NHS £800m deficit and targets crisis – patients ‘at real risk’

The coalition government will leave office with the NHS in the red for the first time in a decade – and with waiting times at their highest in years, independent experts have warned.

In a summary of NHS performance in England under the Coalition, the King’s Fund think-tank said the service was now under significant strain, with a ‘real risk’ that patient care would suffer and waiting times would rise still further in the coming year.

Hospitals and other providers are heading for an overspend of more than £800m by the end of this financial  year, tipping the NHS as a whole into deficit, the King’s Fund said.

The King's FundThis would be the first time the health service has overspent since 2005/6. “That’s got to be paid by somebody,” said chief economist John Appleby. “The treasury could pick up the tab, but it’s likely the NHS is going to have to find the money in future years. It’s fairly depressing.”

Around half of all hospitals have run up a deficit, many because of heavy spending on new staff – including expensive agency nurses and doctors to improve safety in the wake of the Mid Staffordshire report. However, in three key areas – A&E, cancer treatment and the 18-week wait from GP referral to starting specialist treatment – the NHS is now falling behind its targets.

Mr Appleby said it had become the norm for many A&E departments to miss the goal of treating 95 per cent of patients in less than four hours. With finances under pressure and staffing costs already high, there are fears hospitals cannot do any more to bring down waiting times.

“We’re not in a great position on waiting times,” said Mr Appleby. “My  speculation would be that with the system under pressure financially, next year we’re going to see some real problems with waiting times. That’s got be addressed.”

Labour’s Shadow Health Secretary Andy Burnhasm said hospitals were “trapped in a vicious financial circle with bills for agency staff running out of control and staff failing to keep pace with demand”.

However, despite the deterioration in performance, patient satisfaction remains high. A Department of health spokesperson welcomed the King’s Fund acknowledgement that the NHS had “performed well in the face of huge challenge”.

Cooper. C 2015 The Independent 26th March 2015 P.4

The King’s Fund’s – The NHS under the coalition government

“It’s definitely going to get worse – the question is, what will future Governments resort to in an attempt to save our NHS (or syphon it off)?”

One Night in A&E Nets Doctor £3,258

A startling but not unexpected report that A CONSULTANT was paid more than £3,200 to cover a single shift during the winter crisis that hit A&E.

Four hospitals paid more than £2,000 for A&E consultants to work a shift and three hospitals hired nurses on more than £1,700 for single shifts.

Doctor HireThe highest was the £3,258 United Lincs Trust paid for a locum to work 12 hours and stay on call 12 more, according to figures obtained under the Freedom of Information Act by Sky News.

Dr Clifford Mann, of the Royal College of Emergency Medicine, said: “Market forces really are extreme with the lack of permanent people.”

United Lincs Trust said: “We pay the market rate.”

The Department of Health said: “We want to reduce reliance on agency staff.”

Gregory. A 2015 Daily Mirror 24th March 2015 P. 6

A Sky News investigation by Thomas Moore, Health and Science Correspondent finds NHS hospitals paid thousands of pounds for doctors and nurses to work a single shift at Christmas.

“It’s enough to make me feel sick –  justifiably, with what’s happening in our country”

Manchester Health Plan Can Save NHS – Report Out

Manchester’s plans for developed healrth and social care have been hailed as a blueprint that could rescue the NHS from its cash crisis.

Under the proposals for devolved powers announced last month, Greater Manchester will run its own, £6bn health budget from April next year, integrating health and social care.

National Health ServiceSavings of up to £50m annually from a total health and care budget are expected.

A report published today describes Manchester’s approach to healthcare as different to any other under developed powers and one which will offer a more “efficient, fair and sustainable” system than anywhere else in the UK.

The report, “Letting Go: How English devolution can help solve the NHS care and cash crisis”, was carried out as an evaluation for the think-tank Reform by former Labour health minister Lord Warner alongside Jack O’Sullivan, health consultant and former associate editor at The Independent.

Smith. L 2015 The Independent Daily Briefing 23rd March 2015 P. 21

more detail at: Manchester’s health revolution will be a beacon for the rest of the UK

“This is a massive shift of administration and resources. Lets hope it’s a success – we certainly need one!”

Free tattoo removal costs NHS £350,000

More than 2,000 people have been given laser treatment after having second thoughts about their body “art”.

And last night MPs branded it a “sheer waste” at a time when many hospitals are working at full stretch to provide a good service.

Tattoo removal is not available automatically on the NHS, but doctors can arrange it if the inkings cause patients “significant distress”. Four in ten people say they regret having a tattoo and one in six hates them enough to want them removed.

TattooThe number of licensed tattoo parlours has soared over the past decade, as football and showbiz celebrities have made the designs seem trendy.

Figures obtained under the freedom of information laws show 2,016 people had tattoos removed on the NHS since 2010 at a cost of £330,182.

But the total cost is likely to be higher as many trusts do not have statistical breakdowns giving the reasons for laser treatments. The cost can range from £150 for a small tattoo up to more than £1.000.

Shadow health secretary Andrew Gwynne said: “People will struggle to see how this sheer waste of precious NHS money can be justified when hospitals do not have enough staff.

“Patient care is already heading downhill and more nurses could be lost under Tory spending cuts.”

NHS England said: “Tattoo removal is only ever available where a GP and a specialist agree a person’s tattoo is causing them significant distress or serious mental health issues.”

Wooding. D 2015 The Sun on Sumday 22nd March 2015 P.13

“Any guesses at how much the £350,000 is underestimated?”

Labour pledge to help whistleblowers and fight bullying

An Exclusive in the Sunday People reports that Labour will create a new independent NHS body to protect health workers if it wins the General Election.

Known as NHS staff champions, they will be the first port of call for whistleblowers who believe patient safety is at risk.

They will also deal with allegations of bullying or intimidation by hospital managers and senior doctors.

The move by shadow Health Secretary Andy Burnham comes as new figures show two in five nurses are suffering from stress.

An NHS survey revealed that 41% of hospital nurses and midwives are overwhelmed by their workload – a 27% increase since 2010.

And half said the ward they work on is now dangerously understaffed.

NHS champions will help to cut work-related stress and tackle aggressive behaviour by the public, which affects a third of NHS workers.

StressAnd the police will get powers to issue on-the-spot fines for physical or verbal abuse of NHS staff.

Mr Burnham told the Sunday People “I’m going to have a big job rebuilding the morale of a shattered worforce. They’ve been ground down over the last five years.

“They feel under the cosh, demoralised and exhausted.”

Mr Burnham added that he will recruit 20,000 more nurses to ease the pressure, paid for by a Mansion Tax on homes worth more than £2million.

Although the champions will work within the NHS they will have the same independence as the Chief Medical Officer.

WORN-OUT nurses took 4.8 million sick days last year, new Department of Health figures show.

Nearly 23,000 nurses and health visitors quit the NHS last year – 4,000 more than four years ago.

The Royal College of Nursing said morale is at rock bottom with increasing numbers of nurses going off sick with stress.

Labour’s Andrew Gwynne said: “These figures are appalling and reflect the reality of what is happening under David Cameron.”

Nelson. N 2015 Political Editor – Sunday People 22nd March 2015 P. 2

“We can only hope the NHS will be intact and serving us and its staff far better after the next Government’s tenure”

English hospital bills Welshman £1,775 – he’s a foreigner!!

Tony Brooks for the Daily Express reports that a Welsh resident claims he was treated like a health tourist by English hospital bosses who branded him a “foreigner” and billed him £1,775.

Nicholas White fell ill while visiting relatives in Cambridgeshire before Christmas and spent three days in a local hospital undergoing tests.

When he went back to Hinchingbrooke Hospital in Huntingdon for a follow-up procedure a few weeks later he was stunned to be told that he was expected to pay.

On returning to Barmouth, North Wales, the retired teacher received a bill from  Hinchingbrooke NHS Trust demanding immediate payment – followed by another claiming it was overdue.

     ” Scrounger

English-born Mr White, 64, who has lived in Wales for 15 years, had been advised by his GP tro return to Hinchingbrooke because he would have to wait six months to be treated locally.

He said: “Moments before I was due to have the procedure I was ushered into a side-room by an administrator and told I would have to pay for the examination and the previous three-day stay because I was ‘technically a foreigner’.

“I was lost for words when it was explained. Then last week I had a reminder warning me my balance was overdue.

“It was completely unacceptable – I was made too feel as if I was a health tourist scrounger. I felt I was being hounded for payment.”

The hospital has since admitted making an error but Mr White added: “I found the whole episode upsetting and the charges unsettling. I recently retired and do not have access to that sort of money.”

A Hinchingbrooke spokesman said: “It would appear the invoice was sent to the wrong place due to an administrative error and we were a bit confused about who had to pay. We are sorry for that.”

A spokesman for the Betsi Cadwalaldr University Health Board said: “It is usual practice for NHS bodies to bill the health board directly when Welsh residents receive NHS care in other parts of the United Kingdom.

The invoice should have been sent straight to the health board and we would have paid it without ever involving the patient.

“On Friday 9th January, Circle announced that they were regretfully withdrawing from their current contract to manage Hinchingbrooke Health Care NHS Trust. Circle had taken operational control, but had given up its contract, citing “unprecedented” increases in A&E attendances and funding cuts. “

“Our hospitals are failing under NHS or private control.”

NHS – Funding Plans – We’re Still in the Dark

NHS staff and patients remain unsure about the Government’s long term plans for the service, despite new spending commitments announced yesterday, experts say.

Responding to the Chancellor’s Budget statement, which Labour attacked for only making passing mention of the NHS, the Nuffield Trust think-tank said the service still had “no certainty about wider funding plans up to 2020”.

National Health ServiceWhile the Budget did confirm £1.25bn in investment over the next five years to improve children’s mental health services there was little detail on how a funding “black hole” predicted by 2020 would be filled.

Experts project the NHS is facing a £30bn funding gap by the end of the decade unless spending increases and the health service becomes more efficient.

NHS England’s chief executive, Simon Stevens, has indicated that the health service will need an extra £8bn a year by 2020 to close the gap. Even that figure is based on the assumption that the service can make £22bn of efficieny savings in the next five years.

Rob Webster, head of the NHS Confederation, said cuts to social care were having knock-on effects on the health service. “Social care is on its knees and the NHS is feeling the pain,” he said.

Cooper. C  2015 The Independent Daily Briefing 19/03/2015 P. 9

“Mr Osborne, on the run-in to a general election, would be shouting from the roof-tops if he had a panacea for our health and social care system. He does not, and it will carry on in an appalling state and probably get much worse.”

Pharmacists – A ‘hidden Army’ that could reduce GP waiting times

Charlie Cooper writing in the Independent Daily Briefing – Patients visiting their GP surgery with long-term health problems such as asthma and high blood pressure could be given an appointment with an in-house pharmacist instead of a doctor, according to radical proposals to bring down waiting times.

Many GP  surgeries already have pharmacy counters, but under the new proposals, pharmacists themselves would take on a far more hands-on role in running the practice, and even consulting patients.

The plan, announced today by the Royal Pharmaceutical Society, would see pharmacists take control of a GP practice’s medicine stocks and liaise with local hospitals and care homes about prescriptions.

PharmacistThey would also relieve pressure on GP waiting lists by seeing those patient whose main reason for visiting was to get repeat prescriptions.

This could include large numbers of patients who have already been diagnosed with a long-term health condition, such as asthma, high blood pressure, diabetes or heart disease.

NHS England welcomed the “ideas” which it said complemented existing plans to increase the GP workforce.

A chronic shortage of newly trained GPs, coupled with a growing wave of retirements, mean that surgeries around the country are understaffed, despite the NHS recently singling out general practice as a key area with a £1bn funding boost.

By contrast, there is a surplus of pharmacists – health professionals who must train for five years, and some of whom are qualified to prescribe medicines.

GP waiting times remain a live political issue, with the RCGP estimating that there will be 67 million occasions in 2015 when a patient will have to wait a week or more to see their doctor or a practice nurse.

While there is no timescale to the proposals, the RCGP said that practices should start recruiting as soon as possible,. with a vision for every GP practice to have a pharmacist on staff within five years.

Dr Maureen Baker, chair of the RCGP, said the “hidden army of highly trained pharmacist” could be a solution to the GP workforce crisis.  As well as seeing patients, she said the expertise of pharmacists could help GP practices’ avoid purchasing more medicines than they needed, freeing up funds for better patient care.

“Pharmacists are an untapped resource and they will often know the patient better than the GP – especially those with long-term conditions,” said Katherine Murphy of the Patients Association.

How they compare:

GPs

There are more than 65,000 GP’s registered in the UK (around a quarter of all doctors) but the profession is still under-staffed. GP’s are trained to have as broad a medical knowledge as possible and need to build strong relationships of trust with patients.

Salary

Average salary in the UK in 2012/13 was £92,900.

Training

10 years: five at medical school, two in foundation training, and three in GP training.

PHARMACISTS

Pharmacy involves the preparation and dispensing of medical drugs. Pharmacists play a major role but often forgotten role in healthcare, with 1.6m people visiting pharmacies in England each day. Pharmacists work in community dispensaries, but also in hospitals and in GP practices.

Salary

Starting salaries range from £20,000 to £35,000 but more experienced staff can earn £40,000 to £60,000.

Training

Four years at an approved school of pharmacy followed by one year’s work experience in a clinical setting. More experienced pharmacists can gain additional qualifications that allow them to prescribe drugs.

“Will this happen? – Don’t bet on it just yet. To integrate these proposals into primary care would take quite a few years and in the coming years there are going to be upheavals as healthcare funding is starved and there is a seemingly unstoppable drift towards privatisation. “

NHS Tourists Leave £62m in Unpaid Bills

Health tourists have saddled the NHS with a staggering £62million in unpaid bills.

Sick foreigners swoop into Britain for care and then jet home – leaving the taxpayer to pick up the tab.

One patient racked up a whopping £400,000 bill, while another notched up £15,000 in care costs for booze addiction.

NHS TouristAnd one London hospital alone – King’s College – was left with an £18million debt after foreign patients checked out without clearing their tab.

Bosses admit a soft-touch policy is luring health scroungers to Britain. However, new rules could help recoup up to £500million a year by 2017-18.

A Department of Health spokesman said: “We want international visitors to feel welcome to use the NHS provided they pay for it – just as families in the UK do through their taxes.”

Bosses at Norfolk and Norwich University Hospital pursued one women in Zimbabwe over an unpaid £3,000 bill.

Caroline Nyadzayo,34, and her baby were snapped in 2013 with health minister David Poulter.

Farrell. J 2013. Daily Star 16/03/2015 P. 2

“Our NHS – some ‘business model’!!”

A&E – Record Number of Winter Patients

The NHS confirmed that 190,000 more people attended A&E this winter compared with last winter, with 51,000 more admitted into hospital as an emergency case.

Attendances spiked in December, but the pressure on hospitals was greatest in early January when several declared major incidents. All hospitals  experienced problems finding beds for new emergency patients, as capacity problems in the social care sector meant thousands of elderly patients who were otherwise well could not be discharged from hospital.AccidentDr Sarah Pinto-Duschinsky, NHS England’s director of operations and delivery, paid tribute to A&E and other staff for the way they had coped  with the ‘incredible’ increase in demand.

“These record numbers, up by between 6 per cent and 9 per cent some weeks, mean that although the NHS won’t have met the A&E average 95 per cent target for the full year, staff continued even during this busiest winter ever to treat more than nine in 10 people within four hours. And most patients were, in fact, treated in under an hour,” she said.

But bad news is on the way for NHS England as it is set to miss its A&E waiting times target over an entire year for the first time.

Average performances for 2014/15 is now guaranteed to fall short of the goal of treating 95 per cent of patients at A&E within four hours.

The milestone is the latest sign of log-term decline in NHS performance against the number of key targets – a consequence of rapidly increasing demand from patients, against a background of straitened NHS funding.

Cooper. C 2015 The Independent Weekend Briefing 14/03/2015 P. 8

“There are only so many beds in our hospitals and in community care – will there be any changes to make next winter a better time to fall ill or have a serious accident?”