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  • NHS breaking recruitment rules with one in four new doctors coming from 'banned' developing countries Telegraph report on a worrying development linked to the gathering NHS workforce crisis begins:
    "The NHS is breaking recruitment rules, with one in four new medics now coming from developing countries which are supposed to be protected by ethical codes, an investigation reveals.
    "The Telegraph has uncovered evidence that the health service is targeting medics from such countries - despite strict rules which are supposed to protect the poorest parts of the world.
    "The Department of Health and Social Care and the Department for International Development identifies 97 countries which “should not be actively recruited from” because they are in receipt of aid, and often suffering from shortages of medics.
    "They include Pakistan, Nigeria, Egypt, Myanmar, Zimbabwe, Bangladesh and Sri Lanka.
    "But NHS trusts have used agencies to recruit doctors from such countries, the investigation reveals."

  • Revealed: Why one county saw a third of all 12-hour A&E breaches (£) HSJ report on crisis of under-resourced mental health care and its impact in Lancashire:
    "Two reviews have uncovered a catalogue of problems with Lancashire’s mental health services, which have led to patients being unlawfully detained in seclusion rooms and a crisis situation developing in the county’s emergency departments.
    "HSJ has learned the reviews raise major concerns about Lancashire Care Foundation Trust’s underresourced community services, a lack of crucial bed capacity, inadequate support for patients in crisis, and overstretched accident and emergency liaison psychiatry teams.
    "The multiple shortcomings have stranded mental health patients in hospital emergency departments with a lack of appropriate support. Lancashire had more than 1,000 cases of patients waiting over 12 hours for admission to a ward in 2018-19, according to statistics published by NHS England, which was a third of all 12-hour breaches nationally. The bulk of these cases were mental health patients."

  • Cancer patient scans cancelled over equipment problems BBC report notes that "Hundreds of cancer patients at West Midlands hospitals have had scans cancelled due to equipment problems.
    "Alliance Medical, a company contracted to supply isotopes needed to perform the scans, has admitted production problems has led to a shortage.
    "They need radioactive isotopes, the commonest of which is fludeoxyglucose (FDG), which has a short life and must be used within hours.
    "Hospitals with scanners in Birmingham, Coventry and Stoke-on-Trent have reported a 10-month shortage of FDG and about 10% of tests have been cancelled since August 2018.
    "Meanwhile, prostate cancer patients in Birmingham have seen appointments cancelled from a lack of FEC, another isotope."

  • The Price of Care: Are private care providers putting young people at risk? Sky News report on scale and poor quality of privately provided Child and Adolescent Mental Health services:
    "The most unwell are sent to mental health units commissioned and paid for by NHS England, but they are often run by private companies like The Huntercombe Group.
    "Most recent figures show there are 1,282 under-18s, most of them girls, who have been admitted to mental health units across England.
    "In 2017-18 the NHS paid private providers £156.5m for beds or specialist care such as eating disorder services.
    "The figure is almost half of the total CAMHS specialist budget."

  • The case of Circle vs. the NHS – why NHS and private providers do not compete on a level playing field CHPI blog by Vivek Kotecha underlines the differences between NHS trusts and private clinical providers. He notes that:
    "Circle Nottingham made a profit before tax of £2.9m in 2017, a 5.3% margin on £55m of revenue, and has been running the centre for eleven years."
    However he does not point out that Circle as a whole has never made a profit: its private hospitals lose money and are heavily dependent on NHS-funded patients.
    Vivek goes on to correctly argue that:
    "the financial performance of an NHS hospital trust cannot be usefully compared with that of a private provider because they are very different organisations. Competition and tendering rules may call for measuring the financial strength of different bidders, but ignore important differences between them."
    One important error in an otherwise useful article is to claim Virgin "successfully sued" CCGs in Surrey, while in fact the company secured a £2m out of court settlement as the CCGs caved in.

  • Big tobacco, the new politics, and the threat to public health With several Tory leadership contenders sympathetic to its ideology, the Institute of Economic Affairs is closer to power than it has been for decades. In an exclusive investigation in the BMJ, freelance journalist Jonathan Gornall reveals how the organisation is funded by British American Tobacco and has links with senior conservative ministers, and warns:
    "After orchestrating a series of attacks on public health initiatives, the IEA may now hold the key to No 10."

  • Kent NHS campaign group launches stroke services legal challenge Save Our NHS in Kent (SONiK) lodged its application for judicial review regarding the controversial Kent and Medway stroke plans on May 14, after Medway's Tory council retreated from its previous commitment to challenge the plans and Kent County Council refused to take a stand.
    Isle of Thanet news reports:
    "Campaigners fighting against proposed reforms to NHS services have filed the necessary papers which they hope will lead to a hearing being granted. If successful, their case against local NHS commissioners will be heard in the High Court later this year."

  • Bed bugs found in King's College Hospital postnatal ward BBC report highlights a fresh concern over hygiene standards after 35 years of competitive tendering of cleaning services. It notes:
    "Staff working in a maternity ward are having to wear protective clothing after bed bugs were found on the unit. King's College Hospital in Denmark Hill, south London, said a number of beds were being treated for the creatures."
    "A spokesperson said women were still being admitted on the postnatal ward but are being informed about the issue. Visiting hours have also been reduced.
    "The 5mm-long bugs are not dangerous but can cause itchy red bite marks.
    "The hospital said staff were wearing "appropriate protective clothing" while deep cleaning is carried out on the ward."
    Despite offering this handy advice the BBC does not probe any further as to why this poor level of hygiene should prevail at a leading teaching hospital.

  • Mental health services in crisis are abandoning patients to meet targets Guardian reports on a worrying trend in cash-strapped mental health services, noting:
    "Patients with serious mental health problems are discharged in a way that was unthinkable five, let alone 15 years ago, sometimes without warning. Carers, activists, police and GPs are often left desperately trying to link the person back into mental health services. Sometimes this will succeed, though often via a traumatic experience such as being sectioned. For others, it is too late."

  • First for-profit hospital in Korea killed off Welcome news from the International Medical Travel Journal that:
    "Local government and resident pressure in Korea have killed off Greenland International Medical Centre, the country's first foreign owned for-profit hospital.
    "The Jeju Island case proves how difficult it is to introduce a for-profit hospital and attract foreign capital to the local medical industry in the country.
    "Greenland International Medical Centre, established on Jeju Island as a successful example of attracting foreign investment, has collapsed before it even opened.
    "The Jeju provincial government nullified its conditional approval of the Chinese-owned medical centre for failing to open its doors by the March 4 legal deadline.
    "The nation's first for-profit hospital had only 47 beds, and its service was to be limited mainly to cosmetic surgery.
    "In 2015, the Ministry of Health and Welfare approved the establishment of South Korea’s first foreign owned for-profit hospital. China's Greenland Group built a three-storey Greenland International Hospital on Jeju Island at the cost of US$69 million. Greenland hired 100 doctors and nurses. But the plan to open in early 2017 was continually delayed until March 2019 when the Public Opinion Investigation Committee voted against its establishment.
    "All hospitals in Korea are non-profit ones run by non-profit corporations that must reinvest proceeds only for medical purposes. In 2012, the health ministry changed its regulations to allow for-profit hospitals in eight free economic zones and Jeju Island, if half of the total amount of investment comes from foreign investors. Local patients can receive treatment at for-profit hospitals if they forgo their health insurance cover."

  • Hundreds of foreign doctors mull leaving UK over 'crippling' fees Guardian report by Denis Campbell notes that:
    "Hundreds of overseas doctors are considering quitting the NHS in protest at being charged thousands of pounds a year for visas and healthcare in order to work in the UK.
    "Medics from around the world are considering taking their skills abroad, angered by high charges and fees. Immigration rules mean they must pay thousands of pounds a year for a working visa, and £400 a year for them and each member of their family to use the NHS.
    "More than 500 doctors from outside the EU have voiced their concerns in testimonies given to EveryDoctor, a campaigning organisation run by medics to improve how the profession is treated."

  • Circle launches fresh court challenge over lost contract Update in The Lowdown on the latest legal challenge to the NHS by a profit-seeking private provider of clinical services -- Circle in Nottingham, seeking to extend its contract to run a treatment centre, at higher cost than the local NHS trust.

  • System hosting GP at Hand must find £100m savings (£) HSJ article reports the latest evidence of the negative impact on the NHS of the GP at Hand digital service, hosted by Hammersmith & Fulham CCG. Now:
    "The North West London healthcare economy must cut costs by “about £100m” as demand pressures grow, according to its finance director.
    "The alliance of eight clinical commissioning groups in north west London ended the year with a £56.7m deficit – missing its control by over £47m.
    "Paul Brown, chief finance officer, told the May committee meeting of the eight CCGs the year-end deficit was in addition to “about £50m worth of non-recurrent measures that we took – so really the underlying position was over £100m.”
    "We don’t think it is possible in this financial year to achieve financial balance,” Mr Brown added."

  • Care home group paid £48.5m in dividends while warning of cuts FT offers further proof of the cynical operation of collapsed private care home operator Four Seasons and its hedge fund owners who saddled it with debt.

  • 10 English NHS hospital trusts overspend by £850m Guardian report by Denis Campbell quotes the big deficits but also quotes Labour's jon Ashworth putting the correct interpretation -- that the hospitals are underfunded:
    "“Whatever Theresa May claims about NHS funding, the reality is many hospitals remain seriously in the red. Years of financial squeeze and staffing troubles have left hospitals struggling,” said Jonathan Ashworth, the shadow health secretary.
    “NHS bosses are now even telling hospitals to scale back maintenance plans despite facing multibillion backlogs in repairs because the cash simply isn’t available. Whatever the spin, our NHS continues to suffer from Tory austerity.”

  • NHS SCANDAL: Doctor blows lid on STEALTH privatisation – do not be fooled by NHS logo Article in Daily Express reports Dr Tony O'Sullivan, the co-chair of Keep our NHS Public and a retired consultant paediatrician, warning that "the use of the NHS logo by private companies is another way British people are being deceived as the health service continues to undergo elements of privatisation."

  • Princess Alexandra Hospital cleaners back strikes to halt outsourcing from the NHS UNISON press release reports domestic staff at the Harlow hospital voted 98.6% in favour of strike action on an 83.5% turnout.
    "They warn that if their services are allowed to be transferred into the private sector it would spell ‘disaster’ for their patients, as hospitals with outsourced cleaning have higher rates of infection than those where the service is in-house.
    "Princess Alexandra Hospital currently has some of the lowest rates of infection in the country, including instances of MRSA."

  • Pressure points in the NHS BMA round up of monthly data on A&E, waiting list and delayed transfers of care, warning that "performance figures show a health service that is on its knees".

  • Worcestershire acute trust slammed as NHS Improvement moves in Bromsgrove Standard report on the latest phase of the crisis of Worcestershire Acute Hospitals NHS Trust, which has been challenged by NHS Improvement for failing in its duty to operate efficiently, economically and effectively, for failing to comply with healthcare standards and failing to ensure its services are safe and of sufficient quality.
    The trust will have to to implement a series of Enforcement Undertakings agreed with NHS Improvement over its failure to provide safe services.

  • Interactive graphic showing performance on Type 1 A&E within 4 hours Neat site to look at trusts' performance

  • Four Seasons’ collapse exposes the UK’s broken outsourcing model David Rowland,director of the Centre for Health and the Public Interest argues in New Statesman that "pumping greater amounts of money into the current financialised system is likely to encourage the type of risky behaviour by private equity investors which, in the case of Four Seasons, and care home companies like Southern Cross before it, has caused significant anxiety for thousands of older people."

  • Corporate care home collapse and ‘light touch’ regulation: a repeating cycle of failure LSE blog by David Rowland following the care home chain Four Seasons going into administration. He looks at the failure of the regime designed to prevent such situations, as well as the cause of the collapse, and concludes that the rights of hedge funds and private equity investors to extract profit from the care home sector are given priority than the rights of older people to a secure home at the end of their lives.

  • NHSE/I orders trusts to cut capital funding bids HSJ Exclusive warning once again of the desperate lack of capital to fund any new building projects, service developments or even basic backlog maintenance, reports that new NHS England/NHS Improvement finance boss has written to finance directors urging them to to cut or defer their plans:
    "He asked trusts to consider deferring expenditure “which is not deemed to be essential or already contractually committed” into future years, and said revised plans that increase capital spending above acceptable limits would not be accepted."

  • The postcode lottery of mental health care in England: Vulnerable patients in some parts of the country get HALF the NHS funding of those in better-resourced areas Mail online reports analysis by mental health charity Mind, which looked at investment across 42 NHS regions in England, which revealed
    "patients in some parts of the country get half the funding of those living in better-resourced areas.
    "Just £124 was spent per patient in Surrey Heartlands last year, compared with the £220 allocated by South Yorkshire and Bassetlaw."
    The disparity is a real problem, but levels of mental health needs do vary from one area to another: the question is whether the Mail would be so interested in this if the figures were the other way round?

  • We're facing a Mental Health Crisis: it's time to act A new video from Keep Our NHS Public launching a major mental health campaign. Find out why Government policy is directly responsible for crisis and what must be done to end it.

  • UNISON Petition: Say no to Circle! Nottingham University Hospitals UNISON Branch have launched a national petition to raise awareness of Circle Healthcare’s attempt to take the NHS to court to keep the contract. They have had the contract for 11 years, despite very quickly losing National Centre of Excellence status.
    When the contract was up for renewal in July 2018, Circle withdrew, saying £67 million wasn’t enough – but the NHS Trust were happy to take it back in house. This led Circle to take them to court, where they were bizarrely awarded an extra year on the contract.
    Now they have lost again and are desperate to hang onto their £67 million cash cow – so it was back to court they went on May 15.
    The branch has held a joint demo with Keep Our NHS Public to support the return of Nottingham Treatment Centre to the NHS, and now they need your help.
    Sign the petition here.

  • More than half of GPs fear their increasingly heavy workload puts patients at risk, study reveals Article in The Sun (a paper not often referenced here) highlights a survey by the excellent Pulse magazine on the pressures on GPs:
    "“Family doctors warn they are making mistakes as they struggle to deal with up to four-times as many patients as they should.
    Full-time GPs offer an average of 41 consultations a day, with a mix of face-to-face, phone, online and home visits.
    But this is more than the 30 a day they consider safe. One in ten deals with at least 60 patients daily, with one reportedly seeing 124.
    The results are based on a poll of 1,681 GPs by doctor’s magazine Pulse, who quizzed medics on their workload on one day.”

  • Call to give dementia patients cash for care Times report flags up findings of a cross-party group of 68 MPs, who now argue that dementia can no longer be left to a failing social care system and demanded a chunk of a £20 billion NHS budget boost to help sufferers.
    "Every dementia patient should be entitled to a personal budget of thousands of pounds a year to spend on carers, home adaptations or the higher care home fees charged to those with the disease, they said. Such patients are charged about 15 per cent more for care because they are considered harder to look after, and the MPs said NHS funds should make up the difference."

  • GP pressure: Numbers show first sustained drop for 50 years An analysis by the Nuffield Trust think tank for the BBC shows the number of GPs per 100,000 people has fallen from nearly 65 in 2014 to 60 last year, the first sustained fall in cover for over 50 years.
    "The last time numbers fell like this was in the late 1960s and it comes at a time when the population is ageing and demands on GPs are rising.
    "Patient groups said it was causing real difficulties in making appointments.
    There have been reports of waits of up to seven weeks for a routine appointment, while those needing urgent appointments have been forced to queue outside practices in the early morning to guarantee to be seen."

  • NHS nursing crisis worsened by Brexit exodus More evidence that Brexit is a major threat to the NHS. The Guardian report’s NMC figures showing the number of EU-trained nurses and midwives working in the NHS across the UK fell from a record high of 38,024 in March 2017 to 33,035 in March this year, a drop of 4,989.
    “The 13% fall prompted renewed warnings that Britain’s decision to leave the EU was exacerbating the NHS’s growing staffing crisis.
    “The referendum result has made many EU nationals feel unwelcome. It’s no surprise nurses and midwives think they’ll be better off elsewhere,” said Sara Gorton, the head of health at the union Unison.
    Gill Walton, the chief executive of the Royal College of Midwives, said: “Unfortunately over the last year just 33 midwives arrived from elsewhere in the EU to work as midwives here in the UK, and we used to count them in their hundreds. UK maternity services are already stretched and short-staffed, but Brexit threatens to make things even worse.”

  • Number of patients waiting more than 18 weeks for treatment skyrockets Daily Mirror reports a trebling in four years of numbers of people waiting over 18 weeks for cataract operations.
    "The number of patients waiting more than 18 weeks to have serious eye conditions treated has rocketed.
    This February, 59,000 waited longer than four-and-a-half months.
    In February 2015 it was just 17,000."

  • Emergency care - a Quality Watch report A new Nuffield Trust report looks at trends in the quality of emergency care. Useful figures.

  • Child mental health: UK provision 'worse than in much of eastern Europe' Guardian report on EU-funded Milestone Project findings that Britain comes in at 18th in a league table of the 28 EU countries on provision of specialist inpatient beds per 100,000 young people for those who are suffering from conditions such as anxiety, depression, psychosis, self-harm and suicidal thoughts, and 21st on numbers of psychiatrists specialising in child and adolescent mental health services (CAMHS), with just 4.5 psychiatrists per 100,000 young people.
    “On that measure, Britain is again behind a raft of east European countries such as Estonia (16.8), Lithuania (14) and Latvia (11.2). …
    “Experts warned that the UK’s low rankings meant that troubled under-18s were not getting the care they needed.”

  • Forensic science labs are on the brink of collapse, warns report Guardian report highlights problems of yet another high-profile and ridiculous privatisation that has driven forensic labs to the point of crisis:
    "The inquiry heard that many private forensic service providers – including the three with the largest market share – were experiencing serious financial difficulties, with some on the brink of collapse. Concerns were also raised about the outsourcing of forensic services by police authorities to unregulated providers that had not met minimum quality standards set by the government’s regulator.
    The overall quality and delivery of forensic science in England and Wales was described as 'inadequate'."

  • Four Seasons hit by winter rise in elderly deaths FT report highlights business implications of increased numbers of deaths of older people on profits of hedge fund-owned and debt-laden, failing care home firm Four Seasons:
    "Heavily indebted care home operator Four Seasons Health Care has been hit by a steep rise in elderly deaths over the winter as it attempts to stabilise the business ahead of a crucial restructuring.The company, which has 14,000 residents in 330 homes, said occupancy levels had fallen more than 2 per cent between the end of December and the end of March after “a very high level of winter deaths” in line with a nationwide increase, partly caused by an outbreak of flu."

  • Four Seasons Health Care with 22,000 staff and 17,000 patients goes into administration The Sun reports on the latest scam by a care home sector firmly in the grip of asset stripping financiers. There is little doubt care home staff will lose their jobs or face even worse terms and conditions as the gravy train rolls on to the next crisis.

  • NHS bosses meeting to discuss £196m plan for Calderdale and Huddersfield hospitals When is an A&E not an A&E?
    Halifax Courier report describes how the 24/7 A&E at Huddersfield Royal Infirmary will differ from a full A&E:
    "While A&E services will remain at HRI, all "blue light" ambulance patients who are in a serious condition or are expected to need hospital admission will be taken to an expanded Calderdale Royal Hospital (CRH))."
    The plan, which marks a sharp retreat from the proposal to demolish HRI and switch all acute services to Calderdale Royal Hospital is apparently progressing:
    "A Strategic Outline Case report which sets out how £196.5m of Department of Health money will be spent to keep both hospitals open has been released by Calderdale and Huddersfield NHS Foundation Trust."

  • VINCI starts work on new £100m Birmingham hospital Report in Construction Enquirer of a very worrying link-up between a major NHs Trust and a profit-grabbing US hospital chain.
    "The 138-bed specialist hospital is being built on the Queen Elizabeth Hospital Birmingham campus, for a partnership between HCA Healthcare UK (HCA UK) and University Hospitals Birmingham NHS Trust Foundation Trust (UHB).
    "It will be equipped with the latest technology to provide some of the most complex surgical and medical procedures and treatments across cancer, cardiology, neurology, hepatobiliary, urology, orthopaedics and stem cell transplantation."
    No prizes for guessing where the highly-skilled surgeons and nurses to deliver this private care will be trained and poached from – hence the close proximity to a giant NHS University Hospital.

  • Americans borrow $88 billion annually to pay for health care, survey finds CNN story reveals staggering scale of costs to individuals of the partial and inadequate "insurance" that fails to cover the needs of so many despite levying hefty premiums.

  • How GPs went on strike to enforce a safe limit on patient contacts Pulse story from Catalonia offers food for thought.

  • 'Deep dive' required for unrealistic savings plans An exclusive in the (£) HSJ based on new NHS Providers report, revealing data to show the gaping inequality between trusts some of which face enormous targets for "savings" despite the government's grudging increases in funding:
    "more than one in 10 trusts would need to make savings worth more than 6 per cent of turnover to achieve their control totals, with one trust reporting an 8 per cent savings target.
    The average savings target for 2019-20 is 3.6 per cent, according to the data based on survey responses from 99 trusts."

  • Commissioners reject funding request for in demand service (£) HSJ article flagging up the reality of CCG under-funding of mental health services -- this time in Birmingham and Solihull, but dressing it all up in meaningless verbiage suggesting they are committed to improving care. Not clear why the Trust would sign up to such a joint statement that denies them the funds they need.

  • The messy, cautionary tale of how Babylon disrupted the NHS Excellent summary in Wired magazine of the company that is causing chaos in primary care in London and is spreading that chaos to Birmingham.

  • Number of patients seen by hospitals rockets by five MILLION annually in 15 years as NHS demand reaches breaking point, study shows Daily Mail take on the report from York University on increased productivity in the NHS. It does reveal that the figures used for the report only run up to 2016-17, hence some slightly strange conclusions such as claims of reducing numbers of emergency admissions while most trusts are facing the opposite.

  • 'Inefficient' NHS has seen productivity grow twice as fast as economy Independent article highlights research that confirms the astonishing strength of public sector model continuing to deliver under massive strain:
    "Productivity in the English NHS has grown at twice the rate of the wider economy, despite the government using supposed inefficiencies to justify ever more drastic cuts.
    Improvements in survival rates and numbers of patients treated in the health service each year have vastly outpaced investment in staff and budgets, a report by the Centre for Health Economics at York University found.
    Pound for pound the NHS delivered 16.5 per cent more care in 2016/17 than it did in in 2004/05. This compares to productivity growth of just 6.7 per cent for the wider economy."

  • Low pay and rising demands on care workers revealed in Sheffield Hallam University study Yorkshire Post report. "Warnings have been made of a workforce crisis as carers face increasingly demanding workloads while remaining among the lowest paid people in the country.
    A study by Sheffield Hallam University found that reduced local authority funding means there is little opportunity to increase wages.
    At the same time, care home residents are becoming increasingly frail, leading to rising demands on staff."

  • Upfront fees 'deterring immigrants from seeking NHS care' Guardian story notes government-imposed charges are having the effect ministers wanted -- deterring people from seeking treatment regardless of how sick they are:
    "A report published on Thursday by the British Medical Association said pregnant women were going without antenatal and postnatal care for fear of being charged, and that patients were being informed of four-figure charges just before having surgery.
    In one case, a patient reportedly did not seek cancer treatment because she was ineligible for free NHS care, and died as a result.
    The NHS introduced upfront charging for elective care in 2017 as part of the government’s “hostile environment” towards immigrants."

  • Interserve Healthcare lands place on £200 million NHS framework Facilities Management Journal manages to avoid a single critical comment about a recently collapsed company now winning the chance to compete for more NHS contracts:
    “The framework forms part of the delivery contracts for the NHS in England, Scotland and Wales and will run for two years, with an option to extend by up to two years. Interserve Healthcare (IHC) has been named on each of the three Lots which comprise the framework agreement.”
    FMJ goes on to sing Interserve’s praises: “IHC is a high-quality provider of person-centred care services in the community. […] The three Lots IHC has been named on include contracts to support the NHS to discharge patients so that they can be cared for in the community and at home. If successful on the framework, IHC will work with the NHS to support patients who require ongoing treatment prior to full discharge.”

  • Watchdog calls for UK's big four accountancy firms to be split up Guardian report on yet another weak-kneed Competition and Markets Authority review of the "big four" which have also played such a damaging role in driving failed policies in the NHS. Notably there is still no value for money scrutiny of the quality of work they produce.
    “The Competition and Markets Authority (CMA) resisted calls for the breakup of the big four – PricewaterhouseCoopers, EY, Deloitte and KPMG – but said this option could be revisited within five years if the profession does not improve. […]
    “It also called for firms to be forced to hire smaller “challenger” auditors to analyse their books alongside the big four, in an effort to stoke competition.”

  • OTC medication rationing only made a quarter of its targeted savings Pulse magazine reveals what moat of us could have predicted -- NHS England's mean spirited attempts to get even the poorest patients to buy more drugs "over the counter" has saved only a fraction of the claimed £100m -- which in turn is a minuscule fraction of the NHS budget.

  • Scotland post-surgical deaths drop by a third, say researchers 17 April 2019 Share this with Facebook Share this with Messenger Share this with Twitter BBC report that literally screams out the question of why this simple measure to ensure safety has not been done before:
    "Deaths after surgery in Scotland have dropped by more than a third, research suggests.
    A study indicated a 37% decrease since 2008, which it attributed to the implementation of a safety checklist.
    The 19-item list - which was created by the World Health Organization - is supposed to encourage teamwork and communication during operations.
    The death rate fell to 0.46 per 100 procedures between 2000 and 2014, analysis of 6.8m operations showed.
    Dr Atul Gawande, who introduced the checklist and co-authored the study, published in the British Journal of Surgery, said: "Scotland's health system is to be congratulated for a multi-year effort that has produced some of the largest population-wide reductions in surgical deaths ever documented."

  • Half of patients on statins have ‘sub-optimal’ response to treatment Pulse story highlighting long term large scale research published in Heart magazine which confirms that statins are not good for everybody and are too widely used:
    "The study, published in Heart, was carried out by primary care researchers at the University of Nottingham and looked at just over 165,400 primary care records for patients who were started on a statin between 1990 and 2016.
    "They found that 51% of patients had a sub-optimal response to statin therapy after two years on treatment, meaning that they hadn’t achieved a greater than 40% reduction in LDL-C levels.
    "When figures were adjusted for age, sub-optimal responders were 22% more likely to experience a CVD-related event, such as coronary artery disease, stroke or TIA, or peripheral vascular disease than optimal responders."

  • Implementation, Impact and costs of Policies for Safe Staffing in Acute NHS Trusts The Southampton University report that has flagged up warnings that one acute trust ward in every four is understaffed with qualified nurses, and that the systems set up to monitor standards after the Francis report are being dropped.

  • Lancashire County Council - Older people's day services charging consultation Lancashire County Council brings together heartless cuts with the brutal reality of means testing for social care, proposing to jack up charges for day centres: note the massive £11 daily INCREASE in charges for already extortionate day care for people with dementia. If you are going to suffer from dementia, it would be best to spend all your money first, or you can wind up paying through the nose for uncaring council services.
    "We are proposing to charge older people who pay the full cost themselves the actual cost of providing the day service.
    "This would mean an increase in the charges as follows
    - From £31.30 to £37.45 per full day for older people to use the council's day services
    - From £35 to £41 per full day for older people to use the council's day services with transport to and from the centres (where transport is available)
    - From £54.75 to £65.50 for older people who have dementia to use the council's day services, reflecting the additional staff costs to support them to attend and take part."

  • Automate the State: health and social care Obscurely-funded so-called Taxpayers Alliance is the latest unsavoury ally for Health Secretary Matt Hancock who has apparently been enlisted to help plug their ideas for "automating" health and social care -- a slight variation on their normal pitch for privatisation and an insurance-based system. Has Hancock asked where their funding comes from? Is any of their funding from the UK or taxpayers, or is it from tax-dodging mulitnationals?

  • Large health insurer pockets $1.7 billion tax refund US report revealing the huge and growing US government subsidy and support for te brutal US health insurance industry. "
    "Health Care Service Corp. didn't pay a dime in federal taxes in 2018, according to its latest financial report. Instead, the health insurance conglomerate received a $1.7 billion tax refund, which swelled the company's net profit to $4.1 billion.
    "The big picture: As Axios reported last year, the Blue Cross Blue Shield companies were on track to retain huge sums of money in 2018 due to the Republican tax overhaul and the growing profitability of their health plans. HCSC was among the biggest winners.
    "By the numbers: HCSC, which is the parent of the Blues plans in Illinois, Montana, New Mexico, Oklahoma and Texas, tallied a net profit of $4.1 billion on $35.9 billion of revenue in 2018 vs. $1.3 billion net profit on $32.6 billion of revenue in 2017."

  • MP Rachel Maclean signals change - 'centralisation of hospital services isn't delivering for Redditch' Interesting report from Redditch Standard on apparent demoralisation of local Tory MP who has tried to defend the centralisation of services in Worcester and downgrade of her local hospital, but has only seen performance plunge from bad to worse.

  • More than 71,000 'frail' patients were rushed back to hospital after just one day last year because they were 'discharged too quickly to free up beds' Catchy Daily Mail headline for article which appears to be based on pretty aged data:
    "The findings from Healthwatch show 71,398 patients were readmitted to hospital as an emergency a day after their discharge in 2017/18.
    "This is up 11 per cent on the 64,268 cases in 2016/17, and up 29 per cent on the 53,538 cases in 2013/14.
    "The figures also show that 484,609 patients were rushed back to hospital as an emergency one month after being discharged."

  • A&E Attendances and Emergency Admissions, March 2019 Statistical Commentary A&E waiting times data shows 2018/19 performance, 88% v 95% target, was WORST EVER YEAR in 15 years. Explains the eagerness and urgency of scrapping the target they are getting further from hitting.

  • The Lowdown A regular, free to access, online round-up of news and analysis on the NHS for union and campaign activists.

  • Family's anger as government's social care plans delayed for fifth time Sky News report on yet another, seemingly indefinite, delay in producing the frequently-promised but ever-receding Green Paper on funding and organisation of social care. It seems unlikely a government that could face an election at almost any point will want to run the gauntlet of public criticism of plans that will affect a large section of their cbore vote.

  • Children who need help with mental health face postcode lottery – study Guardian report on findings of the children’s commissioner for England who found wide disparities in spending per child in different parts of England with more than a third of areas seeing a real-terms fall in spending on these services. This is despite soaring demand and increased government funding for children’s mental health nationally.
    while local authority spending per child in London was £17.88, it was just £5.32 in the east of England. According to the study, a few very high-spending areas mask a larger proportion of low-spending areas.

  • #PatientsNotPassports Website promoting a toolkit designed to support you in advocating for people facing charges for NHS care, and in taking action to end immigration checks and upfront charging in the NHS.

  • Nurses should be prepared to take industrial action to defend safe staffing levels Nursing notes reports speechs from James Anthony, a Registered Nurse from Birmingham, to UNISON’s Annual Health Conference arguing that chronic staffing shortages are having a direct impact on patient care.
    He said: “Safe staffing tools and legislation are important. But it is us, nurses on the coalface, who know what is and isn’t safe. It will be down to us to win safe staffing levels.
    “We will need to raise our concerns when staffing isn’t safe.
    “We will need to stand together to demand safe staffing. And I have no doubt that as nurse shortages deepen and austerity continues unabated.
    We, nurses in hospital and community teams, must be prepared to stand together and, where needed, take industrial action to win safe staffing.”

  • Patients Not Passports – challenging healthcare charging in the NHS This is a new Medact briefing paper examining NHS charging and the introduction of immigration controls in the NHS. It is designed to be a tool used to support people in campaigning against the Hostile Environment. It sets out the policy and ideological background to NHS charging; reframes and challenges some of the arguments used to justify the policies; and presents evidence and analysis of the likely impact of restricting access to the NHS.

  • Sir David Behan: HEE needs to be clearer about its purpose Extraordinary (£) HSJ report of interview with HEE's new chair Behan who somehow feels there is room for confusion over the purpose of a body named Health Education England and established to train health professionals.

  • NHS England's proposals for new legislation mean business as usual Short statement and longer more in depth analysis of proposals on which NHS England has sought "engagement" with the public and campaigners, developed by KONP and HCT.
    The two statements make clear that the only NHS England proposal that can be supported the way it is argued is the call for repeal of the controversial "section 75" of the 2012 Health and Social Care act and the associated regulations designed to compel Clinical Commissioning Groups to carve up services and put them out to tender. KONP and most campaigners fought this legislation every step of the way as it was forced through Parliament by David Cameron's coalition with Lib Dem support, so there is no sensible reason why we would now oppose it being scrapped.

  • Theresa May's post-Brexit immigration plan could close a quarter of services in some hospitals say health bosses due to nurse shortages Daily Mail recycles Telegraph story highlighting potential impact of £30k minimum salary for migrants coming to UK.

  • How to fund social care? What are the different options for funding social care? The Nuffield Trust offers a tool to help direct further investigation.

  • Collapsed private provider to the NHS owes £11m (£) HSJ article on collapse of Coperforma the disastrous private provider of patient transport services brought in by Sussex CCGs -- before a predictable collapse.
    "Clinical commissioning groups in Sussex ... have claimed the company owes them £7.6m. In a statement, the county’s CCGs said: “The Sussex CCGs are actively pursuing all options to maximise recovery for the NHS of costs incurred as a result of the failure of the patient transport service contract."

  • Combined Performance Summary: February – March 2019 Another extremely useful round up of figures by Jessica Morris of Nuffield Trust reveals:
    "•The proportion of people waiting over 18 weeks to start elective treatment reached 13% in February 2019. It has been three years since the referral-to-treatment target was last met.
    •In February 2019, 2.3% of patients had been waiting over 6 weeks for a diagnostic test, which is a 1.3 percentage point drop on the previous month but 44% higher than it was in February 2018.
    •In February 2019, 23.9% of patients waited longer than two months to start their first treatment for cancer following a GP urgent referral. This is a small 0.1 percentage point increase on the previous month, but over 4.8 percentage points higher than in February 2018."

  • Telford hospice funding cuts 'heartbreaking' BBC report.
    Telford CCG shows more contempt for provision of services outside hospital by deciding to cut £250,000 of funding to a hospice.
    The decision is "heartbreaking" and "flawed", its supporters have said.
    Telford and Wrekin Clinical Commissioning Group (CCG) said it was a "difficult decision" to make the cut to its £1m grant, resulting in a loss of two beds at Severn Hospice in Telford. Staff at the hospice said they were "extremely disappointed" by the decision.

  • Patients Not Passports A 47-page report for campaigners fighting the charges that have been imposed by ministers on overseas patients treated in NHS hospitals. Published by Medact.

  • What does the UK spend on health and social care? Fascinating infographic from John Appleby in BMJ illustrates what happens to the UK’s spending on health and social care (a grand total of nearly £208bn—including £5.3bn of capital spending). It shows the money comes from two main sources, public (£157.6bn) and private (£44.9bn), and eventually flows through to various types of care: inpatient care, home based care, prevention, and medical goods.

  • Your Insurance Is Getting Disrupted — With or Without Medicare for All Well written article in The Intelligencer, a US magazine, points out the lack of any logical reason to continue to throw more money at a broken US system that excludes millions from any health cover, but is becoming less affordable for employers.
    "more and more firms will be unable to both retain profitability and provide their employees with decent coverage. Already, the quality of employer-sponsored insurance is steadily declining, as businesses pass rising costs onto their workers."
    It shows the reason why single payer is the obvious and more affordable alternative:
    "Canada has a single-payer system that enables it to save money on redundant administration, and to dictate reimbursement rates to medical providers. America, by contrast, subsidizes the private insurance industry (and its wasteful administrative bureaucracies), while allowing physicians’ cartels and hospital monopolies to dictate their own pay rates to private providers. Thus, a competently designed single-payer system would be less expensive than maintaining our existing one."

  • Children who need help with mental health face postcode lottery – study Shocking figures in Guardian report reveal wide inequalities between areas in allocation of resources for child and adolescent mental health services -- despite years of empty NHS England and government rhetoric about "parity of esteem" and promises to improve services.
    "Researchers used spending data from local authorities and NHS clinical commissioning groups, which each contribute roughly half of funding, to calculate that local areas allocated £226m for low-level mental health services in 2018-19 – just over £14 per child.
    "while local authority spending per child in London was £17.88, it was just £5.32 in the east of England. According to the study, a few very high-spending areas mask a larger proportion of low-spending areas."

  • Surgeons demand clarity on private hospital safety Times article reports Royal College of Surgeons call for private hospitals to be forced to publish their safety records, to protect patients.
    "Regulators have backed the college’s demand that the hospitals share data on doctors’ performance, the results of treatment and patient records."
    The article explains:
    "While private hospitals must report problems to the Care Quality Commission (CQC), unlike the NHS they do not have to publish or share data on the number, type or outcome of their procedures and are not subject to freedom of information law. A report by inspectors last year said that 41 per cent of private hospitals were not doing enough on safety."

  • GP patient services at risk due to cuts in Birmingham BBC report on cuts that will hit some of the most deprived areas of Birmingham:
    "Tens of thousands of patients could lose access to specialist GP services when funding is cut, it is understood.
    "Some practices in Birmingham receive money through personal medical services (PMS) contracts to provide extra care to patients. But Birmingham and Solihull Clinical Commissioning Group said it will cut the contracts from April 2020, in line with NHS guidance. Doctors said the cuts will mean patient care suffers.
    "The BBC understands it will affect about 20,000 to 30,000 patients across more than 15 practices. The practices are in the some of the most deprived areas of the city, including Sparkhill and Balsall Heath and Alum Rock."

  • Britain's Version Of 'Medicare For All' Is Struggling With Long Waits For Care US Forbes magazine cynically exploits lengthened waiting times for NHS care as a reason to reject publiocly funded health care -- while ignoring the tens of millions in the US who cannot afford to access health care at all, and the long waits in US Emergency Rooms.
    "Long waits for care are endemic to government-run, single-payer systems like the NHS. Yet some U.S. lawmakers want to import that model from across the pond. That would be a massive blunder.
    "Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. That's well below the country's goal of treating 95% of patients within four hours -- a target the NHS hasn't hit since 2015."

  • Councils spend millions on agency social workers amid recruiting crisis Grim results from chronically low morale in fragmented, heavily privatised social care service include declining quality of service and lack of continuity of support for some of the most vulnerable service users. Guardian report reveals that
    "Data obtained through freedom of information requests shows that many English councils are routinely spending tens of millions of pounds – a total of at least £335m in 2017/18 – hiring agency social workers.
    "Experts said the difficulty experienced by councils in attracting permanent staff meant vulnerable children and families were often seeing multiple social workers in a single year, making it harder for them to engage with services."

  • ‘Second-class’ NHS workers struggle as pay gap widens Observer report based on UNISON research reveals that:
    "The estimated 100,000 low-paid cleaners, porters, security guards and catering staff who work for private contractors in hospitals across England are being treated as “second-class employees”, thanks to a growing pay divide between public and private sector workers, according to the country’s leading health union.
    "Concerns about the pay gap come ahead of tax and benefit changes in the new tax year, starting this weekend, which have fuelled fears of widening inequality, despite claims by the government that the era of austerity is over."

  • Countess of Chester Hospital says no to Wales' patients BBC report on struggling Cheshire trust:
    "An English hospital has said it will no longer take in patients from Wales except emergencies and maternity cases.

    The Countess of Chester NHS Foundation Trust decision will impact on thousands of people in Flintshire who currently use it, with immediate effect.
    "The decision follows a row over payments to the hospital for caring for patients from Wales. A Welsh Government spokesman said limiting access to Wales' patients on financial grounds was "not acceptable"."

  • L’Arche: Failures are ‘systemic’ in NHS treatment of the disabled Catholic news agency draws on a recent example to argue there are serious and systemic NHS failures especially in treatment of people with leaning disabilities.

  • Having your fudge and eating it Another splendid long read from Sally Gainsbury of the Nuffield Trust on the manipulation and false claims about NHS funding
    "When is £2.1 billion of funding not actually £2.1 billion of funding? Seemingly when it’s awarded to NHS providers in exchange for pulling off £800 million in spending cuts they might otherwise not have troubled themselves with.
    "The NHS has engineered some pretty impressive accountancy fiddles over the last three years, with an underlying deficit of over £4 billion in the provider sector massaged down to the slightly more palatable £1 billion mark in the reported accounts. But as ever, the more audacious manoeuvres remain the preserve of Whitehall."

  • NHS offering £127m of contracts to private companies despite health secretary pledging: 'No privatisation on my watch' Independent article drawing on research by Labour Party and shadow health secretary Jonathan Ashworth:
    "The party released data showing 21 NHS contracts worth £127m are currently out to tender - 19 of which have been put out since mid-February. The figures were revealed by House of Commons Library analysis and include a £91m contract to run an NHS assessment service in the South East, a £16m deal to provide health services in Leicestershire and a £6m tender for a GP surgery in High Wycombe.
    "Labour accused Mr Hancock of breaking his promise to prevent further privatisation of the NHS."
    "Commenting on the latest figures, Jon Ashworth, the shadow health secretary, said the contracts should be kept in public hands.

    Speaking on Saturday at the annual general meeting of Health Campaigns Together, which opposes privatisation in the NHS, he is expected to say: “Since the Tories’ wasteful reorganisation of the NHS we’ve seen privatisation after privatisation of NHS services, breaking up integrated care, costing the taxpayer and leaving a poor quality service for patients.
    Commenting on the latest figures, Jon Ashworth, the shadow health secretary, said the contracts should be kept in public hands.

    Speaking on Saturday at the annual general meeting of Health Campaigns Together, which opposes privatisation in the NHS, he is expected to say: “Since the Tories’ wasteful reorganisation of the NHS we’ve seen privatisation after privatisation of NHS services, breaking up integrated care, costing the taxpayer and leaving a poor quality service for patients.
    "Commenting on the latest figures, Jon Ashworth, the shadow health secretary, said the contracts should be kept in public hands.
    "Speaking on Saturday at the annual general meeting of Health Campaigns Together, which opposes privatisation in the NHS, he is expected to say: “Since the Tories’ wasteful reorganisation of the NHS we’ve seen privatisation after privatisation of NHS services, breaking up integrated care, costing the taxpayer and leaving a poor quality service for patients."

  • Matt Hancock called in to settle Oxford hospital scanners row Guardian follow up to the most high-profile privatisation story in current news:
    "The health secretary has been called in to settle a row over a “murky and opaque” plan to privatise a key element of cancer treatment currently handled by one of England’s most highly respected hospitals.
    "The proposal to let the company InHealth take charge of the Thames Valley regional PET-CT scanning service ... has been set aside until the Department of Health completes a review of the procurement process.

  • Ministers accused of cover-up over migrant health reports Guardian report by Denis Campbell reveals that:
    "Ministers have been accused of a cover-up for refusing to release official reports into whether migrants’ health has been harmed since they began being charged upfront for NHS care before they can be treated.
    "The leaders of Britain’s doctors, nurses and midwives are demanding the release of three government reviews into how hostile environment immigration policies have affected access to NHS care.
    "In 2017, the Department of Health and Social Care (DHSC) commissioned three separate investigations into key aspects of its decision to compel NHS trusts in England to implement upfront charging from October that year.
    "It published a summary of its findings late last year. However, it has still not published the reports themselves ..."

  • Can we import improvements from industry to healthcare? BMJ article brings critical approach, noting that "Recounting oversimplified improvement examples from other industries (often aviation) can provoke considerable frustration and scepticism among clinicians exposed to the unique challenges and everyday complexities of trying to improve healthcare. Patients are not aeroplanes, and hospitals are not production lines. Nonetheless, many successful efforts to improve the quality and safety of healthcare have taken inspiration from other industries."

  • Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho Free access BMJ article by Mark Hellowell on the first, notorious PFI-style hospital project in Africa "highlights several beneficial impacts of the transaction, including the achievement of high clinical standards", as well as "a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health."

  • Oxford hospital trust faced defamation threat from NHS More revelations on the determination of NHS England to force through a privatisation of PET-CT scanning service in Oxfordshire despite opposition of NHS consultants, trust board, staff and politicians of all parties. At the same time as NHSE claiming to want to end competitive tendering.

  • Liverpool hospital workers demonstrate over plans to withhold pay Union News reports:
    "Unite members are today spearheading a demonstration to protest against cleaning contractor ISS’ plans to withhold pay from low-paid hospital staff at the Royal Liverpool Hospital and Broadgreen Hospital.
    "ISS, Europe’s largest commercial provider of cleaning and one of the world’s largest providers of facility services, is moving staff from weekly pay to fortnightly pay and changing pay dates after introducing a new payroll system."
    GMB members are also involved in the campaign.

  • Elderly go blind as NHS ignores eye surgery rationing advice Times report, based on research warns that
    "Tens of thousands of elderly people are left struggling to see because of an NHS cost-cutting drive that relies on them dying before they can qualify for cataract surgery, senior doctors say.
    "The NHS has ignored instructions to end cataract treatment rationing in defiance of official guidance two years ago, a survey by the Royal College of Ophthalmologists has found."

  • NHS patients have cancer scans cancelled after supplier problems Guardian report says
    "Concerns have been raised that problems related to the supply of a substance used to screen for cancerous cells is causing delays for NHS patients in England, with many exposed to repeated cancellation of scans at short notice.
    "Choline is a radiotracer injected into patients an hour before PET-CT scans, predominately when patients are feared to have a recurrence of prostate cancer. Without it the scans cannot go ahead.
    "The worries surrounding its availability come as waiting times for cancer patients in England are at a record high, with almost one in four patients not starting treatment within the two-month target period."
    Scans using an alternative chemical are currently only available from the private sector at costs of £1500 or more.

  • When A Nurse Is Prosecuted For A Fatal Medical Mistake, Does It Make Medicine Safer? The answer is clearly 'no', and this US report highlights a common problem.
    "The American Nurses Association issued a statement criticizing the charges, saying that "the criminalization of medical errors could have a chilling effect" on health care workers' willingness to report errors.
    "The phenomenon of criminally charging health care providers after a patient is harmed is rare, "but it grows less unusual every year," says Stephen Hurley, a Wisconsin lawyer who has defended nurses in similar cases and advised hospitals on the topic.
    Most high-profile cases tend to involve death, a significant injury or a patient well-known in the community, he says. And prosecutors tend to focus on nurses, he says, rather than physicians or hospital administrators, though he's not sure why."

  • Government orders hospitals not to reveal Brexit impact assessments to protect 'commercial interests' Independent reports: "Requests for information about the impact on the supply of goods and services, and on EU staff numbers, should be refused, the department of health and social care has said.
    "Releasing the information could cause trusts “premature financial harm, and so possibly put public wellbeing at risk,” hospital bosses were told."

  • Commons Health Committee inquiry into NHS waiting times for elective and cancer care Link to send in a written submisssion. The background is explained thus:
    "Between 2010-11 and 2017-18, the number of patients referred urgently for suspected cancer increased by 94%. The NAO report found that, for cancer, this is due to NHS England’s policy of encouraging more urgent referrals to improve early cancer diagnosis; this has improved early diagnosis of cancer and improved survival rates. However, it also found that NHS England’s understanding of the increase in elective care referrals is limited. Nevertheless, the report found that constraints on capacity, including a lack of finance, staff and beds is linked with the decline in waiting time performance."

  • Mental health patients in ‘acute distress’ STILL sent miles away five years after pledge to end practice Eastern Daily Press on the desperate lack of local bed provision by Norfolk & Suffolk Foundation Trust:
    "With services bursting at the seams, 82 people from the two counties were shipped away from their homes and loved ones in January - spending a total of 1,359 nights out of the counties."

  • Hospital death leaves children motherless BBC report on the failures of care at Dudley's Russell's Hall Hospital where management have failed to tackle system failures in diagnosing sepsis despite repeated CQC criticism.

  • You’re killing people: how I was carted out of county just for treatment Hard hitting comment on lack of mental health services in Norfolk by Steven Downes, who recalled his own experience:
    "In August 2015, less than 24 hours after a crisis, at 1am I was put in the back of a private ambulance (which was nothing more than a glorified minibus) and driven from the Norfolk and Norwich University Hospital to a private hospital run by the Priory in South-West London."

  • Matt Hancock: 75 years on, let’s celebrate how we Conservatives were the original Party of the NHS. And are still serving it today Generously displaying his own historical ignorance, a member of the Party which in 1946 and right into 1948 time and again marched through the lobbies to block Bevan's that established the NHS, and that wanted hospitals run privately, or by charities or local authorities, with funding to be private with some from taxation, but mostly rates, claims credit for the completely different socialist policy that was implemented.

  • UNIVERSAL CREDIT AND HEALTH AND WELLBEING IN SHEFFIELD Sheffield’s Health and Wellbeing Board chairs have written to The Secretary of State about their concerns around the negative impact of universal credit on people’s health.
    They point out that:
    "It is clear that Universal Credit, and the broader welfare reforms undertaken from 2010 onwards, are impacting on the most vulnerable people in Sheffield, with particularly severe impacts on mental health;
    "Of the 20 welfare reforms carried out since 2010, 19 have been regressive in their impact in our city;"

  • NHS trusts call in the bailiffs to chase ineligible patients’ debts Theresa May's "hostile environment" for migrants translated into brutal action by NHS trusts seeking to chase up charges for "ineligible" patients -- but with predictably miserable results. The Observer reports:
    "Three-quarters of NHS hospital trusts in England are using private debt firms to chase treatment costs from overseas patients and refused asylum seekers in a practice branded “inhumane” by critics."
    "Debt recovery firms have pursued thousands of patients for millions of pounds in recent years, prompting complaints of harassing phone calls and intimidating doorstep visits. The debts relate to the cost of treatment for patients who are ineligible for free NHS care under government immigration rules..."
    "Data released under the Freedom of Information Act shows that 77 of 102 hospital trusts have used private debt firms to pursue ineligible patients. Of 60 trusts that provided patient numbers, 8,468 patient debts were referred to private debt collectors between 2016 and 2018.
    "However, of the 48 trusts that provided full financial details, only about £1.5m of the £21m of debt referred to private firms during those three years has been recouped – barely 7%."

  • Closing the gap: Key areas for action on the health and care workforce Joint report on the NHS workforce crisis by the three big think tanks, Nuffield Trust, King's Fund and Health Foundation outlines a detailed and costed set of solutions for overhauling how the NHS recruits and keeps its staff, "provided this can be backed by £900m a year in investment."

  • GP numbers will fall 7,000 short within five years despite increasing trainees Pulse magazine pulls out the primary care aspect from a major report by think tanks on NHS staffing. It notes:
    "The report said: ‘The NHS in England has 2,500 fewer FTE GPs than it needs this year, and a projected gap of 7,000 FTE GPs within five years if current trends hold.
    ‘These figures do not take account of the growing expectations of general practice as underlined in the NHS long-term plan. Unless action is taken, shortages of this scale represent a fundamental threat to the sustainability of primary care in England.’"

  • Having more registered nurses on general wards is linked to lower mortality Useful reminder of some perhaps unsurprising facts about staffing levels from a research paper based on an NHS hospital: it finds that
    " Increasing registered nursing staff by an hour for each patient per day could reduce the risk of death by 3%.
    "If the ratio of healthcare assistants to nurses gets too high, the data also suggest that rates of missed vital sign observations and mortality increase in line with the extra registered nurse time spent supervising other staff.
    "Increases in nursing skill mix, by having proportionately more registered nurses, may be cost-effective for improving patient safety."

  • Why poverty is bad for the nation’s health The real impact of austerity since 2010. Useful blog for the Health Foundation by Jo Bibby focuses on growing levels of poverty and the impact on health and need for health services.

  • NHS calls on private sector as waiting list spirals (£) HSJ article revealing the failure of the much vaunted devolved health care system in Manchester to contain waiting lists, and the resultant resort to using private hospitals for treating NHS patients.
    "Despite a national requirement for local areas to limit the size of their waiting list to “no higher” than it was in March 2018, the number of waiters in the city of Manchester has grown by more than 10 per cent. This compares to average growth of around 5 per cent in England."

  • Overstretched health visitors say babies will DIE because of service cuts Mirror exclusive report notes that:
    "Nearly a third of health visitors have case loads topping 500, a survey reveals – twice the recommended safe level set by the Institute of Health Visiting.
    "And 42 per cent said they fear they will soon have a “tragedy” on their hands due to an at-risk child slipping through the net.
    "Since October 2015, the number of health visitors in England has been cut by a quarter – from 10,309 to 7,852. And the number of training places has dropped from 2,787 in 2013/14 to 448 last year."

  • Southwark and Lambeth Integrated Care Evaluation of the Older People's Programme Final report Interesting research on an "integrated care" project which again shows that it may improve services for patients, but is unlikely to generate big reductions in hospital admissions or costs, since patients receive more care and treatment than before.
    It concludes:
    "•There was evidence of reduced A&E attendance in the fourth year of the programme compared to that expected in the absence of the intervention but no evidence of reduced emergency admissions.
    •The costs of the programme were £149 per resident aged 65 and over but the savings in hospital costs were only £86 per resident aged 65 and over, equivalent to a net increase in health service expenditure of £64 per resident.
    •The number of Holistic Assessments carried out by GPs and consequent Integrated Care Management were both associated with significant increases in elective activity and costs."

  • Public money wasted replacing free service with private contract Angry press statement by charity Warwickshire and Solihull Bloodbikes, who have discovered after the event that their 365 days a year free service transporting blood products to University Hospital Coventry and Warwickshire has been replaced by a private tender - with them excluded from the tendering process.

  • Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots Free Veteran campaigners for "single payer" health care reform in the US, Steffie Woolhandler and David Himmelstein, critique the various options, noting that:
    "The leading option for health reform in the United States would leave 36.2 million persons uninsured in 2027 while costs would balloon to nearly $6 trillion. That option is called the status quo."
    By contrast, proposals to extend Medicare for All:
    "would replace the current welter of public and private plans with a single, tax-funded insurer covering all U.S. residents. The benefit package would be comprehensive, providing first-dollar coverage for all medically necessary care and medications. The single-payer plan would use its purchasing power to negotiate for lower drug prices and pay hospitals lump-sum global operating budgets (similar to how fire departments are funded)."
    "Most analysts, including some who are critical of Medicare for All, project that such a reform would garner hundreds of billions of dollars in administrative and drug savings that would counterbalance the costs of utilization increases from expanded and upgraded coverage. Reductions in premiums and out-of-pocket costs would fully offset the expense of new taxes implemented to fund the reform."

  • Liverpool Women's Hospital staff win pay rise after strikes BBC report on victorious outcome to strikes by contract cleaning staff in Liverpool

  • NHS Assembly announced to help deliver the Long Term Plan 56 already influential people have been appointed to NHS England's so-called "NHS Assembly" -- but the list includes no leaders or activists from TUC health unions, and no grass roots campaigners or well known independent voices.
    However the political right wing is represented by a former advisor to Iain Duncan Smith,
    Charlotte Pickles, blandly described as "Managing Editor of the comment and current affairs site Unherd.com", but who "will soon be taking the role of Director at [fundmentalist neoliberal 'thinktank'] Reform."
    And the private hospital sector is also represented - by Jim Easton – Vice-Chair of the Independent Healthcare Providers Network (IHPN).
    We can already predict that this Assembly is a pointless exercise. How long till it is abolished?

  • GPs raise alarm over CQC failure to report on fast-growing GP at Hand GP Online with another update in the GP At Hand saga: now it seems uninspected services are threatening to destabilise GP services in Birmingham.
    "Birmingham LMC executive secretary Dr Robert Morley said he was 'astonished' that the CQC had yet to update its report on the service despite a near ten-fold increase in its patient list over 15 months, and described GP at Hand’s planned expansion to England’s second-largest city as 'very concerning'."

  • Halt privatisation of cancer scanning or risk patient harm, MPs tell NHS England Guardian reports more all-party fall-out from the privatisation of PET-CT scanning services in Oxford/Thames Valley. Plus:

    "In a related move, the Guardian can reveal that NHS PET-CT scanning service in south-east London will also be part-privatised. Alliance Medical is part of a consortium that has been awarded the contract, alongside King’s College hospital and Guy’s and St Thomas’ NHS trusts."

  • MENTAL HEALTH SERVICES Addressing the care deficit NHS Providers survey of mental health trust leaders shows it is the poorest and most vulnerable that are being driven to depression and despair by government policy.

  • NHS signals four-hour A&E target may end BBC report pulls out some of the points from the NHS England proposals

  • Clinically-led Review of NHS Access Standards NHS England's new proposals to change access targets for A&E and elective care.

  • Overwhelming ballot result shows how out of touch Boots senior management are from their pharmacists Excellent result by (HCT-affiliated) PDA Union representing Pharmacists, who have been battling for recognition in Boots
    The result of the historic ballot was 3,229 votes (92.4%) in favour of the trade union, with only 266 votes (7.6%) supporting the senior management proposal. This also meant that 47.5% of those eligible to vote supported the union, which surpassed the 40% threshold required for the union to succeed.

  • NHSE proposes to axe 18-week target (£) HSJ report on the latest moves by NHS England to move the goalposts in the hope that it can make declining performance look less of a problem.

  • 400 care home operators collapse in five years as cuts bite Guardian reports that "UK care home firms are buckling under the pressure of funding cuts, crippling debt and rising costs, according to research by the accountancy firm BDO.

    It found that in the period between 2014 and 2016 there were an average of 69 care home company insolvencies per year. The number rose sharply to 123 in 2017 and another 101 collapsed last year."

  • The deepening health crisis in the UK requires society wide, political intervention Free access BMJ blog highlights the fall in in life expectancy:
    "The trend that started in 2010-2011 has worsened. The total fall in life expectancy compared to 2015 projections is 13 months for men and 14 months for women."

  • Electronic Health Records Were Supposed To Cut Medical Costs. They Haven't Another excellent Forbes article drawing on a new study by Harvard Business School and Duke University. It points out that:

    "The problem: Automation may help on some record-keeping tasks, but it also imposes its own costs. “In fact, more costs were shifted over to doctors in that they had to enter more codes into the so-called automated system,” Kaplan says. “Turns out that that gets them annoyed, and it distracts them from dealing with the patient.”

  • Shropshire Council 'plan' to close down GP surgeries and the Community Hospital in Ludlow to 'save' their Helena Lane Day Centre PFI project. Shropshire Defend Our NHS warns on council cutbacks
    "Shropshire Council has put together a draft ‘Ludlow Place Plan’ – with THEIR proposals for OUR hospital. They want a ‘Ludlow Health Facility’, with hospital and GP services on one site. There are a few problems with this.
    "One is that they haven’t actually bothered to ask Ludlow GPs! That's close to unbelievable - but we've checked.
    "The other problem is that Shropshire CCG is trying to push through £5m cuts to community hospitals. We think the plan is to downgrade Ludlow Hospital and move whatever’s left to the Council’s Helena Lane site. And if they do, it’s certainly not big enough for the NHS services we’ve got at the hospital now."

  • Private ambulances increasingly used by NHS ‘putting patients at risk’, damning report finds Independent highlights "damning" CQC report.
    "The Care Quality Commission (CQC) said it was concerned about the quality of care, staff training and use of medicines.
    "Inspectors gave a number of examples of poor practice, including one provider who was “based in a hotel room and did not store controlled drugs appropriately, a paramedic who had their drug bag under their bed in a B&B, and morphine books with pages missing, illegible entries and incorrect information”.

  • Man told he's going to die by doctor on video-link robot Not the kind of service Matt Appcock wants us to imagine, but possibly more like the way some of these "digital" solutions may work out. Worse, if it's an AI robot, he might not even be dying after all.

  • Health coverage loses its booster shot after funding runs out for this media critic Report on the closure of a US-based website that monitored the quality of health reporting in the US and UK -- and pressed for higher standards. Quality of Guardian medical journalism ranked below 10 US and international news sources.

  • New issue of The Lowdown NHS news bulletin New issue of The Lowdown brings new stories on cuts and controversial plans in Shropshire, Derbyshire, Kent, Friarage Hospital, plus privatisation of PET-CT (Thames Valley) and patient transport services, NHS England plans for new legislation, post-Brexit problems accessing health care in Europe – & much more. Pdf plus searchable website

  • Speaking up for a safer NHS John Lister for @nhscampaigns, writing for Public Sector Focus, restates the need for a campaign and a major conference demanding action to Make Our NHS Safe for All

  • NHS consultation cost £2,640 per response: Health chiefs have splashed out millions with no benefit to patients, critics say Evening Standard report flags up the £2.2 million spent on consulting on proposed changes to hospital services in south-west London – getting just over 800 responses.
    "Critics said a total of £40 million to £50 million of taxpayers’ money had been blown in two decades without improving healthcare in the area." Health chiefs seem hell-bent on developing a smaller 400-bed hospital adjacent to the Royal Marsden Hospital in place of the ageing St Helier Hospital in Carshalton -- a massive reduction in local access to services.

  • Chief nurse leaves maternity investigation trust (£) HSJ story reveals Deirdre Fowler, director of nursing, midwifery and quality at Shrewsbury and Telford Hospital Trust, is leaving the trust as an independent inquiry examines more than 200 cases of potentially poor maternity care.
    "However, the trust said her departure is not linked to the investigation, and she is leaving to take up a new position and to be closer to her family."
    Of course. How could anyone think otherwise?

  • Advert for the latest "private GP" service by US-owned HCA Wealthy? Worried but not really ill? Why not give an American health corporation £300 a year? Obviously if anything is wrong with you, you will need the NHS to step in and deliver treatment the private sector does not regard as profitable. Or just go direct to a proper GP.

  • Snubbed STP accuses centre of not fully considering capital bids (£) HSJ report notes one of many examples of trusts getting far less capital than they had expected to carry out STP projects.
    East London Health and Care Partnership (the sustainability and transformation partnership for NE London) has been awarded just £0.5m out of the £2.3bn so far allocated nationally -- but not even received that money yet.
    "Surplus land on one of its sites had been sold off without any funding being provided for a replacement facility.
    "The STP submitted nine bids totalling nearly £430m in 2017 …" the largest amount being for "the redevelopment of Whipps Cross Hospital, run by Barts Health Trust, for which around £350m was sought."

  • NHS prescription costs set to rise again in April for millions of patients Mirror story: "UK prescription charges are set to hit £9 in April as NHS charges rise once again for millions of patients.
    "The NHS prescription charge in England will increase by 20p from April 1 - up from the current £8.80. It comes after prices rose to the 'highest price ever' in 2018 - with the Prescription Charges Coalition dubbing the news "catastrophic" for households."
    Prescription charges raise relatively insignificant sums towards the NHS budget, but inflict disproportionate harm on low-paid families. While almost 90% of prescriptions are dispensed free to older people and to other exempted groups, they are a deterrent to those earning just enough to pay, but not enough to be able to cover such high costs per item.

  • RCEM Vice President warns against becoming "immune to the human impact of what the numbers mean" as performance declines again in Winter Flow Project Statement from Royal College of Emergency Medicine on the latest performance figures

  • English county where ONE GP covers home visits for 500,000 patients Daily Mail story highlighting the reduced cover in Shropshire from Shropdoc and other thinly-served out of hours GP cover:
    "Although [in Shropshire] there is a second GP working at night carrying out ‘triage’ assessments on the phone they are not available to do consultations or home visits. And this doctor is also responsible for triaging incoming NHS 111 calls from Wales.
    "Shropdoc insists that patients can also be seen by one of two ‘urgent care practitioners’ – who are either nurses or paramedics.
    "Freedom of information requests by the Mail show that out-of-hours provision is hugely patchy. In Milton Keynes, Bucks, there is one GP overnight for 290,000 patients, Cornwall has three GPs for 575,000 and Oldham has one for 230,000."

  • Hospital reconfiguration faces delays as costs soar (£) HSJ report highlights what many may find a welcome delay in pushing through highly controversial plans to "centralise" services in East Kent:
    "A joint committee of the clinical commissioning groups in East Kent will be asked to approve the next steps – including detailed evaluation of two options – at a meeting next week.
    "Public consultation on the project was expected this year, but has now been delayed to next year.
    "Since the plans were first outlined in 2017, the expected costs of one option, involving a consolidated accident and emergency, consultant-led maternity and specialist services at a new build hospital in Canterbury, have risen from around £250m to more than £300m."

  • In the room... Blog by Roy Lilley airs some ideas on how the escalating NHS staffing crisis can be addressed.

  • Centralising the NHS – the local Democratic Deficit at the heart of the NHS Long Term Plan Excellent blog from Mark Gamsu takes up the issue of loss of accountability, as spelled out by responses from Health Campaigns Together and KONP, and adds useful graphs and info.

  • Warm winter provides cold comfort for struggling NHS The Financial Times, with very useful graphs, delves into the data to see how this year's winter crisis compares with the last two. It finds that over and above the continuing decline in the A&E performance on the 4-hour target: "Other signs of strain are a sharp year-on-year change in the number of patients being admitted as an emergency and a marked rise in the number waiting more than 12 hours to be admitted after a decision has been made to keep them in."

    A separate measure, that tracks how long people spend in A&E from the moment they arrive saw almost 333,000 people waiting longer than 12 hours in 2017-18, the latest data available, from about 262,000 the year before.

  • Can councils be true partners in ICS? (£) HSJ article following up on Luton council's decision to pull out of one of the original integrated care systems. It notes that:
    "An NHS England/NHS Improvement implementation paper is due soon which should give clearer details on how ICS are expected to develop, including when and how their partnership boards must be set up.
    "These boards can include councils but, perhaps mindful of the 2016 debacle when STPs were drafted and NHS England had to try to stop councils from releasing them, regulators have recognised they cannot force local authorities to take part."
    So far there is no evidence that councils are seen as anything other than a handy and undemanding way of getting an apparent stamp of legitimacy while the NHS remains firmly in the driving seat. Councils appear to be willing to sign up for ICSs in which they receive no recognition or role, and resist any suggestion they should demand the ICS be made in any way countable to local people.

  • A fifth of NHS doctors were bullied or abused last year, study finds Guardian report based on a BMA survey of 7,887 doctors of all grades across the UK, which found that 39% believe that bullying, harassment or undermining behaviour occurs in their main place of work and is a problem.
    Of those, 10% said it was “often” a problem while 29% it occurred “sometimes”.
    A fifth (20%) said they had experienced such behaviour during the past year, but only a third of these said they or a colleague had reported incidents to their employer.

  • Health Secretary asked to look at A&E changes Weston mercury reports CEO of North Somerset Council writing to Matt Hancock to challenge plans to permanently downgrade Weston Hospital's A&E:
    "“I write on behalf of all elected members at North Somerset Council to make clear there is cross-party support for 24/7 accident and emergency services to be retained at Weston General Hospital."

  • Brexit will make it harder to 'wash, dress and feed' thousands of elderly people Evening Standard highlights warnings from ADASS that social care staff, even lower paid than nurses and not covered by any exemptions, are likely (if not certain) to be excluded from coming to Britain by the government's planned £30,000 minimum income requirement -- worsening the already dire shortages of staff and social care services.

  • Virtual GP service allowed to expand out of London despite criticism from doctors NHS England continues with its crusade against evidence or evaluation of pilot schemes, giving the nod to Birmingham adopting the controversial privately-led service that has caused financial havoc in general practice across London and which has yet to be properly evaluated.

  • Combined Performance Summary December 2018 - January 2019 The Nuffield Trust's Quality Watch data with very clear graphs, based on NHS England's Combined Performance Summary, which provides data on key performance measures for December 2018 and January 2019.
    SitRep data for Week 6 of 2019 was also released, giving a more up-to-date analysis of how the NHS is coping this winter.

  • Queen's Medical Centre needs £77m of urgent improvements Nottingham post report reveals that: "Examples of maintenance needed can be upgrading software on medical equipment, maintaining generators and boilers, and ensuring the structural integrity of buildings."
    The bigger bill for urgent repairs in the whole of Nottingham University Hospitals trust is £104m.

  • Priory to close 'inadequate' High Wycombe hospital Guardian report highlights more evidence of poor quality private care propped up by subsidies from NHS budgets. Time to cut the support and invest the money in expanded NHS services.
    The Priory Group is privately owned – in 2016 it was bought by US firm Arcadia Healthcare for £1.3bn – but 85% of its income comes from the public sector.

  • Private providers could grab unlimited share of GP consultations online GP Online report flags up the implications of the minimalist answer from health Minister Stephen Brine to a question from Shadow Minister Justin Madders on the estimates of the share of online consultations to be delivered by private companies.
    The report also makes clear the extent to which the government is forging ahead with the roll-out of "digital first" consultations without any consideration of the level of exclusion this will bring for older, poorer and less literate patients for whom it is less appropriate. Coupled with Health Secretary Matt Hancock's insistence that letters to patients should increasingly be restricted to emails rather than conventional posted hard copy, it is clear that the government remains insensitive to the needs of anyone other than young middle class patients and the private app industry.

  • A&E waits at worst level for 15 years in England The downward curve of A&E performance continues, driven I n part by continued increases in numbers needing emergency admission. During January, only 84.4% of patients were treated or admitted in four hours - well below the 95% threshold. Eleven trusts had a performance below 70 per cent.
    Nearly 330,000 patients waited longer than they should with hospitals reporting significant problems finding beds for those needing to be kept in.
    The performance is even more worrying for the more serious "type 1" cases: nine trusts recorded 60 per cent or below. Croydon Health Services Trust was the worst at 49.2 per cent.

  • Greece, 10 Years Into Economic Crisis, Counts the Cost to Mental Health A sobering reminder in the New York Times of the brutal austerity imposed on Greece by the EU and IMF concludes: "Even if the Greek government manages to address weaknesses in the health care system, health experts note that the main reasons behind the mental health crisis are very much alive.
    “As long as there is unemployment, insecurity and debt, the products of the financial crisis, this problem will not go away,” said Dr. Sioras, the union leader. “I fear it will get worse.”

  • Newly-obtained cabinet orders show health overhaul well underway Shocking story from CTV news in Toronto on the latest moves by the neoliberal Ontario Provincial Government, led by Doug Ford, driving to abolish all of the local and accountable bodies controlling health care across the province and rolling them into one "super health agency" with powers to close, cut and privatise at will. The campaign of resistance is getting under way -- but the government is moving fast.

  • NHS staffing crisis as thousands of midwives quit over the stress of the job Daily Mirror report highlights NHS Digital figures showing record numbers of midwives "quitting the NHS because the pressure of the job is ruining their lives. … almost one a day resigns because they are unable to find a decent work-life balance.
    "Understaffed wards have left many having to work longer and do more after years of NHS underfunding."

  • What matters to you? - Urgent Treatment A quick as a flash survey by Shropshire CCG, announced on Feb 1, closing on Feb 12. The main factor being smuggled through with barely any public scrutiny here is reducing the proposed hours of UTCs from 24/7 to 12 hours 9am-9pm. Surely that calls for a serious explanation, discussion and decision making process?

  • Interserve is caught in the fault lines exposed by the Carillion collapse Prem Sikka in Left Foot Forward examines a now grimly-familiar sounding story of the efforts to keep contractors Interserve afloat:
    "To finance its bad investment and dividends, Interserve built a debt mountain. Its long-term debt increased from £406m in 2015 to £647m in 2017, and in 2018 reached £807 million.
    "It owes £799m to suppliers and has a pension scheme deficit of £48m. In 2017 Interserve paid £28.4m in interest charges compared to £23.3m in 2016. For the first half of 2018, the interest payments rose to £31.1m.
    "A loss-making company, with low margins on contracts and turnover of £3.2bn cannot sustain a debt of £807m. So the deal has been cut with banks to convert £480m of debt into shares. This may provide some breathing space."

  • Concerns over birthing options as NHS shuts midwife-led centres Guardian's Denis Campbell brings together the stories on plans in England to close 8 midwife-led units, for a variety of reasons:

    "NHS chiefs have sparked controversy by shutting eight birth centres in England, prompting criticism that pregnant women are being denied the choice of place of birth that all have been promised.
    "The wave of closures has resulted partly from more women choosing to give birth in obstetric units in hospital, where doctors are in charge, rather than in birth centres, where midwives are the only staff. It is also linked to the shift toward older motherhood, the rise in maternal obesity, the drive to reduce stillbirths and a shortage of midwives."

  • Nursing degree applications down 30% since bursary axed RCN press release commenting on latest UCAS figures that show that despite a small increase on last year, the latest figures from UCAS show nursing degree applications in England have fallen by 13,000 since 2016.

  • Just Another Day The full UNISON report, which sums up: "Staffing shortages across the health service clearly have a direct effect on patients. Almost half of the respondents (45%) said there were not enough staff on their shift to deliver safe, dignified and compassionate care. This was most pronounced in acute inpatients with 59% saying there were too few personnel to deliver the required standard of care. It was also a serious issue for those in mental health (45%), primary care (41%) and community health (36%)."

  • Health service staffing is compromising patient health, says UNISON Press release highlighting latest UNISON survey.

  • Diabetics in Britain worry a no-deal Brexit could put their lives at risk Interesting Washington Post article which is clearly not targeting either side of the British Brexit debate. It points out "Diabetes has become one of the most high-profile conditions to be highlighted by Brexit jitters, in part because 99 percent of Britain’s insulin is imported, largely from the E.U. It also needs to be refrigerated, so it cannot sit indefinitely in traffic jams."

  • ‘Crumbling’ NHS hospitals face £3bn repair bill (£) Sunday Times article shows 6 of the 10 largest backlog maintenance bills are London hospitals. The backlog has grown because "ministers repeatedly raided the health infrastructure budget". The consequences are serious:
    "Patients and staff are being put at growing risk of harm, with more than 5,500 serious safety incidents last year, including deaths. Surgery often has to be delayed or cancelled because of infrastructure problems such as burst pipes and failing heating systems."

  • Leeds NHS campaigners stage ‘protest and celebration’ Yorkshire Post gives welcome advance publicity to Yorkshire Health Campaigns Together is organising march through Leeds on Saturday March 30. People taking part are being asked to assemble outside Leeds Art Gallery on The Headrow at 11.30am on the day.

  • DHSC slaps down quangos over Brexit messages HSJ (£) report shows Department of Health busily proving that "arm's length bodies" are supposed to shut up when told and toe the government line even when it's obvious ministers are making a complete pig's breakfast of the so-called negotiations, with potentially disastrous consequences for NHS services and patients.

  • International recruitment scheme adds 34 GPs to workforce in three years Telling story from GP Online: government incompetence and the dire impact of Brexit and Theresa May's "hostile environment" for overseas visitors of all kinds are now severely impacting potential recruitment to run GP services and making a nonsense of promises to recruit thousands more. How much has been wasted on these recruitment projects?

  • Why are there More Than Double the Number of Non-Elective Admissions to Hospitals of Ealing Patients than Westminster Patients? Ealing campaigners flag up the inequalities issue again:
    "In 2015/16 there were more than twice the number of Ealing patient NELs compared to Westminster patients. Of the 426,086 patients registered with Ealing’s 79 GP surgeries, 31,726 of them were NEL admissions to hospitals. Of the 177,950 patients registered with 25 Westminster GP surgeries, there were 6,286 NEL admissions.
    "Calculated as NELs per 1,000 weighted registered patients, Ealing scored 74.46 whilst Westminster scored 35.32. Admittedly there are only 25 GP surgeries (out of a total of 35) in Westminster included, because there were fewer than 50 NELs or less than 500 registered patients at 10 surgeries."

  • Chief Inspector publishes report on Home Office collaborative working with other government departments and agencies Chief Inspector Borders and Immigration report reveals Operation DINTEL– secret Home Office operation using NHS data on patient debt to track down asylum seekers and migrants at their home address and arrest them. Doctors of the World, highlighting this aspect of the report, also flags up evidence thatsharing NHS patient data with the Home Office makes many of our patients too afraid to see a doctor when they are unwell.

  • ​1 million new patients unable to access NHS dentistry, as recruitment and retention crisis mounts Hard hitting report from British Dental Association with some atark figures:
    "•BDA analysis of the government's own GP Survey – based on feedback from over 350,000 adults – reveals nearly 1 in 4 new patients (estimated at over 1 million in total) not currently on the books with an NHS dentist have tried and failed to secure an NHS appointment.
    •This data points to access problems across every English region – with over 40% of these irregular attenders missing out in parts of Norfolk, Derbyshire, West Yorkshire and Cornwall, reaching over 60% in parts of Lincolnshire.
    •The BDA's new national survey of dentists suggests nearly 3 in 5 practitioners (59%) based in England are now planning to scale down or leave NHS work entirely in the next 5 years
    •Those with higher NHS commitments are the most likely to leave - 67% of dentists seeing more than 75% NHS patients expressed their intentions to move on – falling to 51% among those doing less NHS work."

  • Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial While NHS England and trusts are obsessed with cutting so-called 'back office' staff, this BMJ free access report on an Australian study shows the effectiveness of medical scribes to speed implementation of decisions:
    "A medical scribe helps the physician by doing clerical tasks. The scribe stands with the physician at patients’ bedsides, documenting consultations, arranging tests and appointments, completing electronic medical record tasks, finding information and people, booking beds, printing discharge paperwork, and doing clerical tasks.
    "They do this via a computer-on-wheels connected to the hospital’s electronic medical record system. The aim of the role is for scribes to do clerical tasks otherwise done by the physician, enabling the physician to manage more patients in the same amount of time."

  • £8 billion funding black hole by 2025 will swallow up popular council services The Locla Government Association points out that:
    "Between 2010 and 2020, councils will have lost almost 60p out of every £1 the Government had provided for services.
    "Some councils are being pushed to the brink by this unprecedented loss of funding and an ongoing surge in demand for children’s services, adult social care services and homelessness support. This is on top of having to absorb other cost pressures, such as higher national insurance contributions, the apprenticeship levy and the National Living Wage.
    "More and more councils are struggling to balance their books, facing overspends and having to make in-year budget cuts."

  • Waiting times now even longer at QMC's revamped emergency department The Nottingham Post reports that "The hospital’s four-hour target performance – a key measure the Government sets – has been dragged down. The target is to see 95 percent of patients within four hours.
    "In January this year, the actual performance was 72.6 percent – down from 80.2 percent compared to this time last year."
    The reorganisation to separate minor cases from more serious ones has backfired:
    "Despite there being a seven percent total increase in the number of people attending in January compared to the year before, there was an 18.1 percent rise in patients with ‘minors’.
    "This caused delays for redesigned A&E department, which were compounded in part by staff shortages in the UTU."

  • Neighbourhood Midwives closure: Mothers-to-be left 'high and dry' Yet another private contract failure as company walks away at shortgg notice leaving pregnant mums stranded. Question keeps coming up: why do gullible CCGs keep bringing in these private companies to disintegrate care and undermine NHS services, when NHS trusts could be funded to do the job better as part of their existing work?

  • Surgeons do make mistakes – it’s time to reboot the surgery checklist Lord Darzi in the Guardian points out that
    "In January 2009, the surgical checklist was mandated for every operation across the NHS in England. It was promoted across the globe by the World Health Organization, and checklists have since been introduced in thousands of hospitals and more than a dozen areas of medicine to prevent medication errors, pressure sores, blood clots and injuries in childbirth."
    "But when applied to medicine, they have met resistance. Some surgeons scoffed at the idea that such basic checks could make a difference. Some objected that it was a box-ticking exercise. Staff complained it was poorly worded, time-consuming, inappropriate or redundant – and bridled at what was felt to be another top-down initiative."

  • All the headlines from the 2019/20 GP contract at a glance As usual Pulse magazine is the first with this detailed coverage.

  • The GP substitute will see you now BBC headline on the new 5-year GP contract wrongly dismisses valuable skills of therapists and professionals who can play a valuable role in enhancing primary care, but must not become a way of preventing patients seeing a GP when they need to.
    According to the report:
    "An army of more than 20,000 physios, pharmacists and paramedics are to be recruited in England to work alongside under-pressure GPs, NHS bosses say."
    It's not clear whether any let along all of these promised staff can be delivered, especially those already in short supply elsewhere in the NHS -- physios, paramedics etc.
    BMA GP leaders have "warmly welcomed the move but warned extra doctors were also needed."

  • Little evidence that integrated care initiatives deliver Slightly exaggerated HSJ (£) headline for an article from Nuffield Trust which is not entirely negative in its evaluation of an Age UK project involving enhanced care, while stressing this is not a guaranteed way to make savings:
    "Our findings shouldn’t deter innovations like Age UK’s programme. Where there is evidence that such schemes benefit patients, as well as health and care staff and carers, it is right that they are considered as valuable local options for enhancing services.
    "But these findings – alongside those of our previous evaluations – suggest that we shouldn’t bank on the prospect of significant savings in the shorter term without good evidence suggesting otherwise. We need to stop being over-optimistic about likely financial benefits, especially from reductions in hospital activity. Often, doing more for patients is going to cost more, not less."

  • Former NHS nurse born in UK with no criminal record deported to Ghana Shocking result of Theresa May's "hostile environment" even for British citizens exposed by the Independent:
    "A former NHS nurse who was born in the UK and has no criminal record has been deported to Ghana, in a case that raises fresh questions over the British government’s treatment of Commonwealth nationals in the wake of the Windrush scandal.
    "Dean Ablakwa, 34, is currently stateless and unable to work in the Ghanaian capital Accra after the British government removed him in June 2017, despite the fact that he had previously worked and paid taxes in the UK for more than a decade."

  • The inverse care law in the digital age Open access BMJ blog by Dr Helen Salisbury makes the key point about digital access to NHS services:
    "The people most in need—elderly people, disabled people, and those who have missed out on education—are the least likely to succeed in accessing the services they’re entitled to. It sometimes looks as if designers of patient pathways create models with themselves in mind rather than the likely users. Perhaps picturing their own grandparents, or elderly neighbours, might improve the design process."

  • 'Healthy Weston' consultation proposes to make "temporary" night closure of A&E permanent After a long period of 'temporary' night-time closure of the A&E department at Weston Hospital, the Clinical Commissioning Group finally comes clean and admits it won't reopen.

  • Health Secretary backs private firm profiting from patients who can't get an NHS dentist Mirror reports that app-mad Health Secretary Matt Hancock is once again backing a private company cashing in on the inadequacy of NHS funding and services, this time in dentistry. The problem is especially bad in Hancock's own constituency:
    "Visiting one of its surgeries in ­rural Mildenhall, Suffolk, Mr Hancock said: “Companies like MyDentist play a really important role in delivering a good service to keep our nation’s teeth strong.”
    "Half of all NHS surgeries are closed to new patients because of a Tory funding crisis, it is estimated.
    "In Mr Hancock’s West Suffolk constituency, fewer than one in 10 is taking new adults and some patients face a 20-mile round trip for a place."

  • Care workers forced to cut short home visits or be left out of pocket The Guardian highlights UNISON research:
    "According to freedom of information requests by public sector union Unison, 54% of local authorities do not make it a contractual condition that the care agencies they commission pay their care workers for the time spent travelling between visits.
    "That means many homecare staff end up earning less than the government’s £7.83 an hour minimum wage for over-25s, rebranded in 2015 as the “national living wage”. "

  • No-deal Brexit could see ops cancelled, NHS trust says BBC reports concerns of a major midlands acute trust:
    "NHS trusts could "quickly run out of vital medicine" in the event of a no-deal Brexit, the chief executive of a leading hospital group has warned.
    "Dr David Rosser of University Hospitals Birmingham (UHB) said that, despite NHS stockpiling, shortages would likely occur due to "unprecedented" distribution challenges."
    Most of the West Midlands voted heavily for Brexit. None were warned this might be the result.

  • Campaigners publish appendices removed from Shropshire CCGs' website on controversial cuts plan Shropshire Defend Our NHS have stepped in to make sure crucial information remains in the public domain as the battle hots up over cuts to vital NHS services. Their Twitter account states: "Transparency? Our health bosses seem to have forgotten its meaning. This morning they removed all the Appendices to their Decision Making Business Case from the Future Fit website." It links to a Google Drive account with all of the deleted appendices displayed.

  • Exclusive: NHS England told to act on internal review to end 'avoidable harm' HSJ (£) exclusive highlights leaked information on chronic failings to improve access to diagnostics and treatment for serious spinal problems:
    "Spinal patients have been exposed to “avoidable harm” due to “wholly unacceptable” delays in their treatment, according to an unpublished NHS England report.
    "HSJ has seen an internal review by the national commissioner that highlighted the issues two years ago, and which recommended 54 additional specialist beds were needed to address the problems.
    "However, separate bed data has suggested the situation remains largely unchanged, prompting concerns from a leading charity and the all-party parliamentary group on spinal cord injury."

  • Royal College of Emergency Medicine open letter to Simon Stevens, CEO NHS England, on 4-hour A&E targets This extremely hard-hitting and angry letter begins:
    "Dear Mr Stevens,
    "I fear that you are hell bent on undermining the benefits that the four-hour A&E standard has delivered to patients over many years, a decision you claim that so called ‘top doctors’ want.
    "It begs the question who are these ‘top doctors’ you quote? They are not from the leaders of the body representing over 8,000 people working in our A&Es, the Royal College of Emergency Medicine, who believe the target is vital for timely, high quality patient care.
    "They also cannot have spent much time with patients in emergency departments, as if they had they would know that the service is perfectly capable of triaging patients and determining who needs what and when. Minor issues are not the problem and can be dealt with quickly; major issues are always prioritised."
    Its final line is equally uncompromising:
    "So Mr Stevens, who are these doctors with such contempt for the patient interest?"

  • Shock over dirty and dilapidated John Radcliffe operating theatres The Oxford Mail reports that "Oxford University Hospitals NHS Foundation Trust has ... been issued with an urgent notice under the Health and Social Care Act to improve the conditions which the Care Quality Commission (CQC) said affected all areas of the main operating department."
    The rerport adds:
    "The hospital’s surgical provision is currently rated as ‘requires improvement’ by the CQC.
    "The report published following an inspection in 2014 highlights a lack of staff, with senior clinicians feeling at the time that the trust board was ‘motivated by financial, rather than by clinical motives’."

  • Amid Brexit vote chaos, the government quietly finalises council cuts The New Statesman comments that the "extra" money announced behind the smokescreen of the Brexit fiasco is nowhere near enough:
    "councils still face a funding gap of more than £3bn this year, according to the Local Government Association. The pressure to set legal budgets, with an average 49 per cent drop in real terms spending power since 2010 and rising social care demands, means councils need substantially more than a 2.8 per cent raise."

  • Future Fit: Health Secretary will be asked to step in over decision The controversial and hotly contested 'Future Fit' plan to reconfigure and downsize hospital services covering the 2,000 square miles of Shropshire was rubber stamped by a tightly-controlled 1-hour meeting on January 29, held in a remote venue, with no opportunity for any opposition views to be heard.
    Shropshire and Telford & Wrekin Clinical Commissioning Groups (CCGs), backed the plan to centre emergency care in Shrewsbury, despite this being overwhelmingly rejected by the public during consultation last year.
    The decision has immdeiately been challenged by Telford & Wrekin council, who have invoked their scrutiny powers to refer the plan to Secretary of State Matt Hancock.

  • 'Desperation and despair': Barnsley's long battle with austerity Guardian report on the impact of a decade of austerity and council spending cuts on public services in Barnsley, where 62% of councils spending is now on social care, and there are fears that almost all other services will need to close to keep this running.

  • Doctors attack plan to scrap four-hour A&E target Guardian report on the NHS England "review" of the 4-hour target that has been missed by most trusts and across the NHS for so many months notes:
    "NHS bosses are facing a backlash against plans to scrap a target to treat patients within four hours of arrival at A&E.
    "The body that represents A&E doctors said the move was an attempt to “bury problems” in the NHS. The proposal has sparked fears of a return to the days when some patients waited many hours in A&E to start treatment.
    "Dr Taj Hassan, president of the Royal College of Emergency Medicine (RCEM), said: “In our expert opinion scrapping the four-hour target will have a near-catastrophic impact on patient safety in many emergency departments that are already struggling to deliver safe patient care in a wider system that is failing badly.
    "“Let’s be very clear: this is far from being in the best interests of patients and will only serve to bury problems in a health service that will be severely tested by yet another optimistic reconfiguration.”"

  • Tory council funding shake-up set to send more cash to richer Tory areas Daily Mirror report highlighting "inverse care law" in new formula for allocating local government funding, which takes funds from more deprived Labour-run boroughs to boost the budgets of already wealthier Tory-rujjn councils.

  • Anguish as ‘lifeline’ Alzheimer’s Society service in Sunderland is set to close Sunderland Echo report on closure of the only unit delivering support for Alzheimer's patients in the greater Sunderland area, which is being closed because the funding for the service does not cover its costs. How many similar schemes are closing elsewhere in England?

  • NHS App begins public rollout The much-vaunted NHS App is now being rolled out, although its practical use is much more limited than many may assume: unlike GP At Hand it does not include any provision for online consultations, or the controversial Artificial Intelligence diagnosis system developed by private company Babylon that has been repeatedly exposed as unreliable on a number of issues. NHS England states now that:
    "When the GP practice is connected patients will be able to use the NHS App to:
    •book and manage appointments at their GP practice
    •order their repeat prescriptions
    •securely view their GP medical record
    •check their symptoms using NHS 111 online and the health A-Z on the NHS website
    •register as an organ donor
    •choose whether the NHS uses their data for research and planning."
    Critical comments on Twitter include questioning the use of a young, fit looking, white, middle class, posh woman with an I-phone as the promotional graphic, suggesting the app is most attractive to those who have least need of the NHS, and a comment that will ring bells in many areas: "There is no mobile phone connectivity in the rural area I live in. Many of our elderly living on pensions and those in poverty cannot afford broadband. What use is an app?????"

  • More 'social prescribers' to ease pressure on GPs BBC report on one aspect of the planned use of thousands of additional staff to support GPs as part of the new contract. However the suggestion of using a thousand staff "trained to prescribe social activities, like exercise groups and art classes, to GP patients who don't need pills" raises the question of who has trained them, what qualification they are required to have, who will check on the effectiveness of the work they do and what will happen when patients fail to benefit from inappropriate services. Also who will pay for the services, since many "community" projects have been going under as a result of continued local government cuts.
    The BBC tells us that the "link worker's role is to help patients find suitable community activities to improve their health and wellbeing." What happens if they can't?

  • Hospital appeal for public donations to buy pyjamas and underwear for cancer patients Shocking ITN report highlights the impact of austerity spending limits on Abertawe Bro Morganwwg University Health Board in South Wales. The market may no longer be a factor in Wales since devolution, but Westminster spending limits and Welsh Assembly Government policies are still taking their toll.

  • CCG may struggle to 'pay its bills' due to financial pressure of Babylon GP at Hand Article from Pulse notes cost of the trendy online GP service promoted by Health Secretary Matt Hancock on Hammersmith & Fulham CCG, which is unfortunate enough to host the service, which covers a wide swathe of London. Hammersmith CCG "reported a £2.5m cash deficit, citing Babylon GP at Hand as the ‘key driver’ of cashflow issues, and said the situation is 'expected to worsen in the near future'."

  • 'Patients lives are at risk' as Hull hospitals struggle to recruit enough medical staff The Hull Daily Mail notes a big increase in vacancies: "Full time staff vacancies for hospital trusts in Hull and East Yorkshire rose to 623 between July and September last year, compared to 492 during the same period in 2017 - a rise of 26.6 per cent."

  • On the same page? Taking a closer look at the Long Term Plan and the Planning Guidance The Nuffield Trust's Helen Buckingham points to interesting contradictions between the two documents, which are supposed to be closely linked.
    She notes that "Although there is a clear expectation that operational plans will be agreed across organisational boundaries, it takes a lot more than a plan based on organisations to deliver care that is truly integrated around the individual. A recent QualityWatch assessment of the development of integrated care shows that progress has, at best, stalled. Patients and carers are feeling less supported and less involved in their care than they were seven years ago, and there are significant variations between different groups of patients. "

  • Stroke units could close under new NHS England plans HSJ (£) reveals plans could close more than a third of the 126 stroke units. This is sure to create even more local battles as communities in the areas facing closures fight longer journeys and delayed access to treatment.

  • NHS report shows thousands of bed blocking incidences occur due to people waiting for community equipment There were 137,436 delayed transfers of care (DTOCs) between November 2017 and November 2018. Almost 89,500 were from acute hospitals and nearly 48,000 being non-acute.
    41,246 incidences were attributable to social care, while more than double (85,045) were attributable to NHS trusts. According to the NHS, a DTOC occurs when a patient is ready to depart from acute or non-acute care but is still occupying a bed. This can happen for a wide range of reasons, including waiting to be placed in residential care, waiting for community equipment and waiting for assessment completion.
    During the one-year period, almost 4,000 people experienced a delayed transfer of care due to waiting for community equipment or an adaptation.

  • A disorderly exit A welcome flicker of light and humour in this excellent blog on the comings and goings at the mythical but strangely real NHS Blithering. It's almost more convincing than many real CCGs.

  • NAO report: NHS financial sustainability A report that views the latest announcements through rose-tinted glasses to put a positive spin despite the fact that during 2017-18
    "We consider that the growth in waiting lists and slippage in waiting times, and the existence of substantial deficits in some parts of the system, offset by surpluses elsewhere do not add up to a picture that we can describe as sustainable."
    The positive spin comes from the promised extra cash:
    "Recently, the long-term plan for the NHS has been published, and government has committed to longer-term stable growth in funding for NHS England."

  • Exclusive: Up to 250 deaths to be reviewed at surgery crisis trust HSJ (£) exclusive on the review of 5 years of heart surgery patients treated at St George's hospital in London

  • London trusts to lose £300m after tariff change HSJ (£) report reveals the impact of tariff changes on trusts in the capital, many of which are already facing deficits and under-funded for their rising caseload. Less clear how trusts are expected to take this in their stride.

  • Dying man given bill for tens of thousands of pounds for NHS treatment More evidence of the lethal impact of Theresa may's "hostile environment" which negates the ethics of health professionals and the values of the NHS.

  • NHS memo reveals two patients died after waiting for A&E care Save Our NHS in Kent issued a statement to local press.
    "This is shocking and saddening news. No patient should lose their life in this way, waiting to be seen by a doctor. It appears that conditions at QEQM A&E have worsened to a degree where tragedies like this are able to happen. Something is dreadfully wrong in our NHS; we know that last year at William Harvey Hospital, paramedics were forced to keep emergency patients waiting in ambulances until the hospital could take them in. Every quarter of the NHS is saying that staffing problems need to be urgently addressed and that pressures on frontline staff are unacceptable. We must all ask why there isn't a major national debate and in-depth parliamentary scrutiny happening right now to find solutions."
    "Local people are very upset about this news but are praising the frontline staff at the hospital."

  • NHS to sell DNA tests to healthy people in push to find new treatments This latest move by NHS England is wrong on so many levels -- selling tests, selling them to people who don't need them … encouraging uncertainty, not least over the growing commercialisation of health care. If the NHS does not provide it free, then it is admitting they do not work and provides no benefit. If it's needed it should be at no charge.

  • Futureproofing Leicester’s Hospitals. Why we need YOU to get Involved Save Our NHS Leicestershire sets out the need for people to challenge local plans:
    "Virtually no detail about the plans has been put into the public domain and made available for public scrutiny."
    Campaigners warn that the public are being asked to trust that ‘doctor knows best’. This seems doubtful: time to get active!

  • Carillion Pocketed £205m Despite Finishing Just 10% Of Much-Delayed Hospital Huffington Post reports on Birmingham's Midland Metropolitan Hospital: "Construction giant Carillion earned £205million from a contract to build a multi-million pound hospital despite completing just 10% of vital engineering work before it went bust.

  • STATEMENT FROM MEDWAY COUNCIL Document to KENT AND MEDWAY STROKE REVIEW JOINT HEALTH OVERVIEW AND SCRUTINY COMMITTEE argues the proposals for centralisation are wrong. "Medway Council believes that the proposed sites that have been selected for the
    provision of HASUs (Darent Valley, Maidstone and William Harvey, Ashford) are not in
    the best interests of the health service in Kent and Medway. Furthermore, Medway
    Council believes that there were flaws in the way that the Joint Committee of Clinical
    Commissioning Groups was led to choose the selected sites. This invalidated the criteria
    used on the public consultation documents and failed to provide evidence to support the
    evaluation criteria."

  • Are patients benefiting from integrated care? Fascinating figures from the Nuffield Trust show the case for integration is far from proven; on several measures patients do worse.

  • Future Fit officials criticised over Newport venue for crucial vote Shropshire Star reports local Defend our NHS has voiced criticism of the location and the timing of an important meeting, claiming that people using public transport will be unable to attend.: "A vote over the future of Shropshire's health services will be taken by a 15-person panel at Newport's Harper Adams University on January 29.
    "The result of the vote will confirm whether the county's only A&E department is based at Royal Shrewsbury Hospital or Princess Royal Hospital Telford. "

  • RCEM statement on four-hour target speculation Statement by Royal College of Emergency Medicine says:
    "The four-hour ECS has been a resilient, sophisticated and very successful overall marker of a hospital's emergency care system performance for the last 15 years. Sadly, the past five or six years has seen a steady deterioration in system performance due to under investment in acute hospital bed capacity, cuts in social care funding and understaffing in EDs. This has resulted in a significant increase in the number of crowded EDs which scientific evidence clearly shows is linked to increased mortality and morbidity for patients. It also results in secondary attritional harm to staff having to work in such environments which further compromises patient care.”

  • Concerns raised about lack of consultation on targets review (£) HSJ report on complaints by the Royal College of Emergency Medicine that they have not been consulted by NHS England on revision of targets for A&E performance.

  • Leeds had worst A&E waits in West Yorkshire in December Leeds Live report .
    "Hospitals are tasked with treating or discharging 95 per cent of emergency department patients within four hours.
    "Leeds Teaching Hospitals, which runs LGI and Jimmy's only managed a figure of 75.4 per cent in December, normally one of the toughest months of the year.
    "The result is the worst in West Yorkshire, with Bradford hospitals only slightly better at 75.5 per cent."

  • £4.5bn primary care funding will relieve pressure on GPs, promises Hancock Pulse magazine notes that to get access to the extra money "GP practices in England will be mandated to join primary care networks of 30-50,000 patients from April."

  • Ford flirts with private health care at his peril Ontario Health Coalition Executive Director Natalie Mehra secures a spot in the The Star newspaper in Toronto to challenge the latest moves by the neoliberal provincial government headed by Doug Ford.

  • STP could miss planned deficit by more than £35m (£) HSJ report reveals the Kent and Medway health economy is likely to end the year with a net deficit of at least £113m, nearly £36m worse than previously forecast.

  • GP urges colleagues to reject hyper-acute stroke unit plans as decision looms Isle of Thanet news report on intervention by Dr Coral Jones, who is a GP and an active member of the Save Our NHS in Kent campaign, who has spoken out as a decision announcement becomes imminent on centralisation of stroke services.
    "A doctor and NHS campaigner is calling on her colleagues to vote against plans to close emergency stroke units, including the one at Margate’s QEQM Hospital, in favour of three hyper-acute bases for the region."

  • It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care Health Affairs article revisits a 2003 article with current statistics and finds that: "The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article’s publication."

  • Are Andrew Lansley's NHS reforms being binned? Are Andrew Lansley's NHS reforms being binned, asks the BBC report. Not yet, because the regulations compelling CCGs to contract out services could simply be deleted by ministerial action -- but all we have is a polite suggestion from NHS England.

  • Flooded wards and leaking ceilings of "slum" NHS hospital hit by Carillion collapse Mirror article picks up on the desperate state of the Royal Liverpool Hospital after work on the £430m PFI replacement was halted by the collapse of Carillion.

  • Care cuts failing older people in England, says human rights group Guardian highlights Human Rights Watch report on growing crisis in social care, and notes that: "an ageing population, rising care costs and government cuts mean adult social care services face a £1.5bn funding gap by 2019-20, rising to £3.5bn by 2024-25, according to the Local Government Association."

  • Prescription Drug Costs Driven By Manufacturer Price Hikes, Not Innovation Maybe not a shock to many, but useful exposure of rip-off pharma industry and why its proces keep rising.

  • Care cuts failing older people in England, says human rights group Human Rights Watch report accuses the government of a lack of oversight of a social care system which is largely devolved to town halls and voices concern about a 140% increase in adult social care complaints since 2010 following a cut of almost 50% in central government funding for councils.

  • Spend on 'vital' community services cut by a fifth HSJ flags up research revealing cutbacks over the years in services which are supposedly key to the NHS Long Term Plan's ambitions for mental health: "The average spend by trusts on their community teams decreased from £6.2m per 100,000 people served in 2012-13, to £5.3m in 2016-17. This is a 15 per cent reduction in cash terms. Once inflation is considered, the cut was 20 per cent."

  • Home Office doubles charge for migrants to use the NHS Another racist measure giving a kick in the teeth to the NHS's multinational workforce and many more:
    "The standard Immigration Health Surcharge (IHS) will today double from £200 to £400 a year, a sum the Home Office says will bring much-needed funds to the National Health Service. But those who have to pay it - even if they are already working and paying taxes - say the doubled charge will be crippling for people including NHS workers, families with children, and people who have been in the UK since childhood."

  • Revealed: The number of operations cancelled every day at Leicester's hospitals Leicester Mercury report notes a 6 percent increase in a county where there are still plans to axe acute beds.

  • New regime revealed for trusts with biggest financial holes A new jargon buzz phrase revealed by the HSJ: “accelerated turnaround process.”
    Apparently NHS Improvement will deploy this new scheme to deal with the 30 trusts which combined account for the net total of the trust provider deficit of £1.2bn.

  • Public health functions could return to NHS under long-term plan Local Government Chronicle report on the likely proposal for NHS England to fund at least part of the public health services currently funded by local authorities, which have been cut year by year since 2015. It flags up one result: "Funding for health visitors was only moved to local government in 2015. The health visitor workforce peaked that year following a national workforce target but it has since shrunk by approximately 19 per cent."

  • BMA calls for ten year NHS plan to deliver beyond grand ambition and address realities BMA's Chand Nagpaul calls for some more realism to balance up the fantasy in the Long term Plan, and notes "“Ultimately, there is a need for honesty about how far the £20.5 billion over five years will stretch. This is well below the 4% uplift that independent experts have calculated is required, and below historic spending levels since inception of the NHS. World class care requires world class funding and the investment in the long-term plan will still leave the UK falling behind comparative nations like France and Germany."

  • NHS staffing crisis could harm plan to save half a million lives Guardian version of the hyped-up advanced PR spin claiming that NHS Long Term Plan could save 500,000 lives over 10 years. In fact this figure does not appear in the Plan.

  • May gives no guarantee on NHS waiting times despite extra £20bn Guardian flags up Theresa May's refusal to guarantee that the NHS will get back to delivering A&E care, cancer treatment or planned operations within key waiting times despite its £20bn a year funding rise.

  • New reductions to the public health grant will heap more pressure on local authorities Health Foundation report tots up a £900m real terms reduction in public health funding between 2014/15 and 2019/20. "The core public health grant has fallen by a quarter (25%) per person since 2014/15." To put right the cuts would cost £3.2bn.

  • The health care workforce in England: make or break? Nuffield Trust, Health Foundation & King's Fund team up on this report, and set five tests for NHS England's new Long Term Plan: the score when it appeared? 0/5.

  • England’s poor have worse access to GP services than the rich FT publicises important Nuffield Trust research on access to primary care

  • May's long-awaited 'plan' won't heal an NHS cut to ribbons by Tory policies While we wait for the repeatedly delayed NHS "long term plan" HCT editor John Lister takes a critical look at what has come out of the much vaunted 5-Year Forward View adopted in 2014 - almost 5 years ago.

  • Row breaks out as Virgin Care wins Cheshire West sexual health contract Labour council privatises one bit of public health that has not yet been cut -- criticised by Labour MPs. Yet another tale of council irresponsibility on health issues.

  • Annual Report of the Chief Medical Officer, 2018 Chief Medical Officer Report Chp 6 p8 "The UK has fallen down the rankings significantly ... for life expectancy at birth. In the most recent two years ONS has reported statistically significant increases in infant mortality across England for all infants"

  • Tories ‘sneak out’ £85million in public health cuts on day MPs leave for their Christmas break Welfare Weekly reports:
    "The UK Government has been accused of attempting to “sneak out” further cuts to public health spending as MPs leave Parliament to begin their winter break.
    "Analysis by the Labour Party, backed up by the House of Commons Library, reveal that public health budgets will fall by £85 million next year, equal to £2 less per head or a drop of 3.3%.
    "Labour say the “devastating cuts” will affect vital public heath services such as stop smoking services, sexual health advice services and drug & alcohol misuse services for children and young people.

  • GPs paid just £152 per patient as funding barely rose in 2017/18 Article from GPOnline reveals that "GP practices received £152.04 per patient in 2017/18, official data reveal - an increase of just 0.4% compared with the previous year". In total £9.1bn was paid out to 7,543 GP practices in the 2017/18 financial year, fractionally up from £8.9bn the year before.

  • Royal colleges call for suspension of NHS overseas visitor charges pending review Royal Colleges become unexpected but welcome allies in the fight to scrap the vicious and reactionary imposition of charges for treatment of overseas visitors by the NHS, spelling out the potential dangers as well as the issues of principle.

  • NHS will still be short of nurses in five years, Dalton warns On the brink of Brexit, with European recruitment collapsed, a Brexodus of EU-trained staff made to feel unwelcome and insecure here, and after the disastrous axing of bursaries, (£) HSJ reports NHS Improvement CEO Ian Dalton's warning that it will be more than five years before the number of nurses the NHS needs are available to it.

  • For both health care and health care journalism, there’s something missing in the middle More thoughts on health reporting from the US with important lessons for British health journalists.
    "We see a lot of really low-quality journalism–hastily written, blatantly promotional, and often molded into clickbait. Too much money is apparently being spent on daily not-ready-for-prime-time health care news – money that dresses up unimportant health care news with attention-grabbing wrapping paper that isn’t warranted. Why are people even being paid to do churnalism, churning out junk news every day to meet some quota? And why are some being paid to put their name on what is really just a regurgitated news release?"
    Gary Schwitzer adds “Not every story needs to be either clickbait or worthy of a Pulitzer. The middle ground–complete yet efficient reporting–is what both readers want and need to read. Adopting our 10 criteria can be a good starting point for this kind of journalism”

  • 42 percent of new (US) cancer patients lose their life savings Headline says it all: the lunacy of the US health care system that takes the heaviest toll from the sick and the poor, but also penalises the middle classes, and anyone who is not wealthy and healthy.

  • Financial regime has cost us £19m, says struggling trust (£) HSJ article highlights the genius idea of a national finance regime on the NHS that levies hefty fines on trusts already broke and in special measures for failing to meet performance targets --deepening the crisis (this example is University Hospitals North Midlands).

  • 6 reasons journalists should just say no to Mayo Clinic’s latest journalism ‘residency’ program A valuable lesson in avoiding conflicts of interest from the priceless healthnewsreview.org in the US.

  • NHS to offer mature students £5k to become mental health nurses Guardian report that government is trying to redress some of the damage to recruitment done by their decision to axe bursaries -- by offering a "bonus" instead, for "mature students, likely to be those aged over 25 [who] agree to specialise in mental health or learning disability. This is after:
    "Applications for undergraduate degree courses in nursing have plummeted by 32% since bursaries for student nurses were scrapped in England in 2016, despite warnings that the move would backfire. Applications from mature students to study mental health and disability nursing fell even more sharply – by 40% – between 2016 and this year."

  • Six months on: NHS England needs to focus on dissemination, implementation and audit of its low-priority initiative (£) Study in Journal of Royal Society of Medicine notes that:
    "in most cases NHS England advising doctors to stop prescribing a drug, in a report and in a consultation, is not sufficient to cause a noticeable change in clinical practice at a national level."

  • One in 10 NHS commissioning groups 'failing or at risk' five years after Lansley reforms, NAO finds Independent report notes the level of failure of the CCGs established as commissioners by the 2012 Health & Social Care Act.
    "While a number of CCGs have since merged to offset performance or budget issues, the NAO warns this undermines their ability to respond to local issues which was a primary driver of their inception.
    "The NAO found that 42 per cent are rated as “require improvement” or “inadequate” – while 10 per cent are deemed “outstanding” – and more than a third (75) of CCGs overspent against their budget in 2017/18.
    "This is an increase on 57 CCGs in the year before and the total overspend last year stood at £213m with their budgets facing a further 20 per cent in cuts by 2021.
    "However the NAO also warned that NHS England has yet to conduct a review of whether CCGs are working as intended, and say there will be significant changes in future that they must adapt to."

    Despite ministers pledging no more top-down reorganisations of the NHS, the health service has been introducing Sustainability and Transformation Partnerships over the past three years.

  • This Health Startup Won Big Government Deals—But Inside, Doctors Flagged Problems Fascinating article on Babylon in Forbes magazine pointing out the concerns of doctors working on the AI project:
    "They found that around 10% to 15% of the chatbot’s 100 most frequently suggested outcomes, such as a chest infection, either missed warning signs of a more serious condition like cancer or sepsis or were just flat-out wrong, according to one insider. […] Interviews with current and former Babylon staff and outside doctors reveal broad concerns that the company has rushed to deploy software that has not been carefully vetted, then exaggerated its effectiveness."

  • Why You Should Be Concerned About Plans to Reconfigure Leicester’s Acute Hospital Services Save Our NHS Leicestershire warns:
    "UHL’s new plans do not include an increase in the number of beds, despite ongoing issues with capacity in local hospitals. In response to a question from a member of the public at a BCT engagement event, the UHL spokesman confirmed the reconfigured hospital facilities will have 2,048 beds. In May 2018, UHL had 2,045 beds. Even though current bed numbers are closer to 2,000, this represents no real increase to address (a) the current capacity constraints and (b) future capacity needs arising from an ageing population, a growing population and rising need."

  • Royal Surrey County Hospital board papers for December Thanks to HSJ's Alison Moore for her tweet drawing attention to the Chair's report in these otherwise unremarkable Board papers, which includes important throwaway lines from a recent meeting of NHS Providers Chairs and CEOs, which heard from Ian Dalton, CEO of NHS Improvement:
    "Total emergency admissions have increased year on year but the step up is greater this year than previously, and NHS Providers cannot see anything that will change that dynamic. It will be a tough winter, and Boards need to understand this. there is real nervousness about lack of capacity in the system."
    However these fears have not led to any reluctance by NHS Improvement to drive through more downgrading and closure of hospitals, or them dropping the failed and impractical STPs. In fact there are still plans to halve the number of acute hospitals:
    "NHS providers expects some consolidation of STPs and believe that Ian Dalton thinks there should be 50 to 100 providers rather than 211. "
    However NHS providers seem more concerned with who is in charge rather than whether this is the right policy:
    "NHS Providers is nervous that ID thinks it’s NHS I’s role to determine who should merge with whom."

  • Reflections on a 45-year career and 13 years leading HealthNewsReview.org Veteran US health reporter Gary Schwitzer best known to may for his long crusade to raise standards of health reporting, takes an overview now the valuable www.healthnewsreview.org has lost its funding and has ceased its fierce and principled scrutiny of US and UK health reporting.

  • Trust seeks £14m capital for fire safety works (£) HSJ story on East Sussex Healthcare Trust seeking £13.86m to address fire risks “noted” by the fire service at Eastbourne DGH, but which has been treated wityh little urgency up to now.

  • NHS denies sick patients in North Yorkshire face 'Spanish Inquisition' This Northern Echo story follows a local councillor complaining that seriously ill people who had been unjustly refused transport under the new regime had faced a “Spanish Inquisition-style” interrogation as they attempted to get transport to a hospital clinic. Most important is that this is a CCG facing sharp questions -- from a council scrutiny committee trying to do what many other councils should be doing: holding NHS managers to account for their decisions and for gaps and failings in local services. More of this needed!

  • Quarter of UK student nurses drop out before graduation, study finds So applications for nursing courses are down by 23%, but the people who have been most deterred have been mature students with some experience in health care. of the younger cohorts still applying, a quarter of those who start courses drop out. So we are training only 25% of the numbers trusts need to recruit. This plus Brexodus is a formula for long term failure.

  • Analysis: Health systems should be publicly funded and publicly provided (£) Important BMJ analysis from three academics, Neena Modi, Jonathan Clarke, and Martin McKee, making the case that a market in healthcare increases the likelihood of inequity and exploitation, with suboptimal care for both rich and poor.

  • ‘Catastrophic’ funding gap could pause district nurse supply for a year (£) HSJ report warning that "The supply of district nurses coming into the NHS could drop to zero in 2021 unless the government provides additional funding".
    "According to figures published by NHS Digital, there has been a 40 per cent drop in the number of district nurses working in the NHS since 2010."

  • REVEALED: Ten hour ambulance waits and year-long mental health delays in north Norfolk Eastern Daily Press report of a survey in North Norfolk, showing two people waited 10 hours for ambulances and three others waited a year for mental health support.
    "Three survey respondents had waited a year to be seen by the Wellbeing Service after being referred by their GP for issues including anxiety and depression. And 34 respondents had waited longer than a month to be seen."
    "Almost 30pc of respondents who asked for a GP appointment in the last three months waited longer than a fortnight, and the same percentage said they were unsatisfied with their GP surgery.
    "And almost 50pc of respondents said they weren’t confident in the local NHS to help treat their health or mental health issues."

  • Locking wards has no place in psychiatric rehabilitation, says royal college (£) BMJ report on Royal College of Psychiatrists statement that it is increasingly concerned about the use of locked rehabilitation wards for people with serious mental health problems. 1025 patients are funded by CCGs in private sector, mostly on 'locked' wards, and at double the cost of NHS psychiatric beds, with admissions averaging almost twice as long as NHS. Private sector has no incentive to discharge early.

  • Hundreds of patients in Dorset ‘at risk of dying under NHS cuts’ Read more at: https://inews.co.uk/news/health/dorset-nhs-poole-hospital-cuts-review/ Prominent coverage by the i newspaper of excellent research by Dorset campaigners to indicate the dangers of the proposed "centralisation" of maternity, A&E and children's services in Bournemouth, at the expense of massive downgrade of services in Poole.

  • The private A&E will see you right now This (reported in the (£) Times) of course is not a proper A+E but an urgent care centre for the worried wealthy. Anyone with real emergency needs would be mad to go here rather than a proper hospital with the full back up of a multidisciplinary workforce. Private sector could kill off some rich idiots.
    They have described their service as "like flying first class compared to the economy NHS": but first class generally gives you MORE comprehensive service rather than simply fancier placemats and higher prices.
    This "A+E" is only able to offer a fraction of what you get -- and serious cases need -- from the NHS. For the worried, deluded, not very ill wealthy.

  • Ambulance staff in Essex told 'not to take food breaks' in 'confusing' message as demand soars Essex Live report on a confused message from ambulance control, later rephrased, which told staff that because of high numbers of calls they were not allowed to stop to collect food for their breaks. But even after this was corrected it is clear that frontline ambulance crews face working 11 and a half hours or more in a shift, but only get 30 minutes uninterrupted break - without the option of 'service breaks' to collect food or for comfort breaks. Hard to see how this high-stress working regime is safe for ambulance crews or for patients.

  • Opening the door to change. NHS safety culture and the need for transformation New CQC report warns that with both money and staff in short supply, safety is increasingly at risk:
    "Staff are struggling to cope with large volumes of safety guidance, they have little time and space to implement guidance effectively, and the systems and processes around them are not always supportive."

  • Plan to end Huddersfield A&E gets green light – campaigners see red KONP update on the latest developments in the long-running battle to save Huddersfield Royal Infirmary, and challenge spurious -- and potentially dangerously misleading -- plans which claim to be retaining an A&E but in reality leave only an urgent care centre.

  • Capita failure over cervical screening letters more extensive than thought Guardian reports on the latest updated numbers of women affected by the most recent high profile fiasco by contractors Capita in their 7-year contract for support services to primary care: the company argues that not many of the test results were abnormal so relatively few suffered harm. Lucky, but not convincing.

  • Hospitals 'in red zone' with record numbers of A&E patients Guardian report on latest NHS figures which show:
    "• 87.6% of patients arriving at A&E were treated within four hours, far off the 95% target and the lowest proportion ever for November.
    • 94.2% of hospital beds were full last week, well above the 85% figure that evidence shows is the safe limit for bed occupancy.
    • A&E units had to divert patients to another hospital 25 times last week, of which 11 occurred at the troubled Worcestershire acute hospitals trust.
    • 10,675 patients had to spend at least 30 minutes with ambulance crews before being handed over to A&E staff, in breach of NHS rules which say that should never happen."

  • Pensioner poverty rises as benefits freeze bites More indications that the continued austerity regime is not only making many people's lives miserable but undermining their health and shortening lives.

  • Life expectancy drops for Britain's poor for first time since Second World War Mirror report underlining widespread concerns at a reversal of the previous long term trend towards longer life expectancy.

  • NHS waiting lists for lung and bowel treatments double since Conservative-led government came to power, analysis shows Independent report on new figures clearly lays blame on austerity policies imposed since 2010.

  • Hammond's Budget birthday present is more austerity Tony O'Sullivan analysis the current financial squeeze on the NHS in Public sector Focus

  • 'Patients will be put at risk...' - Anger as 288 hospital jobs will remain UNFILLED to save £10.9m-a-year Stoke Sentinel reports that "Hundreds of vacant positions are no longer being filled at Staffordshire's two biggest hospitals - to save a whopping £10.9 million-a-year.
    "The 'vacancy pause' will affect 288 jobs at the Royal Stoke University Hospital and Stafford's County Hospital.
    "It is the latest money-saving plan by the University Hospitals of North Midlands (UHNM) NHS Trust which remains in financial special measures." Campaigners are unconvinced by claims that the job losses will not affect patient care.

  • Interserve: Major government contractor 'seeks second rescue deal' Yet another weak and wobbly major contractor that is struggling to float on a sea of almost £500m borrowing. How long can they last? will minister bail them out?

  • Hospitals in race to combat ‘toughest ever’ winter crisis for NHS too little, too late? Some remarkably small-scale steps being taken by trusts around the country to fend off the widely-expected deeper winter crisis.

  • Combining Transitional Care and Long-term Self-management Support Interesting study publish by the Journal of the American Medical Association (JAMA) confirming the unsurprising point that lending additional support to patients over and above "usual care" improved results – resulting in fewer COPD-related hospitalizations and emergency department visits. So all we need is more resources to improve outcomes!

  • Patients at risk with doctors at ‘breaking point’ and looking to quit in unprecedented numbers, GMC warns Independent report warns that:
    "Patient safety is being put at risk by doctors on the 'brink of breaking point' thanks to out of control NHS pressures, the UK’s medical regulator has warned.
    "Ministers are running out of time to act as patient numbers continue to rise and staff are forced to make 'risky compromises' to training and care, the General Medical Council (GMC) said.
    "With doctors at the limit of what can be done safely, the GMC warns doctors are looking to quit the health service in 'unprecedented numbers'."

  • Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study The University of Southampton research paper showing the important role of registered nurses in maintaining the safety of patients.

  • Policymakers warned as nursing associates poised to enter NHS (£) HSJ article notes that as the first cohort of nursing associates are due to qualify and join the English NHS next month, "NHS Improvement has developed safe guidance about it and warned that nurses should not be substituted with associate staff."
    It highlights new research that confirms that "a lower level of registered nurse staffing and a higher use of nursing assistants was associated with a higher death rate."
    The new associates need to be used to complement, not replace, the numbers of registered nurses.

  • Pensioners left in pain amid NHS cuts to hip and knee operations Daily Telegraph article highlighting Royal College of Surgeons figures that show a reduction of 7,000 operations to replace hip and knee joints in the last year, as arbitrary rationing and exclusions restrict surgery in some areas to those in the greatest pain (and drive those who can afford to pay to consider going private to escape the pain that is not deemed severe enough).

  • Mental health - The NHS patients who are 'abused and ignored' Useful BBC backgrounder on the latest proposals for reform of the Mental Health Act.

  • Help needed from the North East Thoughtful (£) HSJ article discusses the gathering crisis of mental health services in Lancashire, where there are increasing delays admitting patients in serious need of treatment, and where "A few weeks ago, chief constable Andy Rhodes took the unusual step of publicly criticising the county’s mental health provision, saying his officers are having to pick up the pieces of a system in crisis."

  • Internal incident amid 'unprecedented' demand at top hospital (£) HSJ Short article on the desperate bed shortage at the Royal Free Hospital, before the winter pressures gather force. The HSJ points out that the Free "has missed the national target for processing 95 per cent of emergency attendances in less than four hours for the past two years."

  • 'Gross insult' NHS fee rise for overseas nurses gets go-ahead Free access article from Nursing Times on the latest shot fired by ministers into their own feet, with the tightening of the "hostile environment" for nurse recruitment and training. Parliament has just agreed to double the annual fee overseas nurses must pay to use the NHS from £200 to £400, despite strong opposition.
    The "immigration health surcharge" has to be paid by temporary migrants from outside the European Economic Area (EEA) .
    The policy has raised more than £600m "for the NHS", and the rise is expected to bring in an additional £220m a year -- but as yet there is no estimate of the numbers of nurses who might have been deterred from applying as they get the message from a hostile government that they are not welcome.

  • GP seven-day access programme did not reduce A&E attendance, study finds A further Pulse article following up on previous critical reports highlighting the waste of time energy and staff resources delivering "7-day" GP appointments that almost nobody with health needs really wanted.

  • Council quits leading ICS due to 'lack of democratic oversight' (£) HSJ report on decision of Nottingham City Council to pull out of so-called "Integrated Care System" -- an important if belated step that points the way for other councils that don't want to get dragged into rubber stamping cuts, closures and potential privatisation.

  • Health visitors warn of 'child tragedy' fears as caseloads rise Alarming article in Children and Young People Now warns that:
    "More than four in every 10 health visitors in England feel so stretched they "fear a tragedy" at some point, research has found.
    "Nearly half (44 per cent) of health visitors said they are now working with caseloads of more than 400 children.
    "A survey of more than 1,200 health visitors found that 43 per cent believed they may not recognise a child in need until it's too late as a result of rising demands in recent years."

  • ‘The biggest disgrace at mental health trust is that people were warned, and failed to act’ Local mental health campaigner Emma Corlett writes in the Eastern Daily Press on the chronic crisis if the Norfolk & Suffolk NHS Foundation Trust which is supposed to deliver mental health services. Instead the picture is:
    "A perfect storm of cuts, incompetence and stigma has seen services unravel, with people struggling to access services, being discharged too soon, and staff under intolerable pressure with unmanageable caseloads.
    "Following a savage real-terms budget cut, the number of doctors has been reduced by 51 (around 25pc) and the number of nurses by 163 (1 in 8) compared to when the trust was formed in 2012, while referrals have rocketed.
    "The number of patients referred but still awaiting their first contact is 2,732 (as of October 12).
    "That’s a lot of people in distress, without support."

  • One in three GPs likely to quit within five years, warns RCGP GP Online reports a ‘gravely concerning’ RCGP survey of over 1,000 GPs.
    It "found that nearly a third (31%) of respondents said they were likely to leave the general practice workforce within the next five years - citing stress and retirement as the main reasons.
    "Nearly one in four (37%) GPs responding to the survey said there were GP vacancies in the practice where they work, while 5% said their practice will probably close in the next year."

  • Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs New consultation document, published in late November, outlining further restrictions and exclusions from NHS services, with consultation running into 2019.

  • Why general practice is bracing itself for a fresh winter crisis Pulse analysis of the likely impact of the winter crisis on primary care services

  • MP welcomes local trust being put into special measures There was discussion in parliament of the decision to halt the planned closure of A&E services at Telford Hospital as a result of the recruitment of locum medical staff at premium rates.
    Responding to the earlier news of the Shrewsbury & Telford Hospitals Trust being put into special measures, local Ludlow MP Philip Dunn said:
    "It should be regarded as support for the trust and the staff who are working tirelessly to provide the best care for all the people of Shropshire.
    "People need to see what is happening here, rather than just believe everything that is being said by campaigners who might have an agenda."
    Mr Dunne's agenda has not been made clear: however from his recent statements and silences we can assume it does not include consistent defence of local health services in his constituency.

  • Changing the face of Health Services in Oxfordshire – what is going on? Oxfordshire KONP newsletter notes and analyses the latest changes, notably:

    "An even more significant and worrying development is the creation of a new body, the Integrated System Delivery Board (ISDB). The terms of reference of the ISDB were presented and approved at the November 2018 meeting of the Health & Wellbeing Board without even a murmur of dissent. Briefly, this board is made up entirely of executive officers (CEOs). It meets in secret every month and its minutes or documents are not published. The public is excluded from meetings. Not a single elected official sits on this board."
    This is the body drawing up plans for an "Integrated Care System" in Oxfordshire by the spring of 2019.

  • Former NHS England and hospital boss to lead integration firm (£) HSJ reports that Samantha Jones, a former hospital boss and NHS England director has been appointed the chief executive of the UK arm of American insurance firm Centene.
    Centene, which owns half of the Ribera Salud company embroiled in the Alzira style hospitals in Valencia, Spain, has been advising "integrated care" vanguard projects in Nottinghamshire. It is also one of 78 companies and consultancies on a government-approved list to contract for a role £300m of new NHS spending on digital technology.

  • Revealed: STP leader’s damning assessment of local commissioners Evidence of the ineffectiveness of STPs is widely available, but in this case the criticism comes from a man heading all of the CCGs in the patch.
    (£) HSJ reports on "A candid assessment of the health system across Kent and Medway," which "has concluded the sustainability and transformation programme has not unified the system, is dominated by providers and little significant action has been taken on improving commissioning.
    "The comments were made in Glenn Douglas’ report to a clinical commissioning group governing body meeting this month, despite himself being the accountable officer of all eight CCGs in the Kent and Medway STP.
    "He has since distanced himself from the remarks, saying they reflected a “moment in time” and the system had moved on."

  • Fresh batch of CCG mergers approved (£) HSJ reports that more cash-strapped CCGs, in Devon and in Derbyshire are to merge.
    This will result in even more remote and less accountable bodies that find it easier to close ears and eyes to the views and needs any local communities.

  • Health Secretary Matt Hancock accused of breaking ethics rules Excellent challenge to Matt Hancock's bizarre advertorial in the Evening Standard [see previous Infolink entries].

  • "Annoyed is an understatement," says Redditch MP Rachel Maclean on link bridge delays at Worcestershire Royal Hospital The nightmare continues at Worcestershire's under-bedded, under-funded hospital which has been further burdened by unrealistic CCG and STP plans to "centralise" acute services in one of the most scattered populations in England.

  • Detecting BS in Health Care American study that could be usefully re-run in England, and begins with an assumption that works very well here:
    "In the past several months, we have observed several notable signs of deceptive, misleading, unsubstantiated, and foolish statements — what we will call “BS” — in the health care industry. "

  • Council worker's dummy run from Southend to Basildon Hospital entailed a four-hour round-trip on public transport Basildon Echo reports on exercise that reinforced Southend council's decision to refer stroke centralisation plan to Secretary of State:
    "A proposed “treat and transfer” scheme could see stroke patients and other casualties assessed locally before being taken to Basildon for specialist stroke or other emergency care, if it was required.
    "It would mean relatives, many elderly, travelling miles to visit in-patients and for those without cars it would be especially arduous. Faced with a lack of detail on the scheme, a council employee was asked to undertake the journey to gauge how long it could take.
    "Councillors discovered the return journey by public transport would take more than four hours during off-peak times."

  • Q2 figures show trusts are responding to growing pressures, but can not keep up NHS Providers response to the latest statistics from NHS Improvement

  • NHS managers will be trained by the army in bid to boost leadership skills Matt Hancock with yet another wildly inappropriate idea: he is churning them out at a rate of knots.

  • New chief executive for Great Ormond Street (£)HSJ reports that it is Dr Shaw, a spinal surgeon, who "has worked as medical director for BUPA, and as deputy chief executive and medical director at the Royal National Orthopaedic Hospital."
    Let's hope it's his NHS hat he chooses to wear for his new job.

  • Why the World Bank’s optimism about global poverty misses the point Useful article from The Conversation which notes that:
    "If we are to have a serious debate about world poverty on End Poverty Day, we have to start by acknowledging that the global problem of poverty is far more extensive than World Bank rhetoric would have us believe. Two big factors need to be confronted. The first is that the majority of the world’s poor live in countries that have experienced strong economic growth. The second is that the growth strategies these countries have practised create and reproduce poverty."
    "Whether we use monetary estimates – Sumner uses a poverty line of $2.50 a day – or estimates of multidimensional poverty; that is, poverty measured according to health indicators, education levels, and economic standards of living – as many as 70% of the world’s poor currently live in what the World Bank refers to as middle-income countries."

  • Global health disruptors: 2008 financial crisis. We don’t have the money to deliver the sustainable development goals, says Ronald Labonté Canadian academic and international campaigner Ronald Labonté notes the enduring impact of the 2007-8 banking crash on plans to improve health care for the poorest countries, and points to where all the promised money has gone:
    "Indebted governments, which had been reluctant to invest more heavily in global health development assistance, pumped $11tn (£8.6tn; €9.6tn) into failing banks, some as direct subsidies and the rest by creating new money (quantitative easing) and keeping interest rates at historically low levels. "

  • NHS providers to start next year underwater financially, despite new money Nuffield Trust's Sally Gainsbury estimates NHS deficits will exceed NHS providers' own forecasts of £558m, and hit £900m by the end of 2018-19.
    That £900m would be even AFTER "£2.45bn of emergency Provider Sustainability Fund funding plus around £850m of one off savings, indicating an underlying gap between NHS trust reliable, recurrent income and day to day costs of £4.2bn a year."

  • Understanding the health care needs of people with multiple health conditions Health Foundation report finds, based on analysis of data from 2014 to 2016 for 300,000 people in England, that one in four adults had 2+ health conditions, equating to approximately 14.2 million people in England.
    "Over half (55%) of hospital admissions and outpatient visits and three-quarters (75%) of primary care prescriptions are for people living with 2+conditions.
    "In the least-deprived fifth of areas, people can expect to have 2+ conditions by the time they are 71 years old, but in the most-deprived fifth, people reach the same level of illness a decade earlier, at 61 years of age."

  • Asylum seekers 'too afraid' to seek NHS care, report says Theresa May's "hostile environment" is putting the health of asylum seekers -- and the rest of us -- at risk by deterring people from accessing treatment.

  • Threat to future of mental health 'places of safety' to keep people out of police cells, North Yorkshire police tsar warns Yorkshire post reports North Yorkshire's Police, Fire and Crime Commissioner Julia Mulligan "spoke out after the police inspectorate yesterday warned that forces were being left to pick up the pieces of a “broken” mental health system.
    "The NHS-funded facilities, called Section 136 suites, are used to house people detained by the police under the Mental Health Act to prevent them having to go into cells.
    "But of four centres opened across North Yorkshire since 2012, one is closing, another has halved its capacity and a third is under threat of closure, Mrs Mulligan warned."

  • Hancock wants ‘mid career business leaders’ to turn 'NHS trailblazers' (£) HSJ reports that, learning nothing and forgetting nothing from decades of similar failed initiatives, Matt Hancock is again setting off merrily down a familiar blind alley of bringing private sector managers in – to be bamboozled and demoralised by the complexity of the NHS.

  • NHS regulator raises bar on creation of wholly owned subsidiaries NHS Trusts that were attempting to establish "wholly owned subsidiaries" now face new hurdles to surmount, according to Public Finance magazine. After a series of strikes and disputes with unions, NHS Improvement stepped in and published an addendum on subsidiaries on 23 November following a consultation.
    It requires trusts to submit business cases to an NHS Improvement review panel to receive a ‘traffic light’ rating. Business cases with high financial risk will be rated ‘red’, while low-risk proposals will receive a ‘green’ rating.
    "Where a trust attempts to set up a subsidiary in the face of a poor risk rating, the regulator would “use its regulatory powers and step in,” an NHS Improvement spokesperson told PF.
    For some reason this annoys NHS Trusts which wanted the go-ahead for this new form of privatisation, and believe they should be allowed to act like commercial bodies, at least according to NHS providers Deputy chief executive Saffron Cordery, who told Public Finance:
    “We are concerned that the level of detail and the steps outlined in the new review process go a long way beyond what is normally expected of trusts and what is required for other transactions and commercial activities.”
    The question for unions is whether the new restrictions are strong enough to halt further moves to hive off staff.

  • Health secretary Matt Hancock: 'AI can augment the human factor' of medicine The advertorial for private GP at Hand app company Babylon featuring the endorsement by Health Secretary Matt Hancock: now Babylon logos have been removed and both Hancock and the Evening Standard deny it I an advertorial -- see if you can spot any critical editorial approach.

  • Spending cuts breach UK's human rights obligations, says report The Equality and Human Rights Commission has found that the poorest 20% of people in England lost an average of 11% of their incomes as a result of austerity, compared with zero losses for the top fifth of households.
    And, as the Guardian reports, the EHRC concludes that "Cuts to public services and benefits that disproportionately affect the least well-off, single parents and disabled people put the government in breach of its human rights obligations"

  • Urgent care company collapse leaves GPs just 10 days to find out-of-hours cover Pulse magazine reports that Primecare, which forms part of the financially struggling Allied Healthcare group, had written to over 20 Birmingham GP practices for which it directly provides out-of-hours cover, informing them they would stop services by the end of November.
    "The decision also affects a number of CCGs, which have been told the services they contract from Primecare will cease by mid-December."

  • Top physician flags concerns over race to cut length of stay Another (£) HSJ article, identifying another misguided obsession of "efficiency" plans as a potential threat to safety of patient care.
    "The British Geriatrics Society’s new president Tahir Masud, who began a two year term this month, told HSJ he supported the principle of NHS England’s drive to cut length of stay, but warned the system could be near to a “nadir”.
    "The warning comes after a Healthwatch England study this month found the number of patients readmitted to hospital within 30 days of discharge was growing “faster than before”, with a nine per cent increase over the last 12 months alone across the 70 trusts it obtained data for."

  • Early cancer diagnosis rates drop in several areas (£) HSJ report on statistics from Public Health England showing that in 16 CCGs the proportion of cancers being diagnosed at an early stage has dropped. The figures span from late 2011 to the first half of 2017.

  • King's Fund report on Population Health Improvements in life expectancy grinding to a halt. Inequalities widening. A gloomy picture of life shortened by austerity.

  • Interesting comments from Roy Lilley on private contractors and NHS "Despite a life-time in business and a belief in the private sector for its ability to adapt, adopt, be nimble and all the things a bureaucratic lump like the NHS can never be, I have to say the NHS is no place for private companies.
    "Looking back, I can't think of one that has come into the NHS and made a decent fist of it."

  • The nation's health as an asset Important Health Foundation report highlighting the evidence on the social and economic value of health.

  • Figures show rise in EU nationals exiting public sector after Brexit vote Alarming Guardian report points out that 12.5% of NHS staff are not British, with 5.6% up to now coming from Europe, including 7% of nurses and 10% of doctors.

  • Moving cancer operations from King’s Lynn to Norwich would create “serious risks”, say doctors Unusual and welcome resistance from senior doctors to desperate plans to relocate cancer surgery from Kings Lynn to Norwich, 45 miles away.
    The Eastern Daily Press reports that
    Staff committee chair, consultant surgeon Harald Geogloman:
    “When discussing the most recent proposal for cancer patients to have their surgery at the NNUH in case beds become short at the QEH, it became clear that our local CCG was not informed of any such proposal and none of its details.
    “They were understandably unable to comment on the details of the proposal, but shared our concerns regarding safety for patients and QEH staff, as the idea seems to be QEH staff travelling as well and performing the operations in Norwich.
    “The HMSC [staff medical committee] is against the proposal as it creates many serious risks for staff and patients, for very little gain.”

  • Babylon, A Private Health Care Company, Sponsored A Newspaper Series That Included An Interview With The Health Secretary Buzzfeed story contains a screenshot of the original Evening Standard story, complete with Babylon logo.

  • Quarterly performance of the NHS provider sector: quarter 2 2018/19 Official figures confirm yet again that despite all the promises and plans in the last 25 years the numbers of emergency patients just keep going up, even across the summer months.
    "There were 940 more emergency admissions per day compared to the same quarter last year. A total of 6.18 million people visited A&E during the quarter — 252,360 (4.3%) more than the same period last year. NHS staff treated more emergency patients within the four-hour A&E standard — 5.52 million patients, compared with 5.34 million for the previous quarter. "
    As a result NHS Providers' boss Chris Hopson notes in a Tweet that:
    "Trusts are working absolutely flat out but failing to keep pace with unholy combination of rapidly rising demand, ongoing financial squeeze and workforce shortages."

  • Thirty-six trusts told to take 'firm action' on deficits (£) HSJ reports "NHS Improvement’s mid year performance report showed a combined deficit of £1.23bn for the first six months of the year. This was around £80m worse than for the same period in 2017-18, despite an increase in the “provider sustainability fund”.
    How they are supposed to eliminate these deficits is not explained.
    It's clear that many trusts have effectively given up on even trying to balance their books, safe in the knowledge that they can't all be replaced by management consultants.

  • Update: Most NHS email accounts restored after mass shutdown The NHS IT systems failure affecting 1.2 million email accounts that the mainstream media declined to cover seems to have been resolved fairly quickly, but should surely raise questions of back-up systems to ensure continuity of care and access to key information.

  • Most doctors fear hospitals won't cope this winter Guardian report based on Royal College of Physicians survey showing that:
    "Almost six in 10 doctors reported feeling “very worried” or “worried” about the ability of their hospital to deliver safe patient care over the winter period. The poll, conducted by the RCP, found that only 17% of respondents were “confident” or “ very confident” about preparations."

  • Figures show rise in EU nationals exiting public sector after Brexit vote Guardian report drawing on survey of NHS trusts in England finds that:
    "hospital trusts, all in England, who responded to the freedom of information requests recorded a 22% increase in the number of EU nationals leaving their jobs according to the figures supplied, a “damning indictment” of the Brexit result according to one leading doctor. Trusts particularly affected at the time include:
    "University Hospital Southampton NHS trust, which reported that the number of EU nationals leaving its books rose from 161 in 2016 to 226 in 2017, a increase of 40%. It currently employs 1,221 EU nationals.
    "Guy’s and St Thomas’s trust saw EU leavers rise from 325 to 424, an increase of 30%. It employs 1,999 EU nationals.
    "The Liverpool-based Walton Centre trust, which specialises in neurology and neurosurgery, reported that the number of EU employees leaving rose from 134 to 172, an increase of 28%."

  • Report exposes how PPPs across the world drain the public purse, and fail to deliver in the public interest Excellent and succinct Eurodad report gives an in-depth, evidence-based analysis of the impact of 10 PPP projects that have taken place across four continents, in both developed and developing countries.
    "These case studies build on research conducted by civil society experts in recent years and have been written by the people who often work with and around the communities affected by these projects.
    "The countries included are: Colombia, France, India, Indonesia, Lesotho, Liberia, Peru, Spain and Sweden. The sectors they cover are: education, energy, healthcare, transport, and water and sanitation.
    "Although we do not intend to generalise our conclusions in the vast and complex universe of PPPs, these 10 cases illustrate the most common problems encountered by PPPs. Therefore, they challenge the capacity of PPPs to deliver results in the public interest."

  • Conflict of interest: how corporations that profit from privatisation are helping write UN standards on PPPs Briefing by Public Services International to UNECE Working Party on PPPs, November, 2018. Just after British Chancellor Philip Hammond announced the government would sign no more PFI deals, the lobbying for more, similar PPP contracts to be signed internationally has been stepped up. This report begins:
    "Despite growing evidence of systemic problems with public-private partnerships (PPPs), the UN Economic Commission for Europe (UNECE) continues to try develop and promote global standards for private sector participation in public infrastructure and services. The UNECE’s PPP Roster of Experts and Business Advisory Board are largely comprised of individuals representing corporations which have profited heavily from PPPs, corporations that advise on tax avoidance, corporations convicted of corruption and bribery, consulting and law firms that benefit from privatisation transactions, and more."

  • Lobbyist Documents Reveal Health Care Industry Battle Plan Against “Medicare for All” Useful exploration of the underhand tactics being employed by those who benefit from the current disastrous and costly $3 trillion US health care system to prevent changes to establish universal access to health care.

  • Exclusive: Public want new NHS money to go on cancer and staff, not digital (£) HSJ publishes outcome of opinion poll that shows that contrary to the enthusiastic commitment of Health Secretary Matt Hancock, and most recent pronouncements from NHS England, the public put digital access to NHS services at 16th out of 16 potential priorities. Top is improved cancer care, followed by recruitment and training of staff and improved mental health.

  • Cancer screening overhaul announced by NHS in wake of Capita cervical smear blunder Independent reports: "The NHS has announced an overhaul of cancer screening in the wake of revelations that nearly 50,000 women missed cervical smear invitations or results because of failings with a privatised service.
    "Changes could see the NHS bring screening in-house and end the involvement of private firm Capita, which accepted responsibility for the cervical cancer “system error” and is three years in to its seven-year contract."

  • When Hospitals Merge to Save Money, Patients Often Pay More New York Times article on the perverse impact of merging hospitals in the private sector-led US health care scenario. It warns
    "The hospitals have argued that consolidation benefits consumers with cheaper prices from coordinated services and other savings.
    "But an analysis conducted for The New York Times shows the opposite to be true in many cases. The mergers have essentially banished competition and raised prices for hospital admissions in most cases, according to an examination of 25 metropolitan areas with the highest rate of consolidation from 2010 through 2013, a peak period for mergers.
    "The analysis showed that the price of an average hospital stay soared, with prices in most areas going up between 11 percent and 54 percent in the years afterward, according to researchers."

  • UK cancer and children’s wards being hit by closures Guardian report pulls together various examples of cutbacks in cancer care and children's services, including Queen Elizabeth Hospital Kings Lynn, where patients face an 80-mile round trip trek to Norwich if cancer services close.

  • Matchborough mum gives birth on the M5 after failing to get to hospital Redditch Standard reports that Anne-Marie Williams, who lives just 5 minutes from the Alexandra Hospital, wound up giving birth in the back of an ambulance on the M5, headed for the crisis-ridden Worcestershire Royal hospital.
    "while thankful for her healthy new-born baby, [she] is furious with the lack of maternity services near Redditch."
    She said: “The Alexandra Hospital doesn’t allow women to give birth there anymore.
    Despite the efforts of campaigners, Worcester's perpetually crowded hospital, with an almost constant queue of ambulances outside waiting to hand over patients, was chosen as the base for "centralised" maternity care in the sparsely populated county.

  • UK austerity has inflicted 'great misery' on citizens, UN says Guardian front page coverage of the UN report highlighting poverty in Britain

  • Statement on Visit to the United Kingdom, by Professor Philip Alston, United Nations Special Rapporteur on extreme poverty and human rights The 24-page report of the UN investigator who has just exposed the scale of poverty unleashed by 8 years of government-imposed austerity since 2010.

  • U.S. Has Spent Six Trillion Dollars on Wars That Killed Half a Million People Since 9/11, Report Says Hard hitting report in the unlikely setting of US magazine Newsweek, underlining huge spending and loss of life as a result of continuing US "war on terror" since 2001 now involving intervention in almost 2/5 of countries of world. For a fraction of this sum the USA and many of the countries lacking universal health care could have been provided with health services -- perhaps creating new friends and allies for the US rather than lengthening the list of enemies.

  • Poverty causing 'misery' in UK, and ministers are in denial, says UN official Even the BBC here obliged to carry a bland summary of a hard-hitting UN report on the state of play in Britain after 8 brutal years of austerity, forcing up levels of poverty -- and undermining public health.

  • Two-thirds of land proceeds go into revenue, despite reinvestment pledge (£) HSJ report reveals the extent to which, (as campaigners have warned) forced sales of NHS land assets are effectively being used to prop up flagging revenue budgets:
    "NHS provider accounts show that £206m (63 per cent) of the £327m raised from land sales in 2017-18 helped prop up the Department of Health and Social Care’s revenue budget, rather than topping up its capital account.
    "It comes after a period in which capital budgets have been repeatedly cut and raided, which has resulted in a spiralling backlog of overdue maintenance work. Local health leaders have also been frustrated by the delays they have faced in getting new infrastructure projects signed off."

  • Ex-Capita boss set to lead CCG as council link dropped (£) HSJ reveals a series of ructions in Trafford as the flimsy facade of "integration" of primary care services and NHS with local government is ripped to shreds. The more they talk about it, it seems, the less it happens. Whether a former Capita boss can improve matters for the CCG remains to be seen: many will have their doubts.

  • Council scrutiny blocks "ill-conceived" plan to axe 24-bed ward Members of a Durham County Council scrutiny committee have intervened to halt County Durham and Darlington NHS Trust's proposals to close ward six at Bishop Auckland Hospital.
    Bishop Auckland councillor Joy Allen, a member of the authority's cabinet, told the Northern Echo: “It’s an ill conceived plan, poorly implemented and operationally flawed.
    “Scrutiny has paused the process and we hope we can get it stopped and keep the staff and keep the resources at Bishop Auckland Hospital.”
    The next day the Northern Echo reported on the victory that was achieved:
    “After a grilling by County Durham councillors, not only did County Durham and Darlington NHS Foundation Trust apologise, it also promised the 24-bed service would remain open while its future is considered.”

  • Full details: New NHS England and Improvement structure Diagrams and lists published by HSJ show literally hundreds (over 400) top-paid directors' jobs in the NHS Engprovement merger plan. This should ensure that every bureaucrat who wants to stick around can find a place to sit and claim their salary and expenses without being noticed.
    It's not clear how this could possibly be an improvement or a streamlining of the current structure.
    It also appears that the merged body has deliberately ignored the 44 STP areas and instead planned to divide England into 41 new areas to confuse absolutely everybody.

  • BMA: Capita failed to deliver over 47,000 cervical cancer screening letters Latest revelations via Pulse magazine and BMA on the fiasco of the Capita contract for "back office" services to GPs:
    "The [BMA] GP Committee called Capita’s running of services ‘nothing short of shambolic’ and said it is ‘frankly appalling’ that the private company’s ‘gross error’ may have put patients at risk."

  • Hancock interview: ‘Big private health companies’ won’t run integrated care HSJ report of interview with Health Secretary Matt Hancock, including a discussion of proposed changes to legislation and a statement claiming the government is not aiming at the privatisation that many campaigners have feared:
    "The health secretary has told HSJ the government is 'not going to hand [integrated care contracts] to the big private healthcare companies”, and would make this clear in Parliament when it presents new NHS legislation.
    Matt Hancock also said he was hoping for cross party “buy in” for changes to current NHS laws, and was “absolutely up for” seeking to agree proposals with the Labour party.
    NHS England and Improvement are expected to propose changes to the Health Act 2012 later this year, in the NHS long-term plan, or early next year.'"

  • There is no version of Brexit which will benefit the NHS — only varying degrees of harm BMJ blog by Sarah Wollaston and Paul Williams highlights Brexit impact on workforce of NHS and social care, and argues:
    "The reality of Brexit is vastly different to the fantasy Brexit that was mis-sold to the public during the referendum campaign. The promise on the side of the bus of an extra £350m per week has crashed into the inconvenient truth that there is no Brexit bonanza for the NHS, only a Brexit penalty. The committee heard evidence that pharmaceutical companies are already spending hundreds of millions on contingency planning. Ultimately these costs will be passed on to the NHS and taxpayers, money that would be far better spent investing in patient care. The costs will only increase as the clock ticks down to 29 March 2019. Stockpiling and refrigerated warehousing do not come cheap, let alone chartering special air freights for medical radioisotopes and other essential supplies with short shelf lives."

  • NHS denied treatment for migrants who can’t afford upfront charges Guardian report on the impact of the "hostile environment" imposed by Tories on migrants, and its consequences for health care:
    "Hundreds of patients have been denied treatment for serious health problems including cancer, arrhythmia and cardiac chest pains after ministers forced the NHS to impose upfront charges on migrants deemed ineligible for free healthcare, the Guardian can reveal.
    "In one case, a patient with advanced stage cancer died after she went a year without treatment because an NHS hospital demanded £30,000 upfront to provide chemotherapy."

  • Social workers faced with assessing up to 50 children in Northamptonshire each are 'drowning in cases', report finds Northants Tedlegraph report highlights developing crisis in social services in the bankrupt Northants council:
    A damning Ofsted report of the county council's children's services revealed that its social workers are struggling to handle 'unmanageable caseloads', leaving Northamptonshire's children 'at risk of harm'. Overall the children's department services have significantly declined since Ofsted's last inspection in 2016:
    "Social work caseloads in the first response teams are too high with many social workers responsible for between 30 and 50 children.
    "Social workers reported to inspectors that they were 'overwhelmed' and 'drowning'."

  • Hospital food at risk from no-deal Brexit Yet another reminder of the multiple threats that could be posed by a no-deal Brexit, all of which are of course glibly dismissed or ignored by the Brexit fundamentalists and those who follow them.

  • ‘Historic breakthrough Alzheimer patients around the globe have been awaiting’ The excellent Health News Review in the US points out the absurd exaggeration by a news report of a press release from West Virginia University on the preliminary findings on an experimental treatment with just one patient so far.

  • Departing county leader attacks cuts and urges care settlement With Surrey County Council facing a funding gap of £36m in 2018-19, rising to £86m by the end of 2019-20 and to £94m the following year, its Tory leader David Hodge is standing down after 7 years, telling the council it was “extremely disappointing” that government had passed on extra responsibilities to councils without proper funding, and calling for a long-term funding settlement for social care services.
    The Local Government Chronicle quotes him as saying:
    “It is sometimes difficult for someone in local government, that despite continually finding savings and continually facing increased demand, that we are expected to carry on while the National Health Service receives more funding.”

  • Surgeons say Gloucestershire hospital plan 'not safe' BBC report highlighting the warnings of almost 60 consultants and senior doctors at Cheltenham General Hospital, who argue that moving out-of-hours general surgery to Gloucester could put patients at risk.
    The trust plans to move emergency and inpatient general surgery seven miles away to Gloucestershire Royal Hospital.
    One doctor, who asked to remain anonymous, told the BBC: "We can see a plane crash about to happen. It's going to be catastrophic."
    Gloucestershire Trust bosses are clearly as unwilling to take professional advice as their equivalents in Shropshire and elsewhere.

    "The trust doesn't realise the detail in their plan. It's not safe."

  • NHS faces £2.3bn ‘cost shock’ in no-deal Brexit, says think-tank Financial Times report on Nuffield Trust research warns:
    "A no-deal Brexit would deliver a “cost shock” to England’s NHS that would swallow up all the money available to improve services for patients in the next two years, a think-tank has warned."
    The Nuffield Trust has concluded that the NHS is facing up to £2.3bn in extra annual costs by the end of 2019-20 owing to a sharp rise in red tape and trade barriers should Britain fail to secure an agreement with other European member states.
    "The think-tank concludes that 'extra costs on this scale would eat up all the funding available to improve patient care next year and the year after'."
    Not to mention the threat posed by soaring levels of unfilled vacancies after the collapse of EU recruitment.

  • We must not ignore plight of low-paid men as once we ignored that of working women Important evidence of the reduction in living standards of the poorest, impacting on their health and that of their families.

  • How the Big Four accountancy firms have become guardians of greed Daily Mirror report - on the same accountancy and consultancy firms that have so repeatedly deepened the crisis of the NHS over the last 30 years.

  • A&E Providers (includes those without Improvement Trajectories) - October 2018 Excellent interactive resource charting performance of A&E units in England

  • Opinion: The P3 party is over in the UK so why is Nova Scotia embracing the formula? Op-ed article by HCT editor John Lister in the Nova Scotia Chronicle Herald responds to the recently announced provincial government plan to build a new 600-bed hospital and other buildings in Halifax for a staggering $2 billion Canadian, financed through P3 (Public Private Partnership) analogous to PFI. The October announcment in Halifax came just as Philip Hammond was facing the hefty cost of bailing out collapsed Carillion hospital projects in Birmingham and Liverpool, and preparing to announce no more PFI/PF2 deals would be signed.

  • GP at Hand could face re-inspection by CQC More trouble for the much-hyped app-based service that is undermining GP services in London.

  • NACC Meals on Wheels Survey 2018 The report on which the Guardian article below revealing the cutbacks in services was based.

  • Less than half of councils still offering meals on wheels More eveidence of the disntegration and collapse of what undeveloped social care system we have left after 25 years of privatisation, means tested charges and fragmentation. Access to services is a postcode lottery and any concept of prevention has been killed off by vicious "eligibility criteria" to exclude all but the most desperate cases from any support at all. If this makes you angry, come to our Reclaim Social Care conference on November 17 - tickets via www.healthcampaignstogether.com

  • People must take responsibility for own health, says Matt Hancock Further proof of Matt Hancock's complete lack of suitability to the job of Health Secretary displaying his ignorance of public health and preventive work over the past decades by simply lecturing people and telling them to change their lifestyle while food monopolies, junk food and alcohol corporations continue to profit from peddling their unhealthy wares undisturbed, and more years of relentless austerity grind down the living standards of the poorest.

  • NHS funding boost: the need to manage expectations Analysis by Nuffield Trust's Sally Gainsbury in advance of the Budget on October 29.

  • Budget 2018: plenty of spin but no more money for the NHS Keep Our NHS Public analysis of Philip Hammond's budget, with a table calculating the long term gap in funding opened up since 2010 by austerity budgets that have lagged increasingly behind cost pressures and growing population.
    See also the HCT analysis at

  • Securing the future: funding health and social care to the 2030s Health Foundation report which notes that the £2bn extra for mental health "is welcome but would not be enough to make any serious inroads into the substantial unmet need." To do that, mental health spending would need at least a further £1.5bn

  • Is £84 billion being spent on the NHS? Full Fact dissect the government claim that an extra £84 bn is going to be spent on the NHS, and conclude:
    "The increase is £20.5 billion in real-terms for the NHS in England between 2018/19 and 2023/24. There is a way of calculating the figures that gets £84 billion, but it’s unhelpful and contains some potentially misleading figures."

  • How to spend it Autumn Budget 2018 response Detailed critique of Hammond's budget by the Resolution Foundation finds that the poorest 10% of the population stand to gain just £30 per year, most of that from the unreliable Universal Credit system, while the richest 10% stand to pocket a massive £410.

  • Autumn Budget 2018: IFS analysis IFS boss Paul Johnson concludes: "this is no bonanza. Many public services are going to feel squeezed for some time to come. Cuts are not about to be reversed. If I were a prison governor, a local authority chief executive or a headteacher I would struggle to find much to celebrate. I would be preparing for more difficult years ahead."

  • Preferred bidder named for controversial £450m contract (Paywalled) HSJ report reveals that despite fears of privatisation of services out of hospital in Ealing the contract is set to go to an NHS trust. It appears the funding of the contract was too low to offer any hope of a profit for private companies -- so it is probably also too low to allow a viable contract for NHS providers.

  • Budget 2018: 'NHS will face cuts as well as gains' Even the BBC catches on to the harsh reality behind the happy clappy rhetoric of the government's latest "increases" in NHS funding.

  • Just £32m withheld from PFI providers as councils overpay for poor service Infrastructure Intelligence report on local authorities and PFI notes:
    "Councils are often reluctant to withhold payment as they are concerned about the legal implications of doing so. However, PFI contracts will invariably have some sort of contractual mechanism to allow payments to be reduced for failures in performance. Councils and ultimately taxpayers should not be paying for services if they are not being delivered by PFI contractors.”

  • A quiet crisis: local government spending on disadvantage A worrying report from the Lloyd's Bank Foundation which warns that "Almost all (97%) of the reduction in spending has occurred in the most deprived fifth of local areas. Metropolitan and other urban areas concentrated in the North and Midlands, as well as coastal districts across England, are over-represented in
    this group."
    The result of cuts is that " councils have had to shift away from preventive spending
    towards crisis spending. For example, there has been a 46% reduction in
    spending on preventing homelessness, while spending on homelessness crisis support has increased by 58%, primarily through the cost of providing temporary accommodation."

  • Robert Francis attacks 'perilous state' of Healthwatch funding Healthwatch -- a watchdog body so feeble and toothless it has not even campaigned against cuts in its own funding. The (paywall) HSJ reports its chair, Robert Francis, complaining that the numbers of full time staff employed by Healthwatch had crashed by 22 per cent in two years, while this year’s funding for some local areas had been slashed by 50 per cent.

    Full time staff employed by Healthwatch has fallen from 525 in 2015-16 to 408 in 2017-18, while funding has dropped 35 per cent since Healthwatch was created under the Health and Social Care Act in 2013."

  • CCG's service cuts leave patients with 'nowhere else' Despite all the government guff insisting mental health is a prioritythis (paywall) HSJ article reveals that in Derbyshire CCGs are so short of cash they are cutting crucial services for people with severe illnesses such as personality disorders.

  • NHS funding rise may address our most visible challenges but neglecting wider health stores up problems for the future Health Foundation's Anita Charlesworth sets out her critique of Hammond's budget.

  • Health campaigners launch petition for A&E departments at all three main east Kent hospitals Important new challenge to cuts and closures in East Kent.

  • Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Rates of premature mortality are twice as high in the most deprived areas of England (Blackpool) compared to most affluent (Wokingham), according to a new study of health at a local, national and regional level across the UK.

  • Commitments to mental health sends right message but more support for core services needed NHS Providers' response to October Budget, including comment on PFI:
    “Whilst we note the chancellor’s announcement on the future of PFI, a number of trusts with particularly onerous existing PFI contracts will need further financial support if they are to meet the prime minister’s stipulation that no NHS organisation should be in financial deficit over the medium term. We will need the forthcoming review of NHS capital spending to set out how trusts can fund big building projects in the future."

  • RCP calls Budget 2018 'one step forward, two steps back' for NHS Royal College of Physicans points out: "Yes, councils will get an extra £700 million to care for the elderly and those with disabilities ... but this can only go a small way to alleviating the pressures placed upon the NHS by having to care for people in hospital who would be better looked after in the community. "

  • New money welcome but key services left hanging - Nuffield Trust response to Budget Nuffield Trust analysis of Oct 2018 Budget warns that "the financial fate of the vital services on which the NHS relies on was once again left hanging today.
    "While more money going into social care will be welcome, it is another short term fix to a system nobody seriously disputes is fundamentally broken. Troublingly, we heard no guarantees today about the budgets for hospital buildings, IT investments, training or public health."

  • Nationalise the Special Purpose Vehicles to end PFI! Updated version of an important analysis that sets out an affordable, practical way to renationalise PFIs and reduce the haemorrhage of cash to tax dodging offshore financiers and investors.

  • NHS Improvement's plans for 29 Pathology Networks to cover England A collection of reports and proposals from NHS Improvement, which should start to sound the alarm in many areas where this process has been taking place below the radar with little if any consultation or information to NHS staff or to local communities whose servics may be destabilised or "centralised" miles away.

  • No debate, no transparency – it’s the latest Tory NHS reforms Analysis by Labour shadow minister Justin Madders published by SHA.

  • Steeling ourselves for winter 2018/19 Strangely muted NHS Providers Report which avoid referring to levels of trust deficits and debts but does emphasise shortage of bed capacity, staff vacancies and the weaknesses of the dysfunctional and cash starved social care system as reasons to fear 2018/19 winter will be worse again than last year.

  • Is £84 billion being spent on the NHS? Short answer: no. Longer answer, with same basic conclusion is provided by Full Fact, which notes that "There is a way of calculating the figures that gets £84 billion, but it’s unhelpful and contains some potentially misleading figures."

  • Mental health services are failing to meet rising demand, new TUC report reveals The report – which features new analysis by the NHS Support Federation – shows that in the last five years the number of patients accessing mental health services in England has risen by a third (540,000). However, over the same period the number of mental health nurses, doctors and beds in the country has fallen.

  • King George Hospital, Ilford to close cancer unit The local Guardian newspaper reports on the latest move to downgrade and close the Ilford Hospital, diverting patients and resources to the already desperately overstretched PFI-funded Queens Hospital in Romford.

  • https://www.hsj.co.uk/mid-cheshire-hospitals-nhs-foundation-trust/patients-will-suffer-from-regulators-funding-denial-says-trust-ceo/7023643.article (£) HSJ report reveals a Trust CEO speaking out publicly, after Mid Cheshire Hospitals Foundation Trust was denied £1.4m in capital funding for winter because the trust had told NHS Improvement it could not meet a requirement to reduce its four hour waiting time breaches by 50 per cent. More CEOs need to speak out to reveal this kind of tension.

  • NHS reliance on EU staff in numbers – full scale of Brexit risk revealed In the NHS, 63,000 staff – 5.6% of the total workforce – are from EU countries, including 10% of doctors and 7% of nurses, according to an article by Prof Karen Bloor in The Conversation. Some key hospitals in England depend on the European Union for up to one in five staff, and even higher proportions of doctors and nurses.
    Senior figures in the NHS have warned that recruitment from Europe has dried up, with potential knock-on effects on waiting times, operating theatre capacity and beds.

  • Taking our health for granted: Plugging the public health grant funding gap This Health Foundation briefing paper assesses the extent of cuts to the public health grant since 2014/15 and "projects the amount required per year to plug the funding gap that now exists."
    It demands a major reversal of policy: "At a minimum, the government should reverse real-term cuts and allow additional investment in the most-deprived areas by providing an additional £1.3bn in 2019/20. The remaining £1.9bn should then be allocated in phased budget increases by 2023/24, with further adjustments for inflation."
    It warns that even this increase would not inject sufficient resources to finance the improvements called for in the Five Year Forwatd View in 2014.

  • Not content with closing A&Es, Shropshire health bosses are now targeting mothers. Facebook post from Shropshire Defend Our NHS warns that "the well-respected Midwife Led Units in Oswestry, Bridgnorth and Ludlow are to be closed permanently leaving open only the ones at the two hospitals" [Shrewsbury and Telford]. There is "no mention of any provision for home births."

  • Young people back single-payer health care According to a new poll, 69 percent of young Americans between the ages of 15 and 34 favor a national health plan, known as a single-payer program. Eighty-eight percent of young Democrats and 40 percent of young Republicans favor a government-run health insurance program, according to the poll. Roughly two-thirds of young independents are in favor.

  • Buried in "Hilariously Stupid" White House Attack on Socialism, An Accidentally Strong Argument for Medicare for All Incompetent and ignorant Trump team produce a 72-page document seeking to rubbish socialism and Bernie Sanders, only to include a chart showing shorter wait times for seniors under the current U.S. healthcare system compared to those under the Canadian and Nordic systems. Health care for senior citizens is run through the publicly-funded, low cost Medicare system which campaigners want to extend.

  • Poll Shows 52% of Republicans Support Medicare for All President Donald Trump and the GOP's lie-filled ads, videos, and op-eds attacking single-payer have not been enough to convince even their own constituents that providing healthcare to every American at a lower cost is bad policy, a poll published Monday found that a majority of Republican voters support Medicare for All.

  • Thousands Demand Doug Ford Disavow Health Care Privatization and Cuts Ontario Health Coalition reports 8,000-strong province-wide lobby of provincial parliament building in Toronto protesting at massive cuts in mental health already announced by new right wing provincial govt, further cuts threatened, and long waits for patients for emergency care in over-stretched hospitals.

  • Social care crisis: Councils receive 5,100 new requests for adult care EVERY DAY amid soaring demand Daily Mail one of few news outlets to highlight these worrying figures from new figures and warns "the situation will only get worse if more money isn't spent".

  • Hospital to trial use of cutting-edge tech in £1.2m scheme to cut A&E admissions "The Test Bed programme will see digital technology used to keep heart condition patients out of A&E": when you have not got enough beds or staff to look after patients face to face, there is always the hope that magic will help out. Scary stuff from local paper in Stoke on Trent.

  • Staff in NHS hospital with one of the biggest deficits in England say wards lack enough showers and toilets ITV story on over-stretched Hereford Hospital also reveals that the 1930s hutted wards that were supposed to have been replaced by the PFI-funded new hospital in early 2000s -- and demolished -- are still part of the bed complement of the hospital. The story does not mention that chief executive is overseeing the crisis part-time, since he is also CEO in South Warwickshire AND George Eliot Hospital in Nuneaton.

  • NHS £20bn boost risks being spent to pay off debts, experts warn Guardian reports govt adviser Peter Carter, backed by NHS Providers, urging Theresa May to write off almost £12bn in loans that have covered up chronic overspending by hospitals. If not, they argue, she risks her £20bn NHS boost being spent on debt repayment rather than improving healthcare.

  • The policy behind Liverpool’s empty hospital Rather strange New Statesman article, quoting some odd sources, concludes reasonably that "If there is an upside to the empty corridors of the Royal Liverpool, then, it is that Carillion’s collapse may make it more difficult for governments to justify the use of PFI in future."

  • Dealing with the legacy of PFI: options for policy makers Important new study from CHPI examining five potential ways of mitigating the damage of PFI, and suggesting they are all worthy of consideration, although one of them appears to offer significantly more savings that the others.

  • Shropshire A&E waiting times are second worst in country Shropshire Star sound the alarm over disastrous delays and waiting times even before reckless hospital bosses implement their plan to axe overnight A&E services at Telford.

  • Brexit: most doctors and nurses now think NHS will get worse Guardian picks up on growing fears among health workers, who will no doubt be brushed aside by arrogant ignoramuses such as Rees Mogg and Johnson as "experts" who should be ignored in favour of the now highly suspect mandate they procured from the least informed.

  • A conversation with the public: could different be better? "What if the NHS could meet people’s needs in a different way, that shifted care out of acute hospitals?" asks Professor Keith Willett, Medical Director for Acute Care @NHSEngland in a King's Fund blog.
    Indeed. A nice dream to have. What if there was an escalator to take climbers up Everest without climbing ropes? What if we had a government willing to fund the NHS properly? What if NHS bosses came up with serious plans instead of idiot fantasies? What if Prof Willett + the King's Fund faced up to reality?

  • 'No excuse' for mental health failings in Lancashire https://www.lep.co.uk/news/health/no-excuse-for-mental-health-failings-in-lancashire-1-9395469 Lancashire Post flags up yet another example of a council scrutiny committee doing what they are supposed to do -- and scrutinising the actions of management.
    "Members of Blackpool Council’s adult social care and health scrutiny committee grilled Dr Leon LeRoux, clinical director for Lancashire Care NHS Foundation Trust, about a series of failings in the way mental health services are being run, as reported in The Post.
    Mr Marsden said: 'I think the scrutiny committee did a superb job of really bringing to account a highly worrying series of failings both administrative and otherwise that have been going on, particularly at The Harbour'."

  • ‘GP at hand’ app Babylon bleeds cash (£) Times story reveals losses of £23m from a company valued at £213m, Familiar pattern with Ali Parsa's projects - strong on rhetoric, weak on profits.
    this is just what happened with Circle at Hinchingbrooke Hospital before firm walked away from contract.
    What happens to patients if Babylon goes bust, along with GP at Hand?

  • BBC headlines "New checks to crack down on free prescription fraud" The "crackdown on prescription fraud" like the moves on "health tourism" is a non-issue elevated into deliberate misdirection by govt and NHS England (aided by BBC) away from real, massive problems of underfunding, disintegration and privatisation weighing down on NHS.
    Allegations that prescription fraud is a significant problem are designed to appeal to the most ignorant layers of Daily Mail readers + to those who bought the lies about "health tourism". We need a crackdown on ministerial lies and diversions.
    The biggest "prescription fraud" is the fact that people in England have to pay for prescriptions while in Wales, Scotland + N.Ireland they are free, so no charges to fiddle. Best solution: scrap prescription charges, remove this ridiculous obstacle to care for lowest earners.

  • Are NHS leaders being required to play fast and loose with the law? Blog by David Lock QC highlights the extent to which NHS England's proposals for so-called "integrated care" mean that "legally enforceable rules about pricing NHS services, maintaining the division between commissioners and providers, the rules about the operation of competition within the NHS and numerous other aspects of the 2012 Act are simply being ignored."
    Lock argues:

    "Personally, I regard the 2012 Act as an extremely long, complicated and tortuous disaster. Its model of operating the NHS as a managed market where free-market competition would magically deliver benefits for patients and value for money for the taxpayer always struck me as being a flawed ideology which was not supported by any evidence. I also accept that there is a complete disconnect between the resources provided to the NHS and the legal duties that NHS bodies are required to deliver with those resources. But as a former parliamentarian and as a QC, I cling to the old-fashioned notion that Acts of Parliament that create laws are required to be followed; and that individuals in positions of leadership in public bodies are required to act lawfully. "
    He urges NHS leaders to put pressure on government to change the law rather than ignore it.

  • What Trump gets wrong about Medicare-for-all Two veteran campaigners for "single payer" system to provider care for all in the US explain Trump's catalogue of lies, deception and misunderstanding.

  • Child health in England in 2030: comparisons with other wealthy countries Royal College warns of declining child health.
    "England has poorer health outcomes than the average across the EU15+ (the 15 EU countries in 2004 plus Canada, Australia and Norway) in most areas studied, and the rate of improvement in England for many outcomes is lower than across the EU15+.
    "This means that unless current trends improve, England is likely to fall further behind other wealthy countries over the next decade.
    "The marked inequalities observed in most key outcomes are likely to widen over the next decade as problems in areas such as infant mortality and obesity are worsening more quickly amongst the most deprived section of the population.

    "If infant mortality begins to decline again at its previous rate, rates will be 80% higher than the EU15+ in 2030. If UK mortality continues the current ‘stall’ then it will be 140% higher in 2030."

  • Avonwood Manor nursing home to close next month Brexit impact hits hard at services for older people even in Tory Bournemouth. "Chief executive and owner Kumar Gnanakumar said “uncertainty over Brexit has presented us with a double-edged sword”.

    “Recruiting suitably qualified staff, particularly nursing staff, from the EU is even more difficult now and we are heavily reliant on agency staff. In addition, we’ve recently found that the sentiments of banks and investors have changed towards care facilities that require extensive operational and premises turnaround, and they are now increasingly reluctant to lend money to care home owners for these purposes'."

  • Revealed: NHS England sent 154 eating disorder patients to Scotland Guardian picks up on yet another symptom of the problems in mental health services, made worse by contracting out less complex care to voluntary sector organisations and denuding trusts of the income to support services for all.

  • Elite FT seeks support for near £100m deficit Another, contradictory (£) article from the HSJ pointing to massive deficit at Cambridge University Hospitals FT.
    The story is not unique: CUFT's northern neighbour, Norfolk & Norwich Hospital FT in May announced it plans to seek loans of £70.7m during the year, bringing its total of borrowing to £128m.
    The Trust also rejected a proposed control total of a surplus of £10.7m, and instead
    set out plans to deliver a massive deficit of £55m, more than DOUBLE the 2017/18 deficit. Even this figure “assumes that £30m of savings will be made in year,” even
    though: “to date we have c. £10m of fully worked up plans for delivery”.

  • New NHS efficiency challenge is half that of 5YFV (£) HSJ puts an inappropriately optimistic spin on the latest warnings from NHS Providers and others on the £10bn+ gap between even the "increased" funding due later after Theresa May's intervention and the amount needed to sustain and improve services. Especially given the massive scale of trust deficits.

  • Cuts, cash freezes and privatisation put NHS safety at risk Morning Star publishes articles from HCT's editor John Lister calling for a concerted campaign to "Make our NHS Safe for All".

  • End the Hostile Environment in the NHS - Day of action Facebook updates on Docs Not Cops Day of Action demanding an end to the hostile environment in the NHS, October 23

  • Second Virgin Care practice in Essex rated inadequate by CQC GP Online flags up another Virgin failure, the Church Lane Surgery, in Braintree. The CQC found a 'lack of leadership' and safety systems that were 'inadequate and did not ensure that patients and staff would be kept safe from harm'.
    "Inspectors found almost 2,000 patient letters that had not been actioned by a GP, 588 test results awaiting review and 1,500 sets of patient notes waiting to be transferred or assessed on the day of inspection."
    This is less than six months after another Virgin practice was put into special measures. By contrast 96% of GP practices have been rated "good" or "outstanding" despite pressures.

  • New infographic sets out reality of the NHS funding settlement NHS Clinical Commissioners, not noted for their radicalism or willingness to challenge government, join forces with NHS Providers and NHS Confederation, to highlight scale of financial problem:
    "Pressures such as stabilising waiting times, increasing staff pay and addressing population growth, ageing and chronic conditions are expected to reach as much as £31bn by 2024, far exceeding the £20.5bn pledged by the Prime Minister in June 2018."

  • Government ‘blocked’ involvement of user-led groups in mental health summit Full story from Disability News Service notes: "One letter, spearheaded by the National Survivor User Network, was signed by more than 100 organisations and individuals, including mental health service-users and survivors, user-led networks, academics and mental health professionals from more than 20 countries, including Argentina, Peru, India, Chile, Columbia, Japan, Kenya, Estonia and Hungary.
    "The letter says there was little or no involvement of user-led organisations in planning the event, in a blatant breach of the UN Convention on the Rights of Persons with Disabilities."

  • NHS cannot be 'confident' about medicine supplies after a no-deal Brexit, senior official admits Yet another frightening indication of the potential consequences of crazed fundamentalist Brexiters, willing to sacrifice everything for their xenophobic fantasy.

  • Problematic PR releases: As evidence lags on proton therapy, hospitals lure patients with anecdotes and high-tech appeals As Health Sec Matt "Appman" Hancock keeps plugging unproven technology and evidence free apps, this is a useful illustration of how this type of approach has mushroomed out of all proportion in the commercialised health care of the USA, assisted by poor quality, uncritical journalism -- of which we also have plenty here.

  • Councillors call for evidence on Louth Hospital beds cut Lincolnshire councillors belatedly join the sudden upsurge of councils willing to challenge dangerous and half-baked plans that threaten local services.

  • STPs to create new five year plans (£) update from HSJ. Remember STPs? They were announced early in 2016, half backed plans drawn up 6 months late at end of 2016, and largely ignored or abandoned since. Now NHS England and NHS Improvement say “sustainability and transformation partnerships” and “integrated care systems” will be expected to develop and agree their plans during the first half of 2019-20. Problem is they still lack revenue and capital funding, credible workforce plans, and clinically viable plans in place of continued cuts and downgrades of A&E and inpatient services. Mental health still out in the cold and community health a partially privatised, fragmented, under-funded excuse rather than a serious provision of services.

  • REVEALED: 'Scandal' of NHS staff paying £1million to park at North West Anglia hospital sites Read more at: https://www.peterboroughtoday.co.uk/news/health/revealed-scandal-of-nhs-staff-paying-1mil Local press highlighting another wondrous joy of PFI. Peterborough is the £300m PFI hospital which the trust board were warned they could not afford, and told not to sign up for by the regulator, but they ignored advice and signed up anyway. Ever since the finances have had to be propped up by DH handouts – and fleecing staff for parking.

  • Tories ‘broke UN law’ over decision to ban UK mental health groups from World Mental Health Summit in London Article in Evolve: "Along with severely criticising the Tories for excluding them, multiple mental health user-led and survivor groups noted the brazen hypocrisy of the event being hosted by a UK government who, barely over a year ago, were severely criticised for their shameful record on disability rights by a UN committee."

  • Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer Academic paper ramming home the stratospheric and unsustainable costs of US health care. After 2 years of cancer treatment in the US, 42% of patients have depleted their entire life's assets. Remember these will be people who were insured sufficiently to begin treatment, not the vast number lacking even enough to get started.

  • City mental health team axed on World Mental Health Day Nottingham Post story again underlining government and CCGs' contempt for mental health services.
    "A team of ten nurses who provide mental health care to those in the city were told they were being decommissioned - on World Mental Health Day.
    "Known as the Primary Care Mental Health Service in the City, the team visits GP surgeries across Nottingham, providing mental health care to those who are not ill enough to be admitted to hospital.
    "A decision was made by Nottinghamshire Healthcare NHS Trust and Greater Nottingham Clinical Commissioning Groups (CCGs) to end the service due to 'funding constraints'."
    Note the platitudes and bullsh*t from the CCTG trying to explain away this loss of a quality service.

  • Terminal breast cancer patients 'abandoned' in nurse shortage Nearly three-quarters of NHS Trusts are not providing dedicated nurses for patients with incurable cancer.
    This BBC story flags up a major issue over quality as well as the wider concerns over safety of care in a service so financially stretched by 8 years of austerity funding.

  • Two-thirds of doctors and nurses believe £350m-a-week NHS claim was a 'deliberate lie', poll finds Two-thirds of doctors and nurses believe £350m-a-week NHS claim was a 'deliberate lie', poll finds Sadly this belated hindsight is not enough to halt Brexit madness.

  • Scarborough Hospital: health staff and public demand answers at 'tumultuous' meetings NHS Anger in Scarborough at threat to local services contained in plan drawn up by McKinsey, threatening to "centralise" ever more services in York. McKinsey had pocketed £150,000 for one of their standard packages typically light on evidence of any concern for local access and local needs, and strong on double-speak – such as the ever-popular "there will still be an A&E at Scarborough" (but what services will remain in the building?).

  • Scarborough Hospital briefing no-show: NHS trust is savaged by councillors Angry councillors complain at hospital trust's failure even to turn up to a promised briefing meeting to explain their planned cuts.

  • PM refuses to scrap work capability assessments despite link to suicides Theresa May has refused to scrap her government’s controversial Work Capability Assessments, despite reports almost one in two women taking part in the assessments say they have attempted suicide before or after the process.

  • Cuts causing stress and long-term sickness, social workers tell survey Community Care report on gaping holes emerging in social care. Of 295 children and families’ social workers who participated in the research by Barnardo’s and YouGov, 79% said statutory sector workers were stressed, with many experiencing long-term sickness as a result. The findings come in the wake of a debate last week at Community Care Live, where sector leaders discussed the need for employers to do more to support practitioners experiencing emotional distress.
    Reflecting the stretched picture, 85% of social workers also said they were unable to give all the children they work with the support and time they needed.

  • New statistics from NHS England The NHS is gradually slipping further away from targets as emergency caseload continues to grow -- despite all the fine words and theories of the last 25 years.
    Made worse by pig-headed management pressing ahead with bed closures and A+E downgrades regardless of pressures.

  • Now THIS is fake health news and it appears in major newspapers across the US New epidemic of fake news on health issues in US press -- and no doubt due to appear in low-grade British news outlets too

  • NHS on course for even tougher winter Nuffield Trust report flags up pressure from 7% increase in A&E attendances -- no sign of the long-promised community or other out of hospital services reducing the pressure or easing discharge.

  • How Much are Private Patients Costing the NHS? UNISON Eastern Region report by John Lister. FoI requests to 14 trusts in the East of England asked the numbers of private patients treated in NHS hospitals, how many of them accessed NHS facilities and staff, the amount it cost the NHS and how much patients and insurers were charged.
    Most trusts said they couldn’t answer all the questions, with some citing commercial confidentiality and others saying they simply didn’t collect the data. If trusts don’t know how much private patients are costing them, they surely can’t know how much to charge them, says UNISON.
    It appears that those trusts that did provide financial information are only generating a few hundred pounds per patient, for example Luton & Dunstable Hospital Foundation Trust billed private patients and insurers £1.83m for services costing £1.63m – an average surplus of just £335 a patient.
    NW Anglia Foundation Trust apparently made around £524 profit per patient, but its figures do not include the cleaning or catering staff needed to provide its premium services, suggesting the true surplus is much lower, says the report.
    The FoI replies also reveal how under-utilised the private wards are. Despite hospitals across England struggling to find empty beds for their patients, Luton’s 13-bed private ward treated just 36 inpatients per bed per year – less than one a week, questioning the resources allocated (and denied to NHS patients).

    UNISON eastern region secretary Chris Jenkinson said: “Well-heeled patients shouldn’t be able to leap to the top of waiting lists, getting treated in swanky private wards on NHS sites with access to the round-the-clock first-class services that the private sector simply cannot provide.
    “But these trusts can’t even show that they’re getting enough cash back to justify opening their doors to private patients. It’s truly disgraceful.”
    John Lister says: “Many people have concerns about any NHS involvement in private care – but almost all will condemn the diversion of NHS funds to deliver such care at a loss, which is in clear breach of the guidelines.
    “Once again questionable policies are being concealed behind a wall of secrecy. Trusts must be forced to publish the full financial picture on private patients — and to halt immediately wherever public money is being lost and resources inefficiently used.”

  • Virgin Care set to lose multi-million pound child health service contract in Devon Good news as the bearded billionaire with an aversion to paying tax is set to lose another of his loss leader contracts. One down, hundreds more to follow?

  • Hospital considers plan to suspend cancer ops (£) HSJ reveals another symptom of severe crisis in our NHS, with shades of the 1980s. Hospital has three wards with over 40% nurse vacancies and SEVEN wards with one in 3 nurse jobs unfilled. No easy way to find spare capacity in neighbouring hospitals.

  • Ex-UN chief Ban Ki-moon says US healthcare system is 'morally wrong' The chaos worsened by Trump has ever more critics and fewer, increasingly desperate, supporters who profit from it.

  • National life tables, UK: 2015 to 2017 ONS figures show year by year improvements in life expectancy came to a halt in 2015-2017. High mortality so far in 2018 means this will almost certainly continue. Austerity is starting to shorten lives, and make lives more uncomfortable for the many to help boost profits for the few.

  • Stalled Royal Liverpool Hospital PFI deal could be ditched Cagier comments on the possible scenarios from BBC in Merseyside

  • Taxpayers to bail out Royal Liverpool hospital project Worrying comments on Liverpool PFI from Construction Enquirer:
    “Although the project is at the fit-out stage the final completion bill could still be significantly higher after a survey by consultant Arup raised concerns about significant structural and cladding issues.
    “One source close to the project said:
    “There has even been talk that it could be cheaper to pull it down and start again.”

  • New £335m Royal Liverpool Hospital 'will be bailed out by the government' Local take on the Liverpool PFI story, from the Liverpool Echo

  • Ministers bail out £335m Liverpool hospital‎ after Carillion collapse Sky News first with the story on the end of the second major PFI to be terminated and taken into public hands, following Birmingham's Midland Metropolitan. The aftermath of the Carillion collapse appears to be a welcome and belated collapse in confidence in PFI projects.

  • One week to go -- make sure to respond to NHS England's threat to axe 17 treatments It's already clear that once the 17 are nodded through a growing list of treatments will be excluded from the NHS by CCGs in a new postcode lottery -- almost all of it ignoring or flouting NICE guidance. This link is to the KONP suggestions on how to respond. Don't let them think we are happy with the plans!

  • Sheffield health bosses rethink walk-in centre and minor injuries unit closure after public outcry Yet another victory for common sense and for campaigners who got stuck in. Campaigning can win: doing nothing but grumble guarantees you will lose. And when it's gone, it's gone!

  • Liver and pancreatic services could be switched from Coventry to Birmingham Good local BBC report here on controversial NHS England plans which have not apparently shown any evidence of service failure at Coventry, but argue to concentration of services at already overcrowded QE Hospital Birmingham. From 3.36 hear comments from John Lister, editor of Health Campaigns Together, arguing that whether this goes through depends on whether local politicians are prepared to fight for Coventry's health services.

  • Revealed - Babylon’s national expansion push Exclusive (£) article reveals 17 CCGs in discussion over use of the controversial software that could undermine existing GP practices and leave older patients and those with greater needs with less access to care while prioritising younger, fitter, more pushy types who only want an app.

  • Matt Hancock’s endorsement of Babylon risks undermining NHS innovation Editorial in (£) HSJ joins the growing chorus of criticism of the blatant plugging of the Babylon software used by controversial GP at Hand app by recently appointed Health Secretary Matt Hancock, who appears to have few supporters for his uncritical support and disregard for evidence that the system is safe and effective and will not destabilise primary care services.

  • Bolton members vote to strike over pay equality First strike by UNISON members in a subco against 2-tier workforce in action:
    "The staff , who work in roles including cleaning, catering and portering are employed by Bolton iFM – a wholly-owned subsidiary of the trust.
    "Staff have voted for strike action because they are not being paid the nationally-agreed wage increase for NHS staff that is worth nearly £2,000 this year for the lowest-paid workers – an increase of more than 10%. Bolton iFM has offered only 2%."

  • The Ideal US-UK Free Trade Agreement The Daily Mirror headlined on 19 September on this long and dull 239-page report by hard-line Brexit/neoliberals on a hypothetical trade deal with the US.
    That's because tucked away in a postscript on p228 it says:
    "With that in mind, what might a realistic U.S.-U.K. FTA look like? First of all, full and fast trade liberalization should be the goal, with exceptions limited to the most sensitive products."
    Health care is apparently not one of these sensitive areas … or is it?
    […] "As for other services areas, health services are an area where both sides would benefit from openness to foreign competition, although we recognize any changes to existing regulations will be extremely controversial."
    Too right it would be controversial. No mandate for this from any parliamentary party.

  • Social care is already in crisis – these visa plans would be a hammer blow Polly Toynbee in the Guardian spells out the obvious point arising from the Tories' latest racist plans to filter through only the richest and most highly skilled or migrants to their nightmarish vision for post-Brexit Britain.

  • Conservatives back higher taxes to fund the NHS Possibly some will be surprised by this headline in the Telegraph based on the latest Social Attitudes survey. We should remember that Tory voters tend to be older and Tory Party age averages over 70 - a point where private health insurance is possibly excluded or unaffordable and in any case of little reassurance if you need emergency treatment of have complex needs. But useful as a reminder.

  • Public health schemes fall victim to spending cuts, figures show Labour Party research exposes the scale and impact of repeated cuts by central government to public health budgets administered by local councils -- cuts which have much larger long-term costs than they can hope to save.

  • 'Concern' as York hospital trust fails to replace chief executive Headline sums up the desperation of a trust which nobody wants to manage because of the level of underfunding.

  • Oxfordshire CCG labelled 'serial underfunder' of mental health services Oxford Mail & Times article citing Unite report on reduction of resources in mental health:
    "the union claim[s] that psychological therapies in the area have lost about 90 per cent of their most senior clinicians in the decade since 2007.
    "According to the union, OCCG spending on mental health services is falling below ‘the parity of esteem’ - the principle where mental health must be given equal priority to physical health, as stated by the 2012 Health and Social Care Act - and more funding is desperately needed.
    The CCG spends less than 8.5% of its budget on mental health, an extraordinarily low proportion, of what the mental health trust points out is an already inadequate budget:
    […] "A spokesperson for the trust said: “Nationally, OCCG receives the lowest funding per head of any CCG in the country, and since there is a significant demand for acute services as well, resources for mental health and community services are inevitably limited."

  • Eight trusts tender £2bn pathology contract amid network shake-up (£) HSJ report on massive potential privatisation of pathology services in SE London, Sussex and Surrey in which there appears to be no NHS bid.

  • Towards integrated tech enthusiasm with Matt Hancock Well-crafted critical blog making telling points on Babylon (GP at Hand) and the enthusiastic endorsement of this private provider, from Andy Cowper.

  • The impact of integrated care systems Even this (£) HSJ comment by the perennially servile Chris Ham is obliged to acknowledge problems with "integrated care," and point out:
    "…a need for caution in merging CCGs to align more closely with ICSs, unless these mergers are supported by councils.
    "Where ICSs are making progress, they are doing so despite the current NHS architecture not because of it. The organisational landscape is evolving rapidly and changes in the law will be needed to align the statutory framework with what is happening when the parliamentary arithmetic permits."

  • Worcestershire County Council “Ignored Warnings” Over Looming Financial Crisis Another Tory council displays a complete lack of financial responsibility and demonstrates that any notion of "integration" of health and social services is either fantasy or nightmare for the NHS.

  • Does lack of GPs in Swindon mean more are going to GWH Emergency Department? A silly question with an obvious answer

  • A&E appointments system proposed in NHS targets shakeup Wouldn't it be handy if people could organise their accidents and heart attacks in advance to enable hospital management to cope? Guardian reports on another bright idea from NHS England.

  • EU migrants contribute more to the NHS than they consume Many of us knew this: but more ammo to combat those whose ignorance is compounded with xenophobia and racism.

  • NHS vacancies a 'national emergency' here even the BBC notes the scale of the problem as "NHS Improvement" sits on its hands after setting impossible "control totals" aiming to force further cuts in spending. "The latest figures have been published by the regulator, NHS Improvement, for the April to June period. They showed:
    ◾11.8% of nurse posts were not filled - a shortage of nearly 42,000
    ◾9.3% of doctor posts were vacant - a shortage of 11,500
    ◾Overall, 9.2% of all posts were not filled - a shortage of nearly 108,000
    This is slightly worse than this time last year and comes after improvements at the end of last year and start of this year."

  • Pharma chief defends 400% drug price rise as a ‘moral requirement’ A useful reminder to anyone who thinks big Pharma is in it for the sake of our health rarher than their shareholders' balance sheets.

  • Finally NHS Improvement acknowledges £4bn underlying deficits: how about more honesty on other policies and issues Short, sharp comment piece by Richard Bourne asks the obvious questions that so many in the media have not yeat asked.

  • GPs demand faster CAMHS access as mental illness soars in young people GP online artyicle quotes an Imperial College academic: ": ‘We know that there is already a growing crisis in the availability of CAMHS, with many more children and young people needing treatment than there are services to provide it. Our study suggests that this need is likely to continue to grow in future. Without more radical action to improve access to and funding for CAMHS, as well as a wider strategy to promote positive mental health and wellbeing, we may be letting down some of the most vulnerable in society.’"

  • Rapid rise in patients over 85 highlights need to invest in general practice In normal times this GP online story might simply be stating the obvious: but in these times of constant and tightening pressure on NHS budgets it's clear that the demands of caring for more older patients many of whom have more complex needs puts more pressures on GPs as the front line.

  • GPs demand equal treatment as NHS rolls out £145m hospital winter fund Important reminder from BMA in GP online: "The funding announcement comes after an extreme NHS crisis during the 2017/18 winter, which forced the NHS to cancel tens of thousands of elective operations across England, with hospitals almost entirely full for several weeks in a row. GP practices faced a major knock-on impact as they managed patients facing extended waits for operations - as a heavy flu season also drove up workload."

  • How to respond to NHS England's consultation on restricting access to elective treatment The consultation (discussed in the front page of Health Campaigns Together newspaper) ends at the end of this month. In this link, Tony O'Sullivan of Keep Our NHS Public suggests that answers and the reasons for them that would best respond to the NHS England challenge. Urgent action needed.

  • Epidemic of poor mental health among low-paid workers Report analysing data from over 4,000 UK workers of different job ranks, aged 16 to 65. "We found a worryingly high prevalence of mental health problems among low-paid workers in non-managerial roles.
    "Among all workers, we found that 19% showed signs of depression, 15% had thought about suicide in the last month, 10% felt paranoid, 7% had a psychotic or a personality disorder and 4% had hallucinations. Low-paid workers were significantly more likely to have symptoms of paranoid personality disorder and avoidant personality disorder than those whose jobs were managerial."

  • UNISON calls on Salisbury NHS trust to rethink wholly owned subsidiary plans Another battle to prevent desperate trusts disintegrating their own workforce in the hopes of making savings through dodging tax.

  • RCEM factsheet shows nearly 300 emergency medicine doctors have left to work abroad since 2015 Another hard hitting fact sheet from the Royal College of Emergency Medicine. It notes that hospital trusts are not being paid the full cost of A&E treatment:
    "According to NHS Reference Costs the average cost of an ED attendance in 2016-17 was £148.
    "NHS Trusts are paid for the services of Emergency Departments through something called the National Tariff system. Historically, national tariff payments have not reflected the full costs of treatment in Emergency Departments."
    "Because tariff payments have not kept pace with inflation and because of what is known as the ‘Tariff Efficiency Factor’ the gap between the actual cost of treatment and what Trusts are paid to deliver it has grown."

  • Patients dying on NHS waiting lists 'surges by 10,000' Pulse report follows up on Daily Express figures charting another symptom of decline in under-funded NHS.

  • 40 Percent of Connecticut Households Can’t Afford Basic Needs One of the wealthier US states has rising numbers of families that cannot earn enough to get by. The report shows that between 2010 and 2016 the cost of childcare for families has increased 13 percent. The cost of housing during that same time period increased 9 percent and the cost of healthcare increase 82 percent.

  • Toddler dies while gran reads Mr Men books to him after 'urgent' surgery delayed for 3 DAYS at busy hospital Mirror story: "The little boy went into cardiac arrest after waiting at ‘extremely busy’ Royal Manchester Children’s Hospital (RMCH) for three days. The inquest heard he required an ‘urgent’ procedure at Royal Manchester Children’s Hospital but it kept being ‘put off’, the coroner was told."

  • NHS bill for hiring non-UK staff could hit £500m post-Brexit, say doctors Guardian report on another shocking hidden cost of Brexit: "The Royal College of Physicians (RCP) has calculated that the costs of recruiting EU and non-EU staff could more than triple from the current £150m a year if freedom of movement ends as a result of Brexit."

  • Surprise Medical Bills Are What Americans Fear Most In Paying For Health Care A Kaiser Family Foundation poll found that 67 percent of people worry about unexpected medical bills – more than they dread insurance deductibles, prescription drug costs or the basic staples of life: rent, food and gas. 4 in 10 people said they had received a surprisingly large invoice within the past year. Thesame poll also found that a majority of the US public — regardless of political party — does not want insurers to be allowed to deny coverage or charge higher premiums because of someone’s medical history or health status. Both practices were standard in the health insurance industry until they were outlawed by the Affordable Care Act in 2010.

  • NHS charging for overseas visitors – wrong on every level Strong article from Prof martin McKee on Our NHS blog site explains that regulations that deny visitors NHS care – except for certain infectious diseases and to relieve death pains - are riven with contradictions. They will hit some unexpected victims as well as the intended scapegoats.

  • Low quality healthcare is increasing the burden of illness and health costs globally A new joint report by the OECD, World Health Organization (WHO) and the World Bank points out that poor quality health services are holding back progress on improving health in countries at all income levels.
    Inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices, or providers who lack adequate training and expertise prevail in all countries. The situation is worst in low and middle-income countries where 10 percent of hospitalized patients can expect to acquire an infection during their stay, as compared to seven percent in high income countries.

  • Vital lifesaving NHS equipment in dire need of replacement with more than 1,000 machines more than decade old FoI requests by Labour have found 892 X-ray devices used in clinics were more than 10 years old, with 139 past their replacement dates; 295 ultrasound machines were more than a decade old, with 134 past their replacement dates; and 46 MRI scanners in use which were more than 10 years old, with 10 past their replacement dates.

  • Many serious surgeries cancelled on the day, study finds BBC report on research led by the Royal College of Anaesthetists and University College London, which looked at more than 26,000 cases in a seven-day period in March last year, across 245 UK hospitals.
    "They found one in seven operations were cancelled on the day of surgery."

  • CQC Enforcement Notice: A crisis in local healthcare Campaign blog defending hospitals in Shrewsbury and Telford against reconfifuration plans responds to recent intervention by the CQC: "We applaud the courage of staff who approached hospital inspectors, and told them of the problems. It was staff who blew the whistle here.
    "A letter from the CQC to hospital trust SaTH reported: “Staff across all areas and grades raised concerns with us about this practice (‘boarding’) and told us they felt it was unsafe, demeaning, undignified, and disgusting. Two staff members told us they felt patients who were boarded were treated like ‘animals’ and ‘cattle’.”

  • Choice of Tory peer as NHS England chair 'risks politicising health service' Lord Prior has followed the same path as the incumbent Malcolm Grant, from chair of University College London to chair of NHS England. But Prior has previous as a Tory MP and as parliamentary undersecretary of state for health, a position he held until December 2017. His appointment entrenches Tory political influence in the key NHS body that controls commissioners and providers.

  • Public health chiefs to trial lifetime risk score rejected by NICE Dodgy science behind irresponsible Public Health England app that is urging millions of healthy people to go to their GP for a cholesterol check. There are 8.7 million people in the UK in their 30s. This PHE "heart age" tool seems to be incorrectly telling them ALL to go to their GP to get their cholesterol checked. If only one in 100 do so, that's 87,000 pointless GP consultations

  • Following the Money: Performance trumps transformation A patchy (£) HSJ update on STPs based on a survey with only half of STPs responding, but pretty much echoes findings of a May 2017 survey of all 44 schemes - available (free) at https://healthcampaignstogether.com/pdf/sustainability-and-transformation-plans-critical-review.pdf

  • Patients come clean: 'We have gone to A&E because we can't get a GP appointment' Service under strain, and a reminder that Staffordshire's NHS is still facing massive problems more than a decade after Mid Staffs. Local Sentinel reports "A whopping 23,044 patients went to the Royal Stoke University Hospital's A&E in just ONE month".

  • Focus on: People with mental ill health and hospital use Important report from Quality Watch

  • Revealed: Hundreds of children wait more than a year for specialist help A (£) HSJ reminder of the broken promises to improve CAMHS services.

  • Hospital A&E doctor shifts unstaffed BBC report on crisis in the capital's hospitals

  • Social care needs for over-85s predicted to double in next 20 years Guardian article highlighting new research published in Lancet Public Health with grim warnings for our complacent government:
    "Those who have dementia and at least two other major health conditions, such as obesity or diabetes, will double over the next two decades, it estimated, suggesting an extra 500,000 people will need complex forms of care.
    "The study said health and social care services must adapt to the unprecedented needs of an older population with complex care needs, and warned the state should not rely on family carers as a sustainable solution to the problem."

  • Adult social care services on brink of collapse, survey shows This Guardian article by Patrick Butler appeared in June but supplies background to the latest warnings on the crisis in social care.

  • NHS bosses urge hospitals to send patients to private firms Guardian correspondent Denis Campbell's article quotes NHS Providers' CEO Chris Hopson warning against short sighted referrals to private hospitals:
    "As well as wasting taxpayers’ money it could also further de-stablise the provider sector’s already challenged finances.”
    It also quotes Jonathan Ashworth, Labour’s shadow health secretary, warning of a “bonanza for the private sector”.

  • Dozens more maternity failings exposed at scandal hit trust Most recent of the three latest stories in the (£) HSJ on the clinical and managerial failings in this trust which has focused all its energies on reconfiguration and downgrading one hospital.

  • Nurses walk away from ‘unsustainable’ A&E amid safety fears The first of the series of revelations in the (£) HSJ of the scale of the crisis created by management at Shrewsbury & Telford Hospitals who clearly won't listen to patients, campaigners or staff. Just imagine how much worse this would be after the staffing cuts proposed in their so-called "Future Fit" reconfiguration.

  • The true privatisation of general practice Pulse Editor Jaimie Kafash warns of the implications of the GP at Hand approach for the future and the danger of a massive extension of privatisation:
    "now other private providers are looking to partner with GP practices, offering video consultations or symptom-checkers in a bid to improve services to patients and give them a competitive advantage over neighbouring practices – with, of course, benefits for the companies themselves.
    "So what is the problem with this? Putting aside the lack of evidence for increased use of technology, we need to ask whether we want a private sector philosophy. Innovation is great and should be rewarded – but in the context of improving patient care, not having the best-targeted marketing campaign or aggressively registering those patients who provide the best profit margins."

  • The online providers disrupting the market An in depth article in Pulse magazine exploring the growth and impact of GP at Hand, noting its targeting of 20-39-year-olds and efforts to cherry pick patients, the disruption of other comprehensive GP services, the financial impact on the local CCG and potential £18m cost, etc. Important reading.

  • India is introducing free health care—for 500 million people Newsweek article showing the latest moves by India's right wing Modi government to funnel billions into private hospitals rather than develop a public health care system -- but still adopting a more progressive policy than Trump in the US.

  • CQC warning amid claim hospital patients treated like 'cattle' Second of a number of excellent (£) HSJ articles pointing to the gathering crisis at Shrewsbury & Telford Hospitals Trust -- which confirm campaigners fears the management hell-bent of driving through half-baked "reconfiguration" to downgrade one of the two hospitals have allowed services to decline to crisis levels with grim echoes of the Mid Staffs crisis over 10 years ago.

  • NHS bosses launch urgent drive to address ‘significant under delivery of elective activity' Despite this relatively bland (£) HSJ headline, the article flags up the nonsensical plan to address the lack of adequate funding and capacity in the NHS … by sending more patients for treatment (almost certainly by the same consultants) in the private sector:
    Note that the plans originate from NHS England national director Matthew Swindells, who was a £195,000 a year DoH policy advisor to Blairite Patricia Hewitt 2005-7, before moving to lucrative private sector posts with Tribal and Cerner, before returning to the NHS. By contrast the HSJ reports:
    "NHS Providers warned a significant private sector drive could “destablise” cash-strapped trusts and would simply mean “taxpayers paying a premium rate for an NHS surgeon to do a procedure that most could be doing at an NHS trust”.

  • Where is Greater Manchester's transformation? (£) HSJ article asks the necessary sharp questions about why the much vaunted Manchester plans have gone so wrong:
    "With the help of a £450m transformation fund – a level of investment which other health economies would love to get their hands on – the region has set about trying to reduce demand for acute services, particularly non-electives.
    "But since the start of the devolution deal in 2016-17, when the five-year transformation funding started kicking in, the trendline has shot up in the wrong direction."

  • Wigan NHS boss: Chorley A&E closure would impact us The chief exec who branded strikers fighting to remain in the NHS as 'lazy scumbags' a few months ago has finally been obliged to say something useful, pointing out the potential knock-on effects if plans to axe Chorley's A&E go ahead.

  • Trust paid interim manager £311,000 for six months work (£ HSJ) All the NHS staff still languishing below 2010 levels of pay will no doubt feel a warm glow of satisfaction to know that at least one (freelance) NHS manager is doing very nicely moving from a job at just £47k per month to one paying just as much, then taking a bit of a reduction to £400k a year before hitting the big money at East Sussex Healthcare Trust. His only problem? Little scope to go higher … or is there?

  • Plackard’s success factors for success A welcome blast of well-aimed and very amusing satire and parody here, highlighting the role of NHS England's "nuancing and obfuscation delivery team at Skipton House" and summing up with some comforting words: "we’re not merely preparing for the worst, but embracing it. That’s what we do in Blithering."

  • Why Doctors Are Warming to Medicare for All Good news in this article from Jacobin magazine on the positive gains by US campaigners.

  • Superpractice to have 380,000 patients following eight-practice takeover "Super" used in the sense of "big" rather than any description of the quality of care in a practice so huge, where continuity of care is almost impossible. Questionable claims are made that this will mean more patients can see a GP, when there are no extra doctors and no extra hours being worked. It may be big, but it's not primary care.

  • Lobby Calls for a Full Public Consultation into the Downgrading of the Leicester General Campaigners give more detail on the fight to defend Leicester's hospital services against cash-driven cuts.

  • Plans to 'downgrade' Leicester General Hospital 'need full public consultation' says report Local press report: "Campaigners say they have serious concerns about a £31 million NHS plan to move intensive care beds off the Leicester General Hospital site."

  • Russian trolls 'spreading discord' over vaccine safety online Fake news machine plays on plentiful ignorance in Trump territory -- but also in Europe and other countries where religious fundamentalism fuels "anti-vax" backlash against proven medicine.

  • NHI will ensure universal healthcare for all South Africans: Ramaphosa Hopefully this is a good news story after so many false hopes have been raised in recent years that South Africa would eventually move beyond the old heavily privatised health care from apartheid days to establish universal health coverage.

  • Life-Threatening Heart Attack Leaves Teacher With $108,951 Bill Yet another horror story of everyday US commercial medicine. Teacher was billed twice his salary in addition to the insurance payout for treatment after his heart attack. The total bill was $164,941 for a four-day hospital stay, including $42,944 for four stents and $10,920 for room charges. Calver's insurer paid $55,840.

  • Carillion was ‘akin to a Ponzi scheme’, says top auditor Telegraph report reveals the UK’s longest-ever serving auditor general, Sir John Bourn was “angry and disappointed” when the troubled construction and outsourcing giant collapsed in January.

  • Revealed: Shropdoc cutting services in three Shropshire towns Local news report: "Staff at Shropdoc, which provides out-of-hours emergency care, were told that sites at Oswestry and Bridgnorth will be shut and operational hours cut at Whitchurch." Part of wider cash-cutting programme in Shropshire

  • Stroke Care at SaTH Letter to bosses in Shropshire, Telford and Wrekin questioning the evidence for and safety of proposals to "centralise" stroke care, especially given logistics of the rural area.

  • Radical overhaul of GP Forward View - and billions more investment - needed to protect general practice and patient safety, says RCGP Press release from RCGP report assessing current situation of primary care.

  • Urgent care centre at King George Hospital in Goodmayes placed in special measures after inspection The unit is run by "independent" contractors, the Partnership of East London Cooperatives (PELC). "Inspectors found the EUCC’s clinical streaming process, where patients are initially assessed by a nurse or ‘streamed’ did not safely assess, monitor or manage risks to patients.
    "Of particular concern was that none of the initial checks, nor any of the forms that needed to be filled out, included establishing whether or not the patient was suffering from sepsis."

  • Nurses at Providence Hospital in Holyoke hold August 9 protest against patient care cuts by “wildly profitable” Trinity Health Another shocking insight into commercial health care in the US. One nurse sums up in her comment: “Imagine if your child needed specialized psychiatric care to feel better and they couldn’t get it because a giant corporation made a business decision instead of following its non-profit mission.”

  • Department of Health and Social Care Annual Report and Accounts 2017-18 Interesting not only for the continued overall surplus, but also for figures on page 199, showing spending on all "non-NHS providers" up 3% in cash terms to £13.1bn (but unchanged at 10.9% of total spending). However spending on "private sector" down 0.4% as a share of Department spending (to 7.3%), and spending on "independent sector providers" [for profit] DOWN 2.7% from 2016/17 (to a still unacceptable £8.8bn).

  • Thousands of mental health patients travel miles for treatment In the 12 months to May 2018, adult patients with acute mental health needs were sent on out of area placements due to a lack of local beds 8,285 times, despite Government pledges to eliminate the practice. Many are being sent long distances – with journeys as long as 300km or more: to make matters worse figures in May revealed that around 80% of all the facilities that received a patient who had been sent away by their local NHS were private hospitals. According to PA, patients from Devon have been sent to a private hospital in Darlington for treatment.

  • Campaigners win permission to appeal – leaving NHS England’s consultation making bogus claims on legal status The campaign group 999 call for the NHS has won permission to appeal against the rejection of their judicial review back in April. Until the appeal is heard NHS England's consultation proposals stand on shaky and uncertain legal ground.

  • Suggested lines for summary answers to consultation questions For those who want to answer NHS England's questions, a few suggestions.

  • Ask a silly question … The NHS England approach is not the way to conduct a serious consultation on this issue. For most campaigners, health workers and informed members of the public the fundamental response is “we wouldn’t have started from here”.

  • Going through the motions of consultation The NHS England "consultation" -- 4 weeks in the depth of holiday season, 4 meetings all in mid September, a densely-written 40-page document.

  • It's integration, Jim, but not as we know it Five articles on the NHS England consultation on the proposed contract for Integrated Care providers

  • NHS England choose school holidays to launch consultation The NHS England consultation - timed and organised to minimise participation

  • No redundancies expected in Future Fit shake-up - health bosses Spin from Shropshire health bosses claiming “There will be a ‘small’ reduction in staff at the trust running Shropshire's two main hospitals under the #FutureFit plans.” Campaigner Gill George responds: "Trouble is, their own figures show 842 fewer hospital staff, including 1 in 5 nursing posts. So what goes on??"

  • Kaiser family Foundation 2017 Employer Health Benefits Survey Report on US health insurance reveals the average family premium for employer-sponsored insurance is up 55% since 2007, average worker contributions up 74%.

  • Closing five Emergency Departments in England between 2009 and 2011: the closED controlled interrupted time-series analysis The Sheffield University report on A&E closures

  • New study busts myths on A&E closure debate (£) HSJ article on the widely-quoted 200-page+ report which the mainstream press has claimed shows lives may not be lost when A&E services are "centralised". However one comment points out: "The study found no increase in patient deaths due to ED closures. HOWEVER, with near neighbours only ~4 mins added to 999 response times. EDs now tagged for closure are up to 30 mins away from next nearest hospital. Tell me that won't make a difference!
    Study found MORE problems en-route even with just 5 min increase in transfer time. Studies from Australia and Canada show longer conveyance times to hospitals = pt deaths."

  • Patients given 30 minutes to QUIT care home [Doncaster] Another symptom of the care home crisis.

  • Agreement finally reached to complete the construction of the Midland Metropolitan Hospital Local campaigners comment: "It looks like we've won our campaign for a publicly-funded (non-PFI) Midland Met Hospital in Smethwick/West Birmingham! (Note that a number of people pictured in the press article here originally opposed our position). A very cautious welcome to this news as it's a long time till 2022, but we will keep you updated. "

  • Government promises £300m funding for Carillion hospital Campaigners' demand for public funding of the new Midland Metropolitan Hospital in Smethwick is met – but only after ridiculous efforts to re-float failed PFI have failed. (£) HSJ article

  • Nurses quit NHS to work in Lidl because pay, hours and benefits better More indications of the growing staffing crisis in the NHS

  • Court of Appeal grants NHS campaign group permission to appeal against NHS England’s new Integrated Care Provider contract Belated permission for 999 call for the NHS to challenge the proposals for ICPs in court.

  • HRI cleaners, gardeners and porters lose battle to keep full NHS status Heavy price paid for union branch failure to get sufficient numbers to vote in ballot that went 98% for action. Real threat of industrial action is key to forcing back employers.

  • A&E closures failing to boost patient care, study finds FT article stresses the critical findings of a recent lengthy research report – while the advocates of hospital closures cling on to the notion that death rates have not gone up, as many feared.
    In fact it's clear that there is inadequate data for many firm or far-reaching conclusions. But the argument for "centralising" A&E services has always revolved around claims that it would concentrate specialist expertise and result in better health care. These have always been contested by local campaigners, demanding evidence.
    If there was anything in the 200-page research report that supported that argument, we would have heard all about it by now!

  • Whatever happened to the STPs (in eastern England)? A round-up by HCT Editor John Lister completed for UNISON a couple of months ago, now available online, shows STPs -- once the great white hope of NHS England for getting round the Health & Social Care Act -- have been largely reduced to generalities, empty phrases, and 'alliances' of purchasers (CCGs) on the one side versus providers (trusts) on the other. The report finds no real evidence of integration of NHS services let alone 'integration' with cash strapped social care and increasingly sceptical local government.
    it gives six case studies from the STPs in East of England showing how an idea that might in theory have had some potential has -- in the hands of secretive NHS bureaucrats unwilling to consult or engage with staff or public – become so toxic among local communities that it has had to be re-branded twice since 2016.
    It raises the question of how far any of the 44 STPs have got, given the manifest weaknesses that have been identified with them – no serious business plans, no capital, no money to expand community health services, no workforce plans, no public support or legitimacy, and no legal standing .

  • Medic or not, Dr Bawa-Garba’s case affects us all Keep our NHS Public responds to the welcome court victory of Dr Hadiza Bawa-Garba who had been convicted of manslaughter and struck off the medical register by the GMC following the tragic death of Jack Adcock, a six-year-old boy in her care. She was a junior doctor without proper supervision in an under-staffed and busy unit, with IT systems down for hours -- and she was hung out to dry while the senior management who should have been held at least jointly responsible have escaped censure and dysfunctional, under-funded systems in many hospitals could produce the same failures again.

  • Dr Hadiza Bawa-Garba wins landmark appeal against being struck off Another brilliant victory announced today after a long and often bitter campaign by junior doctors with support from some of the best consultants. Report from GP Online, with links to other background.

  • Midland Metropolitan hospital scraps plans to retender collapsed PFI contract The new hospital for North Birmingham and Sandwell that was left in limbo, only two thirds complete, when contractors Carillion went broke in January is to be completed using public funds, and attempts to retender a fresh PFI project have been abandoned. Even management consultants Deloitte now advise that PFI (PPP) would be more expensive:
    "Analysis by Deloitte, commissioned by the Trust, concluded that the hospital would cost £319 million to complete with standard public sector procurement, and £424 million if completed under a new PPP contract. The increase is due to the increase in risk for a contractor under a PPP contract."
    The total cost of this massively botched contract has yet to be revealed. The initial PFI contract was supposed to complete the hospital for £335m.

  • A Picture of Health No not a re-run of the disastrous plans to cut and "reconfigure" hospital services in SE London, but a new Fabian pamphlet for the NHS 70th Birthday, edited by Jon Ashworth, shadow health & care secretary, including a chapter on privatisation by Health Campaigns Together.

  • Dangerous liaisons: why syphilis and gonorrhoea have returned to haunt Britain The horrific knock-on effect of massive cuts in public health and sexual health budgets combined with contracting out and drive for lowest cost services.

  • Referral restriction plan 'puts patients at risk of opiate addiction' (£) HSJ article based on plans hatched up by Sussex CCGs, under which:
    "Patients would have to endure “uncontrolled, intense, persistent” pain which substantially affects their daily life for six months before being routinely referred for a hip replacement, in a policy being considered by the seven CCGs in Sussex.
    "If adopted, the policy would mean patients are expected to have taken painkillers including opioids, had physiotherapy, and tried to lose weight, if necessary, for six months before referral for surgery."
    Further evidence of the threat posed by NHS England's plans to restrict access to care as headlined in the latest (#11) Health Campaigns Together newspaper.

  • Where is the American "great middle"? “Medicare for All has 54% support in the median state. Even in the state with the lowest support, Wyoming, 45% support the policy,” said McElwee. “There are only eight states where Medicare for All doesn’t hit majority support, and that’s including ‘don’t knows’ in the equation (as not in support). If Medicare for All were on the ballot, it would win an electoral college landslide on par with Lyndon Johnson.”

  • Patients Not Passports A toolkit from Docs Not Cops designed to support you in advocating for people facing charges for NHS care, and in taking action to end immigration checks and upfront charging in the NHS

  • As an NHS doctor, this ‘hostile environment' has made me reject my medal Guardian piece by one of the growing number of NHS staff awared medals for their work combating Ebola in Africa who are handing them back in protest at the government's "hostile enivironment" to migrants which denies them access to free NHS care.

  • Supporting Primary Care Services: NHS England’s contract with Capita The Public Accounts Committee report in full

  • NHS England contract with Capita a 'shambles' that risked serious harm to patients, MPs say MPs finally get to spell out the scale of the failure of NHS England's contract with serial failures Capita. Trouble is NHS England is supposed to be supervising contracting for services by 200+ CCGs, each of which is at least as incompetent as NHS England. The market system itself is deeply flawed, a costly way of ensuring a succession of dysfunctional failures. Time to sweep away market, competition, tendering and privatisation, and reinstate the NHS as a public service, publicly provided.

  • NewYork-Presbyterian ignores critics in plan to close behavioral health unit Another side of commercialised health care in the USA. "Doctors and students, who have taken the lead in protesting the closure [of this mental health unit], charge that NewYork-Presbyterian is simply seeking to replace the uninsured and underinsured patients with those who have better insurance in pursuit of higher-paying specialty services. And the closures come, critics say, as New York City faces dwindling capacity to administer to behavioral health patients."

  • The fight to save Chesterfield hospital Campaign to stop NHS jobs being outsourced from Chesterfield Royal Hospital Foundation

  • 'Fantasy' trust debts overtake PFI liabilities (£) HSJ report reveals that "NHS providers owed the DHSC more than £11bn at the end of 2017-18, up from £8.1bn", while "experts say there is no hope of debts being repaid."
    "The figures reflect the fact that dozens of trusts are struggling to maintain adequate cash levels due to their recurring income and expenditure deficits, and have become reliant on interest bearing loans from the DHSC to pay staff and suppliers."

  • UK private hospitals suffer as NHS brings work back in house Predictable result of trusts facing greater pressure to balance books than to meet performance (waiting time) targets. Tory spending squeeze undermining the NHS. Fewer NHS funded private patients, while new restrictions on elective treatments could push more patients to seek treatment by paying privately.

  • Number of NHS beds for mental health patients slumps by 30% The Guardian reveals the growing gap between government rhetoric and reality on resources for mental health

  • NHS body ‘wastes millions on flawed financial advice’ Guardian makes good use of campaigners' data and experience over 6 years. North West London Clinical Commissioning Group under fire for massive waste of money on flawed management consultants’ advice.

  • Biggest rise in UK poverty since Margaret Thatcher was in power, experts claim Amid pointless NHS England prattle about improving health for all, inequalities -- and with them health inequalities -- are being massively widened by a variety of measures imposed by a reactionary government.

  • One Year After Senate Defeated Trump’s Healthcare Repeal, Majority of Voters Oppose Republican Repealers Some good news for Americans battling against Trump's efforts to break up what remains of limited Obamacare extension of insurance cover.

  • Jeremy Corbyn: One A&E in Shropshire is not enough Explicit support for campaigners from Jeremy Corbyn in opposition to disastrous "Future Fit" proposals

  • Unions hope to defeat hospital staff transfers as Leeds NHS trust puts private company move on hold Promising signs that unions in Leeds are following on successful strikes at Wigan Wrightington & Leigh by putting more trusts under pressure to drop planned "subco" privatisation.

  • Hillingdon Hospital ranked 'inadequate' by CQC inspectors after some major services decline After 6 years of obsessive NW London commissioner focus on closing Ealing and Charing Cross Hospitals, after axing A&E at Central Middlesex and Hammersmith, the decline in other parts of NW London hits the headlines.

  • Health technology and the modern inverse care law FREE BMJ blog by Margaret McCartney concludes that " We need system change: every new policy must be interrogated for evidence of benefit and harm, opportunity cost, and the potential to benefit—or worsen—health inequalities."

  • NCDs—it’s time to embrace the evidence, not industry FREE access BMJ blog - revealing the extent to which WHO action to address noncommunicable disease (NCD) has been stymied by the involvement of "partners" industries that are part of the problem: “There was broad agreement in most areas, but some views were conflicting and could not be resolved. As such, some recommendations, such as reducing sugar consumption through effective taxation on sugar-sweetened beverages and the accountability of the private sector, could not be reflected in this report.”

  • Rival bidder planned 340 more staff for controversial Capita contract Exclusive from (£) HSJ reveals that Capita's £47m bid undercut rival bids for the primary care support services in 2015 … by planning to use half the number of staff -- triggering the subsequent chaos as the contract went wrong for lack of staff! Short term cuts damage quality and create long term costs and damage.

  • Local news hype of robotic surgery doesn’t match many hysterectomy patients’ experiences Exposure and condemnation of junk journalism in the US from a health journalist and a website that have been battling to raise standards. That resource is threatened by loss of funding -- and we don't even have an equivalent in Britain.

  • It’s 4 A.M. The Baby’s Coming. But the Hospital Is 100 Miles Away NY Times article indicating scale or rural hospital cuts and closures in the US -- services concentrating in cities to maximise profits.

  • Colorado health system sues patient over $229K surgery bill, jury awards $766 Another insight into the dysfunctional US health care "system".

  • Dark money lurks at the heart of our political crisis Guardian article by George Monbiot lifts the lid on the funding behind neoliberal organisations like the IEA, generous sponsors of our new Health Secretary Matt Hancock

  • Hospital parking giant condemned for ‘cashing in on the sick’ as profits surge Paying the price of living in England: car parking fees scrapped by Welsh Assembly years ago.

  • Safe Medical Staffing New research report from Royal College of Physicians gives hard evidence to back up fight for increased staffing of NHS services

  • Mental health crisis resolution teams and crisis care systems in England: a national survey Recent (May2018) academic paper comparing 2016 figures with earlier data. Its rather cagey findings show that “current implementation of the CRT model is highly variable. Almost no adult CRTs adhere fully to the model recommended in policy guidance. This is consistent with the findings from previous surveys.”

  • Boston, Lincolnshire councillors declare no confidence in local hospital management The battle over the future of services at Boston's Pilgrim Hospital hits the front page of the local Target newspaper: services could close on August 1

  • Hancock received £28k from chair of group advocating NHS insurance system Pulse magazine lifts the lid on the dodgy past of the new Health Secretary. Apparently, however, according a quote given to Pulse, "The Department of Health and Social Care told Pulse that Mr Hancock is absolutely committed to an NHS free at the point of use with no plans to reform the health service." We can hope, but let's get ready in case this is, as many fear, wide of the mark.

  • May's extra cash for NHS is not enough, says spending watchdog The National Audit Office comptroller Sir Amyas Morse gives the Guardian a forthright critique of government levels of funding the the NHS, with some intersting graphs.

  • Evidence-Based Interventions: Consultation Document The actual consultation document setting out plans for rationing and exclusions of services: the consultation runs to September.

  • Developing the NHS long term plan: evidence based interventions Board paper from NHS England which opens up consultation on restricting or ending NHS funding for access to 17 specific treatments -- but also proposes to move rapidly beyond this to a much more wide-ranging list of exclusions

  • Amazon makes big foray into health care Bloomberg report flags up Amazon's attempts to carve out a slice of the colossal U.S. market for prescription medicine. In 2016, U.S. consumers spent $328.6 billion on retail prescription drugs, according to the U.S. government.

  • Major Sunderland reconfiguration aims to ease financial pressure Even while ministers claim to be putting extra money in the pot, management are seeking ways to cut back services to save money. From (£) HSJ.

  • Apps and algorithms may 'support but will never replace' GPs, says RCGP RCGP press release in response to claims the Babylon app with AI 'outperformed' GPs, based on a flawed and biased test.

  • Fears of future strain on NHS as councils slash health programmes Cuts in public health budgets and services as ministers claim to be increasing spending and NHS England binds on endlessly about prevention and "integration".

  • BETTER HEALTH AND CARE FOR ALL: A 10-POINT PLAN FOR THE 2020s Surgeon Lord 'Polyclinics' Darzi sets out to enrage GPs once again by making a series of proposals that would include making them salaried employees. Published by the once 'left'-leaning IPPR.

  • Lord Darzi - All GP partners should be offered salaried NHS employment Pulse magazine reports a less than enthusiastic response to the latest ideas of the surgeon who has never worked as a GP, but who as a new Labour minister tried to sell us costly and impractical "polyclinics" from 2007.

  • Hammond 'ordered NHS chief to back health funding plan' Guardian fills in the back story on why Simon Stevens apparently changed tack to welcome a settlement well below the minimum he had been pressing for.

  • Fury over week-long trial to take Kidderminster patients to the Alex Latest twist in developing crisis of health services in Worcestershire

  • Targets under review and NHS legislation open to change - PM (£) Paywalled HSJ article updates on apparent Tory moves towards new legislation to unpick some of the 2012 Lansley "reforms" that have dislocated, fragmented and privatised services. Seems as if Tories are wanting to claim that any fresh legislation is at request of NHS -- while manipulating Stevens to follow their script on funding.

  • £20 billion funding boost still falls short, GPs warn GP online adds more weight to those challenging the adequacy of the belated Tory response to the crisis their spending squeeze has created.

  • 100 senior NHS doctors, nurses and academics sign open letter to Theresa May Letter coordinated by Peoples Assembly, Health Campaigns Together and Keep Our NHS Public wins 100 signatures at short notice from consultants, GPs health academics and nurses.

  • May under pressure to explain £20bn NHS funding plan Sky News shows the BBC how it could be done better

  • Sky’s NHS at 70: seventy defining moments Worth a watch

  • One fifth of Babylon NHS patients 'switched back to original GP' Encouraging news from Pulse for anyone concerned at the apparent runaway growth of this latest private sector wheeze from former Circle boss Ali Parsa.

  • Trust with worst financial performance aims for £156m deficit this year (£) HSJ update, revealing Kings College Hospital is aiming to hold deficit at a staggering £156m this year, after coming in £132m in the red in 2017-18 – almost £100m worse than planned, and now still negotiating on a "control total" with NHS England.

  • Decision over Carillion Hospital 'in autumn' as costs soar (£) HSJ article reveals the cost of finishing the hospital which has been at a standstill, with the part-completed fabric of the building deteriorated in poor weather since Carillion collapsed will run into tens of millions.

  • Over 40 Worcestershire acute beds not ready by winter Still the misery continues for Worcestershire patients: despite an extra £8m to provide more beds, Worcestershire Acute Hospitals trust says the two extra wards of acute beds will not be ready until the end of January.

  • The Trump administration believes Obamacare’s preexisting conditions protections are now unconstitutional Yes, Trump has now taken aim at the most popular aspect of Obamacare, which stripped insurers of the right to deny coverage to people with pre-existing health issues

  • Vultures Circle on America's Rural Hospitals Report revealing an increasingly brutal environment for America's rural hospitals, which are disappearing by the dozens amid declining populations, economic troubles, corporate consolidation and, sometimes, self-inflicted wounds.

  • '600 practices will close’ without funding boost, warns BMA Grim warnings on primary care, from Pulse magazine

  • Is this the year the AMA finally joins the single-payer movement? US doctors' campaign Physicians for a National Health Program looks forward to a historic turning point for the American Medical Association, in recent decades a bedrock of the private US health care system.

  • Jeremy Hunt admits he is ‘struggling to deliver’ 5,000 GPs by 2020 Is anyone genuinely surprised that this promise has turned out to be worthless?

  • NHS 'Struggling To Keep Up' As It Holds On To Thousands Of Fax Machines Labour's Jon Ashworth highlights the 11,000 fax machines that still chug away in today's NHS

  • Links for Unite members to book travel to join the massive June 30 #OurNHS70 demo on London

  • US Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind More evidence of the eye-watering expense of health care in the US

  • Paediatric outcomes and timing of admission Free to access BMJ meta-study of research concludes, contrary to Mr J. Hunt's assertions, that "weekend admission overall does not increase mortality but may be associated with a longer length of stay and, in certain conditions, with greater morbidity."

  • Record high for out-of-area beds BMA analysis shows big increase in numbers of mental health patients forces to travel long distances form in-patient treatment

  • Decision over Carillion Hospital 'in autumn' as costs soar Crumbling icomplete new hospital faces further delays and costs after collapse of PFI contractor Carillion: now best hope is for completion 2022. (link to £ hsj.com)

  • Over 40 Worcestershire acute beds not ready by winter Promised extra Worcester winter pressures beds for 2018-19 will not be in place in time despite extra £8m funding

  • Statement: Local Politicians betray the NHS Shropshire campaigners slam "hypocritical" rebranding of local health bosses' efforts to push through hospital rationalisation

  • RCEM Winter Flow report on NHS performance last winter More hard hitting figures from the Royal College of Emergency Medicine

  • Number of patients readmitted to hospital rises to 1.38m in a year Evidence of the inefficiency, ineffectiveness and distortions created by 8 years of under-funding. And note few if any of these patients would have any chance of accessing private treatment if existing NHS services collapse.

  • The NHS doesn’t need £2,000 from each household to survive. It’s fake maths Guardian comment piece challenges the blinkered IFS findings -- and implicitly the uncritical Guardian and mainstream media coverage of their report.

  • Winter 2017/18: the worst ever for the NHS? Analysis from the Nuffield Trust

  • Hundreds of patients quit inadequate Virgin practice Yet another tale of private sector failure, this time from the media's favourite entrepreneur, revealed by GP Online magazine. Important to keep track of failures as well as the contracts won by private firms.

  • Row as CCG fines overwhelmed Stoke on Trent hospital, The £9.2m penalties come on top of losses of £5m income from the patients who could not be admitted for lack of beds. The UH North Midland trust as deficit for 2017/18 was £69m.

  • Online link to latest NHS England statistics Data on waiting times, A&E caseload, bed numbers, delayed transfers of care, etc, free to download.

  • Securing the future: funding health and social care to the 2030s Key report from IFS and health Foundation arguing NHS needs 3.3% increase each year to stand still, 4% a year to improve, in addition to more funding for social care. However the report is seriously hampered by the narrow vision of the authors on where to raise this money through taxation -- apparently ruling out any progressive taxation on the banks and big business, and suggesting a £2,000 hike in taxation on ordinary households over 15 years. But some very useful figures.

  • Rethinking assumptions about delivery of healthcare: implications for universal health coverage Free access article from BMJ

  • Advanced health economies reject control totals The front runners to become "Integrated care Systems" reveal that they are nowhere near "integrated" when it comes to settling deficits, and point out that the risk in accepting "control totals" is greater than the reward. Interesting (£) HSJ report.

  • NHS Community Services - Taking Centre Stage 64-page report on the state of community health services, from NHS Providers. Shows among other things (p16-17) that with just 5% of value of contracts, the private sector holds 39% of individual contracts for community services: "These findings show that while private providers generally hold a large number of low value contracts, NHS trusts hold the relatively small number of high value contracts."

  • Visa restrictions and medical staffing: a perfect storm Excellent challenge to racist laws which prevent recruitment of overseas staff and refuse visas to those already offered posts or training here, from Doctors for the NHS

  • Cancer patient waited 541 days for NHS treatment, report says Guardian's denis Campbell with some grim reminders of the extent to which NHS resources -- beds, staff, cash -- have been depleted by 8 years of frozen funding.

  • Health bosses reveal key NHS services at Darlington, North Tees and James Cook hospitals will be retained Another retreat from controversial downgrading and closures, another victory for common sense and for campaigners who have battled hard to get dangerous and impractical plans dropped.

  • Trump threatens to use US trade talks to force NHS to pay more for drugs Trump and his team bizarrely denounce Britain's "socialised" health system for forcing down the prices of drugs, while successive US Republican administrations have intervened to stop Americans buying cheaper drugs from Canada. GOP is funded and relies on lobby support from health insurers and big pharma. Trump might bully Theresa May into increased prices to be paid by NHS -- but none of this would reduce inflated costs facing Americans, driven by the "medical industrial complex".

  • NHS spending £1.5bn a year on temporary nurses as staff leave in droves, study reveals Independent points to Open University study based on FOI requests.

  • NHS has lost 1,000 GPs since Jeremy Hunt set workforce target Excellent but frightening update from Pulse magazine.
    The figures released by NHS Digital on May 15 reveal that the number of Full Time Equivalent GPs in the workforce has decreased more than 1,000 since September 2015 - when health secretary Jeremy Hunt announced he would increase the number of FTE GPs in England by 5,000. 315 have left in the last 3 months alone.

  • Mapping the NHS winter - Our reflections and next steps NHS Providers, in this latest report drawing conclusions from the crisis conditions in hospitals and health services during the last two winters, makes no overt mention of the plans drawn up in STPs and reconfiguration projects to reduce numbers of acute beds still further.
    But they do say "We cannot continue to be unrealistic about the levels of demand the NHS is experiencing and must have a feasible and deliverable task for the NHS set out by the national oversight bodies."
    This tacit admission that plans up to now HAVE been unrealistic and based on unrealistic assumptions and aspirations is welcome, as long as it means the plans based on this approach are being dropped. So far there is little sign of this being agreed by local trusts and CCGs.

  • Outgoing Chief Executive of Greater Manchester Mental Health Trust: ‘The underfunding of the NHS is almost conspiratorial’ Guardian interview highlighting the need for genuine integration of NHS and social care services for mental health patients, and the impact of austerity on the NHS since 2010.

  • A fork in the road: Next steps for social care funding reform Plenty of useful information in this joint report between the Health Foundation and the Kings Fund, which highlights low public awareness of social care and a lack of agreement on priorities for reform as major barriers to progress, despite apparent political consensus on the need for urgent action.
    It argues that reforming the current system will be expensive, but states that if reform is chosen, England is now at a clear ‘fork in the road’ with a choice between "a better means-tested system" and one that is "more like the NHS" -- free at the point of use for those who need it.
    So nothing new here, but an advanced example of googling that might save you some work.

  • The adult social care workforce in England Hard hitting report from the Commons Public Accounts Committee reveals that care workers are leaving the profession due to crippling low pay - and the Government has done nothing.

  • Jeremy Hunt says 'reconsider' Calderdale and Huddersfield hospitals shake-up Yorkshire Post article revealing the big retreat by Hunt on a major and controversial hospital reconfiguration

  • Hammond and Hunt in battle over NHS funding boost Guardian flags up another division in Theresa May's government -- over how little extra to give the NHS after 8 years of real terms freeze on spending and a growing gap between needs and resources.

  • Spending on and availability of health care resources: how does the UK compare to other countries? King's Fund catches up with those of us who have been pointing out for years that the spending freeze since 2010 has helped reduce Britain's NHS to near the bottom of the league for resources -- and bottom of the heap for CT and MRI scanner availability.

  • Private hospitals’ business model is archaic, unsafe and indefensible More analysis from CHPI's Colin Leys exposing the many weaknesses in Britain's private hospitals.

  • NHS Providers - Mapping the NHS Winter Hard data and responses to the even deeper crisis in hospital services over the 2017/18 winter, as NHS Providers keep up their pressure on the government,

  • GP at Hand CCG likely to receive NHS England bailout as costs soar by £18m Staggering extra costs of a scheme which is destabilising primary care, but delivering highly questionable results, primarily offering additional care to those with the fewest health needs, at the expense of more complex patiients.

  • NHS Improvement director should stand down (£) HSJ's Lawrence Dunhill reports on the devastating findings of a Grant Thornton review of the finances of Barking Havering & Redbridge University Hospitals Trust, which has lurched from a projected £1m surplus to a £44m deficit (available on BHRUT website) -- and calls for the person responsible to resign from NHS Improvement's London team, where he was promoted!

  • Government will halt NHS datasharing with Home Office except for serious crime Campaigning pays off, even as other racist measures including charges for overseas patients remain intact: a statement here from Dr Tim Dudderidge, President of Doctors of the World.

  • Private £39 GP Service to be installed in NHS Hospital in a further sign of creeping Tory NHS Privatisation Alarming news on the growing fragmentation and privatisation of primary care services

  • Senior hospital directors resign as Lancashire's NHS goes £42m into the red Some managers appear to have recognised their own responsibility for the dire conditions faced by staff and patients.

  • Countries' comparative spending on health, Public and private spending, 2016, in US dollars

  • Hunt's car pelted with flour in Stroud Jeremy Hunt's latest expedition to avoid the natives -- a cross between a visit and the Great British Bake Off

  • Bridgepoint explores sale of UK’s biggest NHS outsourcer FT reveals that Care UK is poised to be broken up and flogged off after failing to generate adequate profits to satisfy its grasping owners Bridgepoint (whose well-known names include former Labour Health Secretary Alan Milburn).

  • Brexit blamed as record number of EU nurses give up on Britain Guardian gives latest figures as NHS England and NHS Improvement keep their heads in the sand denying scale of recruitment & retention crisis.

  • GP practices face funding threat as online service ‘targets’ young people Update blog from Dr David Wrigley for Our NHS/Open Democracy on the latest wheeze to substitute apps for care.

  • Homes of elderly should be used to fund social care, NHS head says Simon Stevens dredges up the key proposals of the discredited Griffiths Report of 1988, which from 1993 transferred long term care from NHS (free at point of use) to local govt social services (means tested charges). This was the launch point for massive privatisation, fragmentation, underfunding and chaos in domiciliary care (destruction of Home Help services) and expansion of poor quality privately provided nursing home/residential care. We need to break from this, not revisit the same nonsense.

  • A separate NHS tax would only further its fragmentation Guardian piece by Green MP Caroline Lucas nails the hoary old zombie idea as it creeps out again, stirred back into BBC and right wing headlines by Blairites and others with no real concept of the NHS and its value.

  • Care for 13,000 Britons at risk as provider seeks rescue plan Guardian report on the latest social care provider struggling to survive after a decade of cuts.

  • Time to put care into the system Online facts and figures on the melt-down of England's social care system from Which magazine.

  • Short report on private contracting Handy summaries from NHS for Sale website (NHS Support Federation)

  • A Dedicated Tax to fund the NHS -- A zombie idea John Appleby demolishes the flimsy arguments that are again being wheeled out for some form of hypothecated tax to fill in the gaps in NHS funding created by the 8-year real terms freeze since 2010.

  • No one to look after them Roy Lilley tears into the scandalous treatment of the Windrush generation -- and the dire lack of any serious workforce planning in today's NHS.

  • Tough Task -- the latest updated warning on inadequate resources from NHS Providers A hard-hitting report from the body representing NHS trusts explaining why the gap between the best-performing and most challenged hospital trusts is growing wider, and the gap between official promises of NHS performance and actual services is constantly growing.

  • Realism needed over delivery task for providers NHS Providers, representing trusts, responds to the warning from NHS Improvement that their plans have been unrealistic.

  • NHS spends as little as £2.61 per day on patient food Daily Mirror report reveals 13 hospitals spent less than £5 a day; average spend was just £11 per day on food for patients on hospital wards.

  • NHS and council staff in a new care model 'vanguard' in Greater Manchester have voted for strike action. (£) HSJ article based on UNISON press statement.
    "Unison, which represents 230 council and NHS staff involved in the Stockport Together vanguard, said the decision follows seven months of negotiations.
    "The industrial action will take place on 27 April. The union said 96 per cent of respondents to the ballot voted to strike.
    "HSJ revealed staff’s concerns in January, which presented further difficulties for a project that has already been scaled back from initial plans to form a single accountable care organisation.
    "The project partners – including Stockport Foundation Trust, Stockport Council and Stockport Clinical Commissioning Group – have instead focused on establishing integrated community teams working under an “alliance contract” between providers."
    Union members are concerned about a planned expansion of unqualified support workers, as well as a reduction to the availability of services during peak times.

  • Health Care Assistants doing nurses' duties Three quarters of HCAs are taking on tasks that should be carried out by qualified nurses, according to a UNISON report in the Guardian. A symptom of desperate efforts at cost saving while bridging huge gaps in staffing.

  • NHS Improvement chief: Trust plans are unrealistic and unachievable Article in the (£) HSJ by Lawrence Dunhill, begins:
    "NHS Improvement has told providers their activity, workforce and financlal plans for the
    new financial year do not look realistic or achievable."
    In an email to the sector on April 18, NHSl chief executive Ian Dalton said plans submitted by some trusts are "not sufficiently robust" and further work is needed to address several issues before final submissions are made by 30 April.
    It is the first blast of realism from the top of the NHS since trusts, CCGs and local councils were told just before Christmas 2015 to organise themselves into local "footprints" and draw up Sustainability & Transformation Plans -- few of which are robust, evidence-based or achievable.

  • Hunt halts Horton General closure plans A splendid victory for the Banbury campaigners after such a long haul, showing that no matter how hopeless it may seem it is sometimes possible to get the Independent Reconfiguration Panel to put a spanner in the works. Also a broad, popular, vocal campaign in a Tory area can create a political pressure, which should not be ignored.

  • NHS Improvement pays McKinsey £500,000 to advise on 'purpose and model' A truly shocking story from HSJ, revealing that the NHS regulator NHS Improvement has not got the vaguest idea what it's supposed to be doing, and has to part for a second time with a shedload of cash to management consultants in an effort to find out. More than £1m so far flushed down the PWC to useless consultants to advise equally useless and clueless overpaid NHS executives, while they crack the whip on hard-pressed trusts to slash services to balance the books. Disgusted? You bet!

  • Trust chief calls for review of STP after extraordinary winter Another (£) paywalled HSJ news story highlighting the unravelling of another STP, with a new hospital chief exec in Nottingham pointing to bed shortages and black alerts.

  • KONP tribute to the late, great Prof Stephen Hawking A timely tribute highlighting Hawking's consistent support for the NHS and his role in supporting the JR4NHS challenge to the imposition of ACOs without proper scrutiny by MPs or public consultation.

  • Private firms are not expecting to run ACO contracts (£) paywalled HSJ exclusive that should give some people pause for thought: Jeremy Hunt for one, and many who see ACOs as the threshold of doom. Problems cited by the private sector include the public's political resistance to privatisation, and the level of financial risk to the private sector. Rather than take on ACOs, they are keen to cherry-pick, offering future organisations "elective capacity, access to capital, analytics and diagnostic services".

  • Not a winter crisis but a political crisis Tony O'Sullivan's excellent summary of the gathering storm for Labour Briefing

  • 15 Trusts at 100% occupied, 34 with 99% of beds full on last day of winter crisis reporting NHS England's latest statistics confirm that 8 years of frozen funding since Cameron took over in 2010 have made it winter most of the year round in our NHS. Urgent need to scrap further bed cuts and boost funding & staffing levels

  • Oral evidence on dangers for the NHS of Accountable Care Systems and Organisations Evidence given to the committee by 3 leaders of JR4NHS and KONP co-chair Tony O'Sullivan

  • 'It was like an Arctic expedition’ - paramedics battle through snow for nine hours to reach stranded patient Every day story of NHS dedication -- a 3-mile trek by East Anglia ambulance staff to save a patient

  • Judge's ruling recognises privatisation of one service threatens the whole local NHS Interesting written ruling on plans by Lancashire County Council to hand over children's services to Virgin, highlighted by Calderdale and Kirleees 999callfortheNHS.

  • NHS Dis-integration: Unaccountable Care Excellent short read and up-sum on ACOs/ICOs and the shifty arguments of NHS England, from KONP's Tony O'Sullivan

  • Ambulances' three hour wait outside Worcestershire A&E BBC report points out: "According to national guidelines, Worcestershire Acute Hospitals NHS Trust is expected to deal with 95% of patients who attend A and E within four hours, but the BBC understands on Friday it dealt with 47% in four hours and 49% on Saturday."

  • Yes, the NHS is fractured. But competition won’t heal it Polly Toynbee bangs home some hard points in this Guardian analysis.

  • NHS brings in three month minimum waiting times despite warnings patients will suffer Further proof that underfunding has drastically undermined NHS capacity to meet targets for timely care.

  • Single payer health care cuts costs View from an Oregon doctor, pointing out that waste and corruption arise from the US system

  • Concerns over Shropshire's maternity services aired in open letter to health bosses Hundreds sign open letter to NHS chiefs

  • Government admits it could reprivatise Carillion work it took in-house just weeks ago. Mirror story shows they have learned and forgotten nothing.

  • Answers to House of Lords Questions on Accountable Care Organisations Lord O'Shaughnessy offers the memorable assurance that "An ‘ACO’ is not a new type of legal entity, neither is it a body created under delegated legislation; instead it is a service provider that holds an ACO contract." But he goes on to state that "The Government will not bring forward legislation until the NHS England consultation [due to begin in March] has concluded."
    Does anyone feel reassured?

  • NHS trusts transferring staff into subsidiary companies to cut VAT Guardian story points out that transferring thousands of NHS support staff to "special purpose vehicle" companies may be argued as cutting VAT costs, but " Labour and trade unions have warned that they open the door to driving down wages, pensions and conditions of thousands of NHS staff – and therefore service standards."

  • Third letter to the GMC regarding Dr Hadiza Bawa-Garba (reply to Professor Terence Stephenson) Nick Ross in another letter in the BMJ bangs home the outrageous GMC behaviour:
    "To put it bluntly (and forgive me but I am a journalist at heart) she was abandoned by her consultant, shafted by her employer and then tormented by the courts and finally persecuted and made unemployable by you. I wonder if you looked behind the court decision at the staffing levels and the work load on that fateful day – an absent consultant, a woeful shortage of trained nurses, no rest break and so on - and whether you would consider them to be prudent and acceptable. If so, perhaps you would be kind enough to publish them so that we can all see what the GMC regards as a safe working environment. "

  • [US] National Health Expenditure Projections, 2017–26: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth Article in Health Affairs magazine using official projections to warn that US spending on health care is set to increase from 18% GDP ($3.6 trillion) in 2017 to 19.6% (£5.7 trillion) by 2026, with out of pocket personal spending increasing over 50% from $360 bn to $555 bn.
    Not a system anyone with sound mind would want to copy or import.

  • Written evidence submitted on behalf of the Royal College of Emergency Medicine The Royal College of Emergency Medicine calls out the failures of the Sustainability and Transformation Plans to take account of objective reality, and refutes the notion that there is a "surfeit" of hospital acute beds.
    The RCEM notes that: "In simple terms the nature of demographic change means that the number of ED attendances is rising as the population grows and the average age of the population increases.
    "This being the case, rather than planning for reductions in Emergency Department demand that are unlikely to materialise, it would surely be more sensible to plan for increased ED demand based further population growth and an increasingly elderly population."

  • Migrants aren't a threat to the NHS -- Losing the migrants who helped build it is John Lister's article in The London Economic promoting the One Day Without Us event in solidarity with migrant workers on February 17.

  • Department of Health and Social Care increases raid on the NHS capital budget to almost £4bn BMA article highly critical of the latest Treasury grab for the limited pool of NHS capital notes:
    "Treasury papers, released last week, reveal that £1bn was switched from the DHSC’s £5.6bn capital budget to revenue in 2017/18.
    "This year’s switch comes on top of £2.79bn of annual raids since 2014/15 at a time of heightened demand for rebuilding projects and with the NHS facing a £1bn bill for ‘high-risk’ repairs."

  • Fake News about the NHS An excellent blog by Colin Leys of CHPI exposing common misleading facts retailed without critical comment by ignorant mainstream media news: a case for proper training in health journalism.

  • "With strings attached: taking a closer look at the new NHS money" Sally Gainsbury's latest brilliant Nuffield Trust comment Sally Gainsbury untangles the contortions, deceptions and confidence trickery of last November's budget "increase" -- and why the "extra" money means LESS spending per patient, and the Sustainability & Transformation Fund is now renamed the "Provider Sustainability Fund".

  • NAO report on adult social care workforce Hard facts on the growing crisis in social care.

  • NHS England abandoned 'forward view' for community services (£) HSJ Exclusive, drawn from a leaked document, reveals NHS England has abandoned plans to create a “forward view” for community services, despite arguing that sustainability and transformation partnerships need one to achieve their full potential.

  • Ian Dalton criticises 'unrealistic' A&E plans Another (£) HSJ exclusive on NHS chiefs in retreat on controversial plans reveals that the latest retreat is from many wildly over-optimistic STPs and other reconfiguration plans assuming large reductions in emergency caseload:
    "The chief executive of NHS Improvement has called for an end to “unrealistic” planning for emergency admissions to hospital, arguing that new money for the NHS will not “make it to patients” if demand is underestimated."
    Where will this leave plans such as the closure of Huddersfield Royal Infirmary, planned closures of Ealing and Charing Cross Hospitals in North West London, and many similar schemes around the country?

  • 30 years ago - the first moves to marketise the NHS Extract from John Lister's book The NHS After 60 - for Patients or Profits, looking at the daft ideas being punted around by backwoods Tory MPs – many of them still familiar names – after Thatcher launched her "review" of the NHS in January 1988. see how many of the same ideas are still living a zombie existence in 2018.

  • Annual charge paid by migrants for using the NHS to double Guardian report of latest anti-migrant moves by Theresa May's brutal government -- quoting fears from doctors and others about the potential consequences.

  • "Migrants' NHS fees are doubled in bid to beat the health tourists: Workers will have to hand over £400 a year as part of clamp down" Ghastly xenophobic Daily Mail piece reminds us that despite their surprising and generous coverage of the London #FundOurNHS demonstration on February 3, the agenda of the Daily Mail is scapegoating and whipping up irrational hate against migrants and 'foreigners'. There is of course no evidence 'Health Tourism' is a significant fact in the crisis of NHS underfunding.

  • Theresa May’s masterplan to help struggling NHS trusts deal with winter crisis DEPRIVES them of up to £1.3 billion Sunday Mirror feature based on figures researched by Health Campaigns Together editor John Lister.

  • Video appeal to back our Feb 3 winter crisis protest Labour's shadow health secretary Jon Ashworth urges support for Saturday's Emergency Demo "Fix it Now" in London called by Health Campaigns Together and peoples Assembly

  • The Nursing Workforce - Commons Health Committee Report January publication, flags up concerns over use of less qualified staff to fill vacant nursing jobs:
    “Nursing Associates are intended to supplement nurses rather than replace them, but may ease pressure by freeing up registered nurses' time for tasks that require their degree-level skills. Witnesses to our inquiry expressed serious concern that, particularly given the current shortage of nurses, NAs might be used to substitute for registered nurses.
    "They should not be viewed or referred to as 'nurses on the cheap', and this message must be clearly articulated at national as well as local level. This is however more likely to happen if managers use NAs as a substitute for nursing posts."

  • Hadiza Bawa-Garba could have been any member of frontline staff working in today’s overstretched NHS BMJ blog by Dr Rachel Clarke written back in December. Free to access.

  • "Blood on their hands": NHS protesters shut down road outside Parliament targeting May, Hunt and Branson Mirror coverage of stunt organised by Peoples Assembly and Health Campaigns Together to promote February 3 Day of Action.

  • Doctors pressurised into manipulating A&E performance figures Report in the Independent, followed up by Labour's Justin Madders MP.

  • Video of the brilliant march through Southend on January 27 Hundreds of people marched through Southend High Street to protest against cuts to Southend’s NHS services

  • Back to blame: the Bawa-Garba case and the patient safety agenda Why we should all be concerned that a junior doctor has been hung out to dry by the General Medical Council after a systems failure led to a tragic death. BMJ article, free to access.

  • Blood on their hands - NHS protesters shut down road outside Parliament targeting May, Hunt and Branson Excellent Daily Mirror coverage of HCT/Peoples Assembly stunt highlighting need to build February 3 protests

  • Correspondence between Commons Health Committee Chair Sarah Wollaston and Jeremy Hunt on ACOs Hunt's reluctant agreement to delay ACOs.

  • JR4NHS wins important concession: a national public consultation on ACOs "But don’t be fooled into thinking they’ve given up." says a KONP update from Tony O'Sullivan.
    "Despite repeated questioning from Sarah Wollaston MP, the Committee chair:
    "Hunt refused to delay the ACO regulations that he’s still planning for February, which are intended to facilitate the ACO contract – even though there’s no longer an urgent need for them; and
    "Hunt has still not accepted the need for an Act of Parliament before ACOs can operate lawfully."

  • Creation of first ACOs put on pause by Rebecca Thomas HSJ (£)
    "NHS England and the Department of Health have effectively paused the creation of the first accountable care organisations, pending further consultation.
    Health secretary Jeremy Hunt said the ACO contract - published by NHS England in draft last year - would not be put in place in any areas until after the national commissioning organisation holds a consultation in coming months.
    He wrote to Commons health committee chair Sarah Wollaston on January 22, in response to a letter from her last week requesting that moves to implement ACOs be delayed pending a committee inquiry. "

  • Bedfordshire, Luton & Milton Keynes protests on January 20 covered by BBC Successful events across the BLMK STP 'footprint' leading up to Feb 3 London protest (contingents from the area will be travelling to London)

  • HCT Editor John Lister speaking at HCT Northern Regional Conference in Leeds An overview as government plans misfire into a series of crises

  • Health Committee Chair Sarah Wollaston writes urging Jeremy Hunt to delay introduction of new contract for ACOs "As I am sure you are aware, a great deal of concern has been expressed about the development of ACOs in the NHS. I expect the Committee to consider these concerns, and the responses to them, in the course of its inquiry into Sustainability and Transformation Partnerships, announced last autumn."

  • Most practices in England do not want to provide online consultations GP Online survey reveals that despite £45m NHS England campaign to promote the idea most GPs do not see online consultations as any help with the problems they face.

  • Council paid ‘golden hellos’ to free up beds amid warning NHS crisis will continue With all three of Norfolk's hospitals full to capacity at three points over the Christmas and New Year period, County Council bosses resorted to bungs to entice care homes to take more discharged patients and free up hospital beds. Local press report.

  • NHS crisis: Senior Tory MP hits out at Government's 'disingenuous' use of winter statistics Sarah Wollaston, Tory chair of Commons Health Committee, stops short of calling her own party's ministers liars. But only just.

  • Branson and Virgin set to expand further into NHS A closer look at the complex web of Virgin contracts, by Paul Gallagher for the i Briefing.

  • Care Closer to Home: It Isn't Working. A short film by Save Our Hospital Services Devon.
    This film shows how the government policy of so-called "Care Closer to Home" is failing while 71% of Community Hospital beds have been cut across Devon since 2013.
    For more information on SOHS Devon, visit their website at www.sohs.org.uk

  • Philip Dunne, sacked after his NHS remarks, must now face his constituents Guardian article by Shropshire journalist on May's dismissal of gaffe-prone junior health minister.

  • GP at Hand triples patient list as young patients flock to video consultation service GP Online noting the extent of cherry-picking by this latest departure from General Practice – just 0.5% of recent registrations have come from people over 60 who are most needing good primary care.

  • Sandalwood Court place of safety unit to be temporarily closed Place of safety in Swindon closed for 12 months -- nearest option for Swindon patients now Devizes. Local press report.

  • UK ministers hold crisis talks over Carillion Financial Times report on the gathering crisis of one of the major players in PFI.

  • Emergency care is in a state of Emergency Press release from Royal College of Emergency Medicine on worst-ever month's performance on A&E waiting times

  • Scores of NHS hospitals completely full during first week of January GP Online article using latest figures states: "NHS hospitals reported that every single one of their beds was full on 78 occasions in the first week of January, as winter pressures drove average levels of bed occupancy across England to a new high."

  • Virgin launches pay as you go primary care and "wellbeing" service in Birmingham Care for the worried wealthy (£35 for a "remote" GP appointment with someone you have never met: £55 to meet them in person). Another Virgin move to undermine the NHS.

  • MP says business case for new company at Airedale reveals harmful impact on employee terms and conditions Keighley MP reveals business case plan for 2-tier workforce as NHS Trusts create new "special purpose vehicles" to dodge VAT.

  • Social care postcode gap grows Observer report underlines the other dimension to the NHS funding crisis.

  • One trust in five runs out of beds at very start of winter Independent report

  • Americans die younger despite highest health care spending Bloomberg analysis -- for profit healthcare is bad for your health.

  • NHS Providers weekly update on trusts' performance. Week by week reports on how trusts are coping despite the failure of ministers to respond to NHS Providers' previous Winter Warnings.

  • Hands off HRI petition via 38 Degrees Petition to Jeremy Hunt calling on him to reprieve the services under threat at Huddersfield Royal Infirmary through the review process. The case was referred by local councillors last Summer and we now await the outcome. Last heard, it has not yet got to the top of the review list!

  • Lego's latest: build your own ACS The NHS has teamed up with Lego to create the most absorbing and challenging construction set ever. The Lego Accountable Care System promises to keep you and your family occupied well into the New Year 2023 and beyond.

  • Worcestershire trust already can't cope with winter pressures 13 diverts from A&E in just one week of December

  • Shadow Health SecretaryJon Ashworth calls for campaigning to roll back privatisation A more lengthy blog from Labourlist tackling various aspects of the "toxic privatisation agenda".

  • GPs fear NHS crisis with hospitals full at start of winter Hospital beds 94.5% occupied in first few days of December – before winter crisis even starts. GPs fear impact on primary care and delays in elective treatment.

  • Two thirds of GPs say their practice will struggle to cope this winter Frightening extra dimension of the developing crisis created by 7 solid years of inadequate funding.

  • Practices continue to drop private work in face of growing workload Unexpected result of cash squeeze in primary care -- from GP online.

  • Brilliant pictures of thousands of US nurses fighting for safe staffing In Kaiser Hospitals, California -- yes Kaiser that is quoted as a model for England's NHS. Nov. 2, 2017 — Nurses say they will continue doing whatever it takes to draw public attention to the eroding patient care standards that they warn have a direct impact on health outcomes for Kaiser’s patients. Kaiser is both the largest hospital chain and health insurer in California. #SafeStaffing #Solidarity

  • Impact of the Budget on health spending Note for the Commons health Committee putting an official analysis: spending set to just about match predicted levels of inflation

  • This Budget will deepen the crisis in general practice Just days after figures showed a sharp reduction in numbers of GPs despite promises to increase them, Chancellor Philip Hammond’s Budget statement was "a massive let down for the NHS in general and general practice in particular," says Dr Kailash Chand.

  • CQC shines light on "hidden injustice" in mental health "Nearly a year ago, Prime Minister Theresa May described mental illness as a "hidden injustice". Various statements since then have been taken by some as encouraging signs that government - at the highest level - takes mental illness seriously, and that parity of esteem with physical health services is on its way.
    But feedback from patients is clearly and consistently telling a different story. And those injustices are not hidden. They're right there in the CQC's evidence."

  • Primary healthcare, disruptive innovation, and the digital gold rush What exactly is Babylon up to? BMJ blog

  • Government pledges £3.5bn capital to NHS over next five years (£ paywall HSJ)
    Explanation of how the £3.5 billion plus land sales leaves another £3.3 bn to be raised from private sector investment to meet the Naylor Review £10bn target.

  • 'Which of the children do we shoot first?' - the budget leaves the NHS with harsh choices (£ paywall Health Service Journal Editorial comment)
    "With the underlying provider deficit standing at around £3.6bn – and significant cost pressures emerging in supposed priority areas such as primary care and mental health – there is no confidence at all among system leaders that next year’s funding will deliver what the government wants."

  • Babylon GP appointment app ditched over fears of patients 'gaming' system According to board papers from a London CCG - first reported by HSJ - instead of reducing GP attendance, testing of the app raised a concern that patients who used the app may do so to get faster access to a GP appointment.

  • HCSA's Response to the 2017 Budget – Falling Short on the NHS This is a budget that does not put patient care first, does not support hospital doctors, does not address significant underfunding, and does not “back the NHS.”

  • Budget 2017: NHS trusts given extra £350m for entire winter, despite Brexit bus promising £350m a week Independent critique of Budget, which increases NHS funding this year by just one day's running costs, £350m -- three months after the August deadline NHS Providers said was the last chance to avoid a winter crisis.

  • Matlock motorcade demands increased NHS funding BBC report of a successful event in Derbyshire on November 18, with interview with HCT secretary Keith Venables.

  • NW London Hospital Trust A&E performance worst in the country -- aftermath of 2014 closures Local paper highlights the continued disastrously poor performance of the remaining A&E units left to shoulder the load after closure of A&Es at Central Middlesex and Hammersmith Hospitals in 2014. The hotly contested plan for "reconfiguration" of hospital services at a cost of £513m-plus has just been given the thumbs down by NHS Improvement.

  • Wigan drops plans to axe beds Increased demand and plunging performance in A&E over the summer have forced a CCG to drop plans to axe beds.

  • In post-referendum Britain, the policy of charging overseas visitors upfront further alienates healthcare staff in the NHS BMJ blog by "a migrant GP" reminds us of the obvious dependence of our NHS on skills of EU and overseas-trained staff.

  • Report from Hospital Consultants and Specialists Association -- along same lines as many previous reports on STPs Report on STPs and the extent to which they have attempted and succeeded in establishing links with hospital doctors

  • A TRADE union has spoken out over fears that NHS bosses in Gloucestershire are set to outsource 900 staff into a subsidiary company. UNISON have claimed that the board of Gloucestershire Hospitals Trust will hold secret talks to discuss the plans on Wednesday, “pursuing an alleged VAT saving by selling services to itself” in a bid to cut costs.
    Local press report.

  • NHS and care bosses bed the Chancellor for extra funding Independent article as employers get desperate.

  • NHS hospital staff at breaking point Newsnight film at flagship £500m PFI hospital in Birmingham

  • PFI: five firms avoid tax despite £2bn profits BBC report on findings of European Services Strategy Unit

  • Number of NHS managers recruited soars as shortage of nurses grows Telegraph report shows little solidarity with Tory Secretary of State as he tries to defend his record presiding over 7 years of decline in the NHS.

  • NHS trusts accused of backdoor privatisation over subsidiary firms Guardian report, which warns that:
    "At least three NHS foundation trusts in Yorkshire, the West Country and northern England have set up firms with the intention of taking thousands of workers off the NHS’s books.
    "It means that a staff member whose employment is transferred to the new companies will no longer be an NHS employee, even if they have been guaranteed their current working conditions."

  • The £97m bill for 'midwife shortage' BBC report covering hard hitting figures from Royal College of Midwives

  • The NHS is facing a £21bn funding gap – what does that look like in your area? Live links to identify the scale of the financial gap in each postcode area of England

  • Patient sleeps on chair for a week as trust runs out of beds Report in (£) Health Service Journal underlines desperate shortages of beds and staff in mental health (Birmingham & Solihull)

  • “No end in sight” for UK’s radiologist staffing crisis Key findings of the Clinical radiology UK workforce census 2016 report include;
    Nearly one-in-ten UK radiologist posts (8.5%) were vacant during 2016, nearly two-thirds of which (61%) were unfilled for a year or more
    The need for scans continues to grow. In England from 2013-16 the number of computed tomography (CT) and magnetic resonance imaging (MRI) scans respectively rose by more than 30% - three times more than the rate of workforce growth. Technological advances mean that these scans are more complex than ever before and take longer to interpret

  • Revealed: NHS's plans to bar patients from attending A&E without a referral Shocking story if true -- from Pulse magazine

  • Labour has committed to renationalise our NHS Alex Scott-Samuel writes in the Morning Star on the major stride forward on health policies at Labour conference 2017

  • Private beds in the NHS A long article in the online Independent paper about the use of NHS facilities for private patients. It is based on the work of the new thinktank set up by Deborah Harrington and Jessica Ormerod, formerly of the NHA Party office, who have left and branched out on their own.

  • Making sense of PFI "Why is everybody talking about PFI? Is it really costing the NHS lots of money? John Appleby looks at the small print." Some updated facts and figures -- but not from a campaigning standpoint, raising question: 'so what'?

  • House of Commons Library 'Briefing' on STPs Very poor, limited and superficial review heavily dependent on poor, limited King's Fund report a few months ago. For more information check elsewhere on this website.

  • Former NHS boss Nicholson blasts Hunt's migrant policy

  • STPs: Nuffield Trust & King’s Fund reports from March 2017 Analysis again underlines lack of evidence behind London’s 5 STPs

  • Resignations send stark warning to chief execs on A&E performance (£ paywall) Former Trust Special Administrator leaves ‘voluntarily’ after performance failure

  • STPs – yesterday’s acronym? Guest Editorial by John Lister on RoyLilley’s blog nhs.Managers.net, September 14

  • If our government won’t act to save our NHS this winter, this is what we must do Article for Our NHS/Open Democracy by JOHN LISTER

  • Stephen Hawking Challenges Jeremy Hunt: The Complete Dossier Prof Stephen Hawking versus Jeremy Hunt - the exchanges and correspondence from the Guardian

  • The bottom line: Understanding the NHS deficit and why it won't go away by Sally Gainsbury, Nuffield Trust

  • Hands Off HRI September newsletter

  • NHS Assembly announced to help deliver the Long Term Plan NHS England unveils an unimpressive and not remotely challenging list of 56 people appointed to its "NHS Assembly" -- replete with chief executives but lacking TUC unions, front line staff and vocal campaigners.
    Among those who made it:
    • Charlotte Pickles – "Managing Editor of the comment and current affairs site Unherd.com" who "will soon be taking the role of Director at [neoliberal 'think tank'] Reform".
    • Jim Easton – a voice for private health care ("Vice-Chair of the Independent Healthcare Providers Network (IHPN)"

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