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NHS news review

Conservative election poster 2010

A few recent news articles about the UK’s Conservative and Liberal-Democrat (Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.

The battle for the NHS is far from over | Allyson Pollock | Comment is free | The Guardian

The Lords may yet succeed in rewriting the health and social care bill, but they must truly understand the stakes

Critics of the controversial health and social care bill were taken aback by the partisanship of peers when debate moved to the House of Lords two weeks ago. Amendments by Lord Rea to reject the bill altogether, and by Lords Owen and Hennessy to send parts to a select committee for more forensic scrutiny were defeated after energetic whipping by party bosses.

But all is not what it seems. For many peers it was not pro-competition sentiment that caused them to oppose the amendments but the so-called Salisbury convention, according to which the Lords does not throw out legislative measures trailed in manifestos.

Nor is the battle over by any means. Many peers are determined to rewrite the bill, and the list of amendments for debate on the floor of the house is building daily. More than 350 amendments have been tabled, and more are expected during the debate. The royal medical colleges, professional bodies and the general public have registered their concerns about competition, loss of professional autonomy, conflicts of interest and rank commercialism. The amendments include proposals to delete or alter clause 1 of the bill – which abolishes ministerial responsibility for the health service – and to ensure principles of comprehensive care are written into the legislation.

Professor Malcolm Grant’s evidence to the commons health committee last week adds fuel to the fire. Health secretary Andrew Lansley’s nominee for chairman of the NHS commissioning board, which will run the marketised system, revealed the extent of the legislative chaos when he said that the bill was “completely unintelligible” and with the £20bn efficiency target a “double hammer” for the NHS.

The scale of criticism underlines the constitutional and epochal character that the debate has assumed. Few by now are in any doubt that the England’s social contract is potentially redrawn by measures that shred a public institution designed for universal healthcare.

However, the response brings difficulties of its own – peers have been inundated with advice from thousands of correspondents. Finding a clear line through a bill of such length and complexity that has been amended by the government right up to the last minute was always going to be a huge challenge. But without that clarity, opposition forces will be disorganised and voting patterns a lottery.

The solution to the overload is for peers to work out a clearer understanding of what’s at stake. Put simply, the legal effect of the bill is to abolish the statutory basis of a national health service by repealing duties to provide a comprehensive and universal service. The change is effected by creating clinical commissioning groups (CCGs) with an obligation to cover fewer services and responsibility for fewer patients and residents than primary care trusts (PCTs). Whereas PCTs act on behalf of the secretary of state, CCGs will exercise functions in place of him or her but without a clear primary legislative framework. The bottom line is that commissioners and providers in the new market will have freedom to select patients and services on financial grounds and to redefine eligibility for NHS care and in so doing introduce charges for care.

The blurring of boundaries and responsibilities for funding and provision will make it almost impossible for parliament to hold health bodies accountable for the various elements of their expenditure or for the secretary of state to carry out his or her duty to promote a comprehensive health service throughout England.

The key features of the bill are therefore the move from comprehensive, universal, geographical duties and the assignment of extraordinary discretion to CCGs and the NHS commissioning board. These elements are laid down largely in part one of the bill. It is vital that amendments focus in the first instance on clause 1, which deals with the existing duties of the secretary of state, and clause 10, which sets out the new powers of CCGs.

Reports of drastic cuts to NHS frontline services lie behind the extreme urgency with which the government is pushing its changes. Cuts on the scale envisaged are only possible if the duties laid on government by parliament are abolished. So it is the bill or the NHS; the people will rely on the crossbenchers to decide their fate.

• David Price, a senior research fellow at Edinburgh University, contributed to this article

Kingston Hospital may be hit with more cuts (From Kingston Guardian)

Kingston Hospital could be hit with more swinging cuts as the NHS faces another £6.5m reduction in spending across its services.

The savings outlined for 2012-13 are on top of this year’s £6m target and form part of a national Quality, Innovation, Productivity and Prevention (QIPP) efficiency programme.

Draft plans show £3.3m of the potential identified savings will come from acute care at hospitals.

Another £650,000 will come from mental health, including the reprovision of rehabilitation units from Rose Lodge in New Malden and Fuschia ward in Tolworth Hospital.

Some of the money will be saved from reducing the number of people with minor injuries going to accident and emergency (A&E) and spending less on expensive drugs, although those figures have not been decided yet.

A spokesman for NHS Kingston said: “We will work closely with partners to minimise the effect on front-line services.
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Patients waiting too long at A&E « Express & Star

Seriously ill and injured patients at New Cross Hospital are waiting too long to be seen in accident and emergency – with the situation worsening in recent weeks, a new report reveals.

The latest figures revealed at a meeting of the hospital’s trust board today show the majority of such patients waited up to 52 minutes for an initial assessment by a nurse in September.

This is almost 10 minutes longer than in August, when the majority waited up to 43 minutes.

NHS targets state such patients should be seen in under 15 minutes to reduce risks.

An initial assessment determines the priority patients are given.

The delays are on top of the time it takes doctors to treat or admit a patient to the hospital.

During September the average wait for treatment or admission was one hour and 12 minutes.

This means an average wait of more than two hours.
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Continue ReadingNHS news review

NHS news review

A leaked memo reveals that the Health Secretary will not remain responsible for the NHS despite repeated ConDem assurances that he would. You can’t trust the Tories – or the Lib-Dem Tories – with the NHS.

Conservative election poster 2010

A few recent news articles about the UK’s Conservative and Liberal-Democrat (Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.

NHS power will be held by quango, leaked document reveals | Society | The Guardian

Malcolm Grant, the government’s choice to run the powerful NHS commissioning board, makes remarkable admission

The health secretary will “franchise” the running of the NHS to a quango for up to three years at a time – a move that will result in an unelected academic and the nation’s 38,000 family doctors, rather than ministers, being accountable for the day-to-day running of the health service, according to leaked documents obtained by the Guardian.

In unpublished evidence to the health select committee last week, Malcolm Grant, the government’s choice to run the powerful NHS commissioning board, outlined “an extraordinary transformation of responsibility” that appears to undermine claims by ministers that the proposed legislation will not dilute the government’s constitutional responsibilities to the health service.

At present, the cabinet minister for health has a “duty to provide a national health service” in England, but that disappears in the NHS bill’s proposals.

Grant, a law professor who runs University College London, told MPs that, under the new system, the secretary of state “mandates” the commissioning board to run the NHS every “two … possibly three years” and then retreats into the shadows. The board will hand over taxpayers’ cash to groups of GPs to buy services on behalf of patients.

He admitted there would be “a fundamental change of responsibility and accountability under the bill” because about £80bn of public money would be transferred to the board and GPs. He said these two groups – not politicians – would run the NHS and ensure patients received an adequate level of health provision in England.

“If [GPs] are dissatisfied with what happens in a hospital, they need to deal with it and not simply complain to a secretary of state who no longer has this responsibility, nor to the commissioning board which has given them the responsibility, but to complain to the hospital and get it sorted, and, if it is not sorted, to use their commissioning power to ensure that it is.”

With peers beginning line-by-line scrutiny of the coalition’s NHS bill on Tuesday, the government has been attempting to rebut detractors of all political persuasions influenced by the powerful Lords constitutional committee.

The committee warned last month about the “extent to which the chain of constitutional responsibility as regard to the NHS [will be] severed”. In what is perceived as a sign of panic over the level of peers’ opposition, a 72-page letter from ministers sent to all peers last week conceded a “necessary amendment” might be needed to rectify the impression the government would not be “responsible and accountable” for the NHS.
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UNISON Press | Press Releases Front Page

UNISON, the largest health union, said today that its worst fears for accountability in the NHS were being realised. Leaked documents have today revealed that the Secretary of State for Health would lose accountability for the health service, under plans set out in the Health and Social Care Bill.

Christina McAnea, UNISON Head of Health, said:

“Here are our worst fears for NHS accountability realised. We have long been warning that the Bill would mean the Secretary of State for Health would lose accountability for the health service – and here is the proof. This is just another reason why the Bill represents the end of the NHS as we know it.

“But all is not lost – line by line scrutiny in the Lords begins tomorrow. If peers vote to amend Clauses 1 and 4 of the Health Bill, it could keep the Secretary of State ultimately responsible for the health service. We are calling on them to do so.”

GPs fear NHS reforms will lead to patients losing faith in care – Main Section – Yorkshire Post

RELATIONSHIPS between family doctors and their patients could be damaged by the Government’s controversial NHS reforms, according to new research published today.

The findings are revealed in a study published by the British Medical Association (BMA), which is described by the association as being the “most significant survey of GP opinion in recent years”.

Every family doctor in the UK was approached to take part in the research and around 40 per cent – 18,757 out of a possible 46,700 GPs – responded.

The figures show that seven out of 10 GPs are concerned about conflicts of interest resulting from the NHS reforms, and the same number also say they are concerned about the impact the Health and Social Care Bill could have on the patient-doctor relationship.

Sixty-nine per cent of doctors, meanwhile, say they are worried about their proposed role as both the commissioners and providers of care.

Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said: “The huge response rate shows how strongly GPs feel about the topics in question, particularly when it comes to the changes being made to the health service in England.

“GPs do not want the trust patients put in them to be damaged by these reforms, yet this is exactly what they fear will happen.

“The Government must take heed and further revise its plans for the quality premium in particular, to avoid any potential damage to the doctor-patient relationship.”

The BMA said the results of the study should “serve as a crucial measure of GP opinion for years to come.”

Some three quarters of GPs said they do not agree with the Government’s proposals to link practice income to the performance of their commissioning group, while 85 per cent do not believe that practice boundaries should be abolished.

Other findings show that 88 per cent of doctors say the “intensity of their consultations” has increased in the last five years, while 84 per cent say the “complexity of their consultations” has increased over the same period of time.

Dr Buckman added: “General practice has undergone huge change since the last time we carried out a survey of this size in 2007 – and this is shown clearly by the belief among the vast majority of GPs that the nature of their work has become more complex and intense.

“Much of the work we do now, such as looking after people with diabetes, used to be done in hospital and even though it’s work we want to do because of the clear benefit to patients, it has made it harder to fit a consultation into a ten-minute time slot and it can make it more difficult to deal with surges in demand.

“I’d like to thank all the GPs who filled in the survey as it has given us a great insight into the GP workforce.

“It will be invaluable in shaping our priorities in the months and years ahead.”
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Continue ReadingNHS news review

NHS news review

Dr. Clare Gerada was featured in yesterday’s NHS news review discussing the Health and Social Care / Destroy the NHS Bill incentivising GPs to restrict treatment and the consequent pressures on the relationship between GPs and their patients. The RCGP Annual Conference at Liverpool is to discuss similar issues later today

http://www.rcgp.org.uk/PDF/Programme%20for%20web%20OCT.pdf

The moral maze: the affordability of future health care

Chair: Dr Richard Horton, Editor, Lancet

Panel of speaker to be confirmed:

Baroness Julia Cumberlege
Dr Clare Gerada, Chair of Council, RCGP
Sir Michael Rawlins, Chairman, NICE
Ben Page, Chief Executive, Ipsos MORI
Dr Hamish Meldrum, Chairman of Council, BMA

Scottish Nationalist Party (SNP) accuses the ConDem coalition of destroying the NHS.

Conservative election poster 2010

A recent news article about the UK’s Conservative and Liberal-Democrat (Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.

BBC News – SNP conference: UK government ‘breaking up NHS’

Scotland’s health secretary will accuse the UK government of trying to break up the NHS, in her speech to the SNP conference.

Nicola Sturgeon will tell delegates in Inverness that health service reforms in England amount to an experiment in privatisation.

Scottish ministers say they will protect NHS spending.

Deputy SNP leader Ms Sturgeon will also pledge to stop pensioners languishing in hospital beds.

The UK government’s controversial Health and Social Care Bill aims to increase competition and give clinicians control of budgets.

It says the changes are vital to help the NHS cope with the demands of an ageing population, the costs of new drugs and treatments and the impact of lifestyle factors, such as obesity.

But the legislation has already been substantially altered, following criticism from NHS staff and Liberal Democrat MPs.

Ms Sturgeon, who is also Scotland’s deputy first minister, will tell day two of the conference: “It now seems inevitable that the Tories, aided and abetted by their Liberal partners, will break up the NHS in England.

“Let me make this clear, the NHS in Scotland will remain a public service, paid for by the public and accountable to the public.

“There will be no privatisation of the NHS in Scotland.”

The health secretary will say: “I say that not out of blind ideology, though I have always thought that the ideology of a health service in public hands and free at the point of need is a rather fine one, I say it because I have no doubt that our NHS can and will outperform the privatised experiment south of the border.”
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Continue ReadingNHS news review

NHS news review

Dr. Clare Gerada, chair of the Royal College of GPs is in the news today. She warns that the Health and Social Care / Destroy the NHS Bill is damaging the relationship of trust between GPs and patients, warns of a two-tier health system run like a budget airline and suggests that GP practices should explore alternative models of organisation to GP partnerships.

NHS cuts

SMEs are concerned at the ConDem govenment’s destruction of the NHS and nasty changes to the welfare benefits system.

Private doctors treat healthier patients.

Medical students…

Conservative election poster 2010

A few recent news articles about the UK’s Conservative and Liberal-Democrat (Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.

NHS bill threatens trust in GPs, says doctors’ leader | Society | The Guardian

NHS bill will lead to situation where healthcare is like budget airline with limited seats, says chair of Royal College of GPs

The NHS shake-up risks wrecking GPs’ relationship with their patients by turning them into rationers of care who deny the sick the treatment they need, warns the chair of the Royal College of GPs.

Family doctors could be “compromised” by having to decide between providing sick patients with the best possible treatment or meeting financial targets, according to Dr Clare Gerada.

Giving GPs control of health budgets, the cornerstone of health secretary Andrew Lansley’s restructuring of the NHS in England, could diminish the trust between patients and family doctors, she will tell the college’s annual conference.

“We must not risk long-term benefits being sacrificed in favour of short-term savings,” Gerada will tell the audience of 1,500 GPs in Liverpool. “How soon will it be, for example, before we stop referring for cochlear implant? An expensive intervention but one that in the long term saves enormous amounts of public money. But not a saving from our budget.

“How long will it be before we find ourselves injecting a patient’s knee joint – at Injections-R-us PLC – instead of referring to an orthopaedic surgeon for a knee replacement?”

In a detailed critique of Lansley’s health and social care bill, she will warn that: “As doctors we risk being compromised. We’ll have to choose between the best interests of our patients and those of the commissioning group’s purse. And, to make matters worse, we’ll also be rewarded for staying in budget – and not spending the money on restoring the child’s hearing. Now that’s what I call a perverse incentive.”

Her warning reflects widespread concern among doctors that exercising their financial responsibilities will lead some patients to believe they have been refused treatment on grounds of cost.

Lansley’s reforms also threaten to create a two-tier health service where the well-off can beat queues by paying for fast treatment as private patients in NHS hospitals, because of the proposed easing of the amount which foundation trust hospitals can earn from that source.

“I worry we’re heading towards a situation where healthcare will be like a budget airline. There will be two queues: one queue for those who can afford to pay, and another for those who can’t. Seats will be limited to those who muscle in first, and the rest will be left stranded on the tarmac.”

The British Medical Association, which represents hospital doctors as well as GPs, said it shared Gerada’s concerns.

“In general, we would agree with Clare Gerada’s comments about the impact of the health and social care bill. The BMA has concerns about the conflicts of interest inherent in the bill as well as the effects of the market on healthcare, and her comments fit with the views of most doctors,” said a spokeswoman for the BMA, which wants the bill withdrawn or substantially amended.

A Department of Health spokesperson said: “The NHS is not for sale and this government is committed to a real terms increase in funding for it. We want to give GPs the power and control to make the right decisions on behalf of their patients.

“Talk of budget airlines is nonsense pure and simple. In the new NHS, everyone will fly first class. Quality will improve as both patients and frontline staff are able to make choices.
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NHS doctors are under pressure to replace caring with market values | Clare Gerada | Comment is free | guardian.co.uk

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When I come home from work and my son asks me what sort of day I’ve had, on a good day I want to be able to say “I saved a life”, not “I met a budget”.

Of course, it’s important that GPs are mindful of resources. We have a responsibility to spend the public’s money carefully and wisely. That goes without saying.

But we must never lose sight of the patient as a person, at the heart of our practice. Patients are not “commodities” to be bought and sold in the health marketplace.

In this brave new cost-driven, competitive, managed-care world, I worry about the effect the language of marketing is having on our clinical relationships.

It’s changing the precious relationship between clinician and patient into a crudely costed financial procedure. Turning our patients into aliquots of costed tariffs and us into financial managers of care.

We are already embracing the language of the market when we talk about, for example, care pathways, case management, demand management, productivity, clinical and financial alignment, risk stratification.

We’re already accused of making “inappropriate referrals” whenever we put what’s best for our patients above what’s best for saving money.

We’re being forced to comply with referral protocols and so-called rules-based medicine, in an effort to control medical care before it’s delivered.

Referral management systems – already widespread – place a hidden stranger in the consulting room. A hidden stranger who interferes with decisions that should be made by GPs in partnership with their patients.

Insulting terms, like “frequent flyers”, are being used to describe people who are sick and need our care and attention.

The archbishop of Canterbury attacked what he described as “the quiet resurgence of the seductive language of the deserving and undeserving poor”. If we don’t watch out, the deserving and undeserving poor could soon be joined by the deserving and undeserving sick.

I worry we’re heading towards a situation where healthcare will be like a budget airline. There’ll be two queues: one queue for those who can afford to pay, and another for those who can’t. Seats will be limited to those who muscle in first. And the rest will be left stranded on the tarmac.

This can’t be right. After all, no one chooses to be sick. We must hold fast to the principle that good healthcare should be available to all, regardless of wealth.

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Gerada: We need to move on from GP partnerships – Pulse

GPs need to forget about the partnership model and look at new models of organising their practices, such as federations, says RCGP chair Dr Clare Gerada.

In a sometimes heated discussion over the lack of partnership opportunities for salaried GPs, Dr Gerada urged GPs to stop talking about the partner/salaried divide, saying that model belonged to the last century.

Delegates attending a ‘Partnership Debate’ at the RCGP annual conference backed a motion that the profession was doing new GPs ‘a disservice with a lack of partnership opportunities’, but RCGP leaders urged the profession to think more laterally about how the profession is organised.

Dr Gerada, a GP in Kennington whose practice employs around 100 salaried GPs, admitted the partnership debate was ‘complex’ but argued that a ‘new model’ of general practice was needed in the 21st Century.

She said: ‘I think we should stop talking about the salaried/partnership divide. I think we should start talking about federating – joining and collaborating across practices, sharing expertise and resources.’

‘While the partnership model may be the model for the 20th Century I think we need to move on and find a new model.’
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Pontefract Hospital A&E will close overnight – Lifestyle – Pontefract Express

NIGHT time closure of Pontefract Hospital’s A&E department will start next month, it has been decided today (Thursday October 20).

At a public meeting of the Mid Yorkshire Hospitals NHS Trust all but one member of the board voted in favour of proposals which will see the unit shut from 10pm to 8am from November 1.

At the meeting at Pinderfields Hospital, Wakefield, the trust said the closure was due to staffing levels, adding if enough doctors at the right level could be recruited the opening hours would be reassessed.
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SMEs fear cost of NHS and welfare reforms – IFAonline

More than half of SME employers fear the cost impact of the government’s health and welfare reforms, according to Jelf Group.

As a result it called for the House of Lords to help prevent potentially severe consequences and examine the effects on business of the new regimes.

The employee benefits intermediary conducted a poll of 169 SME businesses at a recent seminar and found 55% worried about the reform’s implications.

It suggested the main reasons that employers were fearful of increased financial pressures came from government overhauls of the NHS and welfare systems.

“Anecdotal evidence of increased waiting lists on the NHS may mean key employees take longer to return to the workplace,” it said.

“In the current economic climate this could be catastrophic for marginally profitable employers and even worse for fledgling business yet to make a return.
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Management in Practice – Private sector ‘treats healthier patients’

Patients seen in independent sector treatment centres (ISTCs) tend to be younger, in better health and from “far more affluent areas” than those seen by NHS hospitals, research suggests.

The research, published in the British Medical Journal, also shows patients undergoing surgery in ISTCs had “slightly better outcomes” than patients treated in NHS centres.

However, the researchers claim such differences are “minor” and “unlikely to be clinically significant”.

The researchers, led by Professor Jan van der Meulen at the London School of Hygiene and Tropical Medicine, claims the study proves ISTCs treat patients with a more “favourable mix case profile”.

Yet, they also claim the results of their research “lessons concerns that ISTCs are ‘cherry picking’ the healthiest patients.”

“Our findings support the idea that separating elective surgical care from emergency services could improve the quality of care,” said the researchers.
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Continue ReadingNHS news review