General election 2017: NHS pay cap 'must be lifted' (BBC News: 7 May 2017)
The pay cap on NHS staff must be lifted because it puts patient safety at risk, NHS bosses say.
NHS Providers said the cap, which limits pay rises to 1% a year to 2019, was causing severe recruitment and retention problems in England.
The body, which represents NHS trusts in England, said the next government must look at the issue immediately.
Labour says it would look to increase pay, but the Tories and Lib Dems have not yet set out any pay plans.
Labour wants to increase pay so it better reflects the cost of living, but has not said by how much.
Over the weekend the Lib Dems did announce they would increase income tax by a penny-in-the-pound to boost investment in the NHS.
Last year the Public Accounts Committee warned that the NHS in England was 50,000 people short of the front-line staff it needed - about 6% of the workforce.
NHS Providers chief executive Chris Hopson said his members were now worried the situation was so bad that services were at risk.
"Growing problems of recruitment and retention are making it harder for trusts to ensure patient safety," he said. "Unsustainable staffing gaps are quickly opening up."
He said the seven years of pay restraint, combined with stressful working conditions, had taken a toll on the workforce.
"Pay is becoming uncompetitive," added Mr Hopson. "Significant numbers of trusts say lower paid staff are leaving to stack shelves in supermarkets rather than carry on working in the NHS."
He added that uncertainty surrounding Brexit meant that "vital recruitment from EU countries is dropping rapidly", saying: "Pay restraint must end."....read more
NHS hospital waiting lists to rise above five million in two years, leak suggests (The Independent: 4 May 2017)
The number of NHS patients waiting for hospital treatment could soar to more than five million in just two years' time, a leaked document has revealed.
If no action is taken, twice as many people will be forced to wait more than 18 weeks for non-emergency surgery such as hip replacements and cataract operations by 2019, according to projections made by health service regulator NHS Improvement.
Total waiting list numbers are expected to rise by nearly 50 per cent from 3.7 million to 5.5 million, based on current trends – resulting in delays that surgeons have warned may result in death or serious disability.
Ian Eardley, Vice President of the Royal College of Surgeons, said the "devastating" figures obtained by the Health Service Journal "hammer home just how damaging deprioritising the 18-week target for planned surgery will potentially be".
The target that no patient should have to wait longer than 18 weeks after GP referral for non-emergency surgery has been in place since 2004.
But the number of patients waiting longer than that is rising, with NHS England chief Simon Stevens suggesting this should be expected as a “trade off” for improved care elsewhere in the health service, including in A&E and cancer units....read more
Exclusive: Social care £2bn won't get NHS through winter, ministers warned (HSJ: 4 May 2017)
Ministers’ headline budget pledge to alleviate pressure on the NHS by handing councils an extra £2bn for social care will fail to deliver “anything like the level of resource” required, NHS leaders have warned.
Chancellor Philip Hammond used the pledge, alongside an extra £100m for emergency departments, to underpin his claim that the Conservatives were “the party of the NHS” – a key battleground in the general election campaign.
System leaders said following the budget announcement that the cash, which is for the next three years, could help “free up in the region of 2,000 to 3,000 acute hospital beds” by speeding up delayed discharges of care, equivalent to around five hospitals, in 2017-18 alone.
But NHS leaders have told HSJ that early discussions with local government counterparts indicated the new cash would instead be used by councils to fill existing budget gaps and provision, help stabilise private sector providers, and offset some of the cost burden resulting from the national living wage.
A new government after the general election on 8 June would need a “plan B” to avert an NHS winter crisis, they warned, with one senior source saying senior figures were “seriously worried” about the winter....read more
Revealed: NHS Ambulances fail to reach most seriously ill and injured patients in time despite efficiency drive (The Independent: 1 May 2017)
Ambulances are failing to reach thousands of seriously-ill patients within the eight-minute target time, despite a dramatic reduction in the number of calls classified as urgent, The Independent can reveal.
Unions warned that lives are being put at risk by slow response times, even as the system is being “manipulated” to make it easier to hit government-imposed targets.
The revelations of worsening performance come from a trial being run in three of the country’s 10 ambulance trusts, which is aiming to streamline the service and ensure the sickest patients are dealt with quickly.
But exclusive figures obtained by The Independent show even though tens of thousands of cases have been stripped out of the urgent category, ambulances are still failing to meet the target.
In Yorkshire, the percentage of the most serious calls responded to within eight minutes fell to 67 per cent between May 2016 and January 2017, down from 71 per cent a year earlier. During the same period, the number of calls classified as requiring an urgent response fell from 235,200 to 53,300.
The number of most urgent calls taken by the South Western ambulance service between May 2016 and March 2017 compared to the year before was reduced from 308,000 to 44,600. But the proportion of calls hitting the eight-minute target remained stagnant at 70 per cent.
Ambulance staff union GMB accused NHS England of “manipulating” targets, saying: “At the end of the day, someone, if they haven’t already, is going to die from a lack of care.”...read more
Nurses will see their pay ‘cut by 12% over a decade’ (The Guardian: 29 April 2017)
workers will have had their pay cut by 12% by the end of the decade because of a government-imposed wage restraint that is now exacerbating chronic understaffing, new research reveals.
The 625,000 health service staff who earn at least £22,000 will have seen their income fall by 12% between 2010-11 and 2020-21 as a result of years of below-inflation 0% and 1% pay rises eroding their spending power, according to a report by the Health Foundation thinktank
The real-terms drop in pay will hit NHS personnel across the UK who are on band five or above in the service’s pay scales, which includes all 315,000 nurses. The Royal College of Nursing’s 270,000 members are currently being polled on whether they should strike – for the first time in their history – in protest at the government holding down their pay by limiting rises to 1% every year until 2020.
Staff salaries have already been cut by 6% since the coalition came to power in 2010, more than the 2% seen across the economy as a whole in that time, the report found. Midwives have seen their pay shrink by 6%, but doctors and health visitors have been hit by 8% and 12% drops respectively.
The Health Foundation also found that England could face a shortfall of 42,000 nurses by 2020, and almost half of all nurses believe that current staffing levels are already dangerously stretched.
Staff pay has fallen back so much that it is now causing major problems, the thinktank said. “The current phase of national NHS pay bill control began at a time of economic recession, with low inflation and high unemployment. However, this is increasingly being replaced by greater numbers of staff shortages and the likelihood of higher inflation.” It adds: “Having contained NHS staff earnings growth in recent years, UK governments now face a situation where recent trends and future projections highlight that earnings in the broader economy are growing more rapidly, and inflation is at a level that will erode the purchasing power of NHS staff.”....read more
Government ‘lacks credible plan’ for improving GP access, say MPs (Pulse: 27 April 2017)
The Government's plans to boost access to GP appointments and expand the workforce lack credibility, according to an influentiual committee of MPs.
The Public Accounts Committee made the comments in a progress report on the Government's GP access programme, which aims to deliver 8am-8pm routine appointments to all, seven days a week, by 2020 and 5,000 more GPs by 2020.
According to the report, the Government is 'moving ahead in rolling out extended hours without really understanding the level of access currently being provided or how to get the best from existing resources'.
It also noted that there is a risk that the evening and weekend GP appointments pledge ‘could prove expensive and duplicate existing out-of-hours services’
On access, the report also noted that 'many GP services are closed to patients at times during supposedly core hours, leading to worse outcomes for patients'.
It highlighted NHS England's attempts to address this via the changes to the extended hours DES in this year’s GMS contract and recommended that NHS England reports back on progress later this year.
The report further warned that there had been 'no progress’ on increasing the number of GPs in the past year, following the latest GP workforce figures which showed the full-time workforce dropped by 1.3% (400 GPs) in the last three months of 2016.
Children's hospital units forced to close to new patients due to staff shortages (The Guardian: 18 April 2017)
Hospital units that treat children and very sick babies are having to shut their doors temporarily to new patients because they are “dangerously” short of specialist staff, a new report reveals.
Widespread shortages of paediatric doctors and nurses also means that the care children receive is being put at risk, according to the Royal College of Paediatrics and Child Health.
A chronic lack of staff is forcing doctors to take potentially life or death decisions about which patients to treat quickly, one paediatrician said. “Last night we only had one registrar instead of two. We had an emergency in A&E and [the] labour ward at the same time and she had to make a snap decision which to go to. It’s being forced to dice with death,” said the medic, who asked to remain anonymous.
Another paediatrician said: “It’s becoming normal to do the work of two or three so corners are constantly being cut and kids don’t get the time and attention they deserve.”
The RCPCH’s new report, based on information supplied by NHS trusts and boards across the UK, found that “in the year to September 2015, shortages of nurses and/or doctors led to periods of closure to new admissions by 31% of paediatric inpatient units and 41% of neonatal units”. Temporary closures have occurred since, as demand for children’s care and resulting admissions have soared. For example, Stafford County hospital had to shut its paediatric A&E unitlast year.
Its report warns that there are 241 vacancies for paediatricians across the NHS and that the number of young doctors choosing to specialise in that area has fallen 28% in the last two years alone....read more
Private provider beats GP federation to NHS contract (HSJ: 18 April 2017)
Commissioners in north London have awarded an extended primary care services contract to a private provider over the GP federation that was already providing the service, HSJ has learned.
Camden Clinical Commissioning Group has appointed AT Medics, a private provider of primary care services, as its extended GP access provider following a procurement process. It is a GP led provider of various primary care services in London, including core GP services and urgent care.
This was despite a receiving bid from the Haverstock Healthcare, a GP federation operating in the borough, and which currently provides the service. It covers 200,000 patients across 26 GP practices in Camden.
HSJ understands that the contract has been awarded as part of a joint procurement process for extended GP services accross five North central London CCG areas – Camden, Haringay, Islington, Barnet and Enfield – related to the national GP access fund.
In a message to local GPs, Rebecca Thornley, assistant director of primary care at Camden CCG, said: “AT Medics, who run King’s Cross Surgery, demonstrated their understanding of the local health system and the needs of Camden patients through the bidding process....read more
Revealed: 100,000 wait more than two weeks to see cancer specialist (The Guardian: 18 April 2017)
More than 100,000 patients a year are “having their worst fears dragged out” by having to wait longer than the stated maximum of two weeks to see a cancer specialist to find out if they have the disease, new NHS figures obtained by the Guardian reveal.
A total of 102,697 people in England did not get to see a consultant within 14 days of being urgently referred by their GP last year – a key patient right in the NHS constitution. Some 25,153 people had to wait more than the official target of 62 days to start their treatment.
Macmillan Cancer Support said growing delays to see a specialist, have a diagnostic test and start treatment meant that “thousands of people are being left in an appalling state of limbo”. The Royal College of Radiologists said it feared that long waits beyond the supposed maximums may also reduce patients’ chances of survival and risk some cancers becoming untreatable.
The findings are contained in an analysis of cancer waiting times performance in 2016 undertaken by the House of Commons Library at the request of the shadow health secretary, John Ashworth. “These statistics should be a badge of shame for Theresa May. It’s a national disgrace that this Tory government’s sustained failure to properly fund cancer services has left thousands of patients waiting longer than expected for treatment they urgently need,” he said.
Dr Nicola Strickland, the president of the Royal College of Radiologists, said: “Any delay in diagnosis or time to start therapy risks a growth in the cancer, potentially making it incurable. These delays increase the anxiety experienced by patients and their relatives at this difficult time....read more
Social care system 'beginning to collapse' as 900 carers quit every day (BBC: 11 April 2017)
More than 900 adult social care workers a day quit their job in England last year, new figures reveal.
Service providers warn that growing staff shortages mean vulnerable people are receiving poorer levels of care.
In a letter to the prime minister, the chairman of the UK Homecare Association said the adult social care system - which applies to those over the age of 18 - has begun to collapse.
The government said an extra £2bn is being invested in the system.
An ageing population means demand is increasing for adult social care services.
Those who provide care to people directly in their own homes, or in nursing homes, say a growing shortage of staff means people face receiving deteriorating levels of care.
"You just can't provide a consistent level of care if you have to keep recruiting new people", said Sue Gregory, who has been a care home nurse in North Yorkshire for 13 years.
"Its very simple, not many people want to do this kind of work, and this is a profession that relies on you getting to know the people you are looking after."...read more
Record number of GP closures force 265,000 to find new doctors (The Guardian: 7 April 2017)
A record number of GP practices closed last year, forcing thousands of patients to find a new surgery, in spite of government attempts to stop local doctors shutting their doors.
NHS England data showed nearly a hundred practices closed in 2016, a 114% increase in GP closures compared with figures from 2014. Of the 92 practices that shut, 58 did so completely, while 34 merged with other local surgeries in order to pool resources.
The drop in GP numbers meant 265,000 patients – an increase of 150% from 2014 – had to change their practice last year, often travelling further for care. Brighton was particularly badly affected with 9,000 patients displaced when four practices closed. There have been a total of seven closures in the city over the past two years.
The new data, obtained by the GP website Pulse, has renewed fears that family doctors are not coping with increased demand and need an urgent cash injection to survive. Senior doctors also expressed concern that government funding was not being targeted correctly. ...read more
Biggest ever NHS tender launched as £6bn contract put on market (HSJ: 7 April 2017)
Manchester health leaders have kicked off the search for providers of “out of hospital” health and care services across the city under a contract worth nearly £6bn – the largest ever NHS services tender.
A tender document, published by NHS Shared Business Services, sets out for the first time the contract value and other details of the ambitious plan to set up a “local care organisation” to provide all non-acute services – including social care – across the city.
The LCO will hold a single 10 year contract to provide services for a population of around 600,000 across the city – but not the entire Greater Manchester devolution region. The contract will be let by Manchester Health and Care Commissioning, a partnership between the city council and a newly formed single clinical commissioning group.
The notice, which calls for expressions of interest by the end of April, said: “Commissioners seek responses from interested providers who wish to deliver… a local care organisation for the population of Manchester with the aim of bringing together a range of health, social care and public health services to be delivered in the community.”
“The LCO is envisaged [to have] an emphasis upon: local population health and prevention of ill health; connecting to community assets and building upon people’s strengths and self-management skills; and targeted care support people’s needs particularly as needs change and become more complex. The estimated total contract value for the 10 year contract term is £5.9bn.”...read more
Virgin Care and CCG in dispute over changes to £270m contract (HSJ: 11 April 2017)
A Midlands clinical commissioning group is locked in a contract dispute with Virgin Care over a controversial “prime provider” contract awarded last year, HSJ has learned.
East Staffordshire CCG disagrees with “contractual claims” made by the independent provider to make changes to the £270m “prime provider” deal that began in May 2016.
The fixed price, seven year contract covers community services, with Virgin Care coordinating services for frail elderly patients, people with long term conditions and intermediate care. Last year, the CCG said it had used the prime provider contract model as it did not have the capacity to deliver the required integration of services.
However, in governing body papers published on 30 March, the CCG said there have been “a number of contractual claims made by Virgin Care for variations to the contract… these continue to be managed through the prescribed contract management and dispute resolution processes”. It is not clear what the nature of these claims are.
The documents also said the CCG is utilising a number of “contractual actions” in relation to Virgin Care in its prime contractor role, and the outcome of “contractual claims made by Virgin Care” present a “potential risk” to the group’s finances....read more
Philip Hammond and Jeremy Hunt tell Theresa May of secret plans to close rural chemists despite assurances to MPs (Telegraph: 26 March 2017)
Ministers are planning to allow hundreds of rural chemists to close across the country despite repeated assurances to MPs this would not happen, The Telegraph can disclose.
In private letters to Theresa May, last August Philip Hammond and Jeremy Hunt warned that pharmacies would have to close because of the cut in a subsidy worth hundreds of millions of pounds a year to the hard-pressed pharmacies.
The Cabinet ministers’ warnings appear to be at odds with ministers’ repeated public claims in Parliament and in official documents that no closures are likely.
They also appear to confirm that Mrs May is concerned about the plans and had to seek reassurances from Mr Hammond, the Chancellor, and Mr Hunt, the Health secretary.
Campaigners said the letters amounted to a "smoking gun" which laid bare the Government's indifference to saving rural pharmacies.
The concerns stems from a Government decision to cut a subsidy for pharmacies in rural and deprived areas by £208million in the 2017/18.
The cut has led to concerns that pharmacies in rural areas will close forcing the elderly to have to travel further for medicines.
According to letters disclosed in a High Court challenge to the plans, and seen by The Telegraph, Mr Hammond and Mr Hunt warned that the cut will result in the closure of pharmacies.
Mr Hunt told Mrs May on August 2 the cut would mean that “500-900 pharmacies will close”, in a letter that was copied to Mr Hammond....read more
Half of £2bn boost for NHS 'spent outside health service' (The Guardian: 26 March 2017)
chiefs spent about half of the £2bn of extra cash allocated in George Osborne’s pre-2015 election autumn statement on buying care from private and other non-NHS providers, an analysis has shown.
The Health Foundation research for the Financial Times showed £901m was spent on buying services from outside the health service in 2015/16 for care provided free at the point of use for NHS patients. It compared with £800m spent on purchasing the same kind of care from NHS trusts.
In his 2014 autumn statement, the former chancellor described the money for NHS England as a “down-payment on the NHS’s own plan” and said it would go towards frontline services.
The report also found that £1 in every £8 of local commissioners’ budgets in England is now spent on care provided by non-NHS organisations. The Health Foundation said the figures showed NHS providers have not had the capacity to deal with rising demand.
Anita Charlesworth, director of research and economics at the Health Foundation, said: “Rising demand for emergency care meant that NHS providers haven’t had the capacity to deliver planned care and patients had to be diverted outside the NHS. NHS hospitals were left squeezed by sharply rising drug and staff costs with little additional funding. The result was big deficits that had to be covered by raids on investment budgets....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
Money earmarked for mental health diverted to balance NHS books (The Guardian: 16 March 2017)
Ministers have been accused of breaking their promises on mental health after £800m earmarked to improve services was diverted to shore up hospitals’ finances.
A leading mental health charity and the Labour party said redirecting the money would hit patient care and hinder the drive, backed by Theresa May, to improve care for people with serious mental health problems.
“It would be incredibly worrying if mental health investment was being sacrificed so that [NHS bodies] can balance their books,” said Mind chief executive Paul Farmer, who chaired the NHS taskforce on mental health that last year recommended sweeping changes, including to funding.
Simon Stevens, the chief executive of NHS England, last year said the money was “funding that would have been available from CCGs for mental health services, community health services, primary care and other things”. It was being held as a “contingency reserve” in case hospital trusts recorded huge deficits this year comparable to the overspend of £2.45bn they made in 2015-16, he said.
In his letter, Baumann confirms that NHS England now intends to use the “full amount” of the contingency fund to offset overspends by NHS acute hospital trusts in 2016-17....read more
NHS delays leave thousands facing long wait for wheelchairs (The Guardian: 21 March 2017)
One in five children who need a wheelchair are being forced to wait beyond the supposed maximum 18 weeks, as are almost one in six adults. Campaigners say the figures reveal a “postcode lottery” in provision across England.
Some 7,200 people who received a wheelchair between October and December had waited at least 19 weeks, despite the NHS Constitution guaranteeing access to one within 18 weeks.
NHS England does not record how long over the 18-week threshold patients have waited for a wheelchair. But the charity Muscular Dystrophy UK says it knows of young adults who within the past year had waited more than eight months.
The NHS England figures obtained by the Health Service Journal (HSJ) show that those with the greatest need for the equipment can face the longest waits.
Nic Bungay, director of campaigns at Muscular Dystrophy UK, told HSJ that long waits for a wheelchair appropriate for their needs were stopping young people “going out independently … and accessing university, work and friends”.
An estimated one in 50 Britons is believed to use a wheelchair to go to work or school, get to the shops, look after their children or undertake other tasks. The Wheelchair Alliance, led by Paralympic champion Lady Grey-Thompson, claims “great variation in ability to access assessment and obtain service provision”, as well as delays in receiving equipment and having it repaired, were affecting too many people.
The campaign group is urging the NHS to ensure equality of access for everyone who needs a wheelchair, which “would prevent confusion and disadvantage when education needs mean a user moving to another area or changing their GP [and put] an end arbitrary age discrimination. This is especially the case where very young children may or may not be provided with chairs depending solely on where they live.”...read more
Dying patients waiting hours for pain relief in NHS funding shortfall (The Guardian: 14 March 2017)
Dying patients are waiting up to eight hours to receive pain relief because of cuts to district nursing services during the NHS’s unprecedented budget squeeze, a new report has revealed.
Severe financial pressures on the NHS are leading to longer waits for treatment and a short-sighted and growing rationing of care that is storing up problems for the future, according to a study by the King’s Fund health thinktank.
The report quotes one unnamed manager of a hospice saying: “The district nurses working at night are not able to give effective response times; you can wait up to eight hours … for patients experiencing pain and discomfort in the last two to three days of their life, it has a massive impact. It’s a frightening time for patients.”
The King’s Fund research has found that district nursing and sexual health services are among the areas of care most affected by six years of the NHS in England receiving annual budget increases of 1.2%, far less than its historic average of 3.7% rises.
It highlights how the diminishing number of district nurses are struggling to give patients prompt high-quality care because they are increasingly overworked.
The need to balance budgets and the smaller numbers of district nurses are prompting some NHS bodies to restrict their eligibility criteria for patients seeking help, refusing it for those with serious mobility problems unless they are completely housebound.
“We heard some examples of providers attempting to limit access. This was mainly through tightening referral criteria, particularly in relation to patients being ‘housebound’. Increasingly, if patients are able to visit their general practice (even if doing so is challenging), they will not be eligible to receive care from district nurses,” the report states....read more
Virgin Care starts legal proceedings against NHS (HSJ: 13 March 2017)
A private provider has launched legal proceedings against eight NHS commissioners after losing a bid for a £82m children’s community services contract.
Virgin Care Services Limited issued court proceedings in the High Court against NHS England, Surrey County Council and the county’s six clinical commissioning groups one month after commissioners awarded the three year contract to Surrey Healthy Children and Families Services Limited Liability Partnership.
The winning bidder is an alliance between Surrey and Borders Partnership Foundation Trust and two social enterprises, CSH Surrey and First Community Health.
A spokesman for Virgin Care Services told HSJ that concerns about “serious flaws in the procurement process” prompted the company to launch proceedings.
“Never before have we been so concerned with the whole process that we have needed to make a challenge of this nature,” the spokesman said....read more
Circle contract win means trust 'risks going in special measures' (HSJ: 14 March 2017)
A struggling NHS trust could lose up to £6.6m of income and risk being put into financial special measures after losing a £73m contract, a report has found.
Lewisham and Greenwich Trust stands to lose up to £6.6m of revenue over five years unless Circle Health, the winner of a musculoskeletal contract for Greenwich, contracts it to deliver community based services and “other orthopaedic activity”, the PwC report said.
The report also highlighted possible risks to the safety of care if Circle subcontracts MSK services currently provided by Lewisham and Greenwich to another provider.
The London trust already has a forecast deficit of £34.6m for 2016-17, which puts the trust’s finances £14.4m behind plan, the PwC study said.
The loss of £1.6m of income in the first year of the three year contract could “add additional financial pressures to the trust”, and lead to “potential intervention, for example being placed into the financial special measure regime”, the report said....read more
NHS finances facing 'nasty hangover' after bid to avert winter crisis (The Guardian: 2 March 2017)
The NHS’s already precarious finances are facing a “nasty hangover” after hospitals cancelled tens of thousands of operations recently in a bid to avert a full-blown winter crisis, experts have said.
Handing large numbers of operations over to private providers and hiring extra staff to cope with extra demand during December and January has also dealt a big blow to NHS trusts’ efforts to balance their books, the King’s Fund said.
The backlog of patients needing non-urgent surgery as a result of the widespread postponement of procedures this winter will also force patients to wait even longer for their operation, Richard Murray, its director of policy, said.
“Increasing spending on agency staff, outsourcing work to the private sector and suspending planned treatment may have helped to relieve pressure in the short term but are likely to result in a nasty hangover as hospital finances take a hit and waiting times increase further,” said Murray.
The service’s finances are deteriorating so sharply there is a real risk the Department of Health could bust its budget for 2016-17, according to the thinktank’s new analysis of NHS performance.
Its latest quarterly monitoring report on how the NHS in England is faring predicts that it is facing several more years of finding it impossible to live within its budget, despite government orders to do so. Hospital trusts ran up a deficit of £2.45bn last year and are on course to overspend by over £1bn again this year....read more