CUTS CAUSING INEQUALITY
'Vulnerable patients' face ongoing caps to care funding (2 March 2018)
Commissioners have been allowed to continue applying cost caps to the more than £3bn of NHS Continuing Healthcare claims as long as they follow new new government rules.
The Department of Health and Social Care’s new framework, developed in partnership with NHS England, does not explicitly ban cost caps as long as commissioners take into account an individual’s needs when they do so.
CHC pays for ongoing care for adults, described by the DHSC as ”some of the most vulnerable in our society” and who are assessed as having a primary medical care need in a community setting. It is arranged and funded solely by the NHS and in 2015-16 cost the service approximately £3.1bn.
HSJ has previously reported that 37 CCGs were introducing policies to cap the cost of providing NHS Continuing Healthcare support in a person’s home if the spend would be significantly higher than a residential care placement. Last year the Equality and Human Rights Commission said it was investigating concerns the policies would be “likely to breach individual equality and human rights.”
The new guidance, published yesterday, said a commissioner “must not set arbitrary limits on care at home packages if this does not represent a personalised approach or an accurate appraisal of the cost” of meeting an individual needs. ...read more
NHS spending £350m a year to send mental health patients miles from home (The Independent, March 1 2018)
The NHS is reliant on private mental health services to treat seriously ill patients, often miles away from loved ones, and is doing too little to ensure they are not being kept in treatment longer than necessary, the care watchdog has said.
A report by the Care Quality Commission (CQC) today warns the health service is spending £350m a year to send these patients “out of area” for care.
Experts told The Independent this reliance is down to a lack of inpatient services to support patients locally, and a lack of incentives for “specialist” centres to send patients home.
The CQC is now calling on NHS managers to draw up plans to "repatriate patients" and to ensure every patient has a care plan aimed at getting them better to bring them back into the community. ...read more
The Crisis In Children’s Mental Health Cannot Be Resolved With Warm Words (Huffington Post:7 December 2017)
According to the Children’s Commissioner, there are 800,000 children living with mental health disorders - that’s the equivalent of at least three children in every classroom.
Demand for mental health support has reached unprecedented levels, and yet three in four children with a diagnosable mental health condition still do not receive the support they need.
For years, teachers and families have been left floundering, unclear as to how best to spot and tackle mental health problems among the children in their care. Many have struggled to get any help when a child is in difficulty until they reach crisis point.
And even then, a quarter of children referred to CAMHS by concerned parents, teachers and GPs are turned away by underfunded and overstretched services...read more
Private health firm gives GPs operation price list for impatient patients (The Guardian: 5 December 2017)
A private healthcare company has sent letters to hundreds of GPs setting out a price list of operations they could offer their patients to beat NHS delays and restrictions.
Care UK, which runs nine centres offering treatment on the NHS, said it intended to use spare theatre time to provide “self pay” procedures ranging from earwax removal to hip replacements.
The company said it was trialling the scheme at two treatment centres in the west of England but insisted core work at the sites would remain NHS referrals.
The move has, however, alarmed some GPs and health campaigners who fear it is another example of creeping privatisation in the NHS....read more
Care access to be rationed in the hope it will force through extra funding (The Guardian: 30 November 2017)
NHS bosses are to meet to discuss plans to ration and delay patients’ access to care, which could set them on a collision course with ministers over health funding.
NHS England’s board will publicly debate what the service will and will not be able to afford to do next year after Philip Hammond gave it less than half the extra money it said it needed.
Thursday’s meeting comes amid unprecedented tension between the organisation’s chief executive, Simon Stevens, and Theresa May and Philip Hammond. Stevens antagonised both of them with a dramatic pre-budget plea that treatment waiting lists could spiral and mental health and cancer care be hit unless the NHS received a £4bn boost in last week’s Budget. The chancellor awarded it just £1.6bn extra....read more
Exposed: ‘secretive’ NHS cost-cutting plans include children’s care (The Guardian, 25 September 2017)
Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.
The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.
The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.
They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.
Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity. ...read more
Health inequality gap ‘is still growing’ in England, new Department of Health data shows (The Guardian: 12 August 2017)
The health gap between rich and poor is growing in England, according to shocking figures compiled by the Department of Health.
Despite government pledges to reduce inequalities in areas such as life expectancy and susceptibility to disability and disease, those living in the most deprived areas of the country run a greater risk of premature death, seeing a child die soon after it is born, and of ending up in hospital as an emergency case. Differing health outcomes for the rich and the poor were identified by Theresa May last year as a “burning injustice”.
The health department data shows that in key areas the gap has widened since 2010 after narrowing over the previous decade. Seven years ago life expectancy for men in England’s most deprived areas was 9.1 years less than for those in the richest areas. By 2015 the figure had risen to 9.2 years. The equivalent gap for poor women also grew over that time, from 6.8 years to 7.1 years. The stark statistics are contained in the health department’s annual report, published this summer.
They have been seized on by David Buck, a senior fellow at the King’s Fund health thinktank and a leading expert in public health and health inequalities. Buck told the Observer: “These are shocking figures. It’s shocking that we live in a developed country where inequalities in health are so wide and are getting worse.
“For the poorest in the country this is a double whammy of early death and poorer health while still alive. They are going to die younger and are facing 20 more years of life spent in poor health relative to the richest. This should be a wake-up call to ministers.”... read more
NHS accused of shrouding £500m of planned cuts in secrecy (The Guardian: 28 July 2017)
Doctors’ leaders have accused NHS bosses of shrouding controversial plans for £500m of cuts to services across England in “totally unacceptable secrecy”.
Patients deserve to know how hospitals being told to “think the unthinkable” as part of the savings drive will affect their access to healthcare, the British Medical Association (BMA) said on Friday.
The doctors’ union voiced its frustration after trying but failing to obtain details of the cuts that are being planned in the 13 areas affected by the “capped expenditure process” (CEP), despite the NHS’s duty as a public body to respond to freedom of information requests.
NHS bodies in just eight of the 13 areas replied, and none gave anything other than vague, general details about what cuts were under consideration.
“It is bad enough that brutal cuts could threaten the services but it is totally unacceptable that proposals of this scale, which would affect large numbers of patients, are shrouded in such secrecy,” said David Wrigley, the BMA’s deputy chair.
In April organisations providing all types of care as well as clinical commissioning groups, the local bodies which hold the NHS budget in England, in the 13 areas were told to make an extra £500m of savings by the end of March 2018 over and above those already planned. The orders came from NHS England and NHS Improvement, the service’s financial regulator, which are keen that its books can be made to balance in 2017-18.... read more
Theresa May to oversee £85m in cuts to public health budgets this year, analysis reveals (The Independent: 12 July 2017)
Theresa May has been accused of taking her “eye off the ball” over public health as it was revealed budgets for a range of services including sexual health and help to stop smoking face new cuts of £85m.
Local authorities in England are being forced to spend more than 5 per cent less this year on public health initiatives than in 2013-14, according to a new analysis from the King’s Fund.
David Buck, the health think tank’s senior fellow in policy, used data from local governments and the Department of Communities to calculate that planned spending on sexual health services has fallen by £64m, or 10 per cent, over the past four years.... read more
Chickens coming home to roost: local government public health budgets for 2017/18 (The Kings Fund: 12 July 2017)
The Department for Communities and Local Government has released new data on local authorities’ planned budgets for public health in 2017/18. It does not make good reading.
Since 2013, when local authorities were first given responsibility for many aspects of public health, they have received a grant for this from the Department of Health. It is easy to forget that in the first few years the growth in this grant was quite generous: 5.5 per cent in both 2013/14 (against an estimated primary care trust baseline) and 2014/15, reflecting the coalition government’s commitment at that stage to investing more in public health. But in 2015/16 things changed dramatically.... read more
Changing population means NHS faces real-terms funding cut this decade (The GP Online: 8 May 2017)
NHS spending in 2019/20 will be 1.3% lower in real terms than a decade earlier once growth and ageing of the population are taken into account, according to public policy analysts.
Research by the Institute for Fiscal Studies (IFS) reveals that real-terms DH spending will increase by 12% over the period from 2009/10 to 2019/20 under current government plans.
This equates to a 1.1% increase per year - outstripping the 0.8% per year rate of population growth over the same period, meaning that real-terms per capita spending will have risen 3.5% over the decade.
However, once changes to the 'age structure of the population' are taken into account, the IFS warns that current spending plans will in fact deliver a 1.3% drop in per capita spending...read more
Government spent £17.6m on consultants hired to draw up NHS cutbacks (The Independent: 21 March 2017)
Firms including KPMG, McKinsey and PricewaterhouseCoopers (PwC) have made millions of pounds from plans that could lead to the closure or downgrade of NHS hospitals.
Health bosses have spent at least £17.6m on management consultants to draw up the strategies, which earmark cuts to departments and some A&Es.
Sustainability and transformation plans (STPs) have been created in 44 regions in a bid to revolutionise services while saving money in the face of an expected £900m NHS deficit this year.
The Press Association used the Freedom of Information (FOI) Act to ask clinical commissioning groups (CCGs) how much has been spent on management consultants to formulate the plans.
The figures show £17,674,998 has been spent so far, though the final bill is likely to be far higher....read more
Hospitals could join prisons and social care in a cycle of “crisis, cash, repeat” unless they receive better financial planning and reforms, a Whitehall report has warned.
Without improvements, public services are doomed to fail or breach spending controls, the report by the Institute for Government and the Chartered Institute of Public Finance and Accountancy (Cipfa) said.
The government’s austerity programme of delivering good services while cutting spending “ran out of steam” in 2015, according to an analysis of official figures. Both organisations are urging the chancellor to ensure any measures in the budget have sound evidence behind them.
The findings come as Philip Hammond comes under pressure to use an unexpected rise in tax receipts to aid public services in his first full budget next week.
Julian McCrae, the Institute for Government’s deputy director, said that unlike others, this report was not calling for more money but instead better organisation to shore up the public sector.
“As we’ve seen with prisons, social care and now potentially hospitals, the government risks getting into a cycle of crisis, cash, repeat,” he said. “This report is a call for better financial planning and reforms that are robust enough to survive public scrutiny.
“It is fundamental to increasing the effectiveness of these public services that ministers, officials and the public know how well government is performing and use this information to guide decisions.” ....read more
NHS staff ask 'least bad' patients to sleep in corridors amid hospital demand crisis (The Telegraph: 28 February 2017)
Patients are being asked to volunteer to sleep in corridors in order to free up spaces on overrun NHS wards, a new report reveals.
An anonymous survey of front-line doctors found staff are deliberately approaching the “least bad” patient in their ward to ask them to give up their bed.
The report on NHS performance in December and January by the Royal College of Physicians also reveals concerns that “panicking” managers desperate to get new patients into recently vacated beds are sidelining proper infection controls.
The latest NHS bed occupancy figures are the highest ever recorded for a third quarter since quarterly data collections began in 2010, providing a further sign of the system’s capacity challenges.
The average occupancy rate for all beds open overnight between October and December 2016 was 88.3% – up from 87.2% for the same quarter in 2015-16 – against the 85% standard, according to data published by NHS England.
Higher bed occupancy figures have only ever been recorded in fourth quarters, which are usually the busiest period of the year for the NHS. Overall, bed occupancy rates were 89% in quarter four of 2015-16, and 88.5% in quarter four of 2014-15.
The average occupancy rate for general and acute beds open overnight in quarter three this year was 90.5%, compared with 89.1% a year earlier.
Health Service Journal analysis of the data shows six hospital trusts recorded average general and acute bed occupancy rates of over 99% for the quarter. Nine more recorded a rate of over 95%, while further 10 recorded average occupancy of over 95%...read More
Government cutting beds across UK hospitals in NHS money saving measures (The Independent: 21 February 2017)
Hospitals will have to be closed and beds cut as part of a series of money-saving measures across the NHS in England.
A new report from The King's Fund think tank has warned that the number of hospital beds could destabilise services that were already "stretched to their limits" after the Winter.
Community services were also "feeling the strain" and could not currently cope with an increase in workload, it said.
Sustainability and transformation plans (STPs) have been put forward by NHS chiefs in 44 areas in England as part of a national programme to transform the health service and save money. The included hospital closures and cuts to some specialist services such as accident and emergency and stroke care.
King's Fund Chief Executive, Chris Ham said that the NHS cannot “realistically” cut the number of beds when this winter had shown that they were needed.
But he added that also said it needs to throw its full weight behind the plans to stand a chance of pulling them off.
The cuts could include a 44 per cent reduction in inpatient bed days in south-west London and a cut in hospitals in north-west London from nine to five. Hospital beds in Dorset could also be from 1,810 to 1,570....read more
An unprecedented rise in mortality in England and Wales, where 30,000 excess deaths occurred in 2015, is likely to be linked to cuts to the NHS and social care, according to research which has drawn an angry response from the government.
The highly charged claim is made by researchers from the London School of Hygiene & Tropical Medicine, Oxford University and Blackburn with Darwen council, who say the increase in mortality took place against a backdrop of “severe cuts” to the NHS and social care, compromising their performance.
The Department of Health (DH) responded by accusing the authors of the paper and accompanying commentary, published in the Journal of the Royal Society of Medicine on Thursday, of bias.
The researchers ruled out other possible causes of the increase, including cold weather, flu and the relatively low effectiveness of the flu vaccine that year, noting that fatalities from the virus rose “but not exceptionally”...read More
Fears of 'two-tier NHS' as GPs allow fee-paying patients to jump the queue (The Guardian: 8 February 2017)
Family doctors in Bournemouth have set up the first private GP service at which people who pay up to £145 a time will be seen faster and get longer appointments than their NHS patients.
The creation of the clinic has prompted fears that other GPs will follow suit and that NHS patients will become “second-class citizens” as general practice increasingly becomes a two-tier health service.
The three doctors running the Dorset Private GP service are offering “the unhurried, thorough, personal care we believe is best for patients” – at a price. Patients pay £40 for a 10-minute phone consultation, £80 for a 20-minute face-to-face appointment and £145 for 40 minutes with a GP.
“With the NHS sometimes struggling to offer a quality service now is the time to choose a private doctor,” according to the website for the trio’s venture. They offer times that suit patients and the chance to see the same GP at each visit, benefits that few NHS patients are offered any more because of the heavy and growing pressures on family doctor surgeries.
Those who pay receive their appointment at the same Poole Road Medical Centre in Bournemouth where the GPs see the NHS patients on their practice list. However, private patients in effect jump the queue to be seen as they can get appointments on the day, whereas ordinary patients can wait up to four weeks for an appointment lasting just seven minutes....read more
CCGs claim rationing decision based on Right Care programme (The HSJ : 8 February 2017)
Last month HSJ revealed that Redditch and Bromsgrove Clinical Commissioning Group, alongside South Worcestershire and Wyre Forest CCGs, intended to restrict knee and hip replacement operations on the basis of a patient’s Oxford knee and hip scores, which are usually used to asses patient outcomes. The CCGs could save £2.1m a year by reducing operations.
The Royal College of Surgeons said the move had “no clinical justification”.
Redditch and Bromsgrove CCG said in a board paper the CCGs had “utilised” NHS Right Care data packs to identify hip and knee replacement surgery as an area where the three groups could reduce expenditure by “circa £2,123,420 per annum”.
In a statement to HSJ last week, the CCG said: “We have worked with our NHS England appointed Right Care delivery partner to understand how to use the Right Care analysis packs properly before making decisions in this area.”...read more
NHS cash crisis in Kent halts non-urgent surgery until April (The Guardian: 2 February 2017)
An NHS body has run so short of money that it has banned patients in its area from having non-urgent surgery for up to 102 days in an unprecedented move that doctors have condemned as unfair and damaging.
Around 1,700 patients will be affected by West Kent clinical commissioning group’s (CCG) attempt to save £3.2m by delaying non-urgent operations from 20 December last year until the new financial year starts in April.
The CCG has introduced what the Royal College of Surgeons says is the longest ban in health service history on patients undergoing surgery to relieve pain, immobility, disability and other problems. The 1,700 patients include those waiting to have a new hip or knee fitted.
It is the latest example of cash-strapped CCGs implementing controversial restrictions on patients’ access to treatment which doctors have agreed they need. It follows a series of rows over the growing number of England’s 209 CCGs rationing care, including to smokers and those who are obese.
West Kent CCG has decided to suspend non-urgent surgery to help ensure that it does not bust its £616m annual budget. It pays for and supervises the care received by 463,000 people in Maidstone, Tunbridge Wells and surrounding areas.....read more
NHS spending per person will be cut next year, ministers confirm (The Independent: 28 January 2017)
The Government will cut the National Health Service’s budget per person in real terms next year, ministers have admitted in official figures for the first time.
Numbers released by ministers show NHS England will face a sharp reduction of 0.6 per cent in real terms of per head in the financial year 2018-19.
The numbers corroborate claims by NHS chief Simon Stevens earlier this month that “in 2018-19, real-terms NHS spending per person in England is going to go down”.
The figures also fly in the face of the Government’s public insistence that it is investing more in the health service, with Jeremy Hunt and Theresa May repeating the mantra of an extra £10bn for the NHS.
That claim was debunked by the cross-party Health Committee in the summer, whose chair, Tory MP Sarah Wollaston, said the number was both “incorrect” and “risks giving a false impression that the NHS is awash with cash”.
The Liberal Democrats said the figures show Tory claims of investment were “disingenuous” while Labour said the Government should use the March budget to close the black hole opening up in the health service’s finances....read more
Archive of earlier articles available here