Why aren’t the UK Health Services centre stage in this election? All 4 are bust.

£100 (Liberals) or £150 (conservatives) extra per head is not enough to change the Health Services for the better. We need to be thinking differently, outside the political mainstream box, and our media are letting us all down by avoiding the main issue. There has to be some form of rationing, and it will be much fairer if it is universal for the big and fearful conditions. The health service is meant to be a mutual based safety net. It excludes dementia by common agreement between the parties, but it does not exclude cancers or emergency surgery -yet. If the brexit vote and decision is over, why aren’t the Health Services centre stage? The conservatives have taken a difficult decision on home based care – from strength of belief they will win this election whatever. More decisions like this need to be taken, and depoliticised.

Lawrence Dunhill in the HSJ reports 18th May 2017: NHS spending as proportion of GDP ‘would fall under Tories and Labour’

Roz Scott in the Brighton and Hove news reports 9th May 2017: Lib Dems say 1p income tax rise would fund £31m boost to NHS in Brighton and Hove and Mr Fallon was in action in last weekend’s Spectator: Sunday political interviews round-up: Fallon – We warned the NHS on Cyber Security

The Kings Fund publishes the Trust deficits, but there is an issue over the next quarterly figures, which are due before the election. These figures are for England, and exclude the other Health Services in the UK.

Dennis Campbell on 9th November 2016 in the Guardin: NHS trusts on course to overshoot budgets by £850m, figures suggest  – Overspend is projected to be more than three times the sum health bosses have deemed acceptable, according to the Health Service Journal

Nick Triggle for the BBC opined 18th March 2017: NHS facing ‘mission impossible next year’

Nick Triggle reports for BBC News 18th May 2017: Conservative manifesto: Why many will pay more for care

Edward Cornick in “Public Finances” on 20th Deb 2017 opined: Deficit figures tell only part of the NHS finances story

Great efforts have been made to control NHS spending, but providers may have hit the limit of the ‘make do and mend’ approach

The latest quarterly figures (Q3) for the NHS provider sector have just been published. The current deficit of £886m reflects the huge efforts that NHS trusts have made for the first three quarters of the year, as they attempt to turn around the provider sector’s finances following 2015/16’s £2.45bn deficit. However, the figures also forecast an end of year deficit closer to £873m rather than the desired target of -£580m set at the start of the financial year.

The latest quarterly figures for the NHS provider sector, covering October to December, have been published today. The latest quarterly figures (Q3) for the NHS provider sector have just been published. The current deficit of £886m reflects the huge efforts that NHS trusts have made for the first three quarters of the year, as they attempt to turn around the provider sector’s finances following 2015/16’s £2.45bn deficit. However, the figures also forecast an end of year deficit closer to £873m rather than the desired target of £580m set at the start of the financial year.

But no matter what these headline figures and forecasts are, they only tell one part of the story of how NHS providers have to manage the money in these straitened times.

We surveyed NHS trust finance directors in early February to get their assessment of the financial performance of their trusts. In total, 99 completed the survey and we will publish the full results shortly. But following the third quarter figures, it is worth examining now what finance directors told us about forecast vs plan for 2016/17. The findings provide us with useful additional context as we head towards the end of the financial year.

One of the questions put to finance directors was whether or not they are on plan for the end of this financial year. Most of them were: almost two thirds (60%) were on plan, with 13% actually over-performing. Of course this still means over a quarter (27%) were under plan. But given where the provider sector has been in recent times at this point in the year, this perhaps represents a qualified success.

But just how qualified?

To answer this we asked the finance directors how much their forecast end of year position would be dependent on one-off measures, such as non-recurrent savings, capital to revenue transfers, and balance sheet and accounting adjustments. The responses showed that NHS trusts will be leaning heavily on these to prop up their positions, with two thirds of respondents indicating they would be very (39%) or quite (27%) reliant on these types of approaches.

The extent of this reliance is revealed by the overall figure that trusts said these one-off savings amounted to. Adding together the 99 providers surveyed, this totalled some £340m. The sample size represents just over 40% of the provider sector and our initial analysis indicates across the whole sector these one-off measures could account for as much as £1bn of savings this year. This is higher than the £622m forecast for non-recurrent savings in the official Q3 figures, which includes standard non-recurrent savings, but not the full range of adjustments that trusts will have to make.

If we put that £1bn figure into a broader context, it means the total amount saved in one-off measures could easily be the equivalent of the entire official aggregate deficit figure for 2016/17. The result is an underlying challenge significantly higher than what’s apparent in the top line official figures.

In the short term, this means the results for the whole service at the final quarter of the year still have the potential to be fragile. If we return to those trusts who are off plan, they have shown some substantial deterioration in their positions. Even those who are on plan said in our survey that maintaining finances going into the final quarter of the year will be a huge ask.

There is also a worsening financial situation for clinical commissioning groups. At Q3 they had forecast an overspend of £370m. Being realistic, we also do not know yet how much of the 1% of their budgets (supposed to equal £800m) that was meant to be held in reserve to cover a larger than plan provider-side deficit will actually be in place at the end of the year.

Finally, add into the mix that there are no more significant reserves left centrally either. This means the Department of Health is again at risk of exceeding its departmental expenditure limit, something which it only narrowly avoided last year.

So even if we squeak through 2016/17, our survey shows serious risks will continue into next year. The money is due to get even tighter and will be combined with a significant persistent underlying deficit. Therefore, asking providers to be responsible for covering the shortfall between funding and demand, essentially the current policy set by the government, will become unsustainable.

NHS trusts report that, having persistently used a range of one-off, non-recurrent approaches to deliver stretching financial targets over each of the last four years, they have now reached the natural limit of these approaches. Further savings require genuine transformation which, in turn, requires investment and management bandwidth – both of which are currently in very short supply.

And this means the ‘make do and mend’ approach that has allowed the provider sector to survive – just – up to this point, will have finally been exhausted. Instead, we will have reached the stage where a clear decision, at a political level, needs to be made about what can realistically be achieved by the NHS within the funding available.

A version of this blog also appeared on the NHS Providers website

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March 2016 – NHS being pressured by government to “fiddle the figures” to make finances seem better, documents reveal – it will get worse

Everyone an=t the coal face knows the truth. It’s worse than the public know. Finances, people and standards are all threatened. Gagging is endemic. There are no exit interviews and the language of health is dishonest. More patients will die. Ii’s much worse than 14 months ago, and Its going to get worse…

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Laura Donelly reported in the Telegraph 24th March 2016: NHS being pressured by government to “fiddle the figures” to make finances seem better, documents reveal

Files show Department of Health has embarked on a national programme to change current accountancy practices

NHS trusts are being placed under pressure from Government to change the way they report on their finances, in what critics described as a desperate attempt to reduce a looming health service deficit.

The health service is currently forecasting a deficit of £3bn by the end of this month – the highest in the history of the NHS – amid widespread failures by NHS trusts to cut their spending.

But documents seen by The Daily Telegraph disclose that the Department of Health has embarked on a national programme to change current accountancy practices, and to encourage trusts to be more optimistic about their financial problems.

The review being carried out by four major accountancy firms aims to explore “areas of opportunity” about ways which NHS finances could bereported differently.

In a series of euphemisms, briefing documents suggest that trusts will be asked whether they are being “overly prudent” in forecasting how much income they might receive from outside the NHS, or how much they likely to end up spending on agency doctors and nurses.

It details 19 specific accounting areas to explore, such as reclassifying assets so they are kept off the balance sheets, or extending their asset lives so they can be valued more highly.

Sally Gainsbury, senior policy analyst at thinktank the Nuffield Trust, said: “This definitely falls into the area of fiddles – being clever about when you book income and when you book expenditure. It pushes most of the problems into the next financial year, it does not solve them.”

“No one is thinking about the long term position. It is misleading the public about what the NHS’s costs really are. ”

A senior figure in NHS consultancy told Health Service Journal the work was “an act of desperation” by the DH, adding: “Directors of finance are getting loads of pressure from the centre to do accountancy stuff they are not comfortable with. [They are] getting their arms twisted.”

On current trends, the NHS deficit is set to reach more than £2.8bn by the end of the current financial year, largely fuelled by spending on agency doctors and nurses.

The figures raise the prospect that the Department of Health could be forced to get a bailout from the Treasury, a serious breach of Whitehall protocol and would be likely to trigger an inquiry by the Public Accounts Committee.

Health officials have repeatedly pledged to clamp down on spending on temporary health workers.

But figures published last month show hospitals have spent £2.72bn on agency and contract staff – £1bn more than was intended.

Nine in 10 NHS hospitals breach new limits on pay for agency doctors and nurses

Meanwhile a Telegraph investigation revealed that more than 20,000 NHS shifts a week are being filled by doctors and nurses on rates which breach the new limits set in order to clamp down on spending.

The figures from NHS regulators show that the deficit for the first three quarters of the year is already £2.26bn – triple what it was for the whole of the previous year.

The situation raises the prospect of the Department of Health failing to balance the overall books, which would be politically difficult, given the extra sums being spent on the NHS.

In autumn’s spending review the government announced the NHS would get an extra £8.4bn this Parliament.

After pleas from the head of the NHS, the funding is being “front-loaded” with £3.8bn being put in next year. But the rapidly deteriorating finances mean trusts are likely to use much of the new money just to keep afloat.

Last weekend, former Liberal Democrat cabinet minister David Laws claimed Downing Street had “leant on” the chief executive of the NHS to reduce the amount of money he said was needed by the health service.

Mr Laws said Simon Stevens, head of the NHS, had told Downing Street that the NHS needed to find £30 billion, and that £15 billion could be found through efficiency savings.

But Mr Stevens was then told there was “no way” David Cameron and George Osborne would sign up to providing the other £15 billion, Mr Laws said.

“He did that, reduced therefore the demand to £8 billion,” said Mr Laws, who said more had been needed.

NHS faces worst financial crisis in its history

A spokeswoman for NHS England denied that Mr Stevens had been “leant on”.

She said a 5-year-plan for the NHS produced by the chief executive in 2014 “clearly and independently said that the NHS would need in the range of £8-21bn real terms annual growth by 2020, depending on levels of efficiency, capital investment and transformational funding.”

A Department of Health spokesperson said:”Patients will expect that the NHS is making sure every penny is accounted for as accurately as possible so we have commissioned some additional assurances on both potential savings and any unaccounted for overspends from an initial sample of 20 organisations to ensure figures are reported as accurately as possible.”

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Chirs Ham (kings Fund) is afraid to mention rationing. So is everyone else. A plague on all their houses?

Chris Ham is an influential figure, but even he is afraid to mention rationing: telling people what they cannot have.

After an hour distributing leaflets for the Liberals, and suggesting every recipient should at least vote, it became clear to me just how uninformed and disengaged the public are about politics and health. Their views are shaped by the media, and this is usually the Mail or the Sun. Sentences of 3 – 6 words, and none longer than 2 syllables greeted me. At the last election, the turnout was only 66% who voted, – or 34% did not. The conservatives won Pembrokeshire with 40% of those voting in 2015. This means Stephen Crabbe won our seat with under 27% of the potential electorate supporting him.

Short term horizons, and local perspectives dominate for all MPs. Saying the unpopular truth, or the hard facts, is seen as negative for votes. So the Health Services will be split, Wales will continue to have a mutual of 3 million people without serious choice for those in most of the principality. Paying the same taxes they will get worse services than the English.

And yet, the election will change nothing as the Labour heart of Wales is “cast iron” in the valleys.

A much fairer voting system will help the health service. Until this comes about it looks as if things are going to get worse. More water ( money ) will be poured into a leaking bucket, by all three major parties.

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Most medics and nurses say “A plague on all their houses”, and who can blame them? If the professionals are disengaged how can we blame the public at large?

Dennis Campbell reports in the Guardian 16th May 2017: NHS needs to change, says expert, and both sides of politics should support it

Chris Ham, head of the King’s Fund, says campaigning over the state of A&Es and maternity units may be ‘good politics locally’ but jeopardises better care

Politicians should support, not oppose, controversial changes to local hospital services in order to save lives, improve care and tackle doctor shortages, a former government NHS adviser is urging.

Professor Chris Ham, the chief executive of the influential King’s Fund health thinktank, said candidates standing in the election should not try to court popularity with voters by joining campaigns against the rundown of A&E and maternity units.

“What’s often good politics locally can also be bad medicine for patients,” Ham told the Guardian. “Where there’s a strong clinical argument that care will be safer by concentrating specialist services in fewer hospitals, local and national politicians should give their support and not stand in the way of painful but necessary change.

“We have to be realistic and accept that not every hospital can provide the full range of services like stroke care, some forms of cancer care and emergency surgery. The solution is to concentrate some of these services in fewer hospitals able to provide specialist care seven days a week. Patients might have to travel a bit further to get better care, but this is a price worth paying,” added Ham, who advised Downing Street on NHS policy while the coalition was in power.

Ham’s intervention comes as the NHS presses ahead with the biggest reorganisation of services seen in decades, in a bid to plug a £22bn looming gap in its finances, which has sparked protests in many parts of England. MPs should accept that widespread understaffing in the NHS means that centralising services has to happen, Ham said. The temporary closure last year of the A&E at Chorley hospital in Lancashire due to its inability to recuit enough medics illustrated that problem.

In recent months a number of Tory MPs who are now seeking re-election on 8 June have been fighting plans to downgrade A&E units used by their constituents.

For example, ex-minister Nick Boles plus neighbouring MPs Caroline Johnson and Robert Jenrick met Theresa May in February to oppose the closure overnight of Grantham hospital’s A&E unit triggered by it having too few middle grade doctors. Jeremy Hunt, the health secretary, then referred the unit’s partial closure to the Independent Reconfiguration Panel.

Andrew Griffths, Andrew Bridgen and Heather Wheeler opposed plans to downgrade Burton hospital’s A&E to a minor injuries unit, and warned that deaths could occur if patients had to travel the ten miles to Derby to get urgent treatment. “We are fighting for the survival of a vital service in Burton. I genuinely think that if it closes, lives will be lost,” said Griffiths, the Burton MP, in March. And Marcus Jones and Craig Tracey have lobbied health minister Philip Dunne against plans to downgrade the A&E at George Eliot hospital in Nuneaton.

“With services like A&E and maternity care, we do not have enough doctors and nurses to be able to offer everything everywhere. This may mean some A&E departments becoming minor injury units and some maternity units needing to be staffed by midwives rather than doctors.

“Given how sensitive these changes are, it is important that local candidates do not try to win favour with the electorate by opposing changes to local hospital services in a kneejerk way,” Ham added.

Labour has pledged to halt all the many planned changes to local hospital services under NHS England’s Sustainability and Transformation Plans programme if it wins power. It has promised a review and to give local people a say in the final decision.

Jeremy Hunt, the health secretary, branded the move “another nonsensical Jeremy Corbyn idea”, given shadow health secretary Jon Ashworth had previously cautiously endorsed STPs and defended the drive to centralise services.

“These local plans are developed by local doctors and communities, backed by the top doctors and nurses of the NHS, and will improve patient care,” Hunt said.

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Not hacking it… Sangfroid?

The Times Leader and letters 15th May 2017: Sangfroid?

Not Hacking It

A massive cyberattack has hit businesses and government services worldwide. The NHS was badly affected because it was badly protected

Some cyberattacks are unavoidable. Criminals and the authorities are engaged in a perpetual race to find vulnerabilities in the computer systems on which citizens, businesses and governments rely. Sometimes hackers will find and exploit new weak spots before spooks and technology companies can fortify them. Yet the ransomware attack that paralysed 48 NHS trusts and dozens of GP practices on Friday was not such a case. The vulnerability was well known. This attack was avoidable and, if the government had heeded experts’ warnings, it would have been avoided.

Computer users across the world logged on last Friday to find that access to their files had been cut off. A message on their screens said that they could have their data back, but only after paying a ransom of $300 (£230) in bitcoin, an online crypto-currency which allows money to change hands anonymously over the internet. Europol reports that there are now more than 200,000 victims in more than 150 countries, from car factories in France to couriers in the United States and the interior ministry of Russia.

This was an attack of unprecedented scale. The vulnerability of the health service made the impact in Britain particularly alarming. Thousands of patient appointments have been cancelled. Some transplants and bypasses were halted mid-operation. Cancer sufferers who had arrived at hospital prepared for chemotherapy were turned away.

Unfortunately the attack may not be over. Its progress was halted on Friday night by a 22-year-old blogger who happened upon a so-called kill switch in the code of the ransomware. Since then hackers have released a new version of the software, without the loophole.

The health service was so acutely affected because too many NHS trusts are using ancient computer systems. The perpetrators have targeted a chink in the virtual armour of Windows XP, an operating system first released in 2001. Microsoft learnt of that vulnerability months ago. In mid-March the company therefore released an update to protect remaining Windows XP users. It seems that many NHS trusts failed to install it.

NHS computers should not have been running on antiquated systems in the first place. According to a recent report in the British Medical Journal 90 per cent of NHS computers rely on Windows XP. Given that, the government digital service should not have terminated its support deal with Microsoft in 2015. An extension, costing only around £5.5 million a year, would have made these incidents less likely and was reportedly recommended by cybersecurity experts at the time.

When the government decided to terminate, trusts were encouraged to migrate to other systems or strike their own support deals with Microsoft, but many did not bother, citing financial pressures. Security should have been higher on their list of priorities. NHS Digital and the Department of Health should also have done more to ensure that individual security updates were installed across the service.

Amber Rudd, the home secretary, has said that lessons will be learnt. They will have to be. Rob Wainright, the chief of Europol, says the number of cases is ever-increasing. Britain is relatively well prepared, with a national cybersecurity centre backed by £1.9 billion of new funding. Small pockets of insouciance, however, could have disastrous consequences, particularly if future attacks involve the large-scale theft of personal data.

Every company, agency and individual must also share the burden of keeping networks safe. The weapons in the hacker’s arsenal are always changing, and they are finding new opportunities to manipulate weak systems for profit across the globe. There will always be risks. This one, however, need not have been passed over.

Cyberattacks and the National Health Service

Sir, The root cause of the horrific National Health Service crash was not the aptly named WannaCry ransomware or the criminals behind it but the lack of NHS expertise in information technology (“Huge hack attack hits NHS hospitals”, News, May 13). The NHS does not need more money for IT; it needs more investment in high-level IT expertise. For instance, how many postdoctoral computer scientists does it employ? How much research is being done to stay ahead of criminals?

Until the National Health Service takes IT seriously, it will continue making poor decisions buying and managing IT, with the harmful consequences such as those we are now seeing.
Prof Harold Thimbleby
Swansea University

Sir, Friday’s cyberattacks on National Health Service trusts were shocking but it is more than three years since Microsoft stopped providing security updates for Windows XP. For NHS trusts to keep the outdated, insecure system is like a householder leaving the key to his front door under the mat outside, with a sign saying “key to house here”. To allow those attacks to happen was gross negligence. “Austerity” is no excuse because it is not expensive to upgrade the system, and certainly less than the weekly salary of one of the numerous NHS managers.
Robert Rhodes, QC
London WC2

Sir, Windows XP, which is still used on some NHS computers, was launched in 2001 when Labour was in power. Since then, new operating systems have been launched: Vista and Windows 7 while Labour was in power; Windows 8 under the coalition government; and Windows 10 when the Conservatives had a majority in 2015.

The Labour, Conservative and Lib Dem parties should all take responsibility for not having ensured that trust boards, chief executives, the Care Quality Commission and NHS management stayed on top of their IT systems.
Kim Thonger

Rushden, Northants

Sir, How much of the blame for the cyberattacks should be laid at Microsoft’s door for forcing costly system upgrades on users by withdrawing support for older, still functioning versions of Windows?
Stuart Jones
Kendal, Cumbria

Sir, Could anything be more illustrative of the short-sightedness of NHS underfunding than the huge cost that will now be incurred in updating the computer system.

I hope the government will also reimburse hospitals for the extra costs they have incurred due to the chaos and rescheduling of operations and appointments.
Valerie Crews
Beckenham, Kent

Sir, There is a simple process to reduce significantly the incidence of cyberattacks such as recently experienced by the NHS.

It should be a disciplinary offence for an employee of any company or institution to open any email attachment coming from outside the company or institution from an unidentified source.
Dr Paul Kilty


Recruitment nightmare in General Practice…. “If you want something for ever you treat it differently. You shield and protest it. You never abuse it. ……”

Neil Roberts for GPonline 10th May 2017 reports: Almost one in four GP vacancies unfilled for more than a year

The Press Association reports in the Guardian: GP recruitment crisis intensifies as vacancies soar to 12.2%

and of course this has been known for at least 10 years… BMA – GP recruitment problems increase (June 2016)

ITV News says its “staggering”: Staggering’ GP recruitment problem hits new high – but waht is staggering is that the problem has not been addressed for so long. (ITV News )

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The reason lies in our short term political system.

It’s going to get worse.

This quotation applies equally to love and marriage as to the Health Services:

If you want something for ever you treat it differently. You shield and protest it. You never abuse it. You don’t expose it to the elements. You don’t make it common or ordinary. If it becomes tarnished you lovingly polish it until it gleams like new. It becomes special because you made it so, and it grows more beautiful and special as time goes by. F Burton Howard.

The rationing of places at Medical School and at Nursing School is a scandal. The prime duty of the state is to keep its citizens safe. All systems are melting down, including IT, and can only be saved with a long term view. Political parties promising to provide money will not clone doctors or nurses..

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We are creating a “caste” of doctors – by neglect. Neglecting to change our electoral system is equally crass..

Not everyone wants to be a doctor. It needs some intelligence, memory, staying power and determination, as well as all round education and communication skills. This is why “graduate” entrants are better bets for the state’s investment. If it costs £250,000 to train a doctor, then we as taxpayers want the best value from our investment.

Currently the drop out rate and the emigration rate are high. Preventing nurses and doctors from the EU from coming here will make the short term skills crisis worse.

There is a new advert in the media, for a medical school in Malta with training and exams run by Barts and the London Hospitals trust.

Studying in Malta.

This is basically a second private medical school for UK provision. The first was at Buckingham, and there is competition for places. Costs and overheads will be cheaper in Malta… With 11 applicants for every 2 places in the UK Medical Schools, there should be plenty of aspirants.

So who will apply? I have no idea of the fees, but lets assume that it will be in the order of £250,000 over 5 years, and add to that travel and accommodation, say £10,000 per annum. The total is a minimum of £300,000. This opportunity is a beginning for what goes on in the Indian subcontinent, where most training places are private. Doctors in the UK from the Indian subcontinent are more likely to be privately trained than not. They are also more likely to come from affluent families who have invested in their children’s education for the long term.

If all 9 failed applicants went to private medical school, and remember that their careers officers all recommended and supported their applications, there would eventually be the same excess of private doctors in the UK. If the government is tempted to reduce the places it funds because of oversupply, then the caste system gets worse.

The short-termism of governments in a first past the post electoral system is now evident to everyone in the UK. (Particularly those who have died early as a result of system failures) But the politicians and the media collude to be against any form of PR (proportional representation) Fair voting systems mean everyone feels they have a chance to influence power.

The protest vote at Brexit referendum was because we don’t have PR. The referendum on PR was ill timed, and mismanaged by Mr Clegg and colleagues, but now there is a real feeling that the time for PR is here. It is present in Scotland and Wales, and could easily be applied to change the House of Lords, and reduce it’s overheads. Would we like GP education to be privatised in the same way?

Don’t be led by the media ring in your nose: vote Liberal for a longer term view, and Proportional Representation. (which form is another debate).

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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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