Care for elderly ‘close to collapse’ across UK as council funding runs out (The Guardian: 26 November 2016)
Theresa May is under intense pressure from senior doctors and a powerful cross-party alliance of politicians to avert a collapse in care for the elderly, as shocking new figures show the system close to meltdown.
The medical profession, together with Tory, Labour and Liberal Democrat leaders in local government, have demanded a funding U-turn, warning that the safety of millions of elderly people is at risk because of an acute financial crisis completely overlooked in chancellor Philip Hammond’s autumn statement.
New figures obtained by the Observer show that 77 of the 152 local authorities responsible for providing care for the elderly have seen at least one residential and nursing care provider close in the last six months, because cuts to council budgets meant there were insufficient funds to run adequate services.
In 48 councils, at least one company that provides care for the elderly in their own homes has ceased trading over the same period, placing councils under sudden and huge pressure to find alternative provision.
In addition, 59 councils have had to find new care arrangements after contracts were handed back by a provider who decided that they were unable to make ends meet on the money that councils were able to pay them.
The medical profession, council leaders and even the former Tory health secretary, Andrew Lansley, are appalled that the social care crisis – exacerbated by growing numbers of elderly people and the rising costs of paying staff – was not addressed in the autumn statement.
In a letter to the Observer, the leaders of the four main political groups in local government expressed their disquiet at the chancellor’s dismissing talk of a crisis despite calls from politicians, NHS leaders, doctors and others....read more
More than four in five (83%) staff working in mental health surveyed said a postcode lottery exists in the level of care that patients receive. In some cases, people with severe conditions such as chronic anxiety and schizophrenia are unable to access help until they have reached crisis point.
The findings are based on a survey of more than 1,000 staff such as therapists, nurses and social workers employed by mental health care services including the NHS and councils across the UK.
The survey also highlights how increased patient demand for services, coupled with cuts in services have left those staff left behind facing intolerable pressures.
More than four in five (85%) surveyed said they had experienced cutbacks, and nearly nine in ten (88%) reported an increased workload. This has led to longer waiting times for patients before they can get help, according to more than half (52%) of staff, says UNISON.
UNISON head of health Christina McAnea said: “The government has pledged £1.25bn for mental health but services are still having budgets reduced. No-one should have to wait weeks to get the support they need, and staff shouldn’t be placed under such pressure that they risk using mental health services themselves.
“With fewer staff and more people seeking help, it’s no wonder that employees who dedicate their lives to helping others feel at breaking point. Funding for mental health services must reach those in need and not be diverted to plug gaps elsewhere in the NHS.”....read more
NHS funding and rationing: The debate intensifies (BBC News: 31 October 2016)
In 2014, ahead of the general election, George Osborne, the Chancellor of the Exchequer, conjured up an extra £1.9bn for the NHS in England for 2015-16, after warnings there had been an unbridgeable gap in the finances.
Under the usual funding formula, this became £2.2bn across the UK, on the assumption the devolved administrations spent their allocations on health.
This was unveiled with a hospital photo opportunity involving Mr Osborne, Simon Stevens, of NHS England, and the Health Secretary Jeremy Hunt and was widely welcomed by health commentators and think tanks.
The election came and went, and it was not long into the 2015-16 financial year before hospital trust bosses were warning of mounting deficits and the sums not adding up.
Fast forward to the autumn of 2015, and Mr Osborne was publishing his Spending Review for the years up to 2020...read More
It is “foolish” of the NHS and the government not to focus on meeting the needs of children with mental health issues, the Royal College of Nursing (RCN) has said, as a poll revealed seven in 10 specialist nurses find CAMHS services either ‘inadequate’ or ‘highly inadequate’.
Of the 631 mental health nurses working in CAMHS surveyed, half said services are inadequate, whilst another 20% said they were highly inadequate. Just 13% believed they are good or very good, and the rest think they are simply ‘adequate’.
Fiona Smith, the RCN’s professional lead for children and young people’s nursing, said: “We are failing young people with mental health problems by not providing services and interventions in a timely manner....read more
NHS rationing under the radar (www.kingsfund.org.uk: 17 August 2016)
After years of increasing deficits, that last year culminated in the NHS posting the largest overspend in its history, local health systems have been told to balance their books.
This intensifies the difficult decisions that commissioners and providers have been facing for some time, about how to prioritise limited funding and balance their budgets in the face of rising demand. While the NHS has always had to set priorities, with these unprecedented financial pressures it is inevitable that some organisations will be forced to restrict access to certain services or dilute quality of care as they seek to curtail spending. In some areas this is happening already...Read More
Rising numbers could face 'crippling pain' as NHS rationing spreads (The Telegraph: 9 August 2016)
Increasing numbers of patients will be left to endure “crippling pain” as rationing spreads across the NHS, one of Britain’s most senior surgeons has warned.
Stephen Cannon, Vice President of the Royal College of Surgeons said bans on all but the most urgent treatment would become “commonplace” without major changes to the funding of the health service.
The NHS is in the grip of the worst financial crisis in its history, with increasing restrictions on cataract surgery and lengthening waiting times for hip and knee operations in most areas.
Yesterday St Helens clinical commissioning group in Merseyside took the unprecedented step of making plans to suspend all non-urgent treatment for four months, in an attempt to tackle its overspend.
In a letter to The Telegraph, Mr Cannon, an orthopaedic surgeon, said such bans would become widespread without a “realistic” increase in funding.
He also called for changes in the way existing funds are spent, to divert more money away from bureaucracy towards front-line care. “I am concerned that we could end up going back to the days when patients waited two or three years for operations” Stephen Cannon, Vice President of the Royal College of Surgeons...read More
Call for cross-party commission into NHS and social care 'crisis' (Nursing Times: 20 September 2016)
The call to Theresa May comes from two former government health ministers and a shadow health minister.
Liberal Democrat North Norfolk MP Norman Lamb, who was a minister in the coalition government, has joined forces with Dr Dan Poulter, former minister and Conservative MP for Central Suffolk and North Ipswich, and Liz Kendall, Labour MP for Leicester West and a former shadow health minister.
In a joint statement, the three senior health figures argued that health and care services in England faced a serious existential challenge, and that partisan politics had failed to come up with long-term solutions to ensure that services are properly funded and sustainable for the future.
Highlighting expert warnings of growing gaps in social care and the diminishing ability of the NHS to meet demand under current spending plans, they called on the government to start a “national conversation with the public and healthcare staff”...read More
Exclusive: ITV News survey finds doctors 'rationing care' as cash crisis hits NHS ITV: 14 September 2016)
More than two thirds of doctors admit they have been left with no choice but to ration care as the NHS cash crisis intensifies.
Services and treatments including mental health care for children, hip and knee replacements and cancer drugs are being restricted in order to save money.
A survey of 1,000 doctors conducted exclusively for ITV News reveals patients are being denied treatments including varicose vein removal and cataract surgery, and forced to pay for care privately or wait for their condition to worsen.
Some patients ended up in A&E because they were refused treatment...read More
Patient choice and private provision decreased public provision and increased inequalities in Scotland: a case study of elective hip arthroplasty (PubMed: 28 July 2016)
An increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13, territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with the greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002.
NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates....read more
Are commitments for mental health all talk and no action? (The Guardian: 29 July 2016)
Promises, platitudes and plans are piling up for mental health, but how much is going to be delivered?
Mental health accounts for roughly £12bn of the NHS budget. In parliamentary terms the current support for mental health is unprecedented – parity of esteem with physical health services is enshrined in the Health and Social Care Act 2012, plus last year’s spending review made explicit reference to improving quality, choice and outcomes in mental health.
But a recent report by the health select committee on the impact of the spending review on health and social care was sceptical about whether the rhetoric is being matched by actions. The committee called for verifiable evidence that the additional cash promised to mental health was reaching the front line, and that the cultural change necessary to deliver parity of esteem was happening.
The NHS planning guidance for 2016-21 instructs clinical commissioning groups to increase investment in mental health at least at the level which matches their overall spending increase, but whether this being done is disputed. NHS clinical commissioners insisted to MPs that this is happening while NHS Providers maintained the money is not coming through. It even accused commissioners of using “weird and wonderful calculation methodology” to justify their claims.
The government has made specific promises: more cash for young people with eating disorders, a “system-wide transformation” of children and young people’s mental health and perinatal mental health, and improved access to psychological therapies. But it is far from clear how the money for this will avoid being dragged into the black hole of the acute sector’s deficit....read more
Two-thirds of GP referrals for child mental health lead to no treatment
(Pulse: 4 July 2016
An increasing number of vulnerable children are being refused vital mental health treatment that is recommended by their GP, finds a major Pulse investigation.
Figures obtained from 15 mental health trusts reveal that 60% of GP referrals to child and adolescent mental health services (CAMHS) lead to no treatment and a third are not even assessed.
The situation for young people with mental health issues appears to be worsening, with the numbers of referrals that progress to treatment decreasing from 44% in 2013 to 39% in 2015.
GPs told Pulse that CAMHS were refusing to treat patients unless they had attempted suicide or self-harmed. Many cases are being sent to school counsellors or charity services, when GPs have requested specialist input.
The figures come despite Government promises to increase access to mental health services for children, with an increase in funding of £1.4bn and a call to all regions to produce plans on how they are going to work together to improve CAHMS services.
The freedom of information requests to mental health trusts found that in Norfolk and Suffolk NHS Foundation Trust the number of CAMHS referrals progressing to treatment was 20%, down from 46% in 2013. At Leeds and York Partnership NHS Foundation Trust the proportion treated fell from 42% to 26%....read more
A national disgrace: NHS fails to treat child mental health (Pulse: 4 July 2016)
A whole generation of children is being failed by mental health services, say GPs who struggle to access specialist help for their patients.
GPs are finding their referrals increasingly batted back, with three in five of those made to specialist child and adolescent mental health services (CAMHS) resulting in no treatment at all.
GPs report that local trusts are raising thresholds for care, with some only accepting patients who have attempted suicide or are experiencing symptoms of very serious mental illness. Cuts to mental health funding mean services have struggled to cope with a 40% increase in GP referrals since 2012. This has meant that young patients are being directed to local charities or school counsellors rather than receiving specialist care.
And this is all occurring as rates of suicide rise in the UK; it is now the leading cause of death among men aged 20 to 34 years.
The Government insists it is ploughing more investment into CAMHS but experts say it may be too little, too late to address a crisis that is causing significant suffering and storing up major problems for the future....read more
Budget cuts leave occupational therapy posts unfilled as referrals rise (The Guardian: 28 June 2016)
Occupational therapists (OTs) make up 2% of the adult social services workforce but are responsible for around 40% of referrals, illustrating just how vital their expertise is. But cuts to council budgets are putting them under increasing pressure as vacancies are left unfilled and waiting lists for services increase. National figures show that the number of OT posts in adult social care in England fell by 4% in the year to September 2015. And in London, 18% of vacancies for experienced OT practitioners in adult and children’s services are being left unfilled. Harold Bodmer, president of the Association of Directors of Adult Social Services and director of adult services for Norfolk county council, says: “Some of that is down to the cuts. What we are trying very hard to do is to put occupational therapy expertise to best use, so that some of their work can be done by other people with OTs overseeing them.”
Julia Skelton, director of professional operations at the College of Occupational Therapists, says the figures speak for themselves: “OTs are working very hard to keep the waiting lists for assessments down. When you consider we make up 2% of the workforce and take 40% of referrals, the figures say everything.”
The picture is similar in the NHS. Some parts of the UK which historically find it hard to recruit – rural Lincolnshire and the north of Scotland – are still struggling to fill posts across the board. In London, NHS trusts are seeing nearly 20% of their band 6 posts left vacant – these are qualified OTs with around two years’ experience, who make up the largest OT group. Most of these vacancies are in acute care, particularly mental health...read more
Sex has got a lot to answer for. The UK is facing a rising demand for sexual health and contraceptive care. Unacceptable levels of sexual coercion and female genital mutilation (FGM) are being reported, sexually transmitted infection (STI) diagnoses are increasing [pdf], and the UK still has the highest rate of teenage pregnancy in western Europe.
Despite all of this, key services are facing monstrous budget cuts alongside so many other sectors of our increasingly weary NHS. This means clinic closures, the dissolution of preventative health programmes, further pressure on already overloaded GP practices, and horrifying long-term financial costs.
In truth, sexual health services have suffered financially for some time. With the implementation of the Health and Social Care Act 2012, responsibility for sexual health funding was allocated to local authorities and these services put out to tender.
Private companies can bid for control over them, which the government claimed would improve standards “through competition and choice”. In reality, the winning bids are often ones that offer immediate cost-saving rather than long-term financial benefits and the best possible standards of care.
In 2015, the government announced its £200m public health budget cut, resulting in local councils spending millions of pounds less than planned on sexual health services nationwide. Add to this a potential 40% cut in central funding to local authorities and you can see how pressure is mounting...read more
‘This isn’t acceptable’: outcry at state of NHS mental health care funding (The Observer: 11 June 2016)
A cross-party inquiry by MPs into the funding of mental health services has received more than 95,000 personal submissions in an unprecedented display of anger over the state of the NHS.
One woman who submitted testimony linking the lack of support to suicide rates said the failure of the system to respond to people in trouble was often “what pushes you over the edge”. She wrote: “I’m scared my husband could become one of these statistics.”
A separate YouGov poll commissioned and crowdfunded by the campaigning organisation 38 Degrees found that 74% of voters believe that funding for mental health should be greater or equal to funding for physical health. The amount actually spent on mental health by the NHS last year, despite government pledges to establish parity, was just 11.9% of overall NHS spending.
Meg Hillier, chairwoman of the public accounts committee holding the inquiry, said the scale of the response underlined the strength of feeling that mental health was being underfunded. “We shall question NHS England and the Department of Health on how they can meet the government’s pledges,” she said.
The poll findings come as a new report, to be published on Monday by the NSPCC, says NHS commissioners are failing to take abused children into account when planning mental health services. The charity says the government’s £1.4bn investment in children’s mental health services is not being deployed to aid children who need help after abuse. Peter Wanless, chief executive of the NSPCC, said: “Often, it’s only when children reach rock bottom, regularly self-harming or feeling suicidal, that the services they need so desperately open up to them. This isn’t acceptable.”....read more
Mental health support 'denied to children' (BBC News: 28 May 2016)
More than a quarter of children referred to mental health services in England in 2015 - including some who had attempted suicide - received no help, a report says.
A review by the Children's Commissioner also found that 13% with life-threatening conditions were not allowed specialist support.
She said the system was "playing Russian roulette" with their health.
NHS England said it was "clearly the case" that services need to expand.
The commissioner obtained data from 48 of England's 60 child and adolescent mental health service trusts, and discovered 28% of child referrals were denied specialist treatment - mostly on the grounds that their illness was not serious enough.
This group included children who had attempted serious self-harm and those with psychosis and anorexia nervosa.
It also found that those who secured treatment faced lengthy delays, with an average waiting time of more than 100 days....read more
Government pledges to put more money into mental health are being broken because the NHS is not passing the money on to the NHS trusts that treat patients, a new report has revealed.
The phrase “parity of esteem” when used to describe the treatment of mental health services in the NHS is rightly being put under the microscope. It has been widely used to communicate a commitment to improving quality, broadening access to services and boosting funding. However, recently it has become clear that there is a gap between this intention and the reality on the ground.
Our report, Funding Mental Health at Local Level: Unpicking the Variation, published in partnership with the Healthcare Financial Management Association, shows just that, and it makes for difficult reading. Despite a number of funding boosts, it is clear that the necessary investment just isn’t reaching frontline mental health services. Our survey found that only half of mental health trusts received a real-term increase last year, despite the fact that the commissioners who fund them were required to increase their investment in line with their overall financial allocation.
Particularly concerning is the finding that NHS England is not necessarily leading by example. It is responsible for setting the rules and for holding local commissioners to account for their spending plans, yet its own specialised commissioning teams are not consistently meeting parity of esteem commitments towards mental health services, with only a third of trusts receiving a real-terms increase in 2015–16.
The situation does not look like it will improve this year either. Although we are still concluding the contracting round for 2016–17, providers were even less positive about receiving additional investment, with only a quarter confident that they would see a real-term increase...(read more)
Vulnerable people regularly refused access to GPs, says charity (The Guardian: 30 April 2016)
Some of the most vulnerable people in the UK are regularly refused access to a doctor, according to a report.
Pregnant women, children and homeless people are among those who have been wrongly turned away from practices. Medical care is also refused to sex workers, domestic workers and people who have suffered torture, trafficking, domestic and sexual violence, research has found.
In some cases, vulnerable people have been refused registration on more than one occasion.
The research conducted by Doctors of the World (DoTW) found that medical centres and GP surgeries were refusing to help at least two in five people, despite their being eligible for free primary healthcare....read more
Mental health trust forced to cut services (Pulse: 6 April 2016)
A mental health trust in Manchester has cut seven frontline community-based services to save £1m, in one of the first major decisions taken since the city was given total control over its health budget.
Manchester Mental Health and Social Care Trust (MHSC) proposed the cuts in October and, despite a huge public outcry, decided last week to push through with plans.
The decision comes as Greater Manchester has been given complete control over its £6bn health budget following the implementation of ’DevoManc’, becoming the first region of England to have devolved healthcare powers.
Services to be cut include those for chronic fatigue and psychosexual disorders, as well as gardening therapies....read more
Jeremy Hunt urged to act against avoidable deaths from epilepsy (The Independent: 12 March 2016)
The Epilepsy Society has launched a new campaign calling on the Health Secretary Jeremy Hunt to act against avoidable deaths from the condition.
Although sufferers are at greater risk of premature death, almost four in 10 of those deaths are avoidable, according to the charity, which says better care, treatment and services are urgently needed. It has also launched an online campaign urging MPs to write to Mr Hunt requesting that a National Clinical Audit into the condition take place – for the first time since 2002.
The Epilepsy Society said the most worrying aspect is the postcode lottery for the 500,000 people in England living with the condition. Data from the Office for National Statistics shows that rates of premature death vary vastly: for example, someone with epilepsy is 49 per cent more likely to die prematurely in West Yorkshire than in Cheshire.
The Department of Health’s removal of two of the epilepsy performance indicators that are used to evaluate local commissioners has left local health decision-makers in the dark about how services are performing in averting premature death in epilepsy, the charity said...read more
Why are more children being prescribed antidepressants? Funding cuts (The Guardian: 11 March 2016)
New research published this week shows that between 2005 and 2013 there was a 54% increase in the number of children and young people prescribed antidepressants in the UK. The World Health Organisation’s director of mental health, Dr Shekhar Saxena, has expressed concern about the reasons behind this rise.
Antidepressants are not licensed for prescription for under-18s, with one exception. The National Institute for Health and Care Excellence clinical guidelines state that fluoxetine, a type of selective serotonin reuptake inhibitor, can be used in under-18s, but should not be prescribed without first referring the child for talking therapy. The two treatments should coexist and the child should be monitored carefully, particularly in the first few weeks after starting the drug, when the risk of the “major harm” Saxena speaks of is at its highest....read more
Liverpool NHS jobs face the axe because of community health funding cuts (Liverpool Echo: 17 February 2016)
Up to 30 NHS staff in Liverpool could lose their jobs as services including exercise classes for dementia patients and anti-smoking sessions face the axe.
Liverpool council is cutting the amount of cash it gives to Liverpool Community Health NHS Trust (LCH) – leaving staff in a “difficult and uncertain time”, according to trade union Unison.
Services that could be cut include healthy eating campaigns, stop smoking sessions for pregnant women, exercise classes for dementia sufferers and work to promote dental health.
Unison warned the cuts will damage the city’s health in the long run by storing up problems for the future.
A statement from the union said 30 LCH staff now fear losing their jobs due to the cuts...read more