPs’ first priority must be their own health, warns former RCGP chair – GPs must put maintaining their own health above caring for patients and running their practices, former RCGP chair Dr Clare Gerada has warned.

It’s the shape of the GP’s job that needs to change. The pharmacist will see you now: overstretched GPs get help…The fundamental ideology of the Health Services’ provision. Funding of this type admits 30 years’ manpower planning failure

NHS ‘is like a train just before a crash’ (and it is now happennin g in slow motion)

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NHS confusing public by using ‘gobbledygook’

In keeping with the BMA in Wales, Nick Triggle reports that “NHS confusing public by using ‘gobbledygook'” in the Times 28th March 2017.

The BMA Wales response to the Welsh Government was that we wanted “a clearer and more honest language” to be used in health. Needless to say this has not happened, and indeed NHSreality does not blame the Welsh politicians. The recommendation for “honest language”, along with “Exit Interviews” was buried deep within the BMA response ( Our health, our health service BMA response) to that part of the Green Paper , and did not appear in any bullet point summary. The rules of the game, for Commissioners (de-commissioners) will ensure that the language barrier remains. Therefore we need to change the rules. Both language and outcomes are going to get worse.. until we agree there has to be a cost.

Imagine the scene. Up and down the country, local NHS leaders are crowded into meeting rooms discussing information transfers and ambulatory care, when someone jumps up and shouts “I’ve had enough of sticky toffee puddings”.

Confused? You’re not the only one. The language being used by the health service is simply gobbledygook, says the Plain English Campaign (PEC).

Steve Jenner, the campaign’s spokesman, said the health service was riddled with “jargon” when it comes to explaining anything from the closure of hospital services to major incidents.d he even believes the NHS may be doing this on purpose.

“If you use impenetrable language it means the public has no clue what is going on. I can’t help thinking that suits the NHS sometimes,” he said.

“What this jargon is describing is very important. It should be articulated very clearly.

“We expect doctors to clearly explain themselves. It should be the same for the NHS management,” he added.

Sticky toffee puddings or important NHS plans?

STPs – dubbed sticky toffee puddings by some in the health service – are among one of the most important developments in the health service in recent years.

But you would never guess from the official name – sustainability and transformation plans.

However, the jargon goes further than that, according to the PEC. Look through most plans – there are 44 of them – and you will find some strange phrases.

Cambridgeshire and Peterborough’s documents, for example, talk about investing in “system-wide quality improvements” and developing a “shared understanding of all the interrelated issues”, while being able to learn “what it means to us as individuals and as organisations”.

Meanwhile, documents from North Central London shared the experience of one patient’s care that went wrong.

It says due to “hand-offs, inefficiencies and suboptimal advice and information transfers” the “patient’s pathway” went on for too long.

Another popular “pathway” is the ambulatory patient pathway. What does that mean? The patient can go home after being seen in hospital.

Is the NHS involved in a medieval battle?

Vanguards are a term used to describe the formation of a medieval army. But the NHS has also – ahem – deployed the term.

There are 50 vanguards that have been set up to test new ways of running services. They were created in 2015 and include schemes to get hospital doctors working in community clinics and to provide advice via video link-ups as well as the creation of super hubs in the community bringing together GPs, district nurses and council care teams.

You should not be surprised to hear evidence of what works best in the vanguard programmes will then be fed into the STP process.

But it’s not just in England where jargon can be found. Northern Ireland’s 10-year health strategy, published last autumn, promised to shift the focus from “treatment of periods of acute illness and reactive crisis approaches, towards a model underpinned by a more holistic approach to health and social care”.

Or, more simply, try to get people to live more healthily and give them better support to stop them needing hospital care.

Running hot or just busy?

Taps run hot, but so too, it seems, does the NHS. Commentators and health service managers have been using the phrase to describe just how busy hospitals and, in particular, A&Es were this winter.

It may be a bit of an odd phrase, but it is at least easier to understand than Operational Pressures Escalation Level Four.

That is the new name for a black alert – when hospitals get so busy they have to cancel non-emergency operations, divert ambulances and call in extra staff.

And guess what red alerts – the level down from black – were renamed? Yes, that’s right, Operational Pressures Escalation Level Three.

Guidance issued by NHS England last year ordered hospitals to use the new terminology when communicating with the public and media.

Not everyone obeyed. Newspaper coverage this winter was littered with reports of black and red alerts.

And what did NHS England make of this? They were unable to provide the BBC with a response.

The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

In Search of the Perfect Health System ( a new book reviewed )

The BMA response ( Our health, our health service BMA response) to that part of the Green Paper

 

 

Invidious options: to have to choose between fears is not necessary.

In Place of Fear (A Free Health Service 1952 Chapter 5 In Place of Fear), citizens are asked to choose between two fears: cancer or emergencies. Which is the greatest will be different for different individuals… As a 66 year old man my chances are greatest for Ischemic Heart Disease, but I have also had two cancers so I am at more risk of another than the average individual. As I get older I am at risk of a fracture, particularly fractured neck of femur, which in my case will be complex as I have had two hip replacements. There are strong arguments for individuals such as myself, living in a region (Wales) without choice, for moving near to a tertiary centre of excellence (teaching hospital). Does cancer care mean treatment as well as palliative and terminal care? The last two are mostly funded by charities… in the richer areas of the country. The life-years saved by A&E may be greater, but A&E deals with lower social classes who don’t vote… If the decision is left to patients we may not get the utilitarian result we need.. Hobson’s choice will of course be decided by administrators, as pithed politicians will sit on the fence. Given a choice, they must fund A&E properly (before cancers), but A&E is not where doctors compete to work… Such an invidious decision does not have to be made if we ration health care overtly. This is not as simple as the choices for an individual..

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Chris Smyth reports 30th March 2017: Patients must choose between A&E and cancer care, warns health chief

Patients must be told they cannot have routine operations quickly if they also want short waits for A&E, cancer care and other treatments, an NHS leader has said.

Simon Stevens, head of NHS England, is being urged to relax targets for waiting times as he prepares to lay out his reforms to the service today.

Niall Dickson, chief executive of the NHS Confederation, which represents all health service organisations, said that it was unrealistic to pretend that patients could have everything they had come to expect when money was so tight. “It’s not reasonable to say that all the current targets have to be met,” Mr Dickson told The Times.

“[Bosses] are on the one hand saying that mental health has to be a priority, elective care’s a priority, A&E’s a priority, cancer’s a priority and so on. Well, there’s got to be acknowledgement that some other things are not a priority.”

Mr Stevens is due to approve a structural upheaval of the NHS. It aims to better join up services around patients and to prevent illness. He has also signalled that he will spell out the financial pressures, threatening to resume a row with Theresa May over NHS funding.

Simon Stevens, head of NHS England, is being urged to relax targets for waiting times as he prepares to lay out his reforms to the service today.

Niall Dickson, chief executive of the NHS Confederation, which represents all health service organisations, said that it was unrealistic to pretend that patients could have everything they had come to expect when money was so tight. “It’s not reasonable to say that all the current targets have to be met,” Mr Dickson told The Times.

“[Bosses] are on the one hand saying that mental health has to be a priority, elective care’s a priority, A&E’s a priority, cancer’s a priority and so on. Well, there’s got to be acknowledgement that some other things are not a priority.”

Mr Stevens is due to approve a structural upheaval of the NHS. It aims to better join up services around patients and to prevent illness. He has also signalled that he will spell out the financial pressures, threatening to resume a row with Theresa May over NHS funding.

“If the money isn’t there you have to acknowledge that. It’s better to acknowledge that than to set up the system to fail,” Mr Dickson said. “It’s just unrealistic to expect the NHS to do everything and it’s unfair on patients and staff to pretend it can . . . It is disheartening, in any business, when a target is set that [staff] cannot deliver.”

The NHS is missing most of its main targets, including for A&E, routine operations, ambulance responses and cancer care. Jeremy Hunt, the health secretary, insisted this month that the target for 95 per cent of A&E patients to be seen within four hours must be met next year, despite January’s figure of 85.1 per cent being the worst on record.

Mr Dickson said: “If the government is absolutely set on, for example, A&E times and mental health, and I can see why they want to do that, then they should perhaps acknowledge that there are other areas where they could relax the targets a bit, which would allow the system to focus on those priority areas.”

Ministers have promised an extra £8 billion for the NHS by 2020 but Mr Dickson said that the “small amounts of additional money” fell well behind long-term average increases and left staff struggling to cope with rising demand from an ageing population.

He said that it was “absolutely right” to demand more savings but added: “We don’t think it’s reasonable to demand big financial savings on the one side, and on the other side expect no diminution of quality when demand is rising, without an admission that the NHS will have to prioritise some activities over others.”

Local health groups have been criticised for rationing services such as fertility treatments or barring the obese and smokers from surgery. Mr Dickson said that NHS England should back these decisions with “an honest admission that the service can’t do anything and that it’s reasonable to make decisions on the basis of priorities”.

•Only a quarter of people are satisfied with social care services, half as many as are satisfied with A&E, the least popular part of the NHS (Kat Lay writes). An annual report from the King’s Fund found that 63 per cent of people were satisfied with the NHS overall last year. Only 26 per cent were satisfied with local authority social care services, compared with 54 per cent who were happy with A&E

Pithed politicians collude in unsafe care, ministers told

Rationing in the NHS – The Nuffield Trust

Health professionals call for NHS Wales ‘vision’ by prospective parties. If you don’t have a choice in Wales, you can buy or game that choice….

If we go on like this the housing debt will be as nothing to the health debt in 10 years time.

Many of us start our lives with debt, usually on property, but this declines as we grow older. If we go on like we are in Health, the housing debt will be as nothing to the 4 UK Health Services debt in 10 years time.. The chancellor is rightly worried about debt, and the future looks bleak…(UK’s borrowing binge is worrying the Bank of England – Larry Elliott in the Guardian 27th March 2017) £50m for Hywel Dda board equates to approximately £156 per head today, and possibly £10,000 per head in 10 years. Expect more and more de-commissioning / covert rationing.

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Ministers refuse to bail out the Welsh Health Boards (Hywel Dda is the worst) – BBC News 28th March 2017

The boards are forecast to over spend by £146m this year.

In one case – Abertawe Bro Morgannwg University Health Board (ABMU) – the financial outlook is said to be “extremely challenging”.

The health board, which covers Swansea and Bridgend, said it was attempting to cut agency staff costs.

As well as ABMU there are overspends at Betsi Cadwaladr in north Wales, Cardiff and Vale board and Hywel Dda in mid and west Wales.

Betsi Cadwaladr’s deficit is now forecast to be £30m, Hywel Dda £49.9m, ABMU £35m and Cardiff and Vale £31m for the 2016-17 financial year.

The health boards will not face a bill to repay the money, but they will be expected to balance their books in the next financial year.

A spokesman for the Betsi Cadwaladr University Health Board said: “We have worked hard throughout the year, and worked closely with Welsh Government, to address our challenges, and we will continue to do so going forward.”

Stephen Foster, of Hywel Dda University Health Board, said: “This is not the financial situation that we would want to find ourselves in and we are putting together significant plans to turn it around.”


Analysis by BBC Wales political editor Nick Servini

These figures show a dramatic deterioration in the finances of four out of Wales’ seven health boards.

They have also prompted a hard-hitting response from the Welsh Government which, until this point, has been keen to stress how they approach problems together.

The tone resembles the approach of the man in charge of the English NHS, Jeremy Hunt, who has not been afraid of calling out heath trusts he believes are under-performing.

The Welsh Government has called for a significant improvement in the financial performance.

That will be easier said than done in the face of intense pressure on these organisations.

Walesonline and the Western Mail report 27th March 2017: Wales’ Health Secretary refused twice to guarantee that NHS services will not face cuts

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