NHS trusts' overspend is £3bn higher than reported, study claims (The Guardian: 31 August 2017)

NHS trusts in England ended last year with an overspend almost £3bn more than previously reported after temporary funding boosts and one-off savings were stripped out, according to new analysis.

The Nuffield Trust found the actual overspend in 2016-17 was £3.7bn, compared with the £791m reported by NHS regulators, which was already above the £580m maximum sought by health service bosses.

In a report published on Thursday the thinktank also says the NHS faces a “next to impossible” task in hitting the target of ending the current financial year with a deficit of just under £500m.

Sally Gainsbury, a senior policy analyst at the Nuffield Trust and author of the report, said: “The official figures on NHS deficits don’t reflect how severe things are for hospitals in England, as the deficits reported include one-off funding boosts or savings that cannot be repeated the following year. Only by looking at the deficit after these have been stripped out can we see the scale of financial challenge facing the NHS – and it is eye-watering.”

The report says trusts have succeeded in making billions of pounds of efficiency savings but these have largely been absorbed by inflation and reductions in the tariff paid to them per patient.

Among the items it says helped flatter the financial position of the 238 NHS acute, mental health, ambulance and community services trusts last year were a £1.8bn injection of cash from the emergency sustainability fund and about £300m the report puts down to “accountancy changes”.

The thinktank says that although the underlying deficit was reduced to £3.7bn by the end of 2016-17, trusts started the current financial year with a spending gap of £5.9bn because inflation is set to be 2.9%, hitting the NHS with additional costs to the tune of £2.2bn, while the national tariff is increasing by just 0.3%.

Even with a further £1.8bn in extra sustainability funding, the Nuffield Trust says providers will have to make cost savings of £3.6bn or 4.3% of operating costs in 2017-18, whereas the highest level of cost efficiencies managed in the past decade was 3.9%, in 2011....read more


NHS 'leaking millions' in PFI contracts (BBC News: 30 August 2017)

The NHS is "leaking" money to private companies in contracts to build and run hospitals, a report says.

Under the Private Finance Initiative (PFI), companies provide money for new hospitals and then charge annual fees.

The Centre for Health and the Public Interest (CHPI) publication - based on 107 PFI contracts in England - said such companies had made pre-tax profits of £831m in the past six years.

The Department of Health said less than 3% of the NHS budget was spent on PFI.

PFI has always provoked vigorous debate about whether the benefit is worth the long-term cost.

The CHPI argues the money made by private companies could have been spent on patients.

Colin Leys, one of the chairmen of the CHPI, said: "This report shows for the first time the huge amount of taxpayers' money which is leaking out of the NHS through the profits generated by PFI companies.

"Given the extreme austerity in the NHS, where patients are being denied treatment and waiting times for operations are rising, the government needs to take action to stop this leakage of taxpayer funds out of the NHS."....read more


Private firms poised to make another £1bn from building NHS hospitals (The Guardian: 30 August 2017)

Companies that have built NHS hospitals under the private finance initiative have made pre-tax profits of £831m over the past six years and are poised to make almost £1bn more over the next five years.

Large sums that could have been used for patient care have instead gone into the pockets of a handful of PFI companies at a time when the health service is starved of funding, according to the Centre for Health and the Public Interest.

Its analysis, published on Wednesday, found that if the NHS had not been paying pre-tax profits on PFI schemes between 2010 and 2015 inclusive, the deficits in its hospitals would have been reduced by a quarter. 


Ambulance call-outs for mental health patients in England soar by 23% (The Guardian: 13 August 2017)

The number of ambulance call-outs for people experiencing mental health problems in England has soared by nearly a quarter in two years.

Data obtained under the Freedom of Information Act shows paramedics helped over 30,000 more patients (172,799) in crisis in 2016-17 compared with 140,137 in 2014-15, a rise of 23%.

An additional 55,000 hours were spent supporting people with their mental health last year, compared with 2014-15 – up by 32%. In London the time spent rose by 45%, according to the request for information made by the Labour MP Luciana Berger.

Berger, a former shadow minister for mental health, said the numbers were “shocking” but came as no surprise. She accused the government of “dismantling” vital early intervention and prevention services so more people are ending up crisis.

The Labour MP said: “Jeremy Hunt has no other option but to introduce ringfenced budgets for mental health to ensure funding reaches the frontline. The health secretary must take urgent action for the sake of patients and staff.”

She added: “Too much money pledged for mental health is not reaching the sector. In the absence of ringfenced budget, funding is being diverted to prop up other areas of the NHS.” ... 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 maternity wards in England forced to close 382 times last year (The Guardian: 8 August 2017)

Maternity wards in England were forced to close their doors 382 times in 2016, according to new figures that have triggered claims of women being “pushed from pillar to post in the throes of labour”.

Campaigners warned that expectant mothers could be left in fear of giving birth at the roadside after a wide-reaching freedom of information request found a 70% increase in the number of maternity ward closures over two years.

Research by the Labour party found that 42 hospital trusts had been forced to shut their doors at some point over the last year – 44% of those who responded – with many blaming staff shortages and bed and cot capacity.

Fourteen of them admitted they had shut down more than 10 times, with some taking more than 24 hours to reopen.

In total, there were 382 occasions when units had to close in 2016. This figure is slightly higher than the 375 occasions from the year before, and an almost 70% increase on the 225 in 2014.

The findings triggered an immediate response from campaign groups, who pointed to the government’s own maternity policy, which says there should be enough midwives to prevent this happening.

Elizabeth Duff, senior policy adviser at NCT, the UK’s largest charity for parents, said: “It’s appalling that a shortage of midwives and equipment means that so many units have been closed time and again so that pregnant women are pushed from pillar to post in the throes of labour.”... read more


Grantham A&E unit's night closure policy to remain (BBC News: 7 August 2017) 

A decision to close a hospital accident and emergency unit overnight has been backed by the government.

United Lincolnshire Hospitals NHS Trust (ULHT) closed Grantham Hospital's unit a year ago because a lack of doctors.

In February, Lincolnshire County Council asked Health Secretary Jeremy Hunt to review the decision.

Mr Hunt then called for the Independent Reconfiguration Panel (IRP) review and backed its view the unit should not reopen until it had "sufficient staff".

The county council's Conservative leader Martin Hill described Mr Hunt's decision as a "disappointing result".

"The fear that this 'temporary closure' would be anything but temporary, has proved to be entirely founded", said Mr Hill.

"It is unacceptable that Grantham district has had a substantial change to hospital services for over a year without proper consultation or planning."

ULHT employs about 17 doctors across its three sites in Lincoln, Boston and Grantham, and needs a minimum of 21 to keep all of them open for 24 hours.

The trust's actions led to protests from a campaign group opposed to the closure of the unit from 18:30 to 09:00.... read more


NHS trust sent cancer patient adverts for private clinic (The Guardian: 5 August 2017)

A terminally ill cancer patient has protested after the NHS hospital where she receives palliative therapy included advertisements for a private clinic with her appointment letter.

Ali Schofield, 33, who has secondary breast cancer, said the inclusion of the leaflets for Nova Healthcare was “disgusting” and “distressing”. It would make patients believe that NHS care was “second class” and they should pay for private treatment.

“I felt really cold when I saw the leaflet because it suggested that I would have better healthcare if I was to go private,” she said. “It offered me access to the latest technologies and made me think: so what am I getting now? It’s disgusting. It puts the seed of doubt into you.”

Schofield, a lifestyle journalist and collage artist, said she was appalled that the NHS had used her medical records to include promotional material for a private company. She also criticised the fact that posters for Nova have been put on the walls of the oncology unit at St James’s University Hospital in Leeds where she goes for her chemotherapy.

Nova, which has a contract with NHS England to provide specialist “gamma knife” radiotherapy, uses the fourth floor of the Bexley Wing at St James’s to offer consultations and daycare for private patients, while NHS patients including Schofield receive their treatment on the first floor.

Leeds Teaching Hospitals NHS Trust, which runs St James’s, has apologised to Schofield and said it would no longer send the leaflets. “Since October 2016 we have sent out around one million letters to patients. Fewer than 1,000 Nova leaflets were included in patient letters,” a spokesman said.

The inclusion of the letters appears to be a breach of NHS England guidelines forbidding the practice. They state that: “Trusts that offer private healthcare services should market and promote their private healthcare services completely separately. They should not market or promote these services within their NHS communications to patients and the public, eg appointment letters [and] NHS test results.” The trust did not explain why the leaflets had been included in the first place.... read more


'Serious concerns' over new bed occupancy target ahead of winter (The HSJ: 4 August 2017)

Leading clinicians have raised serious patient safety and efficiency concerns about a new 92 per cent bed occupancy benchmark for trusts.

The Royal College of Surgeons and the Royal College of Emergency Medics raised concerns following NHS England and NHS Improvement publishing guidance last month.

The Review of Winter 2016-17 set out several recommendations for the coming winter. It said: “Occupancy levels should be more actively monitored and actions taken to ensure that they remain below 92 per cent, to allow patient flow to be maintained to deliver A&E performance.”

RCEM president Taj Hassan told HSJ: “It is extremely concerning that one recommendation seems to revise the safe level of bed occupancy up to 92 per cent. [The college] would have serious concerns about this as a metric of safety and we would be interested in understanding the evidence base behind this thesis.

“Our strong view is that the evidence base all points to 85 per cent as being the safer [and more efficient] level that all systems should be aiming for.”

An RCS spokeswoman said: “Patient safety can be assured at higher levels [but] health experts agree, as a measure of average performance, levels should ideally be around 85 per cent for optimum efficiency.”

However, the colleges welcomed the national focus on bring down bed occupancy. “At present, hospital overnight bed occupancy is around the 94.5 per cent mark, so bringing it down to 92 per cent would be a step in the right direction,” the RCS spokeswoman said.

But they also argued NHS England’s official statistics significantly underestimate current bed occupancy rates – a view support by Nuffield Trust research last year. The think tank’s report said: “Occupancy at midnight is well below the peak number of beds needed on every day of the week. This highlights the serious limitations of a midnight census [used by NHS England] as a basis for understanding the real demand for beds.”... read more


Government cuts 'leave sexual health services at tipping point' (The Guardian: 3 August 2017)

Sexual health services are at “a tipping point” with clinics unable to keep up with demand for tests and treatment, local council leaders have warned.

Central government cuts to local authorities’ public health budgets have left sexual health services struggling to cope with a 25% rise in patients seeking help over the last five years, the Local Government Association claims.

People with sexually transmitted infections face longer waits to see a specialist, and efforts to tackle outbreaks of STIs could be hit, the cross-party body says.

Whitehall-ordered cuts of £531m to public health budgets – almost a tenth of the total – “has left local authorities struggling to keep up with increased demand for sexual health services”.

The number of people attending sexual health clinics in England grew from 1.94 million in 2012 to 2.46 million last year, a rise of 25%. But the government clawed back £200m of the money it was due to give councils in 2015-16 for public health schemes and is cutting another £331m by 2020-21.

Councillor Izzi Seccombe, chairman of the LGA’s community wellbeing board, said: “We are concerned that this will see waiting times start to increase and patient experience deteriorate.

“The reduction in public health funding could also compound problems further and impact on councils’ ability to meet demand and respond to unforeseen outbreaks. We cannot tackle this by stretching services even thinner.”


The Department of Health’s own research shows that every £1 spent on sexual health services, including contraception, saves the public purse £11 in the long-term as a result of fewer unintended pregancies, for example.... read more


Hospital stops children surgery in a bid to improve services (3 August 2017)

Children's surgery will move out of The Royal Orthopaedic Hospital to others "better placed" to provide the specialist care, says the trust which runs the hospital.

The board of The Royal Orthopaedic Hospital NHS Foundation Trust said the Birmingham hospital will cease providing paediatric surgery by 1 January next year but adds that patients currently awaiting surgery will see "no immediate changes".

The decision follows a report by the Care Quality Commission earlier this year which said the hospital "required improvement" within several areas, including it's services within intensive and critical care.

The Trust has undertaken a significant amount of work and investment to meet these recommendations, and progress has continued to be made. However, recent external reviews over the last few weeks have reiterated that paediatric inpatient surgery would be better delivered in a hospital setting with access to extensive centralised care facilities at all times.

The Royal Orthopaedic Hospital Statement
.... read more

Jeremy Hunt has repeatedly failed to meet pledges on mental health care (The Guardian: 1 August 2017)

Jeremy Hunt, the health secretary, has announced plans to expand mental health provision with a £1.3bn injection that will see thousands of new posts created. This would be welcome news were it not for the fact that so far Hunt has failed to deliver on pledges that could have improved services.

For a start, the Health and Social Care Act (2012) made it unlawful to discriminate between physical and mental health. So far, regardless of whether it’s financial budgets or service delivery, mental health services have seen no significant improvement.

Indeed, we have seen the opposite; more than 50% of clinical commissioning groups cut their mental health budgets last year. There has been a trend that when the NHS is under financial strain, mental health budgets get disproportionate cuts. All too frequently we have seen health commissioners raid these budgets to plug growing deficits in the acute hospital sector. Hunt has had ample time to correct the chronic underfunding, and with many mental health organisations struggling with his government’s imposed austerity cuts, we would argue that this is too little, too late.

Mental health services are also facing increasing demand. One in four adults experience at least one diagnosable mental health problem in any given year. A leaked report by a government taskforce painted a devastating picture of England’s mental health services, revealing that the number of people killing themselves is soaring, that three-quarters of those with psychiatric conditions are not being helped and that sick children are being sent “almost anywhere in the country” for treatment. The failure to prioritise and ringfence resources for services has led to a crisis in mental health provision in this country.... read more

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