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  • Mitigating public health risk from evictions Over the last few of weeks campaigners have been working hard to gather together health bodies such as the BMA, the Royal College of Physicians, and the Royal College of General Practitioners, Pathways, Faculty of Public Health, the Royal College of Psychiatrists among others, to write to the government calling on them to protect those experiencing housing insecurity during the coronavirus crisis.
    Housing is a key determinant of health and a right to good health means a right to have safe & secure housing.
    They sent a collective letter to the Housing, Communities and Local Government Minister Robert Jenrick, highlighting the serious public health risk posed by the ban on evictions ending on the 23rd August.
    The letter has now been covered in both the Financial Times and The Guardian.

  • Hospital ‘bed blocking’ numbers hit highest level since 2017 Guardian highlights another indicator of a system lacking capacity and very far from being "integrated": but headline uses the old-fashioned and perjorative phrase "bed blocking" when the proper terminology is delayed discharge or delayed transfers of care.
    Whatever we call it the facts are stark: "The number of “delayed days” in the NHS increased from an average of 114,000 a month in 2012 to more than 200,000 in October 2016, before extra funding and higher council taxes brought the numbers back down.
    "But the latest NHS figures show the problem is returning. December 2019 saw 148,000 delayed days across England, 15% higher than the same month a year earlier. The combined figures for the last quarter of 2019 were the highest in two years."

  • Social care is crumbling, and Johnson’s immigration plans will only make it worse Guardian's Polly Toynbee joins the dots to show the impact of the latest efforts to deter migrant workers:
    "The fourth biggest provider of home care for the frail, the Mears Group, … is abandoning its domiciliary care services.
    “…Social care is collapsing because too few people are willing to work gruelling hours in disgraceful conditions for pitiful pay.
    "The new points-based immigration system announced by the home secretary, Priti Patel, on Wednesday will see many more companies fleeing the sector for lack of staff. With 122,000 vacancies, this decade’s 25% increase in people over 65 means another 580,000 staff will be needed to care for them over the next 15 years. In London, 40% of care staff are from overseas. Median average pay as of last March is a meagre £8.10 an hour, with parts of their hours unpaid: a quarter of staff are on zero-hours contracts."

  • NHS 'took 18 months to help after suicide attempt' BBC report on gaping holes in NHS provision for serious mental illness:
    "Simon, who is from Derbyshire, said: "After one of my first hospital admissions, I received a safety plan through the post 18 months after I had been discharged.
    "When I struggle, I look for things that reinforce my negative view of myself - missing out on a safety plan on discharge reinforced that message that I am worthless.
    "There have been times when I've been given a generic plan which has little or no relevance to me. And, truthfully, if it's not personal, for me it's pretty pointless"

  • The Lowdown – the first year's issues Omnibus collection Searchable compilation of 200 pages of first 22 issues of The Lowdown since January 2019. A wealth of information -- with live hyperlinks to sources. Plus an appeal for support to keep it going another year

  • Government is sharpening its scrutiny of the NHS (£)HSJ column by former special advisor to Matt Hancock Richard Sloggett (sic) who argues:
    "The slide in the performance numbers, a larger than expected majority and the centrality of the NHS to the election victory has led to the exploration of what new powers ministers could take in setting direction to NHSE; as reported recently by The Times.
    "The current model of NHS independence clearly does not suit the Number 10 world view of directional oversight of key organisations to drive improvement.
    "Critics will argue that any moves will miss the point. They argue that direct ministerial control is not a solution to performance issues which are driven by a multitude of factors, many beyond the boundaries of the NHS. And as Dave West adeptly argues legislative change will not likely come in until April 2022 making it a medium-term lever for change at best."
    The question remains why should we expect a government that won a majority by wilfully misleading voters with inflated claims of the amount of "extra" money for the NHS after a decade of real terms freeze should suddenly decide now to put in more cash than they promised?

  • Behind the Scenes at Leicester Royal Infirmary: An NHS Worker Speaks Out Campaigners publicise the anonymous account of an NHS worker at Leicester's Royal Infirmary where a new £40m A&E has not solved the problems of lack of capacity:
    “Multiple Patients have been on the backs of ambulance for over 4 hours throughout the year with nurses leaving in droves and junior doctors saying that there is no way they are going to go into the field of emergency medicine.
    "Nurses are bullied by senior staff and managers to make unwell patients, who should be on trollies, sit on chairs in an already overcrowded waiting area. They call it 'fit to sit'.
    "Half the patients should be in Resus and no matter how much you beg the senior team you are told that it is full with red call patients on the way with no space for the red call emergency, let alone a patient in the waiting room."

  • 360 degrees of spin More brilliant spoofs from NHS Blithering that almost seem lifted from a genuine CCG.
    Director of stakeholder nurturement and realtime feedback Martin Plackard is responding to the latest NHS staff survey:
    "Great care for all
    "Overall we saw a four-fold improvement on last year after seasonally adjusting the baseline to the sector average for an organisation of comparable demographics and applying the deflator.
    "More than two-thirds of you (11%) would be happy to recommend the care provided by your organisation to a friend or member of your family. Only a tiny minority (89%) said they would be “deeply worried” or that they “wouldn’t wish it on my worst enemy”."

  • Marketising the Mental Health Crisis: How the CBT Empire-Builders Colonised the NHS Powerful article by Paul Atkinson on Novaramedia ruthlessly exposes the hype and spin surrounding the IAPT talking therapies as a solution to England's growing mental health crisis.
    "Last financial year, the service had 1.6 million GP and self-referrals. IAPT claims a recovery rate of 50% of people who finish a course of treatment. Given roughly a third never start, and up to a third never finish, the average national recovery rate of all referrals is actually closer to 16%.
    "IAPT stats also reveal that people from more deprived communities fare significantly worse. A couple of years ago, in my own borough of Tower Hamlets, the recovery rate for all referrals from the Bangladeshi community (32% of the local population) was around 4%.
    "Waiting times are growing, despite IAPT’s statistical wheeze of offering a speedy initial assessment, months before any sessions begin. And according to Freedom of Information requests, a quarter of people treated by IAPT have returned to the service between two and 10 or more times.
    "Most of us might consider this evidence-based failure rather than success."

  • We need the biggest NHS rebuild since the Beatles NHS providers again banging the drum for the need for substantially higher capital investment in the NHS, but perhaps over-optimistic on what they can expect from B. Johnson and pals:
    "capital budgets, which cover spending on assets such as buildings, land and equipment and sit outside the NHS 'ringfence', haven’t been set out beyond the end of next year. We have just had a decade of under-investment in NHS capital. The system for allocating capital to the frontline is broken. The money hasn’t got through to where it’s needed most. The system often seems arbitrary and haphazard."
    Will Johnson act? We urge NHS Providers not to hold their breath waiting.

  • Private agencies paying workers less than half what they charge NHS to hire The Mirror lifts the lid on the rip-off charges for use of agency staff – and where the money goes:
    "Private nursing agencies are paying workers less than half what they charge the NHS to hire them.
    "We found one raked in £71.53 an hour for busy overnight shifts but the nurse pocketed just £34.
    "Another hospital paid the same agency £864.77 for a 12-hour day shift but the nurse got £387.
    "The agency, Thornbury Nursing, is owned offshore in the Caribbean and is controlled by a private equity fund run by a major Tory donor.
    "It is part of a string of firms specialising in health temping jobs and run by TowerBrook Capital Partners, which raked in nearly £600million in revenue last year."

  • Locked away: the national scandal you may have missed Excellent Guardian report on the shocking mistreatment of people with autism and learning disabilities:
    "In England, there are more than 2,000 people with autism and learning disabilities in what officialspeak calls “inpatient care”. We now know about them, and the awful cruelties and indignities many of them are suffering, because of the much-maligned mainstream media – and in particular, the tireless work of the campaigning journalist Ian Birrell.
    "Birrell and others have highlighted not just the injustice of the way very vulnerable people are treated by local authorities, the NHS and the private contractors now woven into our public services; …"

  • Improving the prognosis of health care in the USA Free access Lancet article by Yale Uni researchers who are the latest to show the evidence for a single payer system as the way forward in the US:
    "Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017).
    "The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households.
    "Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo."

  • I've been an NHS doctor for five years. The Home Office wants to deport me Guardian reports on more brutality and ignorance from the Home Office, now led by the relentlessly reactionary Priti Patel.
    Dr Luke Ong says "My troubles began towards the end of last year when I applied for indefinite leave to remain in the UK. I am from Singapore.
    "I was five months away from qualifying as a GP and had studied medicine at Manchester University, starting as a doctor in the NHS in 2012.
    "I booked an appointment and paid for it before my visa ran out. I thought that was fine. In reality, the application is made when you attend the appointment, by which time my visa had been invalid for 18 days. I was refused residency for that reason, and since then it’s been a battle to reverse the decision. "

  • Fears Sussex patient transport to hit 'crisis point' Brighton Argus reports on the latest of an apparently endless series of contract failures of patient transport companies as local CCGs go from one stupid decision to the next. Time to bring this service back in house!
    "A union has warned vital patient transport services are nearing “crisis point” after a contractor ran into financial trouble.
    "About 30 staff were left unpaid and without work after private ambulance firm Medi 1 went into receivership, a process similar to administration, after financial difficulties.
    "The company was contracted to run non-emergency patient transport services to hospitals across Sussex.
    "Now the GMB trade union has called on health chiefs to bring these services in-house by contracting them to the NHS-run South Central Ambulance Service.
    “Medi 1 has now become the latest in a long line of failed private contractors,” said regional organiser Gary Palmer.
    “As before staff and their families now have to endure the brunt of profit-driven business failures and need to find new work immediately while struggling without the money they are owed."

  • East Kent baby deaths: Scale of deaths at trust 'not clear-cut' BBC report of a Trust Board and chief executive in denial on the scale of the failure of their services: "The boss of an NHS trust at the centre of concerns about preventable baby deaths has claimed the scale of the failings is not clearly defined.
    "Susan Acott, chief executive of East Kent Hospitals Trust, said there had only been "six or seven" avoidable deaths at the trust since 2011.
    "However, the BBC revealed on Monday that the trust previously accepted responsibility for at least 10.
    "Ms Acott said some of the baby deaths were "not as clear-cut".

  • Huge revamp of Peterborough City Council could see services disappear to tackle financial black hole Peterborough Today report. A Tory-led council points to government cuts as the reason for its growing crisis:
    "The council said years of huge cuts to its government funding had left it on its knees and in a desperate need to scale back in order to survive.
    "This could see a reduced standard for services which it is legally required to provide, while other, non-statutory services could be partially or completely scaled back.
    "Further job losses are also expected, despite dozens of redundancies currently being made."

  • New NHS figures show why we must fight the government’s spin on health service funding KONP's Press Officer Samantha Wathen writes in Left Foot Forward:
    "Behind these never-ending statistics are real people. Patients waiting in fear and pain for treatment, and NHS staff desperately trying to help them, but increasingly being set up to fail. As has been famously asserted: “The NHS isn’t failing – it’s being failed.”

  • Harrowing stories of burned out NHS doctors bullied and broken in decade of Tory cuts Shocking Daily Mirror front page story of insensitive and brutal management:
    "Dedicated to caring for the sick and vulnerable, junior ­doctors should expect to be ­supported and valued as they carry out their vital work.
    "But hundreds have revealed they are subjected to bullying and harassment at overstretched hospitals that have been plunged into a staffing crisis by a decade of savage Tory health cuts.
    "A Mirror investigation uncovered harrowing stories of young medics being denied drinking water during gruelling shifts, working for 15 hours on their feet non-stop and of uncaring managers tearing into them for breaking down in tears over the deaths of patients.
    "One was even accused of “stealing” surgical scrubs she took to wear after suffering a miscarriage at work."

  • Combined Performance Summary: December 2019 - January 2020 Nuffield Trust's regular visualisation of the most recent performance stats. Note that there have been fewer Type 1 A&E attendances and fewer emergency admissions since last year, but a sharp increase in trolley waits over 4hours and over 12 hours -- presumably for lack of beds:
    "There were over 1.32 million type 1 A&E attendances in January 2020. This equates to an average of 42,814 type 1 A&E attendances per day – a decrease of 1% compared to January 2019.
    "Emergency admissions via A&E have been increasing year-on-year, but decreased in January 2020 to 416,541. There were on average 13,437 emergency admissions via A&E per day, which is 1% lower than January 2019.
    "100,578 patients spent more than four hours waiting on a trolley from a decision to admit to admission in January 2020; this is the highest since records began. 2,846 patients had a trolley wait of over 12 hours, which is more than four times higher than in January 2019."

  • Cost of hospital building project doubles in 18 months (£) HSJ article on the soaring estimates of the cost of rebuilding Ashford's William Harvey Hospital, or building an alternative new hospital in Canterbury, notes:
    "The east Kent reconfiguration is not one the government has earmarked for money, although, before the election, Boris Johnson suggested there could be a new hospital for Canterbury."
    More on this story and the Kent & Medway plan in The Lowdown https://lowdownnhs.info/hospitals/kent-and-medway-seeking-820m-for-capital-projects/

  • Racism in medicine—migrant doctors aren’t here just to “fill a gap” GP Rammya Mathew in a BMJ blog argues that "Even at its inception, it was clear that the NHS could not be fully staffed by “homegrown” doctors. Because of this, doctors and other healthcare workers historically bypassed immigration laws, and the 1960s and ’70s saw a surge in the number of doctors migrating from the Indian subcontinent to work in the NHS. This included my parents."

  • New targets set to be phased in from April, says NHSE (£) HSJ report on views of NHS Improvement chief operating officer Amanda Pritchard, making clear that existing 4-hour targets are likely to be ditched:
    "The NHS can expect a phased implementation of new operational targets from April — instead of a full switchover on day one — NHS England’s number two has said.
    "In an interview with HSJ, chief operating officer Amanda Pritchard said its testing so far still suggested — as NHSE’s clinical review of standards reported before Christmas — the four-hour emergency target did not work well for the current model of care.
    "However, she said introducing new measures needed to take place alongside — rather than ahead of — further redesign of urgent and emergency services. Ms Pritchard said this included, for example, reducing bed occupancy to around 92 per cent, redesigning emergency departments, developing 111 and urgent treatment centres, and improving the response of community reablement services."

  • Jeremy Hunt sceptical about building 40 hospitals (£) Times report of the new scepticism of the former Health Secretary now he is trying to prove his independence as chair of the Commons Health Committee:
    "The government’s plan to build 40 new hospitals was “highly ambitious” and its funding promises needed “a lot more thinking and ambition”, the former health secretary said."

  • Health inequality greater than previously thought, report finds Guardian reports on latest NHS data on health inequalities:
    "The new analysis means that men on average are being diagnosed with their first significant long-term condition at 56 and women at 55. In the poorest areas, women are getting their first significant long-term illness at just 47 and men at 49 years old."

  • Nurse unfairly dismissed for wanting to commence NHS whistleblowing process Personnel Today reports on tribunal case of district nurse who wanted to raise concerns over North Tees and Hartlepool Foundation Trust:
    "A senior district nurse with 38 years’ experience was unfairly dismissed after she told management of her wish to instigate her employer’s formal whistleblowing procedure, an employment tribunal has judged.
    "It followed numerous safeguarding concerns raised to her bosses about her team’s workload, employee stress and sickness, and a need for the retraining of healthcare assistants. The nurse had also raised concerns on the risk to patient safety, including one death she felt may have been preventable."

  • “Super‐Utilizer” Interventions: What They Reveal About Evaluation Research, Wishful Thinking, and Health Equity A useful Millbank Quarterly critique highlighting US research that undermines faith in the idea that interventions targeted at so called "frequent flier" repeat patients can reduce dependence on hospital care:
    "Many super‐utilizer interventions claim to be addressing patient “social determinants of health” when they are, at best, identifying and struggling to remedy a subset of patient social risks and needs.6 The truth is that hot‐spotting interventions are primarily cost‐containment strategies aimed at individual, very expensive patients. They are not interventions aimed at the macro‐ and community‐level systems and institutions that drive social, political, and economic disadvantage and health inequities."

  • Nurses to retrain as doctors ‘more quickly’ without EU red tape Nursing Notes reports comments on suggestions from Matt Hancock about swifter training.
    "Nursing leaders warn that the move needs to come without compromising patient care.
    "Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC) said: “Having enough health and care professionals with the right knowledge, skills and values is vital to meet the individual needs of people across all four countries of the UK now and in the future.
    “The NMC supports the wish to explore how education and training for registered nurses and midwives may be achieved in more flexible ways while ensuring our high standards are maintained and not compromised. Every nursing and midwifery professional must be safe and competent to provide the best care and support possible."

  • Health insurers can use this loophole to push pricy medical bills onto you, the patient USA Today report points out that "insurers require preapproval – sometimes called “prior authorization” – for a widening array of procedures, drugs and tests. While prior authorization was traditionally required only for expensive, elective or new procedures, such as a hip replacement or bypass surgery, some insurers now require it for even the renewal of some prescription drugs. Those preapprovals are frequently time-limited.
    "While doctors and hospitals chafe at the administrative burden, insurers contend the review is necessary to ferret out waste in a system whose costs are exploding and to ensure physicians are prescribing useful treatments.
    "But patients face an even bigger problem: When insurers revoke their decision to pay after the service is completed, patients are legally on the hook for the bill."

  • Utah sends employees to Mexico for lower prescription prices ABC news on the US state that is taking advantage of lower priced drugs in Mexico.
    "The cost difference is so large that the state's insurance program for public employees can pay for each patient’s flight, give them a $500-per-trip bonus and still save tens of thousands of dollars."

  • Harvard Study Shows Even Americans With Insurance Can't Afford Care Hard-hitting Harvard study summarised on Crooks and Liars website:
    "The for-profit U.S. healthcare system is so broken that a growing number of people who are fortunate enough to have private insurance coverage are still unable to afford doctor visits and other essential services due to soaring costs—leaving a larger number of Americans with unmet medical needs today than there were two decades ago.
    "That's a central finding of a new study by Harvard University researchers published Monday in the peer-reviewed journal JAMA Internal Medicine, examining 20 years of government data between 1998 and 2017.
    "The study found that despite a major expansion of insurance coverage in the U.S. during that period—most significantly through the 2010 Affordable Care Act (ACA)—"most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased."

  • What the government must do if it is serious about funding the health service Health Foundation's Anita Charlesworth and Ben Gershlick in Prospect magazine explain why the Tory "extra" cash for the NHS is nowhere near enough:
    "The NHS Funding Bill covers spending on front-line patient care but excludes other crucial areas of health spending: funding for training new doctors and nurses, investment in buildings and equipment and the grant to local authorities for public health programmes. These areas have all been cut as the government has “robbed Peter to pay Paul” across the health budget, in an attempt to protect front-line care."

  • Compass Commentator Roy Lilley responds to the "antediluvian" views of Norman Tebbit, pointing out that "If there has been a fall in standards of patient care... if, then I think the truth is, it is entirely the result of not having enough nurses. "

  • Trump's next assault on medicare and the poor Facebook blog by Heather Cox Richardson on the context and history behind the attacks on the publicly-funded health care system for older Americans.

  • What the quality of work means for our health Health Foundation blog makes an unsurprising point, but backs it up with evidence:
    "Half of those in low-quality work in 2010/11 were still in low-quality work in 2016/17. Spending longer in low-quality work is associated with worse health outcomes. Low-quality work can trigger stress, and the damage stress does to the body builds over time."

  • Outdated rants provide no solutions for a modern NHS BMJ blog by NHS consultant David Oliver dismantles an ignorant Daily Telegraph rant by Lord Tebbit:
    "It makes for grim reading. I am not sure what relevant expertise Tebbit has to imbue his opinions with such certainty. He has not been a cabinet minister since 1987, never had a ministerial health portfolio, and has never worked in the NHS. Although his piece made comparisons between the NHS and the armed forces, he has not worked in the military since he left the Royal Air Force in the 1950s."

  • Police are swamped with half a MILLION mental health crisis callouts in a year amid growing pressure on NHS services Daily Mail jumps onto a Sunday Mirror story that "The police have been swamped with half a million mental health crisis callouts in a year as overstretched NHS services struggled to cope with the pressure.
    "The Metropolitan police attended the highest number of calls last year, at 39,584, while South Wales Police attended the second highest at 32,145.
    "Staffordshire police experienced the highest rise in the number of mental health callouts, doubling from 3,112 in 2016 to 6,223 in 2019, reports The Sunday Mirror."

  • Private equity and Britain’s care home crisis (£) FT in depth article on the growing crisi in social care, focused on the malevolent role of private equity capitalists:
    "What has happened is that care homes have become financialised,” says Nick Hood, analyst at Opus Restructuring & Insolvency, which has advised several care home chains. “Their owners are playing with the debt and expecting returns of 12 or 14 per cent and that is simply unsuitable for businesses with huge social responsibilities.”
    "Global private equity, sovereign wealth and hedge funds have piled into the sector in the past three decades, lured by the promise of a steady government income and the long-term demographics of Britain’s ageing population."

  • At least 69 suicides linked to DWP's handling of benefit claims Guardian report flags up the fact that while NHS England talks of addressing social determinants of health, DWP's brutal decisions and imposition of austerity is shortening lives:
    "Families and campaigners have demanded a public inquiry after a government watchdog found that at least 69 suicides could have been linked to problems with benefit claims over the last six years.
    "Amid anger from the loved ones of some of those who took their lives in circumstances where difficulties with the Department of Work and Pensions played a role, the National Audit Office (NAO) report said that the true number of deaths linked to claims could be far higher.
    "And it said that until recently the DWP had failed to actively seek information from coroners and families, or investigate all of the cases that were reported to it."

  • Doctors back Independent campaign on maternity safety as families support inquiry calls (£)Independent report by safety expert Shaun Lintern following up on a major safety story:
    "Leading maternity doctors have backed The Independent’s call for maternity safety training to be reinstated by the government following the Shrewsbury maternity scandal.
    "The president of the Royal College of Obstetricians and Gynaecologists (RCOG) – the leading body for maternity doctors in the UK – lent his weight to the campaign to improve the training of NHS staff, and said that doctors and midwives should train together to help save the lives of mothers and babies."

  • Boris Johnson to seize control over NHS with new law Independent reports proposals to reassert ministerial control over the NHS -- but not in the way campaigners have been fighting for: "Boris Johnson is planning to use new health legislation to impose ministerial control over the NHS.
    "A bill to be introduced this year will contain new powers for ministers, including Mr Johnson, to issue instructions to NHS England’s chief executive, Sir Simon Stevens.
    "The move, which is understood to have been developed over the past year by the health secretary, Matt Hancock, is likely to raise concerns that Conservative ministers could seek to use new powers to extend private-sector involvement in the NHS."

  • Boris Johnson slapped down by watchdog for false claim about Universal Credit Mirror reports on yet another lie by PM Johnson being officially exposed:
    "Boris Johnson has been slapped down by the official statistics watchdog for making a false claim about Universal Credit.
    "Two weeks ago, the Prime Minister told PMQs the six-in-one benefit "has in fact succeeded in getting 200,000 people into jobs."
    "But the UK Statistics Authority has now ruled his claim was inaccurate - because the figure is only predicted once the benefit is fully rolled out in 2024.
    "The public body polices politicians' use of statistics, and repeatedly lambasted Mr Johnson in 2016 for using the fake claim that the UK sends £350m a week to Brussels even after being told it was untrue."

  • Trust shuts ward suddenly after CQC visit (£) HSJ reports: "A trust has closed an escalation ward “following discussions with the Care Quality Commission”, after a visit by the regulator which HSJ understands was critical of some services.
    "Eight patients on Medway Foundation Trust’s 15-bed Dickens Ward — which is mainly used for patients who no longer require acute hospital care but might require other services — were moved to acute beds and the other seven were discharged. "

  • Government’s NHS funding pledge ‘less generous than first appears’ The Independent reports: "Legislation on health spending completed its passage through the House of Commons on Monday, but the Health Foundation think tank has warned the bill falls short of providing the NHS with the money needed to prevent services from declining.
    "It also warned the money only increased the budget of NHS England and ignored other key spending on the NHS workforce and public health as well as social care, which it said were all pivotal to the wider stability and functioning of the health service.
    "…The Conservatives’ funding bill promises a headline-grabbing amount of cash for the NHS of £33.9bn by 2023-24. But Anita Charlesworth, the Health Foundation’s director of research and economics, said this figure does not account for the effect of inflation and counts money already spent.
    "Once these are taken into account, she said the actual money the NHS will receive over the next four years will be just £16.7bn."

  • Change summary - 2020 STP, CCG and Commissioning Hub reconfiguration NHS Digital lists the mergers of CCGs and other changes that will take effect from April 2020.

  • Monitoring the Mental Health Act in 2018/19 Report by the CQC highlights the poor treatment of a vulnerable group of mental health patients detained under the MHA:
    "When a person is admitted to hospital under the MHA, this should be to a location as close as possible to their normal place of residence, their families and other support systems.
    "Unfortunately, patients continue to be hospitalised out-of-area, sometimes over a hundred miles from home, usually because there are no beds in the local hospital. Worryingly, this is frequently being accepted without challenge."

  • NHS pressures in England: Waiting times, demand, and capacity Interesting figures and graphics published in December by House of Commons Library

  • Natalie Mehra, Ontario Health Coalition on “State of Emergency” Overcrowding at Ontario PPP (PFI)-financed hospital in Brampton (in the Greater Toronto area) triggers a "state of emergency" declaration by the local council. Interview with campaigner Natalie Mehra explains the issues nails the problem of chronic under-funding and "hallway medicine".

  • Review of capital expenditure in the NHS The NAO report that has lifted the lid on systematic underfunding of NHS buildings and equipment under austerity squeeze on spending since 2010. Findings include:
    "The growth in backlog maintenance indicates that there is an increased
    risk of harm to patients. In October 2019 NHS Digital reported that the backlog
    of maintenance work to restore buildings to an appropriate standard was around
    £6.5 billion.
    "An appropriate standard includes the physical condition of the estate, as
    well as compliance with fire safety and health and safety standards. High-risk backlog
    maintenance currently stands at £1.1 billion, and grew by 139% between 2014-15 and
    2018-19, indicating an increased risk of harm to patients. "

  • Somerset hospitals' minor injuries units put at risk of closure Somerset County Gazette flags up the threat to minor injury units, and more loss of local access to treatment:
    "SOME of Somerset’s minor injury units could be closed down and replaced with a smaller number of “urgent treatment centres”.
    "The NHS runs seven such units (known as MIUs) in Somerset, which provide health services for people who are unable to see a GP at short notice and don’t need to go to A&E.
    "The government is seeking to roll out urgent treatment centres across the country – larger hubs which are run and staffed by GPs, with longer opening hours and a wider range of services.
    "But Somerset cannot afford to replace all its MIUs with these centres – meaning some of them may close in the years ahead."

  • Parts of NHS 'seriously financially unstable', auditors find Guardian picks up on NAO report:
    "The National Audit Office found that NHS provider trusts reported a combined deficit of £827m and clinical commissioning groups (CCGs) a £150m deficit in the financial year ending 31 March 2019.
    "It said extra money provided by the government to stabilise the finances of individual NHS bodies had not been fully effective.
    "Trusts in financial difficulty were increasingly relying on short-term loans from the Department of Health and Social Care (DHSC), the auditors said. The loans were in effect being treated as income by trusts who had built up debts totalling £10.9bn in March 2019."

  • The NAO has sounded a warning bell on the financial sustainability of the NHS Responding to the National Audit Office’s reports on NHS Financial Management and Sustainability, Anita Charlesworth, Director of Research and Economics at the Health Foundation, said:
    "The NAO has sounded a timely warning bell about the significant financial and operational challenges facing the NHS. Even with the government’s proposed investment, the health service will struggle to maintain current levels of patient care in the face of growing demand, let alone deliver the ambitious improvements to services promised by the NHS Long Term Plan. "

  • Review of troubled service still not launched after 16 months (£)HSJ report on the failure to launch the promised inquiry by the Royal College of Pathologists into the failings of the North Kent PathologyServices:
    "Failings in a merged pathology service based at Dartford and Gravesham Trust led to more than 3,000 patients being recalled in late 2018 and early 2019.
    "Errors flagged included tests which could have shown acute kidney injury not being reported to GPs promptly; running out of essential supplies; failing to secure blood samples; tests not being processed in time; and GPs being unaware of test outcomes due to the way they were sent."

  • Jeremy Hunt chairing the health select committee is a blatant conflict of interest Guardian journalist Denis Campbell tears apart the logic of former Health Secretary Jeremy Hunt being allowed to chair the previously outspoken Commons Health Select Committee

  • PM urged to give NHS 100 new hospitals plus an extra £7bn a year Guardian report highlighting the latest pressure from NHS Providers for more capital (see below for link to the NHS providers report).

  • Is it time to retire the title of manager? The latest jewels unearthed from the bullshit mines of US management journal Strategy-Business:
    "I’d like to propose a list: words that we should consider retiring.
    "Not that they should be deleted entirely from the English language, of course, but just moved out of popular usage.
    "And at the top of my list is manager. The word has had a long and useful run. In the days when industry dynamics were more predictable, executives could focus their attention internally, searching for opportunities to “manage” or refine their processes, and using techniques such as lean manufacturing and Six Sigma to achieve quality improvements and cost savings.
    "The role of managers was clear: The company gave them assets, including time, money, people, and other resources, and their job was to optimize those resources to within an inch of their lives."
    "… So, if not manager, what should people in those roles be called? I vote for team leader, which sends a clear and powerful signal that your job is to lead (and all the responsibilities that go with that, including setting strategy and priorities, and helping people build new skills), rather than just making sure people are doing their assigned jobs. And I know these won’t fly as much, but I also like the idea of calling managers coaches or even talent developers."

  • Rebuilding our NHS - why it's time to invest A new NHS Providers report once again pressing for more capital to be available for repairs and new developments if the NHs Long Term Plan is to become a reality:
    "A comprehensive spending review is likely to take place in 2020. It represents the best
    opportunity that has existed or will exist for many years to address this issue. This report is NHS Providers’ contribution to the discussion ahead of this vital decision point.
    "We surveyed trusts about the nature and scale of the problem that currently exists, and the impact underinvestment is having on the frontline.
    "This publication makes the case for why capital matters and how we have campaigned to influence recent policy developments in this area.
    "Informed by trust leaders’ experiences, we have sought to identify both the opportunity that an improved capital system presents, and a set of solutions that, taken together, would put the NHS on a more sustainable footing."

  • Italian scientists isolate DNA sequence of coronavirus Euronews reports on the swift work by the (publicly-funded, NHS-style) Italian health care system: the contrast with the private sector could not be more stark:
    "A hospital in Rome announced on Sunday that it has isolated the DNA sequence of the coronavirus.
    "Visiting the Lazzaro Spallanzani National Institute for Infectious Diseases, Italian Health Minister Roberto Speranza said the discovery will be immediately made available to the entire international community in the interests of taking further measures against the outbreak.
    "Having isolated the virus means that we'll have many more opportunities to study it, to understand it and to better test what can be proved effective to contain its spread," Speranza told reporters. "All of our knowledge and the images of the isolated virus will be promptly shared with the international community"."

  • DWP clawed back £50million in Universal Credit loan repayments in just one month The Mirror reporting the scale of brutality of the working of the hated Universal Credit system: "Boris Johnson's government clawed back £50 million one month in loan repayments from some of the poorest households in Britain.
    "The appalling cost of the Department of Work and Pension’s five-week wait for Universal Credit payments have been exposed by a campaigning Scottish MP.
    "Chris Stephens MP said he has been staggered to discover the government is reclaiming so much money in what he said is a clear sign of a flawed policy.
    "New claimants for Universal Credit have to wait a minimum of five weeks for their first payment to be processed, forcing many to take out loans form from the Government
    "The borrowing, known as Advance Payments, to cover their basic living costs before their first entitlement arrives and is then deducted from regular payments."

  • 30,000 ambulances are forced to wait outside crammed A&E departments during December and January for over an HOUR, figures reveal Daily Heil expressing shock and concern over the consequences of 10 years of austerity-driven spending limits imposed by the Party they just helped secure reelection. Expect more of the right wing press to run critical stories on Tory health policy in the period between general elections.

  • ‘All we’re asking for is equality’: Homerton Hospital chief quizzed over cleaners’ sick pay Hackney Citizen reports on the poor terms and conditions of an NHS contractor:
    "Councillors quizzed Homerton Hospital chief executive Tracey Fletcher last night as the row over sick pay for its outsourced cleaners, porters and catering assistants rumbled on.
    "The issue hit the headlines in December, after workers employed through facility services company ISS revealed they do not receive pay for the first three days of sickness, forcing them to go to work while ill.
    "Trade unions are now putting pressure on the Homerton to resolve the issue with ISS, with the GMB calling on Fletcher to meet with the employees directly and bring the services currently on a £45m contract with the company back in-house."

  • The 'haunting' image of a man whose medical needs were deemed insufficient for free care. He died weighing 45kg. His widow has one question - 'how ill do you have to be?' Manchester Evening News reports on the appalling case of Barry Balderstone:
    "Ulcerative colitis, Parkinson’s disease, diabetes, double incontinence, chronic kidney disease, unable to move or feed himself.
    "This man's medical needs were deemed insufficient for him to qualify for free, full-time social care.
    "The day after that decision was made - upheld at appeal following two applications - 75-year-old Barry Balderstone died.
    "How ill do you have to be to qualify?," widow Marilyn said.
    "The NHS won't comment on the tragic case.
    "Barry, from Bollington, passed away from advanced Parkinson's. He weighed just 45kg.
    "He lived at Mount Hall Care Home and qualified for £150 a week under the continuing healthcare scheme, CheshireLive reports. That covered a small percentage of the costs of his care.
    "The couple's savings and pension pot were hit hard.
    "East Cheshire Clinical Commissioning Group (CCG) said Barry was not eligible for full funding, which would have paid for all of his care needs."

  • Look Up Your Hospital: Is It Being Penalized By Medicare? US Kaiser Health Networks highlights the financial penalties levied by the publicly funded Medicare system (for older Americans) for poor quality care:
    "Under programs set up by the Affordable Care Act, the federal government cuts payments to hospitals that have high rates of readmissions and those with the highest numbers of infections and patient injuries.
    "For the readmission penalties, Medicare cuts as much as 3 percent for each patient, although the average is generally much lower.
    "The patient safety penalties cost hospitals 1 percent of Medicare payments over the federal fiscal year, which runs from October through September.

  • UNISON-brokered deal ends outsourcing at Imperial College Healthcare NHS Trust UNISON press release states
    "A thousand low-paid porters, cleaners and catering staff at Imperial College Healthcare NHS Trust in London are today (Thursday) celebrating after winning the right to be directly managed by the NHS, says UNISON.
    "From 1 April the staff – who work in the trust’s five hospitals across the capital – will no longer be employed by private contractor Sodexo. The company has held the contract since 2015.
    "As part of the transfer back to the NHS, staff from Sodexo will see their pay, overtime, pensions and sickness allowances brought in line with other health service workers, ending years of unfair treatment, says the union."

  • End-of-life care is vital. Why is it so neglected? Guardian's Owen Jones throws the spotlight on the shockingly inadequate funding system for hospices:
    "Imagine if the quality of your local maternity services depended on how much money had been raised by cake sales and marathons. We would regard this as an intolerable state of affairs.
    "Then why, as Marie Curie’s softly spoken chief executive, Matthew Reed, puts it to me, do we accept this funding model for the care we receive at the very end of our lives?
    "What sort of society allows a patient to take their last breath in a lift as they are rushed from A&E to a ward, “treated like a FedEx parcel as they as die because bed pressures are so great,” as palliative care doctor Rachel Clarke put it to me?"

  • NHS England pledges to change network proposals after 'significant' GP concerns Pulse report on the climbdown by NHS England on primary Care Networks:
    "The network proposals, revealed in a draft document on 23 December, caused anger among the profession when it was announced that GPs would have to carry out 'at least' fortnightly care home visits from September.
    "GP leaders warned the plans were not achievable, due to the increase in workload and lack of additional funding, during a time of a staffing crisis in general practice - and in some regions practices were advised to reject the network DES contract altogether.
    "This was followed by GPs stepping down from their roles as clinical directors of networks."

  • Late diagnosis of lung cancer hitting survival rate, study says Guardian highlighting a report from the UK Lung Cancer Coalition:
    "People with lung cancer are dying after being diagnosed late in A&E because their GP missed signs of the disease despite often repeated visits, experts have revealed.
    "As many as 56% of people in some parts of England who get lung cancer are only diagnosed when they visit A&E ….
    "They are five times more likely to die within a year than those whose condition has been identified either by their GP or through the NHS cancer screening programme."

  • Quality pays. Why Luton & Dunstable University Hospital Foundation Trust should invest in quality services Link to UNISON Eastern Region report opposing Luton & Dunstable FT's plans to contract out cleaning and catering on a 10-year tender (after a wretched 5-year contract with Engie). The report is written by (HCT editor) John Lister.

  • NHS England will 'significantly rework' draft PCN plans, officials confirm GP Online reports that the widespread outrage of GPs at proposals for Primary Care Networks put out to consultation just before Christmas seems to have forced NHS England into a sharp retreat:
    "NHS England is drawing up ‘a significantly reworked set of service specifications’ for primary care networks (PCNs), officials have confirmed, just weeks after controversial draft plans left the future of networks in doubt."

  • Universal Credit case finds government discriminated against thousands of disabled people Liverpool Echo story:
    "The government has suffered a humiliating court defeat and been found to have unlawfully discriminated against thousands of severely disabled benefit claimants.
    "The Court of Appeal has today dismissed the government's appeals against two previous court judgements which found that the Secretary of State for Work and Pensions had unlawfully discriminated against thousands of severely disabled people who were moved onto Universal Credit.
    "The ruling upholds two successful High Court challenges brought by two men (known as TP and AR) which found that people who were previously on disability benefits should be protected against a drop in their income when they move into the controversial Universal Credit system."

  • NHS England asked ‘inadequate’ hospital to admit patient despite ban More shocking evidence from the (£) HSJ on the poor levels of service and low priority attached to learning disabilities:
    "NHS England asked an “inadequate” hospital for people with learning disabilities and autism to admit a patient, despite the service having a “voluntary” ban on admissions in place — and shortly before inspectors decided to impose a legal restriction.
    "The provider said it was an “exceptional case”, where the individual “had several failed placements”, and had stayed at the hospital — Jeesal Cawston Park in Norfolk — “in the past”.
    "However, it appears to highlight the shortage of good quality accommodation and placements available and pressure on commissioners to make use of “inadequate” facilities."

  • Cabinet ministers asked to cut back departments by 5% Now the votes have been garnered in the Tories can show their real intentions all along. Sky News reports:
    "Boris Johnson and Sajid Javid have demanded all cabinet ministers draw up cuts of 5% to their department, despite promising an end to austerity.
    "Ministers have been told to do a line-by-line audit of their accounts and identify 10 projects that can be stopped altogether.
    "Protected departments including health and the Ministry of Defence are NOT exempt."

  • UK Spending ‘a Third Less in Real Terms’ on Health than in 2000 Built Environment Networking website reports on a recent Healthcare Property and Development Conference, at which Health Foundation director Anita Charlesworth warned:
    "We now spend a third less in real terms, than we did in 2000, which is not a picture that is repeated across Europe. Other countries have deepened their investment per worker.”
    She continued: “We stand as a real outlier; we’re particularly under-investing in equipment.”

  • We’ve just witnessed the last avoidable NHS scandal – the ones that will follow are now simply inevitable Comment article in the Independent by Dr Alexis Paton nails the underlying pressure creating systems failures:
    "When things go wrong in medicine, society immediately seeks a culprit. Someone specific who we can blame for what is almost always an avoidable disaster. Individuals have been at the heart of every major medical scandal of both this century and the last. Some have been perpetrators, but most have been victims, whether they are patients or staff who have been harmed.
    "What has mattered most in these scandals is that people are singled out and blamed.
    "That the true culprit of many of these scandals is rather austerity itself may seem like a far-fetched claim, but the blood on its metaphorical hands is real. Instead of tackling structural failures brought on by underfunding, the prevailing approach of the UK government has been to attack people for failings – thus allowing the problems with the under-resourced NHS to be swept under the rug. Austerity has ensured an Everest-like mound has accumulated there. "

  • Senior doctors refused to work evenings and weekends at scandal-hit Kent maternity unit Independent report, drawing on a damning 2016 report from the Royal College of Obstetricians and Gynaecologists, highlighting shocking behaviour by some consultants:
    "A group of consultants who repeatedly refused to work evenings and weekends were at the centre of a maternity unit culture that put patients at risk, according to warnings by experts which are revealed today.
    "Despite damning evidence laid out by the Royal College of Obstetricians and Gynaecologists (RCOG) in a report for bosses at East Kent Hospitals University Foundation Trust, in February 2016, the same mistakes were present in the deaths of other babies at the trust in subsequent years.
    "The RCOG report, uncovered by Derek Richford, grandfather of Harry Richford, a baby who died at the trust, suggests a culture at Margate’s Queen Elizabeth The Queen Mother Hospital in which junior staff were reluctant to raise safety concerns for fear of harassment and intimidation. Poor behaviour by a group of consultants apparently became normalised and tolerated, the report said."

  • 'Got away with it' - NHS manager gloated about coverage of dead great-grandmother Eastern Daily Press reports that after the Norfolk and Suffolk Foundation Trust (NSFT) was criticised in an investigation into the death of 88-year old dementia sufferer Doreen Livermore who was attacked in a care home in King's Lynn by another dementia patient, "NSFT's communications manager, Mark Prentice, sent a gloating email to his colleagues on Thursday morning about the lack of focus on the NSFT and its mistakes in coverage of the case by the BBC on Wednesday and local media.
    "We seem to have got away (again) with the Adult Safeguarding Review.
    "I think we may have been saved by the death of Terry Jones," he writes, referring to the Monty Python star who died on Wednesday from a rare form of dementia."

  • Flawed DES could scupper NHS long-term plan, warns network pioneer GP Online update on the unfolding car crash of NHS England's plans to dump more work onto GPs:
    "NHS England insisted last July that it would be ‘as flexible as we can’ with PCNs and look to avoid a top-down management approach - emphasising that they did not want to ‘stifle innovation’.
    "But Dr Nav Chana said the draft specifications create ‘lots of expectations in a quick timescale’, which risked undermining work already carried out by both primary care homes and PCNs. He said 'unrealistic' expectations had been heaped onto additional staff PCNs are expected to recruit.
    "South-west London GP Dr Chana said some of the GPs who were most highly engaged with PCNs were saying they didn't have the time, energy or resources to deliver the plans in their current form - pointing to an NAPC poll that found 84% of respondents felt they could not achieve the requirements."

  • Public sector finances, UK: December 2019 ONS report on "How the relationship between UK public sector monthly income and expenditure leads to changes in deficit and debt."
    Reveals that Public sector debt at the end of April 2010 was £960bn, by December 2019 was almost doubled at £1.819bn. Where has all the money gone?

  • Are self-reported health inequalities widening by income? An analysis of British pseudo birth cohorts born, 1920–1970 Free access to the study on growing health inequalities in the Journal of Epidemiology and Community Health.

  • Poor Britons have worse health than generation born a century ago, study says Independent reports on a research paper in the Journal of Epidemiology and Community Health which states that poor people in Britain now have worse health than those born in the early 1920s.
    "The health gap between the least and most well-off in society is widening and may heap increased pressure on care for vulnerable older people in the future, according to new research from University College London (UCL).
    "Experts found health inequality among rich and poor women born between 1968 to 1970 was twice that of those born between 1920 and 1922. For men, the gap was one-and-a-half times larger."

  • David Oliver: The risks of discharging patients early against doctors’ judgment BMJ blog by consultant David Oliver raising concerns over medics being instructed to take risks to discharge patients more quickly to free up beds in two trusts:
    "we’re entering dangerous territory when the professional clinical judgment of medics who have assessed and spoken to patients and their families, and who are personally accountable for decisions and consequences, is over-ridden, or when they’re heavily pressured to act outside their comfort zone.
    "… The General Medical Council (GMC) has already issued guidance on formally escalating and documenting concerns whenever staffing, workload, or system failures may put patients at risk of harm.4 Guidance in the GMC’s Duties of a Doctor5 suggests that doctors must prioritise their primary duty of care and patient safety—but also use resources efficiently and make balanced judgments. Colin Melville, GMC medical director, told me, “We always consider a concern raised with [us] on the specific facts of the case, taking into account the factors relevant to the environment in which the doctor is working.” I don’t find any of this especially reassuring, and nor do I see a defence of, “the medical director made me do it.” "

  • 'I want dignity, I do not want to die at home' - Cancer patient's heartfelt fight to save West London hospice My London report on campaign to reopen a West London hospice closed since 2018:
    Hammersmith & Fulham campaigner Jim Grealy is quoted calling for the Pembridge hospice to be reopened as it is easy for people to get to and visit their loved ones.
    “People expect to live and die with dignity,” he added.
    "The temporary closure of the 13-bed hospice in October 2018 followed problems finding a replacement consultant to oversee it.
    "It prompted a review of the end-of-life care offered by Central and West London Clinical Commissioning Groups (CCG).
    "Since then beds have been found for patients who need specialist palliative care at Chelsea and Westminster Hospital, the Royal Trinity Hospice in Clapham and St John’s Hospice in St John’s Wood in Westminster."

  • Quality and inequality: digging deeper The Nuffield Trust and Health Foundation report that has flagged up a partial explanation of why poorer people have higher death rates.

  • Babylon Health holds talks with “significant” number of NHS trusts (£) BMJ report reveals that "The digital provider Babylon Health is in talks with a “significant number” of hospital trusts in England as it seeks to expand its service in the NHS, the company has told The BMJ.
    "Babylon’s managing director for NHS services, Paul Bate, said that the company wanted to spearhead a “fundamental transformation” in the way people accessed healthcare. His comments came as Babylon announced a major 10 year partnership with Royal Wolverhampton NHS Trust, a large acute and community provider that also runs 10 general practices, to deliver joined-up digital care to the city’s population."

  • England's poorest 'get worse NHS care' than wealthiest citizens Guardian picks up on a joint Nuffield Trust and Health Foundation report that explores another dimension in health inequalities:
    "England’s poorest people get worse NHS care than its wealthiest citizens, including longer waiting for A&E treatment and worse experience of GP services, a study shows.
    "Those from the most deprived areas have fewer hip replacements and are admitted to hospital with bed sores more often than people from the least deprived areas.
    "With regard to emergency care, 14.3% of the most deprived had to wait more than the supposed maximum of four hours to be dealt with in A&E in 2017-18, compared with 12.8% of the wealthiest. Similarly, just 64% of the former had a good experience making a GP appointment, compared with 72% of those from the richest areas."

  • Whorlton Hall: Care regulator ‘was wrong’ to bury whistleblower’s report into failings at hospital where patients were abused Independent article on yet another failure to scrutinise and of course long term failure of a private provider.

  • McKinsey boss among new ICS lead recruits (£) HSJ report identifies the five senior leaders who will chair the "Integrated Care Systems" in London, with the most prominent appointee being top dog in McKinsey's operations in Europe, Africa and Australia, Penny Dash, to take the helm in NW London where over £80m has already been squandered on useless management consultancy and unfinished business plans since 2009 (£34m of it spent on McKinsey). The 7-year "Shaping a Healthier Future" plan to axe Charing Cross and Ealing Hospitals was itself given the chop by Matt Hancock last March. But it seems no lessons have really been learned. Allegedly Dash is set to retire from McKinsey before stepping straight into an identical role in NW London -- as if the 2.2m population there needed any more McKinseyism.

  • Exclusive: Trusts told to join forces to boost overseas recruits (£) HSJ report showing that even while ministers try to deter people as many as possible from coming to Britain -- imposing visa charges for EU nationals after Brexit and increasing the so-called "Immigration Health Surcharge" yet again to £625 per person – Trusts are being urged to work together in an effort to recruit the overseas staff who are vital to ministers achieving their promised 50,000 "extra" nurses, etc.

  • Adult social care services back under council control in Bath UNISON reports a major step forward for social care staff who were embroiled in a dispute back in 2018.
    "Care workers, catering and domestic support staff working for Sirona Care & Health were today (Tuesday) informed that their roles will be returning to Bath and North East Somerset Council.
    "The news comes after Sirona announced it would be handing back the contract to provide community resource centres and extra care facilities in September. The services will be back under full council control after with effect from 1st September 2020."

  • HPV vaccine drives cancer causing infections down to very low levels A success story - refuting the nonsense of the anti-vaxers:
    "Cancer-causing HPV16 and 18 infections are now extremely uncommon in young sexually active women in England, following the introduction of HPV (human papillomavirus) vaccination in 2008.
    "These infections were found in less than 2% of 16 to 18-year-old women between 2014 and 2018, new data from Public Health England (PHE) show. In a sample of 584 young women tested in 2018, no HPV16 or 18 infections were detected.
    "This is a dramatic reduction from 2008, when over 15% of young sexually active women were found to have these infections."

  • Emergency dementia admissions to hospitals up 35% in five years Guardian report. Dementia is an incremental problem, not a sudden onset: but the lack of proper support and care for people as it develops has meant growing numbers requiring emergency treatment:
    "The number of people with dementia being admitted to hospital as a medical emergency has risen by more than a third in five years, figures have shown, with a lack of social care blamed for the increase.
    "NHS data showed that hospitals in England recorded more than 379,000 admissions of people with the condition during 2017/18. That was 100,000 more than the number of such patients admitted in 2012/13 – a 35% jump in five years.
    "The Alzheimer’s Society, which obtained the figures, said they meant that more than half of everyone in England with dementia had been admitted to hospital at least once – and sometimes many times – during 2017/18.
    “This is the stark reality of many people with dementia left to fall through the cracks in our broken social care system,” said Jeremy Hughes, the chief executive."

  • CQC did not see damning maternity report for three years (£) HSJ report on another shocking failure of scrutiny by the CQC – and wilful withholding of information by East Kent Hospitals FT.

  • Abdul El-Sayed and thousands of physicians sign open-letter NYT ad endorsing Medicare for All More support for the growing campaign for Medicare for All as flagged up in the New York Metro Times:
    "Abdul El-Sayed, a physician and former health director for the city of Detroit, tweeted Tuesday that he is proud to have signed a letter that was endorsed by more than 2,000 physicians who support Medicare for All.
    "Too many in Detroit where I served as health director go without the care they need," El-Sayed said in a statement to Metro Times. "We can solve it. We need Medicare for All today — we needed it yesterday. But we can achieve it in a tomorrow where we stand together and for one another."
    "The open letter, titled "As Physicians, We Prescribe Medicare for All," was published as a full-page ad in The New York Times."

  • We need a more caring vision not stronger specifications An important audio interview with Londonwide LMC chief Michelle Drage about the draft service specifications for Primary Care Networks. She argues GPs and their colleagues already know what needs to be done. Now they need the space and support to get on with it, .

  • GPs in revolt over NHS England's plan to increase their workload Guardian reports that the Primary Care Networks that were supposed to be a way of creating extra shared resources for GP practices are now threatening to impose onerous and unsustainable extra workload - and triggering another revolt by already hard-pressed GPs. This story of NHS England's incompetence seems set to run and run.

  • Workforce crisis leaves the NHS teetering on the brink - but there is a way forward Guardian article by Dr Kailash Chand sums up the current growing crisis and argues:
    "Understaffing begets poor morale, which further damages recruitment and retention. The number of personnel leaving the NHS because of a poor work-life balance has almost trebled between 2011-12 and 2018-19, according to analysis by the Health Foundation thinktank.
    "Continued understaffing could lead to even longer waiting lists, worsening care quality and the risk that the recent increase in NHS funding secured for frontline services will go unspent; even if commissioners have resources for additional activity, there may not be the personnel to deliver it.
    "The secret to the long-term sustainability of the NHS is to introduce a new model putting prevention rather than treatment at the heart of the healthcare system."
    Given the continued and increasing cuts in public health budgets this does seem to be far from likely as the next steps by the Johnson government.

  • Why is the media so invested in the status quo when it comes to health reform? Veteran health care journalist Trudy Lieberman in a typically well-informed as wide-ranging article last month asks the obvious question of why the US media is so locked in to defending a health care system that such a large percentage of its audience finds unsatisfactory.
    "In the run-up to the Affordable Care Act there were hundreds of media stories about Americans who needed health insurance and care, and those stories helped build support for the law. Where are the stories now about those still left out of the system and the significant challenges that remain for thousands still lucky enough to be in?"

  • Bed shortages leave Sunderland patients to sleep overnight in A&E Guardian reports growing problems in Sunderland's already over-full hospital, raising yet again the question on whether they have any scope to "centralise" more services after the forced merger with South Tyneside Hospital:
    "Patients have had to sleep overnight in the A&E unit of one of the NHS’s biggest hospitals because it is overwhelmed by the number of people needing care, a leaked memo reveals.
    "The situation has arisen at Sunderland Royal hospital because it has been running out of beds despite it having recently added an extra 50 to its normal stock of 970 beds to help it cope with winter pressures."

  • World’s billionaires have more wealth than 4.6 billion people Shocking reminder from Oxfam on the scale of global inequalities -- some useful numbers to put our own situation in context.

  • If we don’t start looking after our doctors there will be no one to care for our patients Extended Metro article from a co-founder of the Doctors Association lifts the lid on the heavy workload and poor working conditions faced by hospital doctors:
    "This combination of spiralling workloads and a decimation of morale and camaraderie has been toxic for our profession. Last year, 55 per cent of UK doctors met the criteria for burnout and ‘emotional exhaustion’, with one in five resorting to the use of drugs or alcohol as a ‘coping strategy’. It’s hardly surprising that we are haemorrhaging doctors out of the profession, and it’s only getting worse. In 2018, just 38 per cent of second year doctors chose to continue their careers in the NHS and enter specialty training with the aim of becoming an NHS consultant or GP – compared to 83 per cent in 2010."

  • The nation's health An important Health Foundation report highlighting widening inequalities in health, which many will have missed when it was first published in the depths of the election campaign last November

  • Long NHS waits help drive more patients to pay for private surgery The Independent's Shaun Lintern gets an exclusive early look at a new report from private sector analysts Laing & Buisson -- but one which is disappointingly based on figures that only go up to 2018.
    Still interesting, but it will be even more interesting to find out if there is an ever larger increase in people "self-paying" for private elective care as the waiting list has risen during 2019.

  • Blog from NHS Blithering - Towards people and impact Another brilliant installment that should bring a smile to your face even as you recognise that the bullsh** it is parodying is the daily currency in NHS management circles. This one addresses absurd job titles, with a feature role for communications guru Martin Plackard, "whose CV features a number of leadership roles in the fields of impact, euphemism management and talent delivery.
    "Plackard, the author of some of the NHS’s best-loved slogans including “Building on future excellence” and “Towards outstanding”, said:
    “It’s easy to overstate the importance of meaning in role design. We need to create roles that appeal to people who refuse to be defined by outmoded ideas about job descriptions, past experience or achievements."
    Just excellent fun for dark times.
    My own personal favourite daft slogan? "For us, excellence is just not enough".

  • Lewisham and Greenwich Trust scrutinised over sharing patients' data with Experian News Shopper reports the struggles by Trust bosses to explain their decision to hand over data on patients to Experian:
    "A decision by Lewisham and Greenwich Trust to hand over patients’ personal data to a credit reference firm was slammed by committee members in Lewisham last night (January 15).
    "Before the activity was exposed by the Health Service Journal, the trust had been using Experian to run UK checks for patients’ credit footprints to see if they were eligible for free treatment."
    The report quotes Jim Lusby, director of integrated care and development at Lewisham and Greenwich Trust, who spoke to the healthier communities select committee about the steps that had been taken in the wake of the scandal.
    "He said the reason the trust took the decision to check everyone was to do it in a “non-discriminatory” way. In hindsight it was not the right choice […] in all honesty I struggle to defend the logic of this,” he told the committee."

  • The four-hour NHS waiting time target saves lives - government should think carefully about changes An unusual and important report from the Institute for Fiscal Studies (which normally only looks at financial matters) argues the importance of the 4-hour target for seeing and treating emergency patients:
    Researchers at the IFS, Cornell University and the Massachusetts Institute for Technology (MIT) have collaborated on a paper which "suggests that the target has meaningful impacts on patient outcomes. "
    It analyses "the impact of the target on the treatments received by patients and their subsequent survival outcomes, and finds that the target was successful in reducing A&E waiting times, but increased the number of inpatient admission and costs.
    "These impacts were accompanied by a large reduction in the mortality rate of A&E patients. These mortality reductions appear to be driven by shorter waiting times rather than additional treatment, and mostly affect patients with severe and potentially time-sensitive conditions such as sepsis and stroke. "

  • Report shows nurse whistleblowing complaints up 68% (£)_nursing Times reports "The number of nurses blowing the whistle over concerns in their workplace has gone up by 68% over two years, new figures reveal."
    Nurses were by far the most common health staff to raise concerns over quality and safety of health care -- followed by admin and clerical staff and allied health professionals.
    RCN official Mike Adams pointed out that "nurses turning to guardians could mean they did not feel comfortable raising issues directly with their managers."

  • Boris Johnson admits solution to social care crisis could still be five years away Independent draws out key admission from a BBC interview with Bozo, who promised in July that he had "a clear plan" to give "every older person the dignity they deserve".
    But: "In a BBC interview, the prime minister backtracked on his pre-election claim to have a ready-to-go rescue package – instead, saying he would be “bringing forward a proposal” later this year.
    "Asked for a date for action to finally be taken to improve social care, Mr Johnson said: “We will certainly do it in this parliament” – prompting the interviewer to point out: “That’s five years away.”

  • Revealed: The trusts where patients lost their sight after follow-up delays (£) HSJ flags up problems caused by chronic lack of capacity in at least 11 trusts.
    "Responses to HSJ’s Freedom of Information Act requests also indicate many trusts have no proper oversight of their waiting lists. Many trusts — including the internationally-renowned Moorfields Eye Hospital Foundation Trust — were unable to say how many patients were waiting for overdue follow-up appointments or suffered harm, either because they did not have the information or it would take too long to extract it.
    "HSJ also found 3,384 cases between November 2018 and October 2019 where ophthalmology patients had waited more than a year past their intended follow-up date."

  • Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care American College of Physicians - the largest specialist organisation of US doctors - comes out for Medicare for All in a remarkable endorsement of the principle of universal health coverage and rejection of the existing US system:
    "This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford.
    "Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage.
    "The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Part 2 presents 2 potential approaches, a single-payer model and a public choice model, to achieve universal coverage. Part 3 describes how an emphasis on value-based care can reduce costs."

  • How is your area coping with pressures? Charts compiled from NHS Digital data by Greg Dropkin of KONP Merseyside give a graphic illustration of performance against target on a range of measures, area by area, and also comparing trusts in the same area with each other. More will be added to complete the picture.

  • Plan to scrap A&E target sparks furious backlash from medics Guardian reports: "Plans to scrap the four-hour A&E target have sparked a furious backlash from doctors and nurses, with some claiming it is driven by ministers’ desire to avoid negative publicity about patients facing increasingly long delays.
    "A&E consultants led a chorus of medical opposition to the move. They pointedly urged NHS leaders and ministers to concentrate on delivering the long-established maximum waiting time for emergency care rather than finding “ways around” it.

  • Health Care Administrative Costs in the United States and Canada, 2017 research paper argues that "The gap in health administrative spending between the United States and Canada is large and widening, and it apparently reflects the inefficiencies of the U.S. private insurance–based, multipayer system. The prices that U.S. medical providers charge incorporate a hidden surcharge to cover their costly administrative burden."

  • Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses The first ever systematic review of economic analyses of single-payer health system in the USA. Researchers analyzed 22 cost estimates over 3 decades, with 20 of the 22 predicting net savings.

  • London council cuts ties with private firm that deems sick homeless people ‘fit’ without meeting them Independent reports a glimmer of hope in a dark landscape as Islington council decides to axe its contract with a private firm exposed by the newspaper and the Bureau of Investigative Journalism. NowMedical, "has been paid millions of pounds in public money by local authorities across the country to produce reports on homeless individuals, based solely on paper records.
    "Diarmaid Ward, the chief housing councillor, said the council planned to bring the medical assessments in-house by employing a specialist occupational therapist, saying this would give the council “more control” and help to deliver a better service for homeless applicants, as well as potentially saving money in the long term."

  • Matt Hancock signals A&E waiting targets likely to be scrapped Guardian reports: "Matt Hancock has signalled that four-hour waiting targets for A&E are likely to be scrapped for the NHS in England after the worst figures on record this winter.
    "The health secretary said it would be better if targets were “clinically appropriate” and the “right targets”, as he defended the NHS’s failure to meet the standard that 95% of patients attending A&E should be admitted, transferred or discharged within four hours.
    "The target was put under review by Theresa May’s government and the NHS unveiled plans last March to pilot changes that would prioritise patients with serious conditions while patients with minor problems could wait longer than four hours."

  • Shrewsbury maternity scandal: More than 900 cases of potential poor care identified at hospital Independent with an update on a long-running scandal:
    "About 100 new cases of poor maternity care at a beleaguered hospital trust have been identified, bringing the total to 900, the government has revealed.
    "The scandal at Shrewsbury and Telford Hospitals Trust ​- the largest maternity scandal in NHS history – is already under investigation and lawyers are preparing to act on behalf of families who say they suffered."

  • Mid Staffs scandal: 10 years on, inquiry chair worries NHS staff too scared to speak up Independent reports: "Ten years on from the Mid Staffordshire NHS trust scandal, the man who led the inquiry into one of the worst care disasters in the service’s history has said he remains worried about the safety of patients and a culture that leaves staff too frightened to speak up.

  • Single-Payer Systems Likely to Save Money in US, Analysis Finds US academic study takes overview of two dozen previous studies – and concludes "single payer" system in place of current insurance would save money from the first year of operation.

  • Matt Hancock Hints NHS A&E Waiting Times Could Be Scrapped Huffington Post reports: "Health secretary Matt Hancock has hinted that landmark NHS targets could be scrapped following the health service’s worst A&E waiting times since records began.
    "More than one in five patients were forced to wait for more than four hours for treatment in December.
    "But Hancock said there was a “problem” with the target as it failed to take into account other improvements.
    "NHS England figures published last week showed just 79.8% of A&E patients were seen within the specified time, way below the 95% target that was introduced by Tony Blair’s government in 2004."

  • NHS funding bill enters Parliament Government press release: ministers continue to boast, without justification, of the "largest cash settlement in NHS history" despite the fact it is only £20.5bn in real terms, 3.4% per year, well below the 4.1% required annually to keep pace with rising costs, and nowhere near enough to compensate for the £35 billion that NHS would have had if increases had continued at pre-2010 average. Worse, enshrining this inadequate sum in law means effectively imposing a 5-year cap on NHS spending, regardless of the scale of continued decline in services.

  • Cornwall hospital to discharge patients early despite saying it may be harmful Guardian report on Royal Cornwall Hospital, the only DGH in Cornwall:
    "A major NHS hospital is under such pressure that it has decided to discharge people early even though it admits that patients may be harmed and doctors think the policy is unwise.
    "The Royal Cornwall Hospitals NHS trust has told staff to help it reduce the severe overcrowding it has been facing in recent weeks by discharging patients despite the risks involved. …
    "The memo added: “One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern.
    “It was agreed, however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm.”

  • CQC slams private provider for leadership and care quality (£)HSJ reports; "The firm which runs a mental health hospital at the centre of an abuse scandal has been criticised by regulators for its leadership, care quality and “high use of restraint and seclusion” across its sites.
    "The Care Quality Commission is calling for “immediate action” from Cygnet Health Care — which ran Whorlton Hall before it closed last year in the wake of a BBC Panorama investigation — following an assessment of its leadership.
    "Regulators found there “was a high use of physical restraint and seclusion,” and high levels of patient-on-patient assaults and self-harm across services run by Cygnet compared to similar mental health services at other providers."

  • Government 'misleading the public' by claiming 18 hospitals built since 2010, says senior doctor i-news reports:
    "One of the UK's leading medics has accused the Government of "misleading the public" after it claimed 18 new hospitals have opened over the last 10 years.
    "In response to a Freedom of Information request from i asking how many new hospitals have been built in England since 1 January 2010, The Department of Health and Social Care (DHSC) said there had been 18 - although this figure includes partial new builds as well as existing hospitals that have either been refurbished or redeveloped.
    "Dr Susan Crossland, president of the Society for Acute Medicine, criticised the department for its answer and said it was conflating several different construction projects in the same list."

  • French Strikes: Macron calls a ‘Temporary Halt’ to his pension reforms but the people will not stand down. Labour Heartlands gives an update on the massive strikes which have barely been reported in the British press and not at all on mainstream TV -- against an increase in the pension age:
    "With clouds of tear gas and smashed store windows punctuating the urban landscape of France, the French government made their first major concession on Saturday, backing down to the unions protesting its pension reform plan. Macron has temporarily scrapped his proposal to raise the retirement age in France but the people and unions are not buying it.
    "Faced with an unrelenting protest over proposed changes in France’s pension system, officials withdrew a move to raise the full-benefit retirement age to 64 from the present 62.
    "The French government's climb down shows that ‘People Power’ is a force to be reckoned with. Alongside the organised backing from the unions and other movements, the people of France have forced the government to temporarily halt the pension reforms."

  • Mental health nurses ‘near breaking point’ due to service pressures Nursing Times reports:
    "The survey of more than 1,000 mental health professionals, carried out by the British Medical Association in collaboration with the Royal College of Nursing and Association of Clinical Psychologists, suggests workforce shortages are having a major impact on workload, staff wellbeing and morale.
    "The findings also show shortages are affecting the quality of care with 52% of respondents reporting they were too busy to provide the care they would like on the last shift they worked."

  • Safety fears as hospitals redeploy nurses to care for patients in corridors Guardian report on the latest crisis measures being taken in overstretched hospitals:
    "Hospitals are having to redeploy nurses from wards to look after queues of patients in corridors, in a growing trend that has raised concerns about patient safety
    "Many hospitals have become so overcrowded that they are being forced to tell nurses to spend part of their shift working as “corridor nurses” to look after patients who are waiting for a bed.
    "Nurses, doctors and hospital bosses have all voiced unease about the practice, which has risen sharply in recent weeks as the NHS has struggled to cope with the extra pressures of winter."
    If only ministers had some way of knowing it would be winter at this time of year.

  • Torn but determined RCN members in Northern Ireland, on strike for the very first time in the history of their union, speak about their feelings.

  • Shropshire 12-hour A&E trolley waits worst in country Shropshire Star reports on another Tory-voting area coming to grips with what they have just voted to continue over the next five years:
    "More patients faced trolley waits of more than 12 hours at Shropshire's A&Es than anywhere else in the country last month, new figures show.
    "The latest NHS England figures, published today, show 348 patients waited more than 12 hours on trolleys in December, while 2,130 patients faced a trolley wait of more than four hours.
    "The figures, which have risen significantly since November, show that 12,434 patients attended the county's A&E departments at Royal Shrewsbury Hospital (RSH) and Telford's Princess Royal Hospital (PRH) last month.
    "And about two in five of them had to wait longer than the four-hour Government target."

  • Bishop Auckland stroke unit closure plan prompts patient fear BBC report addresses one of a number of areas that voted for Tory candidates in December -- only to find that their NHS is now being cut back, as they were warned.

  • LMC issues urgent call to GPs on 'viability' of practices following network proposals Pulse reports on the row over Primary Care Networks:
    "The new proposals, drafted by NHS England and NHS Improvement, state GPs will have to carry out care home visits 'at least' every fortnight and implement structured medication reviews as part of the five national services PCNs will have to phase in from April.
    "Londonwide LMCs are asking practices in a survey whether they believe that these specifications will 'increase or decrease the stability of your practice'."

  • Ministers urged to speed up review of benefits for terminally ill Guardian reports on concerns of charities that "Thousands of people have died before being able to access welfare payments."
    "Campaigners had demanded law changes after thousands of people who had just months to live were unable to access benefits, often finding their claims bogged down in bureaucracy and unnecessary health assessments.
    "Current benefit rules state that claimants can only get their benefits fast-tracked if a doctor says they have less than six months to live – campaigners argue this is too restrictive, and want the definition widened to ensure benefits can be accessed as soon as a terminal illness diagnosis is made."

  • Practices 'face £105,000 loss' for taking part in network DES in current form GP Online flags up the growing disquiet among GPs over the implications of the new Primary Care Networks which were supposed to be giving them additional support:
    "In a move that raises serious questions over the future of the £1.8bn primary care network (PCN) programme, Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs has demanded that NHS England cancel or freeze the proposed specifications - calling them 'completely unrealistic'.
    "The LMC said it 'cannot in any way endorse these specifications, nor do we have any confidence that national negotiations will result in NHS England agreeing to sufficient positive changes'.
    "Its analysis warns that the specifications are 'impossible to deliver' with the available workforce and that that in a best-case scenario practices will face costs 'at least in excess of £100,000 per annum'."

  • $170 Billion and Counting: The Cost of Brexit for the U.K. Figures to remember next time ministers argue they can't put more money into the NHS. Bloomberg reports that the total cost of Brexit to the economy is now greater than the total of payments into the EU in four decades and more since Britain joined!

  • The health and social care workforce gap Report in the House of Commons Library begins:
    "Around 1.2 million full-time equivalent (FTE) staff work in the NHS, and 1.1 million work in adult social care. Around 78% of social care jobs are in the independent sector. Providers across NHS England are reporting a shortage of over 100,000 FTE staff. Adult social care is facing even starker recruitment and retention challenges, with an estimated 122,000 FTE vacancies. This equates to a vacancy rate of around 8% for both the NHS and adult social care, compared with a vacancy rate of under 3% for jobs across the UK economy.
    "Analysis by the King’s Fund suggests the NHS workforce gap could reach almost 250,000 by 2030. Nursing is facing one of the greatest problems with one in eight posts vacant. "

  • U.S. health system costs four times more to run than Canada’s single-payer system Los Angeles Times reminds readers that:
    "In the United States, a legion of administrative healthcare workers and health insurance employees who play no direct role in providing patient care costs every American man, woman and child an average of $2,497 per year.
    "Across the border in Canada, where a single-payer system has been in place since 1962, the cost of administering healthcare is just $551 per person — less than a quarter as much."

  • Combined Performance Summary: November–December 2019 Nuffield Trust crunches the latest numbers on NHS performance:
    "NHS England published its Combined Performance Summary, which provides data on key performance measures for November and December of last year. SitRep data for the first week of 2020 was also released, giving a more up-to-date analysis of how the NHS is coping this winter. Here we show some of these statistics and how they compare with previous years."

  • £1.8bn PCN programme on brink as senior GPs threaten to withdraw GP Online on the developing crisis in Primary Care Networks:
    "the document has been met with widespread dissatisfaction from doctors, who say that the draft specifications create workload ‘vastly in excess of what is credible’ for GPs. They have also criticised a lack of separate funding to carry out additional duties, such as fortnightly care home visits.
    "This had led to a number of senior GPs and leaders of mature networks, including the 2018 winners of the NAPC Primary Care Home of the Year, threatening to pull out of the PCN DES unless it is altered ‘radically’."

  • Long waiting times for GP appointments are unacceptable, says College, as it calls on Government to prioritise general practice which has been 'running on empty for too long' Royal College of General Practitioners steps up the pressure on government to deliver on some of its promises:
    "Professor Martin Marshall, Chair of the Royal College of GPs, said: "It is totally unacceptable to expect patients to wait weeks for a GP appointment. Patients -and GPs - deserve better.
    "However, the situation in which we find ourselves has not happened overnight, and the College has been sounding the alarm bells for many years.
    "Whilst workload in general practice has escalated in terms of volume and complexity, successive governments have failed to invest sufficiently in the family doctor service in order to keep pace with demand, and one consequence is that we now have a worrying shortage of GPs."

  • 'Misery' for A&E patients facing record-long waits BBC report underlines the parlous state of the NHS after a decade of budgets effectively frozen in real terms while demand has increased:
    "Huge pressures at hospitals across the NHS over the last month have led to long delays for patients seeking emergency care, figures suggest.
    "The NHS England December data showed record delays in A&E with one in five patients waiting more than four hours.
    "A key problem seems to have been a shortage of beds on wards.
    "The figures show nearly 100,000 of the sickest patients faced hours stuck on trolleys and waiting in corridors while beds were found for them.
    "Some hospitals were even forced to introduce emergency protocols and turn away walk-in patients deemed not to need immediate help, while many have postponed routine operations to fee up space."

  • Glaucoma patients going blind due to treatment delays, watchdog finds Guardian reports that in one of the richest countries in the world "People with glaucoma are going blind because NHS eyesight services have “inadequate capacity” to follow up such patients properly after diagnosis, an investigation has revealed.
    "An estimated 22 patients a month are suffering severe or permanent loss of sight because of long delays in getting follow-up appointments, the patient safety watchdog found."

  • A&E Attendances and Emergency Admissions: December 2019 Statistical Commentary The latest shocking official figures for December and official commentary admits
    "79.8% of patients were seen within 4 hours in all A&E departments this month
    compared to 81.4% in November 2019 and 86.5% in December 2018. This is the
    lowest performance since the collection began. The 95% standard was last met
    in July 2015. "
    However performance is even worse for the most serious Type I A&E cases, many of whom need beds:
    "68.6% of patients were seen within 4 hours in type 1 A&E departments compared
    to 71.3% in November 2019 and 79.1% for the same month last year. This is the
    lowest type 1 performance since the collection began."

  • NHS Trusts outsourcing pharmacies on huge scale due to perverse incentive Left Foot Forward identifies an interesting aspect of privatisation:
    "A report in the Pharmaceutical Journal highlights figures from the most recent ‘Pharmacy and Medicines Optimisation Benchmarking Project’ report, showing that 50% of the 106 NHS trusts that supplied data have a ‘subsidiary’ outpatient pharmacy.
    "A third (34%) of trusts had outsourced the service to a commercial firm, with 16% having created a ‘wholly owned subsidiary’ (WOS) pharmacy.
    "Under the current law, NHS Trusts have to pay VAT on their medicines. However, VAT can be avoided for Trusts’ outpatient pharmacies by “enter[ing] into a contract with a third-party pharmacy company” – with these “qualifying goods” being exempt from VAT."

  • 81-year-old gran should not have had to die on the roadside on M11 Strong Eastern Daily Press report on failing mental health services in Norfolk & Suffolk states: "Peggy Copeman passed away on Monday from a suspected heart attack while being transported back to Norfolk from Devon, where the pensioner had been sent because there were no suitable beds closer to home.
    "Her family say that she should not have been sent more than 280 miles away in the first place - and that she should not have been put in a position where she had to die on the hard shoulder in such a way.
    "Her death is the latest in a string of shocking stories to have emerged in recent years relating to so-called 'out-of-area' mental health treatment, which is normally required due to a lack of suitable beds in Norfolk and Suffolk."

  • How can U.S. healthcare save more than $600B? Switch to a single-payer system, study suggests Fierce Healthcare report states "U.S. healthcare could save more than $600 billion in administrative costs by adopting a single-payer system like neighboring Canada, a new study suggests.
    "The U.S.’s current multi-payer system cost the country $812 billion in administrative costs in 2017—four times more than Canada, which has a single-payer system—mostly due to the increasing overhead of private insurers, according to a study in the Annals of Internal Medicine.
    "The study concluded that cutting U.S. administrative costs to Canadian levels by adopting single-payer health financing would have saved more than $600 billion."

  • New primary care network contract won’t work, GPs warn (£) BMJ report reveals that “A proposed new contract for general practices to participate in primary care networks contains unrealistic demands and will pile new layers of bureaucracy on overstretched practices, GPs have warned.
    … “The draft document stipulates that from September 2020 GPs will have to visit patients in care homes at least once a fortnight as part of an enhanced care service in residential homes. And from April 2020 primary care networks will be expected to initiate structured medication reviews for the patients most likely to benefit, including all those in care homes.
    … “Nearly all general practices (99%) signed up to the new network DES last year as a way to get additional funding for collaborating in networks. In the first year the only major stipulation was for practices to join a network.
    “But since details of the draft contract emerged GPs have warned that it would be almost impossible for some practices to deliver, because of the short deadline.”

  • Dozens of hospitals leaving NHS staff at risk of attacks by patients Independent report flagging up Health & Safety Executive findings that 25 of the 38 trusts inspected "are in breach of rules designed to make sure they manage risks to their staff from violent patients or members of the public.
    "The Health Service Journal revealed the inspections were prompted by increasing numbers of assaults on NHS staff, including three killings by patients in the last five years."

  • Number of children admitted to A&E with mental health problems jumps 330 per cent over past decade Independent report on a shocking gap in care:
    “Reduced community services and rising mental health issues among Britain’s youth have fuelled a 330 per cent surge in crisis admissions at hospital emergency departments.”
    However the article also points out that: “Analysis of referral criteria used by 29 NHS mental health trusts, by Pulse magazine, found a third only accept patients with “severe/significant” conditions.
    “Just six out of the 29 trusts accept referrals for children with all severities of mental health problems.”

  • STRIVING TO DELIVER: NHS PROVIDERS WINTER BRIEFING 2019/20 Numbers of A&E attendances and emergency admissions increasing while bed numbers fall -- NHS Providers set out the background the utterly predictable drop in performance of overstretched, under-funded and under-staffed trusts.

  • Worcestershire and Shropshire face restrictions on ambulance services to reduce A&E caseload Ambulance crews in Shropshire and Worcestershire, where hospitals are stretched beyond capacity are being told to use restrictive criteria to avoid conveying people from nursing homes, care homes, sheltered housing etc. Needs of older people ignored.

  • Delays in GP appointments increased rather than decreased since Johnson promise (£) Times https://www.thetimes.co.uk/article/eleven-million-patients-wait-more-than-three-weeks-to-see-gp-x9jgzsrrf points out PM’s first speech last July argued: ‘My job is to make sure you don’t have to wait 3 wks to see your GP’. NHS figures (Table 1) show numbers waiting over 3 weeks have increased by 1 million since then compared with same months last year.

  • Real reason the NHS is getting worse each year exposed by expert Feeble Daily Express attempt to come to grips with consequences of a decade of under-funding and policies that have undervalued and underpaid staff resulting in 100k vacancies – and enlisting limp comments from King's Fund "expert" who winds up trying to blame the disastrous performance figures on increased incidence of flu, but concludes: “Although it is not too bad historically speaking compared to our worst ever winter flu epidemics.”
    With analysis like this it's no surprise the Express and its readers have failed to grasp the scale of the crisis created in the NHS by austerity policies and privatisation.

  • 'Outdated' IT leaves NHS staff with 15 different computer logins BBC reports a pathetic £40m allocation in an effort to tackle the huge backlog of inadequate investment in IT kit and systems:
    "IT systems in the NHS are so outdated that staff have to log in to up to 15 different systems to do their jobs.
    "Doctors can find themselves using different logins for everything from ordering x-rays and getting lab results to accessing A&E records and rotas.
    "The government in England said it was looking to streamline the systems as part of an IT upgrade."

  • Surgery patients with deadly sepsis are not getting antibiotics fast enough, NHS audit finds Independent reports: "More than 80 per cent of patients who have signs of a deadly sepsis infection before high-risk surgery are not getting antibiotics fast enough, a major NHS report has warned.
    "Sepsis kills an estimated 44,000 people in England every year and rapid access to antibiotics within the first hour after diagnosis is vital to halt the infection.
    "But a review of performance across 179 NHS hospitals has found a majority of patients undergoing emergency bowel surgery are not getting medication early enough."

  • London ambulance service has safety rating downgraded over staff shortages at call centre Independent flags up weaknesses in the organisation of London Ambulance Service: if you can't get through, your call can't be responded to:
    "Britain’s busiest ambulance service has had its safety rating downgraded by the care watchdog over fears it does not have enough staff to answer 999 calls consistently.
    "Inspectors from the Care Quality Commission (CQC) were told workers at London Ambulance Service‘s two emergency operations centres (EOC) were concerned about staffing levels, struggled to get clinical advice and could not always send out enough paramedics because of demands on the service."

  • Four in 10 GPs suggest seeking private care for mentally ill children Remember all those government claims to be prioritising mental health? Maybe this is what they really want to see -- Guardian report:
    "In a survey, 43% of UK family doctors said they told parents whose children were struggling with anxiety, depression, self-harm or eating disorders to seek treatment privately if they could afford it because NHS care is heavily rationed and involves delays of up to 18 months.
    "The fact that so many families are being directed to private treatment highlights the inability of NHS child and adolescent mental health services (CAMHS) to cope with the growing demand for care from under-18s who have mental ill health."

  • Hospital Group Mum As Members Pursue Patients With Lawsuits And Debt Collectors Grim report from California on the hypocrisy at the top of US hospitals organisation:
    "The American Hospital Association, the biggest hospital trade group, says it promotes “best practices” among medical systems to treat patients more effectively and improve community health.
    "But the powerful association has stayed largely silent about hospitals suing thousands of patients for overdue bills, seizing homes or wages and even forcing families into bankruptcy.
    "Atlantic Health System, whose CEO is the AHA’s chairman, Brian Gragnolati, has sued patients for unpaid bills thousands of times this year, court records show, including a family struggling to pay bills for three children with cystic fibrosis."

  • Children in mental distress denied NHS help until close to suicide Telegraph picks up a story they would not have run before the election, but tries to blame the problem on social media rather than an anti-social government, poverty and other pressures:
    "Children suffering mental health problems are being refused treatment until they are close to suicide, amid soaring referrals, an investigation reveals.
    Medics said services were “washing their hands” of vulnerable children and teenagers, with one in three trusts only accepting cases classed as the most severe.
    "Experts said children were being forced to wait until their condition deteriorated - in some cases resulting in a suicide attempt - in order to get to see a specialist."

  • Nurse shortage forces NHS hospital to shut critical-care beds Guardian reports: "An NHS hospital in Norwich has had to close four beds in its high dependency unit because it does not have enough nurses to staff them.
    "Norfolk and Norwich university hospital (NNUH) decided on Monday to temporarily shut the beds in the Gissing ward of its critical care complex.
    "The beds, which are used for seriously ill patients, have been shut despite flu and other viruses that circulate at this time of year leaving more patients than usual suffering from breathing problems.
    "Hospital managers told doctors in an email that: “A decision has been made to temporarily close our GHDU beds and reduce to 20 bed capacity on our CCC [critical care complex] from today as the nursing staffing is insufficient to keep Gissing open.”

  • NHS to slash waiting time targets for cancer diagnosis despite ‘desperate’ need for more staff Independent reports an another empty gesture from NHs England pretending all is much better than it really is -- perhaps to say thankyou for Simon Stevens' knighthood?
    "Patients should find out whether they have cancer or not within 28 days of being referred for tests from April, under a new NHS target.
    "NHS England plans to bring in the new benchmark with a threshold target of between 70 and 85 per cent of referred patients expected to have been given a definitive answer within four weeks.
    "But the move will heap pressure on stretched diagnostic teams with experts from the Royal College of Radiologists warning it could be unachievable because of the widespread shortage of diagnostic staff and rising demand for tests.
    "NHS data shows hospitals failed to meet the main cancer target of treating at least 85 per cent of patients within 62 days since 2013-14, and performance has dropped to record low levels of just 75 per cent in October 2019."

  • When Medical Debt Collectors Decide Who Gets Arrested Horror story from Pro Publica of real life in Kansas where private medical corporations literally call all the shots.

  • 'Breaking point': fears over lack of intensive care beds for children Guardian picks up on shortages of these specialist beds:
    "Critically ill children are being rushed from one part of England to another because NHS hospitals are running short of intensive care beds in which to treat them.
    "An increase in severe breathing problems in children driven by winter viruses and infections, including flu, means some are having to be transferred sometimes many miles from their home area because there are not enough paediatric intensive care (PICU) beds locally."

  • A thousand patients including dementia sufferers are stripped of social care funding every year as part of tough 'reassessments' of their needs Daily Mail - safely after the election -- highlights the brutality of the regime unleashed by Tory governments since 2010:
    "More than a thousand seriously ill patients, including dementia sufferers, are being stripped of vital care funding every year.
    "They are among the 10,000-plus patients with degenerative and terminal health conditions such as Alzheimer's and Parkinson's disease who undergo tough annual 'reassessments' of their care needs.
    "If they fail to prove they are still ill enough to qualify for financial help, the funding covering their nursing home fees is removed.
    "Some of those affected cannot walk, talk and are incontinent. In the worst cases, elderly people face draining their bank accounts to pay for the care they need."

  • Fat cat boss of private mental health firm receives £445,000 pay rise despite hospitals failing autistic patients Daily Mail flags up interesting angle on failing US-owned mental health provider Cygnet:
    "Cygnet has almost doubled the package handed to its highest-paid director – most likely to be chief executive Tony Romero – from £508,000 to £953,000, according to its latest accounts.
    "The revelation comes after nine of its hospitals were failed this year by the official watchdog. In the latest case, a Coventry hospital for women was threatened with closure on Christmas Eve after inspectors found serious safety, staffing and hygiene issues."

  • Call to scrap £625 fee for foreign doctors and nurses to use the NHS Guardian reports: "The King’s Fund warns that the charges – which are about to go up from £400 to £625 a year for foreign workers and their dependants – are a “perverse” deterrent to the very staff the government admits it needs to attract to plug holes in the NHS workforce. The rise means a health professional from abroad with a partner and two children will have to pay £2,500 a year.
    "Boris Johnson has come under fire for deciding to increase the immigration health surcharge for migrants from outside the European Economic Area and to extend it to EU staff for the first time after Brexit, despite acknowledging that the NHS will need to recruit even more personnel from around the world if he is to deliver his key election pledges of 50,000 more nurses and 6,000 extra GPs by 2024."

  • The crisis in general practice is unprecedented Dr Kailash Chand responds to a Pulse exclusive which reveals that over half of GPs say they're working beyond safe levels, generally dealing with a third more patients than they believe they should be.
    "The public's safety is, of course, every healthcare practitioner's priority, but this could seriously damage it.
    "In a survey of 1,681 UK GPs, the safe limit of patients to see in a day was decided as 30, but in actuality it's more like 41. And one in ten deal with 60 or more patients in a day - which is typically 11 hours long, comprising of eight hours of clinical work and three of admin.
    "The intensity of workload pressures is similarly high, with 29% deeming their patient contacts 'very complex' and 37% 'fairly complex'."

  • Is Paula Vennells a Fit and Proper Person? Interesting blog questioning the credentials of the chair of a major NHS Trust on the basis of their former record.

  • NHS hospitals to employ safety experts to tackle thousands of avoidable mistakes Independent reports: "NHS trusts will be told to identify staff who will be designated as the safety specialist for each organisation.
    "These workers, who will get specific training and work as part of a network across the country, will help to tackle a fragmentation in the way safety issues are dealt with in the NHS and ensure nationwide action on key safety risks is coordinated."

  • District nursing crisis ‘means Boris Johnson’s NHS plan is undeliverable’ Independent flags up a crisis that has been brewing for the last decade or more with no government action:
    "New data has revealed district nurses, who deliver complex care in people’s homes to help them recover and stay out of hospital, are being forced to work an extra day of unpaid overtime every week to try to meet the relentless demand for their services.
    "Three-quarters of teams have vacancies and recruitment freezes and since 2010 the number of NHS district nurses has dropped from more than 7,000 to just over 4,000 in the past 10 years."

  • OECD comparative Data on doctors Link to the OECD figures showing international comparisons.

  • UK's number of doctors per capita is one of lowest in Europe Guardian offers not so much news as a reminder of what a decade of underfunding can do to our NHS: "With 2.8 doctors per 1,000 people, compared with an average of 3.5 doctors across the OECD, the UK shortage is second only to Poland.
    "This shortfall of doctors persists despite the OECD research showing that British GPs and specialists in the UK earn more than three times the average national salary.
    "The OECD report, which examined data between 2000 and 2017, also highlighted the UK’s reliance on foreign-trained medics, with 28.7% of British doctors qualifying abroad, the fifth highest figure in Europe. At 15%, the UK had the second highest proportion of nurses trained abroad, after Switzerland."

  • Doctors told to use 'least unsafe' option in Norwich hospital Guardian reports on alarming conditions forcing awful choices on medical staff in Norwich: "Medical groups have voiced concern that Norfolk and Norwich hospital trust’s instruction to its consultants this week showed it was struggling so much to cope with the number of people needing care that patient safety was being put at risk.
    "At the time the hospital had no spare beds, a full accident and emergency department, 35 patients waiting on trolleys to be admitted, and had declared a major internal incident.
    "In its message, seen by the Guardian, it said: “We would like you to know that the trust will support you in making difficult decisions that may be the least unsafe decision, and we would appreciate your cooperation over the coming days with this.”

  • New Conservative seats and the healthy life expectancy gap Health Foundation crunches some numbers on the newly Conservative constituencies, and finds they are likely to live less long than traditional Tory voters:
    "the seats the Conservatives won are in areas with a lower life expectancy and even lower healthy life expectancy to the England average and to the seats they held from the 2017 general election.
    "On average, a woman living in one of the new Conservative constituencies can expect to live 60.9 years of her life in good health, compared to 65.0 years for a woman living in one of the existing Conservative constituencies – a difference of over four years."

  • Over 2000 doctors write to Boris Johnson demanding 'urgent action' to save NHS Mirror reports that: "The letter written from some of the nation’s top doctors insists that without radical change, the pressures will see the service "hemorrhaging doctors and nurses".
    "There are currently over 100,000 staff vacancies in the NHS nationwide.
    "Organised by the Doctor's Association, it warns the Prime Minister that the NHS is "on its knees" and that it requires "urgent action" now in order to deal with the crisis.
    "Calling for Mr Johnson to invest more than £15billion in the NHS and £8billion in social care the letter says that the Conservative government "must now urgently address the damage inflicted on the NHS by years of under-funding"."

  • UK dementia diagnoses rise 40% in five years BBC reports: "Some parts of the UK have seen the number of people diagnosed with dementia more than double in five years, analysis of NHS data shows.
    "A drive to increase diagnosis rates and an ageing population were behind the increase, experts said. Charities said dementia care provision must improve, calling it a "ridiculous lottery", and "very hit or miss"."

  • One in three over-80s 'provide vital unpaid care for loved ones' in UK Guardian reports on more evidence of the gap where there should be a social care system:
    "Almost one in three people aged 80 and older are providing vital, unpaid care for their loved ones, despite many suffering severe health issues of their own, according to research. The figure has increased by nearly a quarter in eight years.
    "This invisible army of oldest and most vulnerable people in the UK provide a total of 23m hours of unpaid care a week, or 1.2bn hours of care a year, according to figures from Age UK."

  • Britain's postcode lottery for newborn deaths: Mortality rates on NHS wards twice as high in some areas, reveals report Independent reports: "Sick newborns in some areas of the UK are dying at twice the rate of seriously ill babies in other areas, a new report has revealed.
    "The findings raise serious questions about the quality of care in some neonatal units, with experts warning action needs to be taken to tackle the “striking variation”.
    "Across the country neonatal units are also short of at least 600 nurses with four in five failing to meet required safe staffing levels for specialist nurses."

  • 81-year-old gran should not have had to die on the roadside on M11 Eastern Daily Press headlines another scandal of Matt Hancock's local mental health trust:
    "Peggy Copeman passed away on Monday from a suspected heart attack while being transported back to Norfolk from Devon, where the pensioner had been sent because there were no suitable beds closer to home.
    "Her family say that she should not have been sent more than 280 miles away in the first place - and that she should not have been put in a position where she had to die on the hard shoulder in such a way.
    "Her death is the latest in a string of shocking stories to have emerged in recent years relating to so-called 'out-of-area' mental health treatment, which is normally required due to a lack of suitable beds in Norfolk and Suffolk."

  • As someone who works closely with the NHS, it’s clear Boris Johnson is setting us up to fail NHS Providers' Saffron Cordery writes in the Independent: "We’re setting up hard-working health service staff to fail if we pretend that taking NHS funding back to below its historic long-term average is going to enable us to provide the service to keep up with rising demand, close the gap that’s opened up over the last decade and invest in the transformation it desperately needs."

  • One third of GPs have cut their hours in last year, and two thirds plan to Despite Tory manifesto pledges to increase the number of GPs by 6,000, the Telegraph reports “Waiting times to see a GP are set to worsen, with rising numbers cutting their hours, a report by the medical watchdog suggests. More than a third of family doctors have cut back in the last year - and two thirds are considering do so this year, the General Medical Council (GMC) revealed.”
    … “The statistics show 5.8 million patients waiting for at least two weeks, while the last year has seen an 18 per cent increase in the number waiting at least a month.”

  • Sick and disabled people deemed fit after being assessed by doctors who have never spoken to them Independent report: "Sick and disabled people are being wrongly denied housing support and threatened with removal from the UK on the basis of medical assessments by doctors who have never met or spoken to them.
    "NowMedical has been paid millions of pounds in public money by councils and the Home Office to produce reports on homeless individuals and asylum seekers, based solely on paper records.
    "But judges have warned councils against relying on the firm’s advice and overturned decisions determined by its assessments, calling them “irrational” and criticising the firm for not taking the time to meet or speak to those they are assessing."

  • Trust blasted for ignoring coroner’s warnings on ‘unnecessary’ transfers (£) HSJ report notes: "A coroner has criticised a hospital trust for “effectively ignoring” its own policies on transferring patients between hospitals, despite assuring her the issue would be addressed after earlier deaths.
    "Brighton and Hove senior coroner Veronica Hamilton-Deeley questioned the point of issuing the reports if Brighton and Sussex University Hospitals Trust ignored them, as she issued her third prevention of future death report involving repeated patient transfers at the trust.
    "The most recent report involved Jean Waghorn, who was transferred between hospitals three times in 48 hours following a fall. The 88-year-old from Burgess Hill in West Sussex developed pneumonia while in hospital and died in June 2019, four days after her last transfer."

  • Get what they promised.. Roy Lilley's "cut out and keep" check list of the key Tory pledges on the NHS

  • As a former advisor to Matt Hancock, I know only a joined-up health policy can save the NHS Independent comment article with a warning for health campaigners:
    "Whilst Labour’s campaign focused on the supposed sale of the NHS to Donald Trump through a US-UK trade deal, the Conservative campaign adopted a more localised approach. Health Secretary Matt Hancock visited 125 seats, working with candidates to show how more money for the NHS nationally would translate into new equipment, services and support locally. The election result would indicate that the latter strategy was the one that cut through.
    "Having now broken through Labour’s red wall of northern seats, the new administration looks set to make a perhaps even more audacious move. A move to try and make the NHS a Conservative issue, wrapped in patriotism, community and heritage – and with increased funding. "

  • The biggest story in the UK is not Brexit. It’s life expectancy Danny Dorling writes for The Correspondent:
    "I’m a geographer who has been studying mortality records in the UK for the past 30 years. The data I review both yearly and weekly has given me a perspective on British society often missed when following the political circus.
    "In early 2014, I published an article in New Statesman magazine trying to highlight that the fact that something very unusual was happening: the life expectancy of elderly people in the UK – notably women – had begun to fall.
    "The following year, there was a huge rise in deaths. The numbers were released the day after the Brexit referendum result was announced. There was no evidence of a deliberate cover-up. However, the secretary of state for health, Jeremy Hunt, and his agency Public Health England, did try on several occasions between 2015 and 2019 to blame the weather. The trouble with that explanation is that the UK has not had an unusually cold winter since 2010."

  • The NHS staffing crisis is about the expanding knowledge gap – not just numbers Independent comment article notes:
    "A lot has been written about the workforce crisis in health and social care. 43,000 registered nurse vacancies, a 48 per cent drop in district nurses in eight years and not enough GPs to meet demand.
    "When we talk about workforce, the focus is always on numbers. There are campaigns for safe staffing ratios and government ministers like to tell us how many more nurses we have.
    "But safety is not just about numbers. Recent workforce policy decisions have promoted a more-hands-for-less-money approach to staffing in healthcare. More lower-paid workers mean something in the equation has to give. In this case, it’s skill and expertise."

  • Today's figures show safety net of NHS at risk of breaking down Health Foundation comment on Tory funding commitment after performance figures released:
    "Our analysis shows that the NHS will need an increase of £20bn by 2023-24 just to maintain standards of care but more will be needed to improve services. The £18bn extra promised by the Conservatives during the election campaign falls short of what is needed. As a result we can’t expect to see performance stabilise let alone improve any time soon."

  • NHS England 'on its knees' as performance figures hit new lows Guardian report on figures that should have been published on election day:
    "The NHS was “on its knees” even before winter had begun, health service bosses have said as figures showed it missed key waiting-time targets for A&E care, operations and cancer treatment.
    "The performance of the NHS in England in November was yet again its worst ever, prompting concern that it cannot keep up with a relentless rise in the number of people needing care."

  • Pregnant women died after fears Tory crackdown on ‘health tourism’ would bankrupt them, report delayed until after election reveals The Independent reports on the shocking consequences of the “hostile environment” created in the NJHS for people from overseas.
    “The women all died after delays in seeking help because they mistakenly believed that they would have to pay for care under the government’s strict charging regime. They sought help in hospitals too late and died as a result of complications.
    … “All three women identified were eligible for care under the rules and were not health tourists. Undocumented migrants or those illegally resident can face charges.”

  • Every major A&E misses wait target for first time BBC report on the figures held back until December 13:
    "All 118 units fell below the 95% threshold in November as the NHS posted its worst performance since targets were introduced more than a decade ago.
    "Alongside the growing waits in A&E, the data showed there were record delays finding beds for the sickest patients.
    "The numbers on waiting lists for routine care also hit an all-time high."

  • A&E Attendances and Emergency Admissions November 2019 Statistical Commentary The grim A&E figures held back until the day after people voted.

  • ‘Huge demand’ for care at busy Wigan A&E department Wigan Today reported on Election day Dec 12: "Wigan Infirmary’s A&E unit is facing “huge demand” for care, with people urged to get help elsewhere if possible.
    … "It comes just days after the Royal Bolton Hospital was put on “black alert” due to a rise in patient numbers."
    …"The latest NHS England data shows A&Es across the country had their worst-ever performance in October since the four-hour target was introduced in 2004, with 83.6 per cent of people arriving at A&E being treated or admitted in that time.
    "Wigan’s hospital trust saw 86.1 per cent of patients within four hours that month."

  • Three patients died after delayed cancer tests at teaching hospital (£) HSJ reports: "A harm review investigation into delays in diagnosis for patients at the Princess Royal University Hospital in Bromley, south London, was carried out after a backlog of patients was uncovered in May.
    "Newly published minutes show that a September report to the quality assurance and research committee of King’s College Hospital Foundation Trust, which runs the hospital, said a backlog of more than 1,000 patients requiring endoscopy had been identified.
    "It also said that a review of the harms to patients affected — which “focused on [those] that had a confirmed cancer” rather than reviewing all cases — identified: three deaths, eight cases of “severe harm”, and three cases of “moderate harm”.

  • Babies in wealthy areas expected to have up to 19 more years of good health than those in poorer ones Independent picks up new ONS figures revealing growing inequalities:
    "Data published by the Office for National Statistics (ONS) show that a girl born in Nottingham between 2016 and 2018 could expect as few as 54 years of good health, compared with 72 for a girl born in Wokingham.
    "Richmond-upon-Thames had the highest male healthy life expectancy at birth in the UK of 72 – 19 years longer than males in Blackpool, where it was only 53.
    "The ONS said the size of the life expectancy gain between 2013 and 2018 was “small by historical standards”, but in line with the observed pattern of stalling improvements since 2011. A decade ago, life expectancy was growing 6.5 times faster for males and 8.2 times faster for females.​"

  • A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study Worth persevering with this Lancet study that shows the link between improved access to and affordability of health coverage and public provision or social health insurance.

  • Thinking outside the cube: The political determinants of universal health coverage Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) explains that “The World Health Organization defines UHC as all people having access to the health services they need, when and where they need them, without financial hardship. This may sound like pie in the sky when out-of-pocket health expenses push 100 million people into extreme poverty each year.
    … “Yet, to achieve UHC we must think beyond this cube. We need to recognize that countries’ ability to enact policies in support of UHC and its underlying aim of greater health equity are also shaped by transnational political processes that often lie outside of the health sector.”

  • What matters in health (care) universes: delusions, dilutions, and ways towards universal health justice Another article from Globalization and health dissects the ways in which neoliberalism has subverted the apparently straightforward call for universal health coverage:
    “The presumed global consensus on achieving Universal Health Coverage (UHC) masks crucial issues regarding the principles and politics of what constitutes “universality” and what matters, past and present, in the struggle for health (care) justice.”

  • NGOs, austerity, and universal health coverage in Mozambique Article in Globalization and Health shows how NGOs can get in the way of the needed expansion of public health care provision in developing countries:
    “In many African countries, hundreds of health-related NGOs are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage.
    … "After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795.
    “Achieving UHC will require rejection of austerity constraints on public sector health systems, and rechannelling of aid to public systems building rather than to NGOs.”

  • Amazon ready to cash in on free access to NHS data Times report on the scale of new links being made between NHS and predatory capitalist Amazon: "Amazon has been handed the keys to a trove of NHS data it can use to develop products to sell internationally without paying a penny to the UK.
    "A government contract, revealed under freedom of information laws, shows the partnership goes far beyond the tie-up with Amazon’s Alexa voice assistant announced in July.
    "The $863bn company can access “all healthcare information” gathered by the NHS at the UK taxpayers’ expense, including “symptoms, causes and definitions”. It also gets “all related copyrightable content and data and other materials”, excluding patient data. Amazon can use the information to make, advertise and sell “new products, applications, cloud-based services and/or distributed software” and can share it with third parties."

  • There is no evidence to suggest the photo of a boy sleeping on a hospital floor was staged Full Fact website unpicks the tissue of lies that spread like wildfire over Facebook in an effort to discredit the photo that appeared on the Mirror front page:
    "A post on one woman’s Facebook page claimed that she knew a nurse at the hospital, who supposedly said that the boy actually had a trolley bed, and was placed on the floor by his mother for the purposes of the photo.
    "Screenshots of the post and reshares of it have been shared on Facebook thousands of times.
    "Claims from the post are contradicted by a statement from the hospital itself. The woman has since told the Guardian that her account was hacked and that she knows nothing about the situation.
    "The story about the boy first appeared in the Yorkshire Evening Post. The reporter who broke the story, Daniel Sheridan, has said on Twitter that he waited for the hospital to confirm that the incident happened. The original story contains a lengthy statement from the hospital confirming that it did."

  • Brexit: Tory minister admits US will be free to raise prices for drugs bought by NHS Independent reports "Dominic Raab has admitted that the US will be free to charge higher prices for drugs bought by the NHS after Brexit, but insisted the prospect is “hugely unlikely”.
    "Asked if Washington would be free to “jack up prices”, the foreign secretary replied: “The Americans will take their decisions.”
    "He then said: “I think it’s hugely unlikely, why would they do that?” Sky News interviewer Adam Boulton responded: “To get more money, that’s why.”"

  • A Sick U.K. Boy’s Story Was True. But False Posts Followed New York Times helps explain the viral spread of bogus claims that a damning photo had effectively been faked to discredit the Tory government.
    "journalists and researchers have tracked what appears to be a social media campaign to discredit the boy’s family. A message was shared widely on Facebook and Twitter from somebody claiming to know a nurse at the hospital who said the mother had staged the photo.
    “Very interesting,” the message reads. “A good friend of mine is a senior nursing sister at Leeds Hospital.” It then goes on to say that the mother had deliberately put the boy on the floor.
    "It is not clear how widely the false claims were seen, especially because Facebook does not provide a way to track messages posted inside private accounts and groups. Many people posted the message as a screen shot, which also cannot be discovered through a word search."

  • Tory minister admits extra nurses won’t be in place for 10 years and cannot explain how government will stop 18,500 leaving Independent report highlights car crash Nicky Morgan interview revealing deceitful promise of an extra 50,000 nurses:
    "Nicky Morgan, the culture secretary, said the additional nurses would be in place “if you look in 10 years’ time” and struggled to explain how the government would convince current nurses not to leave.
    "It comes after the Tories were criticised when it emerged that 18,500 of the 50,000 extra nurses promised in their election manifesto would not be new recruits but simply existing staff that the government will try to persuade to stay in the NHS. Labour said the claim was “fake” and “frankly deceitful”."

  • Controversial stroke plans delayed (£)HSJ report on delays to the controversial reconfiguration of stroke services in Kent and Medway, which will hold up the scheme regardless of whether an ongoing court case forces NHS organisations to change their current plans.
    "Two hyperacute stroke units were meant to open at Darent Valley Hospital, Dartford, and Maidstone Hospital next March, followed by one at William Harvey Hospital, Ashford, a year later.
    "But the scheme has now been delayed as crucial building work on the HASUs has not been able to go ahead while the plans are subject to both the outcome of a judicial review and the decision of the Independent Reconfiguration Panel. The timescale for the building work at Ashford is also longer than previously anticipated."

  • Tory candidate suggests cancer patients ‘really care’ more about survival rates than waiting times Independent reports novel take on the developing NHS crisis and disastrous performance figures on cancer care:
    "Cancer patients are less concerned about longer waiting times for treatment because they “really care” about survival rates, a Conservative candidate has suggested."

  • Hancock won't talk to us, say 'bullied' doctors at his local hospital in Suffolk Guardian reports "The health secretary Matt Hancock has repeatedly failed to respond to concerns that his local hospital is bullying and intimidating senior doctors to prevent them raising serious issues of patient safety.
    "Doctors at West Suffolk hospital have complained of harassment after trust bosses demanded they give fingerprints as part of a “witch-hunt” to identify staff members who blew the whistle on potentially botched surgery."

  • Delayed discharge from mental health care Royal College of Psychiatrists manifesto warns that "Half of all delayed discharges from #mentalhealth trusts are because of lack of housing and care packages. One of the key decisions the next Gov has to make is how to provide fair and sustainable social care."

  • Hospitals at ‘breaking point’ as winter NHS crisis deepens Independent reports: “NHS trusts have been forced to cancel operations, divert ambulances and leave patients on trolleys as thousands wait for treatment.
    “In one hospital, four patients were left for at least an entire day before a space on a ward became available.
    … “Now NHS staff have reported a surge in demand over the weekend and into this week that has crippled some services.
    “Ambulance call handlers received thousands of extra 999 requests while dozens of ambulances were stuck at hospitals because of delays handing over patients to overstretched A&E staff.”

  • A winter’s tale of promises BMJ blog by Rebecca Coombes notes:
    "The NHS is heading into winter with its performance against key targets the worst on record. These telling signs of pressure have had the consequence of putting the NHS, and not Brexit, centre stage of this unseasonably timed general election.
    "This week The BMJ tackles one significant pain point: the chronic workforce gap in nursing, where the vacancy rate is around 11% in England. The problem, says John Appleby (doi:10.1136/bmj.l6664), is not only the many unfilled nursing vacancies but a growing gap between the supply of labour and the demands on the NHS. We may have more nurses—their numbers have increased by 4% in England over the past decade—but they have ever more work to do. Elective admissions are up 26%, emergency department attendances are up 27%, and first outpatient attendances are up 33%, Appleby points out."

  • Union anger as 'essential' Chesterfield Royal Hospital service outsourced to US company Derbyshire Times reports: "Chesterfield & District Trade Union Council says the firm chosen is US-based multinational health company the STERIS corporation, which is based in Mentor, Ohio.
    "James Eaden, president of Chesterfield & District Trade Union Council, said: “Earlier this year the local community and workers at the Royal raised serious objections to the outsourcing of up to 700 non-medical staff to a ‘wholly owned subsidiary’. Now the trust are going a step further with a full privatisation of a service area at the Royal.”

  • Thousands of patients die waiting for beds in hospitals – study Guardian highlights research by emergency medicine experts on the impact of delays in treating patients:
    "Almost 5,500 patients have died over the past three years because they have spent so long on a trolley in an A&E unit waiting for a bed in overcrowded hospitals, a study by leading NHS doctors has found.
    "Their conclusion that long delays finding spare beds is costing patients’ lives has emerged as Boris Johnson comes under mounting pressure over the fragile state of the NHS.
    "In all 5,449 people have lost their lives since 2016 as a direct result of waiting anywhere between six hours and 11 hours, according to research seen by the Guardian. It found that those deaths represent the total “estimated attributable mortality” from the delays."

  • A&E trolley waits over 12 hours could be affecting tens of thousands more than official data suggests Independent report on challenge by the Royal College of Emergency Medicine to deceptive published figures:
    "A new study by the Royal College of Emergency Medicine has shown the way the NHS officially counts 12-hour waits in emergency departments masks the true picture.
    "The college collected data from 50 hospitals since October with results showing for the first week of December more than 5,000 patients waited longer than 12 hours.
    "From the beginning of October, more than 38,000 patients waited longer than 12 hours for a bed. But the official NHS England data reports on 13,025 patients waiting beyond 12 hours.
    "The reason is the Royal College counts 12-hour waits from the moment a patient arrives in A&E – which is how it is measured in Wales, Scotland and Northern Ireland – but the NHS official only records 12-hour waits from when doctors make a decision to admit the patient."

  • Tories forced into climbdown over claim aide was hit by Labour protester Guardian report unpicks another piece of disinformation:
    "The Tories were forced to make an embarrassing climbdown after aides briefed that an adviser to Matt Hancock had been hit by a Labour protester in an incident that it later emerged had been innocuous.
    … "Conservative sources claimed on Monday afternoon that the adviser to the health secretary had been hit by a protester at Leeds General infirmary during a campaign visit.
    "Aides initially briefed that Hancock’s adviser had been “punched in the face” and tried to point the finger at a Labour “thug”. But a video emerged that appeared to show the adviser walking into a protester’s arm."

  • 'It was chaos': Shocking photo shows Leeds four-year-old with suspected pneumonia forced to sleep on floor of LGI due to lack of beds The Yorkshire Evening Post story that Tory social media hacks worked might and main to discredit -- but which journalist and editor stuck to regardless, and proved to be legitimate.

  • Health Experts Unanimous In Objection To Medicare-For-All In a focus group of three highly paid executives working in US health care corporations, Forbes magazine finds a shocking consensus that they like the system just the way it is and don't want to make health care free for all to access.

  • Dr Hosnieh Djafari-Marbini: The human cost of cancelled operations Mirror article focuses on the human impact behind the statistics:
    "On any given day there are sons, daughters, friends and loved ones waiting nervously at the end of the phone whilst large teams prepare, anaesthetise, nurse, transfer, clean, position, operate and manage recovery of patients.
    "Cancelled operations are now commonplace.
    "With many hospitals operating close to 100% bed capacity even in the summer months, up and down the country patients are constantly waiting, lists are often reordered and “prioritised”.
    "So many of us members of staff working in theatres, rushing in to start our working day around 7am, find we are all ready but with no guarantee of beds i.e. nursing staff to look after patients."

  • The American Health Care Industry Is Killing People Opinion column in the New York Times argues:
    "Last week, health researchers reported that American life expectancy is declining for the first time in half a century, and some of the leading causes have to do with the ruinous health care system. Even if it is the case that reforming American health care might eliminate some jobs, it would seem to be a good trade for the likely benefit: More people might gain access to affordable health care and get to keep living."

  • Patient dies after being forced to wait an hour in ambulance outside overstretched A&E Mirror report:
    "A patient died after being forced to wait for an hour inside an ambulance outside an overstretched A&E department.
    "Paramedics were told there was no room inside Worcestershire Royal Hospital for the man, so he had to stay in their vehicle.
    "His condition deteriorated and he was brought into A&E after an hour but suffered a cardiac arrest and died on a trolley in the corridor.
    "The tragedy happened on November 27 - days after Health Secretary Matt Hancock visited the hospital while election campaigning."

  • American drug firms are lobbying to raise prices for the NHS after Brexit The Mirror reports on a 24-page November document from the US Chamber of Commerce, headed Services Priorities for a Future US-UK Trade Agreement, which makes a worrying comparison between future trade talks and the three-year Transatlantic Trade and Investment Partnership negotiations between the US and EU, which collapsed in 2016.
    It says:
    “Concerns about potential impacts on Britain’s National Health Service are being aired. It should prove easier to overcome these challenges with the UK as an individual negotiating partner.”
    "The report also confirms the “United States will seek rules that prohibit, across all services sectors, discrimination against foreign services suppliers and restrictions on the number of services suppliers in the market”.

  • How many 'new' NHS hospitals are Conservatives building? An unusually useful BBC "reality check" which makes clear that no new hospital projects have started, four of the six new hospital projects have not yet agreed how much money is available, and that generally not much is moving:
    "There will be a £2.7bn investment over five years for the first six hospitals of the 40 pledged.
    "All are existing NHS hospitals and they all have one thing in common - there is no building work happening as yet.
    "For the remainder of the pledge 21 trusts will initially share just £100m to develop the business cases necessary to secure funding for 34 projects."

  • Shrewsbury maternity scandal: NHS used report to create ‘false narrative’ on maternity services "The Independent has obtained a 2013 report, commissioned by NHS managers in Shropshire, which concluded maternity services at the Shrewsbury and Telford Hospital Trust were “safe”, of “good quality”, and “delivered in a learning organisation”.
    "The report, written by rheumatologist Dr Josh Dixey (now high sheriff of Shropshire), delivered a glowing assessment of the care given to women and babies and appeared to gloss over hints of deeper problems within the service.
    "Sources within the Shropshire and Telford clinical commissioning groups (CCGs), which paid £60,000 for the report, said since it was written it had been “proven to be wrong, inaccurate and to have come to the wrong conclusions and recommendations”, but also stressed it was based on the information received from the trust at the time."

  • Health company hopes to ease pressure on NHS with DIY doctor service With almost one on five patients in Buckinghamshire waiting over 2 weeks to see a GP, Buckingham Today plugs a private "DIY" GP service for the worried wealthy -- at £39 per session! But it's a new version of "seeing a GP" -- it's done remotely.
    "The new technology allows doctors to listen to a patient’s heart and lungs, look into their ears and throat, and take their vitals including blood pressure, oxygen levels and body temperature – all without needing to be in the same room.
    "The service is not free however. Patients can book a same-day appointment online at a cost of £39."

  • Patients being put at risk as NHS substitute nurses for care staff with only a few weeks of training The Independent highlights a Health Foundation report:
    "A major new report by the Health Foundation has revealed what it called a “hollowing out” of the NHS workforce with thousands more unregulated and less well-trained care staff being recruited by the NHS, compared to traditional registered nurses.
    "This is at a time when the NHS is seeing more patients who are increasingly older with complex conditions meaning their care needs require more clinical expertise."

  • Billionaires earned enough money in 2017 to end extreme poverty seven times over, report says The bare facts of global inequality and exploitation spelled out in an Oxfam report highlighted by Newsweek:
    "Last year, the world's billionaires made over $462 billion combined—enough money to end extreme poverty around the globe seven times over. With a new billionaire added to the list nearly every two days, wealth inequality widened, according to a new report from Oxfam.
    "Forty-two of the richest people in the world now hold as much wealth as 3.7 billion of the poorest people in the world, according to the report, released Monday by the international charitable organization.
    "The report showed that about 82 percent of wealth created across the globe went to the top 1 percent. "Our broken economies reward wealth not hard work," Oxfam International Executive Director Winnie Byanyima tweeted Monday. "Rich get richer, millions trapped in poverty wages or joblessness. Leaders must reverse this."

  • Exclusive: Leaked NHSE/I workforce plan reveals reliance on nursing associates The (£) HSJ quotes from the leaked document headlined in the Independent discussing the use of less qualified staff as part of the "extra" 50,000 nurses promised by the government, noting "The document is marked: “Numbers are not finalised. Not for wider circulation.”
    It says: “The introduction of the NA role is designed in part to free up time for RNs and enable them to undertake more advanced roles… Expansion in numbers of NAs can therefore help to reduce growth in demand for RNs… Our skill mix assumption is that each NA in the workforce will reduce nursing workforce demand by 0.5 [full time equivalents].”
    The HSJ notes that this "will concern those who are worried about NAs being used as a substitute for registered nurses. One nursing professor warned of neglecting the “safety critical” role of RNs. …
    "Multiple official warnings have been given, including by the Care Quality Commission, about deploying them safely and not substituting them for RNs."

  • Leaked NHS document reveals government plan to use cheaper staff to fill nurse vacancies The Independent's Shaun Lintern points out more of the double-speak in the promise of 50,000 "extra" nurses:
    "A leaked NHS document reveals that plans to grow the number of nurses rely on using 10,000 cheaper and less qualified staff.
    "Even then, the health service will still be more than 20,000 nurses short of what is needed in five years’ time, according to the file seen by the Health Service Journal and The Independent, for the as yet unpublished NHS People Plan.

    "Although the NHS document says there will be 45,000 more full-time equivalent staff, this figure includes 10,200 nursing associates (NAs). Nursing associates were introduced into the NHS this year and include staff who have completed a two-year course."

  • NHS care ‘slipping’ as UK lags behind other countries Independent report from the excellent Shaun Lintern highlights a study by academics from the London School of Economics and Harvard School of Public Health comparing the UK with Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland and the US:
    "Quality of care in the NHS appears to be slipping, researchers have warned, as a new study shows the UK is lagging behind nine other high-income countries when it comes to health spending, outcomes and how much time doctors spend with patients."

  • Expert reveals why the private health insurance sector is in a DEATH SPIRAL - as young Australians are smashed by rising costs Daily Mail report on the crisis in private health insurance with grim warnings on what would happen if any similar system were tried in Britain: see more analysis of this story in The Lowdown https://lowdownnhs.info

  • UK’s largest private hospital chain to be sold to smaller rival FT reports on the sale of the leading private hospital chain in Britain by South African-owned Netcare: they are being bought up by Circle, the company that tried and failed miserably to run one of the smallest NHS general hospitals. BMI relies for over 40% of its income on NHS-funded patients. Circle, which has never made a profit, was taken over by hedge funds back in 2017.

  • Only Labour’s tax promise makes sense Tax expert Richard Murphy with a useful take on the main party manifestos:
    "The IFS have said this plan from Labour is not credible. I disagree. The plan for investment is largely in small projects that can be ratcheted up quickly as skills become available. And the social plans will achieve their goal, including of increasing incomes. This is a plan for the moment.
    "The tax dimension of it (and it’s always an aspect) also makes sense. To the extend that tax is needed the aim is threefold. Wealth is taxed more, as it is dramatically undertaxed now. Labour is right to tax it more. The same is true of corporation tax, where Labour’s proposed unitary tax base for international taxation will lead the world, whilst the increase in rates will simply bring the UK back into line with the world. No one is actually going to change their behaviour as a result of either reform. And nor, when it comes down to it, will almost any one those who are well off enough to earn more than £80,000 a year flee the country, or even work less, as a result."

  • The £20.5 billion NHS England spending increase Full Fact nails a key fraudulent Tory claim to be giving a "record" cash increase to the NHS

  • Tory candidate featured in party manifesto suspended as a midwife Guardian reveals:
    "Natalie Neale, who is taking on the shadow health secretary, Jon Ashworth, in Leicester South, was barred from practising as a registered midwife for 18 months in August under an interim order by the Nursing and Midwifery Council while it investigates an unspecified allegation against her.
    "Under the order, she must immediately inform any organisation employing her as nurse that she is subject to a condition of practice order.
    "Separately, Neale lost a claim for wrongful dismissal earlier this year after she walked out of her role as a clinical advisor for the private health provider Care UK in 2017, when it was running services for West Midlands ambulance service."

  • Fears child poverty may rise to record 60-year high under Tories Guardian highlights report from Resolution Foundation with a grim warning:
    "An analysis by the organisation predicted a rise in the number of children living in relative poverty under a Boris Johnson-led government to 34.5% in 2023-24 up from 29.6% in 2017-18.
    "The thinktank released its research after the manifesto launches showed a huge gulf in what the two main parties are prepared to put into public spending, with Labour committing 28 times as much as the Conservatives.
    "Johnson set aside an extra £2.9bn a year by the end of the parliament that will largely go into more nurses, GP appointments and free childcare, while Jeremy Corbyn set out an extra £83bn a year for a programme of free broadband, scrapping university fees, reversing benefit cuts and extra funding for the NHS and social care.
    "The Resolution Foundation said Labour’s £9bn of extra spending on social security would mean 550,000 fewer children in poverty but would not lead to current poverty rates falling."

  • Johnson accused of misleading voters over a pledge to recruit 50,000 new nurses Nursing Notes breakdown of the Tory manifesto promise:
    "The party pledged to recruit thousands of more nurses and bring back student bursaries.
    "Boris Johnson has again been accused of misleaders voters as a pledge to recruit 50,000 new nurses has been branded “fake”.
    "The new financial support measures for students would produce an extra 14,000 nurses, while 12,500 more will be recruited from overseas and 5,000 from nursing apprenticeships, party aides revealed."

  • Patients left waiting for up to 12 hours at Great Western Hospital Report from Swindon Gazette & Herald on the failing performance at Swindon's PFI-funded hospital.

  • Pensions workaround is best short term response available but falls short of a full and fair solution for all NHS staff NHS Providers respond to the short term fix which ministers have wrongly claimed has scrapped the tax system they brought in that has caused chaos in the NHS, penalising top paid consultants who work overtime.

  • NHS hospital declares 'black alert' as patients queue for hours in A&E corridors Daily Mirror report on crisis conditions at Royal Cornwall Hospital in Truro
    "An NHS hospital has been placed on a 'black alert' OPEL 4 status as patients were filmed queuing in corridors and ambulances piled up outside A&E.
    "Emergencies at the Royal Cornwall Hospital's soared over the weekend before the department was placed on the highest operational pressure level."

  • Care homes need the industry leaks to be plugged, not just more money Open democracy article by CHPI's Vivek Kotecha shows how the extra money for social care is likely just to line the pockets of shareholders:
    "Currently, a substantial chunk of the money which currently goes into the privately-owned adult care home sector doesn't go anywhere near front line care, but instead leaks out to investors, private equity firms, and real estate companies that are often based in offshore tax havens. Pour additional funds into the sector, without reform, and there’s a high risk of more of the same.
    "In September, the Chancellor promised an additional £1.5bn of funding for social care. But in CHPI’s latest report, we estimate that of the £15 billion currently going into the independent care home sector, around 10% leaks out in the form of profit, directors’ fees, debt repayment, and rents, often dubiously calculated and paid to other parts of the same organisation.
    "That’s right – the same amount of money promised by the Chancellor, is currently just leaking straight back out again."

  • NHS nurse stressed after working 12-hour shifts killed herself after 'downward spiral' Guardian reports "A dedicated NHS nurse who had 'nightmares about work' committed suicide after the stress of working 12 hour shifts left her unable to lead a life of her own at home, an inquest heard.
    "Leona Goddard, 35, had dreams of settling down and having a family but struggled to have a social life after being burdened with unpredictable work hours and extra responsibilities at Prestwich Hospital in Manchester.
    "Although her work colleagues rated her as ''outstanding'' Miss Goddard, a nursing manager who worked in a mental health unit, had developed low self esteem due to the long hours."

  • Older people dying for want of social care at rate of three an hour Guardian reports on the shocking scale of the gaps in social care and their brutal impact:
    "At least 74,000 older people in England have died, or will die, waiting for care between the 2017 and 2019 general elections. A total of 81 older people are dying every day, equating to about three an hour, research by Age UK has found.
    "In the 18 months between the last election and the forthcoming one, 1,725,000 unanswered calls for help for care and support will have been made by older people. This, said the charity, was the equivalent of 2,000 futile appeals a day, or 78 an hour."

  • Calls to scrap ‘immoral’ NHS fee for foreign staff Guardian reports:
    "Boris Johnson’s plans to charge foreign staff who help save British lives £625 a year to use the NHS will worsen its staffing crisis, doctors’ and nurses’ leaders have warned.
    "They have reacted with dismay over the prime minister’s proposal to increase the so-called health surcharge payable by non-EU staff for the third time in four years and demand it should be scrapped completely.
    "The Conservative party announced on Sunday it was going to increase the surcharge from £400 to £625 a year for all non-EU migrant workers and extend it to all EU citizens who migrate to the UK after Brexit.
    "The fee is payable for each member of a family migrating, meaning nurses from popular recruitment spots such as the Philippines and India who come to Britain with a spouse and two children will have to pay the government £2,500 a year for the privilege of working in the NHS."

  • Millions 'missing out' on NHS dentistry Just after Labour first floated the idea of restoring free basic dentistry on the NHS -- now incorporated in their manifesto -- BBC report spells out the scale of the problem:
    "More than 2 million adults in England are unable to see an NHS dentist, BBC analysis suggests.
    "They include an estimated 1.45 million who have tried and failed to get an NHS appointment in two years with the rest on waiting lists or put off by cost.
    "Another 2 million assume they cannot get care where they live, suggesting nearly one in 10 miss out overall.
    "Dental leaders said the findings - based on official NHS data - showed access was a problem in every region."

  • Hitting the poorest worst? How public health cuts have been experienced in England’s most deprived communities IPPR report spells out the scale, and unequal impact of years of cutbacks in public health spending since 2014, showing that the poorest areas with the greatest needs have suffered the largest cuts. Why is this not surprising?

  • Privatisation in the English NHS: fact or fiction? Nuffield Trust presents their different appraoch to the scale of privatisation of NHS funded services, that appears to be a tacit counter to the recent blog by CHPI researcher David Rowland -- without ever mentioning it. Instead the Nuffs embark on their own set of figures:
    "Around 22% of the English health spending goes to organisations that are not NHS trusts or other statutory bodies.
    "But this includes many services that the general public would regard as being within the health service. For example, almost all the GPs, dentists, pharmacists and opticians who treat NHS patients are private businesses, and have been since the inception of the NHS in 1948."

  • Shrewsbury maternity trust could be prosecuted for corporate manslaughter Independent's new health correspondent Shaun Lintern has continued his exposure of safety scandals he began when he was at the Health Service Journal.
    The scandal is already the biggest in NHS maternity services, and seems set to be the biggest ever failure of care to hit the NHS.

  • Barking's ex-BA finance chief quits due to lack of progress (£)HSJ report on the failure of a high-flying former BA finance chief brought to earth by the intractable financial crisis of the Barking, Havering and Redbridge hospitals trust.

  • Revealed: NHS running short of dozens of lifesaving medicines Guardian reports on worrying information and government attempts to keep it under wraps:
    "The NHS is running short of dozens of lifesaving medicines including treatments for cancer, heart conditions and epilepsy, the Guardian has learned.
    "An internal 24-page document circulated to some doctors last Friday from the medicine supply team at the Department of Health and Social Care (DHSC), headed “commercial-sensitive”, listed many drugs currently hit by shortages at the NHS."
    The document warned: “This information is confidential to the NHS, please do not upload to websites in the public domain.”

  • NHS bosses accused of gagging staff during election campaign Guardian report probes deeeper after "NHS staff claim they are being prevented from speaking out during the election campaign because their bosses are applying rules about political neutrality too zealously.
    "Health workers have been told not to get involved in any political debates on social media during the campaign. NHS organisations have also banned staff from appearing in uniform or featuring any of their equipment, such as an ambulance, in their online posts or profiles."

  • To Lower Costs, Trump to Force Hospitals to Reveal Price of Care New York Times report on the latest attempt by Trump's administration to bolster the illusion that market forces and price competition can be used to transform the monstrously inequitable and inefficient US health care system - rather than the establishment of the 'single payer' system campaigners are fighting for.
    "The Trump administration on Friday announced it would begin forcing hospitals to publicly disclose the discounted prices they negotiate with insurance companies, a potentially bold move to help people shop for better deals on a range of medical services, from hip replacements to brain scans.
    “For decades, hospitals, insurance companies, lobbyists and special interests have hidden prices from consumers, so they could drive up costs for you, and you had no idea what was happening,” President Trump said Friday afternoon in the White House’s Roosevelt Room. “You’d get bills that were unbelievable and you’d have no idea why.”

  • NHS staff working 1m hours a week of unpaid overtime, Labour says Guardian reports "NHS staff are working over a million hours a week of unpaid overtime to help the health service deal with an unprecedented demand for care, according to research by the Labour party.
    "Its estimate is based on an analysis of data in the NHS Staff Survey of the views and experiences of 497,000 health service personnel in England.
    "The most recent edition of the survey, published in February, found that many staff put in extra hours for no extra pay, and that some do as much as 11 hours a week unpaid overtime.
    "Jonathan Ashworth, the shadow health secretary, said staff working beyond their standard shift were paying the price for the NHS’s widespread workforce shortages."

  • Is the NHS facing unprecedented demand? BBC report notes that much of the rising demand is said by the government to be due to an increasingly elderly population: but this increase should be no surprise – these are not recent immigrants, but people who have been living here for decades..
    “From 2006 to 2019, the whole UK population rose by about 1% per year - but the proportion of those aged 85 or over has risen more rapidly.
    “Figures from the Institute of Fiscal Studies (IFS) indicate treating an 80-year-old is, on average, almost four times as expensive as treating a 30-year-old.
    Older people are more likely to be living with long-term conditions for which there are no cures, notably dementia. They often also have multiple health problems, which can add to the cost and complexity of their care.”
    Perhaps the most chilling note is struck by Richard Murray, from the Kings Fund, who “said the number of people arriving at hospital had risen relentlessly over time. The difference now is that they are often a lot older, have multiple conditions and are sicker.”
    “Relentlessly” suggests an irritation that these sicker older people have not had the decency to die, and that they are only hanging around to be awkward.

  • Global health and the digital Wild West: Short report from the Tek4HealthEquity conference Interesting critque of the new mania for apps and digital technology that is dominant in NHS England and of course dominates Matt Hancock.
    Well worth a read:
    "At the recent Tek4HealthEquity conference (1-2 Nov) organized by the Independent Panel on Global Governance for Health at the New School in New York City, we discussed the conditions upon which technologies might serve health equity. Presentations highlighted that discriminatory design, high costs and weak regulations are just some of the challenges to the idea of digital public goods capable of reducing global and national-level inequities in health."

  • NHS set for 'worst ever' winter crisis as A&E waiting times worsen again Pulse magazine's take on the performance figures:
    "The NHS is on a ‘collision course’ for its worst ever winter recorded, the BMA has warned again as A&E waiting times have failed to improve.
    "New official data released today shows the NHS's peformance against the four-hour A&E waiting time target - in which 95% of patients are expected to be seen - is at its worst level since records began.
    "Only 83.6% of patients were seen within four hours in all A&E departments in England in October, compared with 89.1% in October last year – the lowest figure since data was first collected."

  • Hospital waiting times at worst-ever level BBC report states: "Key targets for cancer, hospital care and A&E have been missed for over three years - with delays for hospital care and in A&E hitting their highest levels since both targets were introduced.
    "The monthly figures - the last before the election - prompted Labour and the Liberal Democrats to attack the Tories' record on the NHS.
    "But Prime Minister Boris Johnson said "huge demand" was to blame."

  • Figures show we could be on track for 100,000 trolley waits Response to today’s NHS performance statistics from NHS England, Nuffield Trust Chief Economist Professor John Appleby, who said:
    “These figures show the next Government will immediately be faced with one of the bleakest winters in the NHS’s history. We have many months to go until seasonal pressures really hit the NHS, but October has already seen an unprecedented slump with performance against the main A&E target worse than ever. The health service is seeing far more patients, yet one in six is now waiting more than four hours in A&E. If the usual trends continue after Christmas, that would head towards one in five."

  • More people than ever turning to food banks, charity says Guardian reports that the Trussell Trust, which runs two-thirds of the UK’s food banks, said it distributed a record 823,145 food parcels between April and September, including 301,653 that went to children.
    "This was a 23% increase on the same period last year, representing the steepest rise the charity has witnessed since its network of food banks was fully established.
    "The top three reasons cited by people needing emergency food were insufficient benefit income, at 36%, followed by delays in benefit payments at 18% and changes to benefit at 16%."

  • Tory pledge to recruit 50,000 new nurses exposed as ‘fake’ after Boris Johnson unveils manifesto Swift deconstruction of key Tory manifesto pledge by the Independent;
    "Boris Johnson has been accused of “deceit” over his plans for the NHS, after his promise of “50,000 more nurses” turned out to include 18,500 existing nurses who the government hopes to persuade to remain in the workforce."

  • Conservative party manifesto 2019: fact checked Full Fact throws the spotlight on the Tory manifesto promises.
    It notes that the Tories appear to have seriously underestimated the cost of paying for and supporting 50,000 nurses:
    "Even without adding training costs, as a very rough indication, 50,000 nurses at pay band 5 cost the NHS in the region of £2.8 billion a year based on this estimate (or £2.6 billion excluding capital overheads). The actual cost will be higher as some move up the pay scale, and considering ongoing training costs as well."

  • NHS scrambles funding to help hospitals with winter crisis (£) HSJ report on the fact that ministers have left it far too late for any extra cash to be found or to affect the performance this winter:
    "In previous years there has typically been pot of winter pressures funding announced by the government – sometimes up to £700m - with money distributed widely among acute providers.
    "The government has not done so this year – and the money of offer, thought to be a smaller amount, appears to be on an ad-hoc basis, targeted at providers that can use the resources most effectively.
    "The purdah period leading up to the general election on 12 December would now be likely to prevent any national announcement of a fund."

  • It’s Narnia on the wards: the NHS is in permanent winter crisis now Polly Toynbee in the Guardian paints the picture of growing crisis:
    "Will there be an NHS crisis during this winter election? There already is, everywhere. It’s Narnia on the wards: permanent winter, as the pressure never lets up in the summer now, with performance figures rapidly worsening year after year. The condition of the NHS is already critical, before the Australian flu epidemic predicted for this winter has even arrived."

  • Is the NHS facing unprecedented demand? BBC attempts a partial 'fact check' of the excuses from ministers for the latest dip in performence of the NHS, noting that:
    "Looking back, from 2006 to 2019 there has been an average 2.2% annual increase in patient attendances at A&E.
    "In October this year, there were about 2.2 million attendances at A&E departments - an increase of 4.4% compared with October 2018 (although just short of the all-time record)."

  • Hospital waiting times at worst-ever level BBC report on performance figures does not try to embellish the picture:
    "Key targets for cancer, hospital care and A&E have been missed for over three years - with delays for hospital care and in A&E hitting their highest levels since both targets were introduced.
    "The monthly figures - the last before the election - prompted Labour and the Liberal Democrats to attack the Tories' record on the NHS."

  • Figures show we could be on track for 100,000 trolley waits Nuffield Trust chief economist John Appleby comments on latest NHS performance figures: “These figures show the next Government will immediately be faced with one of the bleakest winters in the NHS’s history. We have many months to go until seasonal pressures really hit the NHS, but October has already seen an unprecedented slump with performance against the main A&E target worse than ever. The health service is seeing far more patients, yet one in six is now waiting more than four hours in A&E. If the usual trends continue after Christmas, that would head towards one in five.

  • So what would an NHS without private sector provision look like? Propaganda from Independent health Provider Network against Labour's commitment to phase out the use of private hospitals to treat NHS patients begs the even more revealing question: what would the private hospital sector look like without the NHS? Spoiler alert: the NHS deals with all emergencies and complex cases, trains all the medical and nursing staff who work in private hospitals, and also provides back-up care for private hospital patients needing emergency treatment when things go wrong. Without the NHS no private sector would be possible.

  • New inpatients banned at mental health unit rated unsafe Guardian reports on the latest scandal of private mental health provision:
    "The Care Quality Commission (CQC) has stopped the Cygnet Acer Clinic, in Chesterfield, Derbyshire, from accepting new inpatients. It declared that the facility was “not safe” for people to use.
    "Inspectors found that clinic patients had opportunities to hang themselves, and the unit had soaring levels of patient self harm, and a huge shortage of trained staff."

  • Nigel Edwards responds to Labour's 'NHS Rescue Plan' Nuffield Trust boss Nigel Edwards argues "This new money would mean the NHS could breathe a sigh of relief. The extra money for investment in building and equipment is desperately needed and it is particularly encouraging to see some of this go towards general practice.
    “A 4% increase a year will make a big difference compared to the 1.4% average the NHS has grown used to in recent years. It is enough to get most waiting times back on track over time, but tough decisions will still have to be made."

  • Brexit Party NHS spokesman says privatisation in the NHS can be “brilliant” Scram reports "Speaking in an interview with party leader Nigel Farage, Dr David Bull, a Brexit Party MEP, MP candidate and medical doctor, said that private provision in the NHS can be a “brilliant” way of funding the service, which needs an urgent “redress”.
    "In the same interview, party leader Nigel Farage reiterated that, “those who can afford it should be encouraged to take out private insurance”.

  • IEA: Hiking taxes to fund the NHS “won’t sustain the institution” The obscurely funded neoliberal "think tank" the IEA argues that the 1948 NHS model is outdated -- and should be replaced by the more expensive 1890s Bismarck-style systems applied in Germany, France and other countries. The constant factor is their hostility to the NHS and its values.
    "The structure of the NHS is fundamentally outdated, and no amount of money is going to get the health system to function and operate at the level patients deserve."

  • General election 2019: Labour vows to outspend Tories on the NHS Shadow Chancellor John McDonnell said Labour's policy of taxing the "richest in society" and reversing cuts to corporation tax would release money to spend on healthcare.

  • Childhood pneumonia cases up 50% in 10 years, NHS data shows Guardian report notes: "Emergency hospital admissions for children with pneumonia have risen by more than 50% in England over the past decade, figures suggest, with admission rates highest in more deprived areas."

  • Why is life expectancy faltering? Guardian report:
    "Statisticians first noticed in 2013 that rises in life expectancy in the UK had begun to slow down. Gradually, the graph – which been rising for decades – flattened out until, a few years ago, it started to decline for increasing numbers of people. The elderly, the poor and the newborn were worst affected. For example, life expectancies for those over 65 have dropped by more than six months."

  • NHS cancellations of child mental health sessions jump 25% Guardian report on more evidence of decline in mental health service despite constant promises of improvement:
    "Figures obtained by the mental health charity Mind reveal that CAMHS (child and adolescent mental health services) in England cancelled 175,094 appointments with vulnerable patients between August 2018 and July 2019.
    "That was 25% more than the 140,327 which were cancelled during the same period in 2017-18.
    "Experts think staff shortages and the growing demand from young people for help with anxiety, depression and other conditions, lie behind the trend."

  • NHS chiefs warn Johnson’s visa scheme will do nothing to stop post-Brexit staffing crisis Independent report. "The Independent has obtained a document written by NHS Employers, the organisation responsible for recruitment across the entire health service, in response to a consultation on government immigration proposals due to come into force by 2021.
    "It sets out strong opposition to the Home Office’s planned points-based immigration system and new salary thresholds, pointing out many social care staff earn as little as half the proposed minimum of £30,000 per annum needed to obtain entry to the UK."

  • Election special: Don't trust him with our NHS Special 8-page issue of Health Campaigns Together newspaper brings together evidence to separate Fact from Fiction on the state of the NHS. 60,000 printed copies distributed so far.

  • Access to healthcare makes financial sense BMJ blog from September just recirculated in social media: Lucinda Hiam argues 'NHS charging regulations for people without adequate documentation are immoral, unethical, and cost the NHS far more in the long run'.

  • NHS winter crisis bites early after black alerts at Queen Elizabeth and Lewisham hospitals Winter arrives in early November in SE London:
    "Health bosses have moved to reassure patients after both Queen Elizabeth Hospital and Lewisham Hospital reached full capacity this week, triggering a “black alert”.

  • NHS Providers report: The state of the provider sector Some stark warnings in this latest survey of senior managers in England's NHS trusts.

  • General election 2019: Tory plan to attract more NHS staff from abroad BBC report tries to put positive spin on latest Tory charges for overseas NHS staff but has to quote The Royal College of Nursing chief executive Dame Donna Kinnair arguing it is "immoral and heartless" to continue to make nurses contribute towards "the same services they keep running" through the health insurance charge."

  • Boris Johnson promises fast track 'NHS visa' for overseas doctors and nurses Tory plans to cut a part of the huge new charges they are putting in place to deter health workers from EU and other countries from coming to the UK:
    "The Conservatives' new NHS visa will ultimately form part of the party's planned points-based immigration system to be introduced after Brexit.
    "The move reflects concern within the health service that it will struggle to attract the staff it needs when Britain is outside the EU.
    "Under the scheme, the cost of a visa for health professionals would be halved from £928 to £464, while applicants would be guaranteed a decision within two weeks."
    But the £400 per head surcharge for using the NHS will also apply to any health professional willing to brave an increasingly racist and unwelcoming UK: so the fee is not halved but cut by about a third, leaving overseas staff massively discriminated against.

  • Winter after winter, the NHS has been warned it cannot go on the same as before Independent report notes difference this time around: "What makes 2019 different is not only the unwelcome scrutiny of a general election but for the first time there has been no summer respite from high levels of patient demand. Typically, the NHS uses the summer months to catch its breath but this year there was simply no let-up.
    "Many of the biggest hospitals reported record-breaking numbers of patients turning up at A&E in July and August. Nottingham University Hospitals NHS Trust had to declare a “black alert” incident in July – the most serious level of pressure normally reserved for the depths of winter."

  • Lincolnshire health visitors to strike for a month over pay BBC reports that: "About 70 health visitors are to stage a near month-long strike in a continuing dispute over pay and standards.
    "The strike by members of Unite at Lincolnshire County Council is due to start on 18 November and continue until 13 December.
    "The union said workers were significantly worse off since being transferred from the NHS in 2017."

  • Hundreds of mental health beds needed to end 'shameful' out-of-area care Guardian report: "The Royal College of Psychiatrists is calling for the NHS to urgently create hundreds of extra beds for people who are seriously mentally unwell in order to tackle a damaging shortage.
    “Cuts in the number of mental health beds have gone too far and patients and their families are suffering as a result,” said Prof Wendy Burn, the college’s president. “It is clear that some parts of England urgently need more properly funded and staffed beds. Hundreds more are needed.
    “Trusts struggling with dangerously high levels of bed occupancy are being forced to send seriously ill people hundreds of miles away from their homes for care. That must stop.”

  • The British Medical Association criticised ministers over the state of the health service as the Observer reported growing concerns in the Government ahead of the December 12 poll. The Independent reports: "The number of procedures called off by hospitals for non-clinical reasons has increased by 32 per cent in the last two years, the statistics obtained via a freedom of information (FOI) request. Almost 4,000 more were scrapped in 2018 than in 2016.
    "They also show that of the 79,000 operations to be cancelled last year, 20 per cent were scrapped because of staffing issues and equipment failures."

  • Doctors accuse Boris Johnson of only recognising NHS crisis because of election Daily Mirror report: "The British Medical Association criticised ministers over the state of the health service as the Observer reported growing concerns in the Government ahead of the December 12 poll."

  • Boris Johnson criticised for selective quotes about NHS in letter to voters Guardian picks up on protests by charities for misleading extracts of their statements being used by Johnson in his election handouts. Who is surprised?

  • Bristol Southmead Hospital: Racist patients could have treatment withdrawn Grim reminder of the scale of patient racism towards staff that appears to be increasing in frequency: now trust management and Health Secretary Matt Hancock appear to have got the message and beefed up the guidance on how to respond.

  • Time to rebuild NHS and create 21st century health service Article by NHS Providers chief exec Chris Hopson in Public Sector Focus magazine

  • Home Office decried for blocking NHS scheme to use more trainee doctors from overseas Guardian report notes obstruction of NHS plans by racist restrictions imposed by Home Office: "The Home Office is blocking plans already agreed by the health secretary and NHS bosses to let more overseas doctors come to Britain to help tackle the health service’s staff shortages.
    "It has refused to allow the planned expansion of the medical training initiative (MTI) to go ahead, despite its inclusion in the government-backed NHS long-term plan."

  • Don’t sign pledges on NHS or climate, Tory HQ tells candidates Guardian reports leaked internal document that tells Conservative candidates in the general election not to sign up to specific pledges on protecting the NHS from privatisation or trade deals or tackling climate change, but says it's OK to back campaigns to support shooting in rural areas.

  • Midlands teaching trust on ‘black alert’ again (£) HSJ report reveals Nottingham University Hospitals is back into crisis mode shortly after a summer crisis, and has "been on black alert for multiple days after being faced with “very high” emergency attendances since last week."
    As the article was written there were 45 emergency patients waiting for the next bed to become free.

  • Cheltenham A&E will not close, Health Secretary says Victory for local campaigners, but also another sign an election is looming.
    Cheltenham's Tory MP Alex Mr Chalk was leaked a copy of the consultation document in August.
    "It outlined proposals to change the way hospital care is delivered by "creating a centre of excellence for emergency care in Gloucester and a centre for excellence for planned care in Cheltenham".
    Fears there would only be one A&E, in Gloucester, prompted public campaigns including the Chamber of Commerce.
    Mr Chalk asked the health secretary in the House of Commons for his thoughts on the future of the emergency unit: Matt Hancock replied: "No proposals to close the A&E at Cheltenham will be part of the forthcoming consultation."

  • Hospitals substitute nurses as staffing crisis worsens Final HSJ exclusive by departing health journo Shaun Lintern notes the use of less qualified staff to plug gaps in the nursing workforce. It quotes an expert on staffing issues warning of the impact on patient care:
    "Alison Leary, professor of healthcare and workforce modelling at London’s Southbank University, told HSJ: “It’s concerning but understandable that trusts are filling that gap with unregistered support staff because we know from the evidence that skill dilution has a detrimental impact on patient outcomes including survival.
    “Six years after the Francis report we are going back to what he discovered with a focus on financial performance over safety and workforce. It is very concerning this data has been taken out of the public domain. It needs to be subjected to scrutiny and we shouldn’t have to rely on journalists and FOI legislation.”

  • Migrants charged millions by Reading hospital for NHS care Reading Chronicle picks up a local angle on this "hostile environment" policy that has been universally condemned by medical and nursing professional bodies.
    However it allows the Trust to make the unsupported claim that the charges have had no deterrent effect on patients accessing the care they need:
    "If a patient can’t or won’t pay, ‘we will initially follow our internal debt collection process and then, if necessary, the trust’s solicitors will try to settle any outstanding payment in line with government guidance’, the spokesperson said.
    “The trust hasn’t found that the government’s policy on charging overseas visitors discourages them from accessing treatment when required.”
    This is completely the opposite of the view taken by medical royal colleges and others who cite evidence and actual cases to support their argument.

  • New Brexit plan worse for NHS than May’s deal, experts warn (£)HSJ reports views of Nuffield Trust, NHS Confederation and others, including:
    "Another expert closely involved in the NHS’s Brexit response and preparations told HSJ the UK government also had “considerably less” breathing space than with the May deal.
    "The source said: “The transition period is still set to end in December 2020, so there’s nearly a year lost in terms of time to negotiate the future relationship with the EU. The transition period is extendable by two years, but trade deals usually take far longer to agree.
    “If the government fails to agree a deal then we effectively face another no deal cliff edge in December 2020."

  • Boris Johnson drawn into row over 'unsafe' Hillingdon hospital Guardian report notes the crumbling of the hospital serving PM Johsnon's constituency:
    "Hillingdon’s infrastructure has long been recognised within the NHS as a problem and the trust has developed plans for it to be replaced.
    "One senior NHS figure described the state of its buildings as “appalling – the worst of any hospital in London”. Its problems are so serious that the Treasury recently gave it a £16.5m emergency loan to carry out repairs to pipes and its incinerator and heating system and to buynew equipment. But the cost of fixing its backlog of maintenance issues, some of which are classed as critical, is £210m – the second largest among the NHS in England’s 240 trusts."

  • Providers notch up another £800m deficit in three months (£)HSJ report flags up the worsening financial plight of NHS trusts:
    "the provider sector was actually in underlying deficit of around £2.5bn at the end of 2018-19. Lots of one-off savings, from things like accounting benefits and land sales, have long flattered the position and this may now have started to unwind.
    ...
    "Sally Gainsbury, senior policy analyst at the Nuffield Trust, said this wasn’t supposed to happen: “Despite the Treasury, the Department of Health and Social Care and NHSE/I all agreeing that trusts needed much more realistic efficiency targets, trusts are being asked to deliver the same levels of savings.
    “Trusts thought there would be sustainable improvement trajectories, but they are being demanded to improve straightaway.”
    "The figures for the first quarter also suggest there’s already lot of catching up to do.
    "The data shows trusts reported a combined deficit of £806m for the first quarter, which is broadly similar to the position reported at the same stage in each of the previous two years."

  • Two-thirds of doctors and nurses believe £350m-a-week NHS claim was a 'deliberate lie', poll finds Independent reports "Anger among doctors and nurses about the notorious claim of a £350m-a-week boost to the NHS from Brexit has been laid bare, with two-thirds branding it a “deliberate lie”.
    "The boast – made by Boris Johnson and other Leave campaigners – has also strengthened support among health staff for a Final Say referendum, a major survey has found.
    "It comes as the People’s Vote campaign reveals that more than three-quarters of NHS trusts it quizzed have made no preparations for the UK’s departure from the EU."

  • Primary care investment not enough, says NHS England advisor Pulse Today report lifts lid off funding promises on primary care:
    "In January, the Government pledged to invest £4.5bn in primary and community care by 2023/24 as part of the NHS long-term plan.
    "This is £1bn more than the previous £3.5bn pledged in November, which former Prime Minister Theresa May said would be used to ensure more patients are cared for at home and in the community rather than in hospital settings.
    "Despite the increase, GP and NHS England national clinical advisor for primary care Dr Karen Kirkham expressed concerns over the funding, saying it might not be enough to allow services to manage patients 'properly'."

  • Don't let the QEQM stroke unit close due to lack off staff! Change.org petition urging "the East Kent Hospitals trust to immediately measures in place to ensure specialist stroke staff don't leave the stroke unit before the HASUs are in place.
    "We ask that you arrange a pay incentive scheme/retention premium as soon as possible. We don't want an emergency closure to happen at QEQM (as has just occurred at Tunbridge Wells)."

  • NHSX senior adviser: Slow IT at your trust? Quit (£)HSJ article reports bizarre advice from the agency that is supposed to be rolling out n ew technology into cash-strapped trusts:
    "A senior NHSX technology adviser has urged clinicians to move to more digitally-advanced trusts if they are unhappy with their current workplace’s technology.
    "Speaking at a King’s Fund conference on Wednesday, senior technology adviser for NHSX, Terence Eden, added patients should switch GP practices if they are not able to book appointments online.
    "He said “people power” is needed to create “peer pressure” and encourage digital transformation throughout the healthcare system."

  • What the Medical GoFundMes That Don’t Get Funded Say About America Thoughtful artile in GQ magazine on funding appeals in the US:
    "But as I scrolled down a little further, I saw the claw marks of austerity gouging deep into life after life. A telling sign is what happens when you search “health insurance.” The lack of health insurance is a uniquely American problem among industrialized countries, one borne of the sheer go-it-alone malice of our frayed social contract. A search for the term “health insurance” returns over one million campaigns. Scanning through them is a brief glimpse into a maelstrom of social collapse.
    "As Medicare For All— in all the variations Democratic presidential candidates have come up with—is debated on brightly lit stages, and the Trump administration fights to whittle down the Affordable Care Act in court, GoFundMe offers a close-up view of the human cost of inadequate policy."

  • Mid Yorkshire Hospital NHS Trust deal 'expected to cost an extra £223m' Wakefield Express picks up on new research on PFI and its soaring costs recently published in i-news, and reveals the additional costs of a £300m hospital project.

  • What the Health Care Debate Still Gets Wrong Important review by Adam Gaffney of Physicians for a National Health Program updates discussion on the dysfunctional US health care system. The review is of a book by leading academic Uwe Reinhardt, and builds upon his critique of the system:
    "As Reinhardt’s larger body of work makes clear, we cannot separate high prices from the structural failings of our dysfunctional and regressive health care financing system."

  • The state of the NHS provider sector The latest report by N HS Providers flagging up the growing crisis facing front line NHS trusts. Important background to any forthcoming election.

  • UK would lose £130bn in growth if Brexit deal passed, figures suggest Guardian reports official government projections on the cost of Johnson's Brexit deal, which must throw any future pledges on public spending into doubt:
    "Estimates published by the government last year show an agreement similar to Boris Johnson’s settlement, which envisions striking a limited free trade deal with the EU, would strip 6.7% from the UK’s expected path of GDP growth between now and 2034.
    "The 6.7% of GDP cost of Johnson also adds up to making people on average £2,250 a year poorer by 2034."

  • CAMPAIGN #2 - UNDER THE KNIFE Fresh appeal for funds to enable a second round olf showings of the important new film that campaigners have already shown over 60 times in a single week in October.

  • Charity launches legal action against NHS fees for pregnant migrants "Hostile environment" again being challenged this time for its impact on vulnerable patients. Another Guardian story:
    "A charity has launched a legal challenge against the policy of charging vulnerable migrant women £7,000 or more to access NHS maternity care.
    "Maternity care falls under “immediately necessary service” in the UK, which means it must never be refused or delayed regardless of a patient’s immigration status.
    "!But Maternity Action says destitute migrant women who struggle to afford food and accommodation are receiving bills of £7,000 or more. It claims its research shows women are avoiding essential medical care in an attempt to save money."

  • NHS doctor banned from coming back to UK over visa mix-up Guardian gives yet another example of the cost to the NHS of Theresa May's racist "hostile enviroment".
    "An eye doctor has been stranded overseas and unable to resume his career in the NHS after the Home Office banned him from entering Britain over a visa mix-up.
    "The decision by the Home Office’s immigration department has been branded “inhumane” and prompted warnings it will worsen the NHS’s already serious shortage of doctors."

  • Estates returns information collection England 2018-19 Updated offiicial data on backlog maintenance bills in England's NHS show the situation worsening.

  • Google gets green light to access five years of NHS patient data (£) New Scientist reveals worrying fact that "Google will receive five years’ worth of NHS patients’ sensitive records under the terms of a deal signed last month, despite controversy over similar contracts in the past."

  • Council decides not to ask Government to intervene on A&E overnight closure Weston Mercury reports North Somerset council' scrutiny panel has bottled out of referring the controversial permanent night time closure of Weston's A&E to the secretary of state. This is a body blow for campaigners who now have no local body prepared to stand up for local access to emergency care.

  • Pathologists vote to strike over new shifts row at Barking NHS trust that puts patients’ samples ‘at risk’ Press release from Unite the Union:
    "Pathologists at a north east London NHS trust have voted for strike action in a dispute over new shift patterns which, it is claimed, could compromise the integrity of patients’ samples.
    "The warning has come from Unite, which represents 88 biomedical scientists working at Queen’s Hospital, Romford and King George Hospital, Ilford who face losing about £10,000 a year, if the new shifts go-ahead on 4 November.
    "The pathologists, who are employed by Barking, Havering and Redbridge University Hospitals NHS Trust, voted by 87 per cent for strike action. Strike dates are expected to be announced soon.
    "Unite said that it submitted a Freedom of Information (FoI) request to probe what was happening to patient samples and the trust replied: ‘No sample is discarded prior to analysis’.
    "However, the trust cited ‘commercial confidentiality’ in declining to answer the question: ‘How many blood and other examples within the pathology department at Queen’s Hospital and King George Hospital have been processed after the recommended testing time in each of the last 12 months?’"

  • (US) Patients Eligible For Charity Care Instead Get Big Bills Kaiser Health News reports on a less obvious aspect of the US health care nightmare:
    "Under the Affordable Care Act, nonprofit hospitals like St. Joseph are required to provide free or discounted care to patients of meager incomes — or risk losing their tax-exempt status. These price breaks can help people avoid financial catastrophe.
    "And yet nearly half — 45% — of nonprofit hospital organizations are routinely sending medical bills to patients whose incomes are low enough to qualify for charity care, according to a Kaiser Health News analysis of reports the nonprofits submit annually to the Internal Revenue Service. Those 1,134 organizations operate 1,651 hospitals.
    "Together, they estimated they had given up collecting $2.7 billion in bills sent to patients who probably would have qualified for financial assistance under the hospitals’ own policies if they had filled out the applications."

  • Health chiefs blast Boris Johnson's opposition to 'sin taxes' – calling for the PM to 'follow the evidence' and expand them to cover ALL junk food Daily Heil finds room for a straight report on calls from Simon Stevens and other senior NHS figures for extension of "sugar tax" and similar measures to deter unhealthy diet:
    "Health chiefs have blasted Boris Johnson's opposition to 'sin taxes' and are calling for the Prime Minister to 'follow the evidence' and expand them to cover all junk food.
    "The head of NHS England has urged the Government to be 'led by the evidence' showing the so-called sugar tax has worked, days before the results of a review into whether it should be extended to all unhealthy foods are due."

  • Growing pressures on access and staffing risk creating ‘perfect storm’ for people using mental health and learning disability service The CQC's own press release on their State of Care report:
    "In this year’s State of Care, we have highlighted mental health and learning disability inpatient services because that’s where we are starting to see an impact on quality – and on people. There has been a deterioration in ratings in these services – and our inspection reports highlight staff shortages, or care delivered by staff who aren’t trained or supported to look after people with complex needs, as a reason for this.
    “Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all."

  • More than half of A&Es provide substandard care, says watchdog Guardian reports on the CQC's latest State of Care report, highlighting problems in A&E:
    "More than half of A&E units are providing substandard care because they are understaffed and cannot cope with an ongoing surge in patients, the NHS watchdog has said.
    "The Care Quality Commission (CQC) said 44% of emergency departments in England required improvement and another 8% were inadequate, its lowest rating. Last year 48% of A&Es fell into the two ratings brackets combined.
    "Ian Trenholm, the CQC’s chief executive, said A&E was “the department in a hospital we are most concerned about”. The regulator said units were struggling because of increases of as much as 10% a year in the number of people seeking care.

  • Mental health services: CQC warns of “perfect storm” (£)BMJ report on the latest Annual report from the CQC:
    "A shortage of skilled staff, coupled with rising demand, has created a “perfect storm” for patients using mental health and learning disability services, England’s healthcare regulator has warned. …
    "The CQC said that since October 2018 it had rated 14 independent mental health hospitals that admit people with a learning disability or autism as inadequate and put them into special measures. Two of these services have since improved, three are now closed, and one is still registered but with no patients resident."

  • Kidney patients face waving goodbye to EU travel after Brexit More joy from the looming Brexit, according to the (£) Times:
    "[26,000] kidney patients who need life-sustaining treatment when travelling in the EU will have to pay up to £1,200 a week under a no-deal Brexit.
    "The four hours of dialysis they need several times a week is free with a European Health Insurance Card (EHIC). However, the NHS website says: “The [card] may not be valid if there’s a no-deal Brexit. This . . . might mean you need to pay for treatment in full.”
    "Dialysis, which costs about £300 a session, is not covered by travel insurance because it is “a planned treatment for a pre-existing condition”.

  • Troubled care home operator fails to pay landlords (£)FT report on yet another financial nightmare in care home sector:
    "Four Seasons, Britain’s second biggest care home operator, failed to pay millions of pounds of rent this month with no warning to landlords, raising concerns over the care of thousands of elderly residents.
    "… Four Seasons, which runs 320 homes housing 16,000 residents, has been fighting for survival since 2017 after its owner — Guy Hands’ private equity firm Terra Firma — defaulted on an interest payment.
    "… Four Seasons said in a stock market announcement on Monday that it was seeking to renegotiate rents on the remaining 135 leasehold homes. It then failed to pay rent owed to landlords the same day, according to three sources who say they received no advance warning."

  • Adult care staff turnover rises for sixth consecutive year, report finds Community Care article based on new research shows massive rise in staff turnover in adult social care:
    "The adult social care staff turnover rate has risen for the sixth year running, with lack of training and qualifications and zero-hours contracts among factors driving workers to leave, a new report has found.
    "Skills for Care’s annual report on the state of the workforce found turnover among directly-employed staff (excluding personal assistants) had risen from 23.1% in 2012-13 to 32.2% in 2018-19. Turnover was highest among care workers, at 39.5%, and this group had also experienced the highest increase since 2012-13, at 11.1 percentage points.
    "According to the report, staff were more likely to leave their role if they were younger, relatively inexperienced, lower paid, had higher rates of sickness and were on a zero-hours contract."

  • It’s hysteria, not a heart attack, GP app Babylon tells women Times report revealing that so-called AI chatbot Babylon has been programmed with all of the sexist prejudices of the medical profession and may miss symptoms of heart attack in women.
    "Entering identical heart attack symptoms for men and women resulted in different suggested diagnoses.
    "The Babylon app, which bears the NHS logo, uses artificial intelligence (AI) to identify health problems. But doctors found that the algorithm tells a 60-year-old female smoker who reports sudden onset chest pain and nausea that she is probably having a panic attack or pain caused by inflammation.
    "A 60-year-old male smoker with the same symptoms is told that he may be having a heart attack. The man is advised to go to A&E, while the woman is told to contact her GP within six hours if the symptoms persist."

  • England sees 'worst summer on record' for A&E waits Analysis by BBC Newsnight and the Nuffield Trust found an average of 86% of patients were admitted, transferred or discharged from A&E within four hours in the six months to September.
    This is the worst performance in that period since the 95% target was brought in in 2004. Doctors are warning that the system is "running out of resilience" and that winter in A&Es was going to be "really difficult".
    In September there were 64,921 patients waiting more than four hours from decision to their actual admission to further care, of whom 455 waited more than 12 hours. This is a 195.5% increase from the previous year.

  • Boris Johnson accused of 'pork barrel electioneering' with NHS hospitals Mirror highlights story broken in HSJ: “Boris Johnson has been accused of using the NHS for ‘pork barrel electioneering’, snubbing Liverpool and funnelling hospital funding into Tory target seats.”
    Liverpool, Mersey and Cheshire areas have 4.5% of England’s population but just 1% of the new money announced by the Johnson government for hospital building and refurbishment.
    Kathryn Thomson of Liverpool Women’s Foundation Trust told the Health Service Journal she had been left “hugely frustrated” when her organisation was excluded from the list of NHS buildings to benefit from a cash boost.
    She said: “We were the top priority for Cheshire and Mersey, and we understand from NHS Improvement that we were one of the priorities for the north west of England, so we don’t understand why we haven’t got anything. We’ve asked a number of times for feedback on what prevented us getting something, so we could rationalise it, but we’ve never had anything back.”
    Of the 21 trusts receiving seed funding, more than half are in Tory seats, and nine are in seats with majorities of less than 5,000 votes in the 2017 election.

  • PM aide's advisory role with Babylon 'raises conflict of interest questions' Pulse version of the story on Dominic Cummings' links with Babylon quotes Sam Smith, coordinator of patient confidentiality campaign group MedConfidential:
    "This Government and NHSX is committed to using private companies to deliver NHS technology innovation, as was clear from the recent awards to Digital Innovation Hubs.
    "Any innovations they create will only be available to their paying customers – £250m of the NHS budget will be used to fund AI innovation, and then other NHS budgets will be charged to use it, per patient, forever. This double charging makes the worst of PFI look like a good deal."

  • Dominic Cummings accused of conflict of interest over NHS fund Guardian report that may surprise some people:
    "Boris Johnson’s most senior aide, Dominic Cummings, is facing conflict of interest accusations over a consultancy role he undertook for a government-endorsed healthcare startup that is in position to receive a share of a new £250m flagship public fund.
    "Cummings advised Babylon Health, a controversial artificial intelligence (AI) firm working within the NHS, on its communications strategy and its senior recruitment, an investigation by the Guardian and the Bureau of Investigative Journalism can reveal.
    "A GP app developed by the company was later backed publicly on multiple occasions by the health secretary, Matt Hancock."

  • 'It destroys lives' - Teen's dismay at 18-month mental health delay As CQC inspectors return to the troubled Norfolk & Suffolk Foundation Trust, the Eastern Daily Press highlights delays and problems. Waiting times for non-emergency referrals have worsened:
    "The number of people waiting longer than the target of 28 days to be assessed shot up to 1,466 in August from 912 in March."
    More than 30pc of medical jobs are vacant at the NSFT and the Campaign to Save Mental Health Services in Norfolk and Suffolk said the decline in waiting times was down to staffing problems.
    They pointed to massive issues within the NSFT's "crisis teams" who look after those most in need in the community."

  • NHS could lose thousands of staff under Brexit migration shake-up (£) HSJ brings a grim warning that will no doubt be brushed aside by Brextremists as "project fear":
    "More than 60,000 international NHS workers could be at risk of deportation if the government was to tighten immigration rules and increase the salary threshold for visas for skilled workers, analysis by HSJ has revealed.
    "Home secretary Priti Patel has committed to introducing an Australian points based immigration system for the UK after Brexit, while the government has asked the Migration Advisory Committee to consider the evidence for salary thresholds and at what level they could be set.
    "According to NHS Digital data, examined by HSJ, there are 60,611 NHS staff, by headcount, from the EU and the rest of the world who are not currently on the shortage occupation list and earn less than £36,700."

  • Waste in the US Health Care System: Estimated Costs and Potential for Savings An important new free access study in Journal of American Medical Association updates previous estimates and reveals the staggering scale of waste in the US health care system:
    "In this review based on 6 previously identified domains of health care waste, the estimated cost of waste in the US health care system ranged from $760 billion to $935 billion, accounting for approximately 25% of total health care spending, and the projected potential savings from interventions that reduce waste, excluding savings from administrative complexity, ranged from $191 billion to $282 billion, representing a potential 25% reduction in the total cost of waste.
    "Implementation of effective measures to eliminate waste represents an opportunity reduce the continued increases in US health care expenditures."

  • NHS chiefs fear hospitals will not cope amid growing social care crisis Daily Telegraph reports:
    "Eight in ten hospital chief executives fear their wards will be unable to cope within a year, amid a growing social care crisis.
    "A damning report today says most of those running NHS trusts are worried about short staffing and a lack of investment in services to keep the elderly out of hospital.
    "Six in ten trust chief executives and chairmen said a lack of doctors and nurses is endangering decent patient care, with almost 100,000 staff vacancies across the NHS.
    "And eight in ten of those running hospitals said they feared they would not be able to cope with demand within the next 12 months."

  • Digital-first overhaul could strip Babylon GP at Hand of primary care network GPonline follows up on its previous report that GP at Hand's list of more than 60,000 patients - all currently registered with a single west London host practice - would be broken up into more than a dozen separate contracts, potentially from April 2020.
    NHS England also plans to force them to set up physical premises in any CCG area from which they have recruited more than 1,000 patients. See also The Lowdown report: https://lowdownnhs.info/news/private-gp-service-sets-sights-on-further-nhs-expansion/

  • Psychiatrist vacancies 'threaten' NHS transformation BBC report based on Royal College of Psychiatrists survey on the uneven spread and general shortage of consultant staff for mental health:
    "The number of vacancies has doubled in six years - and is particularly marked in children's services, says the Royal College of Psychiatrists.
    "One in 10 consultant posts - 568 out of 5,730 - is vacant, up from one in 20 in 2013, a census by the college suggests.
    Being the BBC it has to include the usual inadequate response from ministers: "The government pledged an extra £2.3bn a year by 2023-4 to improve care."

  • 'It's like a death sentence': retired Britons in EU face loss of healthcare Guardian report flags up the hidden danger of a no-deal Brexit:
    "The UK government announced last month that if Britain crashes out of the EU without a deal the estimated 180,000 retired British nationals in the bloc whose healthcare costs it funds would continue to be covered for six months.
    "Most of the 1 million Britons in the EU are earners, so pay into the health systems of the EU member states they live in. Their healthcare arrangements should be unaffected by a no-deal Brexit.
    "But pensioners, who paid social security when they lived in the UK, are part of a reciprocal healthcare scheme, S1, under which the NHS reimburses the cost of their treatment – and which will cease to exist after a no-deal Brexit."

  • One of UK’s biggest care home operators investigated over finances Guardian warning that:
    "One of the UK’s biggest care home operators, which looks after about 3,000 elderly residents, is being investigated by regulators, heightening concerns over the state of Britain’s social care provider market.
    "More than 150 local authorities in England and Scotland were alerted at the end of August that Advinia Group was failing to co-operate with a regulatory inquiry into its finances.
    "Advinia has 3,250 beds and employs 4,500 staff in its 38 residential homes in England and Scotland. It became England’s 10th biggest care home operator overnight in 2018 after borrowing £59m to buy 22 homes from private healthcare firm Bupa."

  • 'Unprecedented' rise in infant mortality in England linked to poverty Irish publication flags up British statistics:
    "An additional 570 infant deaths, compared to what would have been expected based on historical trends, were recorded in [the UK] from 2014-2017.
    "About one-third of those deaths, which related to children under the age of one, were linked to rising poverty.
    "Rising infant mortality is unusual in high income countries, and international statistics show that infant mortality has continued to decline in most rich countries in recent years."

  • Sunday Mirror demands Government coughs up to end GP crisis caused by Tory cuts The Mirror article warns that:
    "Appointment waiting times have hit a record high as more and more GPs quit, broken by heavy workloads.
    We want to save our surgeries by:
    * BOOSTING the number of trainee GPs by at least 5,000 a year to replace the 1,600 already axed by the Tories – and to cover a looming shortfall of 7,000 in the next four years.
    * CREATING nearly 30 million extra appointments to shrink growing surgery waiting times for everyone which can be as long as TWO MONTHS – especially for patients suffering serious conditions, and
    * ENDING the flood of experienced GPs who are leaving the NHS in droves by improving working conditions wrecked by Tory cuts."

  • NHS delays to surgery risk patients becoming addicted to strong painkillers Times report warns:
    "The NHS is putting patients at risk of opioid dependency by rationing routine surgery, experts have warned. …
    "Some local NHS trusts are delaying operations by up to 12 months.
    "GPs, surgeons and patient groups said the “totally unacceptable” delays raise the risk of opioid dependence among patients awaiting pain-relieving surgery. They say people in need of medical help will be left in pain as they are forced to wait for treatment, and may end up addicted to the enormously powerful drugs."

  • Decrepit NHS mental health wards put lives at risk Guardian article highlighting the continued consequences of chronic neglect of investment in mental health services, which remains an obvious flaw in the latest government announcements of "new" hospitals, none of them for mental health:
    "Crumbling old buildings are unsafe as they offer opportunities for mentally vulnerable people with conditions such as depression and schizophrenia to try to hang themselves or fall from a height, according to mental health trusts in England.
    "New figures show that patient safety incidents in mental health units caused by problems with staffing, facilities or the environment in which people are treated have risen by 8%. In all, 19,088 such incidents occurred in 2018-19 compared with 17,693 the year before."

  • Trump Bars Immigrants Who Cannot Pay For Health Care US National Public Radio report should be shocking, but shows how much our own government's imposition of racist charges to access NHS treatment are all of a piece with the actions of a racist US President:
    "President Trump signed a proclamation late Friday barring legal immigrants who cannot prove they will have health care coverage or the means to pay for it within 30 days of their arrival to the United States.
    "Trump said uninsured individuals are a burden on the health care industry and U.S. taxpayers.
    "Immigrants who enter this country should not further saddle our health care system, and subsequently American taxpayers, with higher costs," Trump declared."

  • Virgin Care hires former NHS regulator boss (£)HSJ reports on a new nice little earner for an ex-McKinsey director who was a health advisor to Tony Blair and led the foundation trust regulator Monitor for five years until it joined up with the Trust Development Authority to form NHS Improvement in 2015.

  • Before travelling abroad it is important to take out comprehensive travel insurance More joy from the looming Brexit: another government warning.
    "The European Health Insurance Card (EHIC) may not be valid after Brexit. You should make sure your travel insurance covers your healthcare needs," whether there’s a deal or not
    "There may also be changes to your vehicle insurance when driving in the EU after Brexit."

  • Future Fit: ‘At last, a solution led by staff on front line’ - Mark Pritchard Local Shropshire Tory MP sings the praises of the 'Future Fit" reconfiguration plan which will axe his local A&E, and replace it with the unknown quality of an "A&E Local" with no beds.

  • Does Quality Improvement really improve quality? An academic tries to get to grips with health improvement which needs to engage and centre on front line and support staff rather than writing peer-reviewed articles for academics to read or conducting "randomised control trials" in which the old discredited way or organising is the 'control', putting patients at risk.

  • US Congress examines private equity role in surging healthcare costs (£)FT report on cost inflation driven by private equity firms active in provision of US health care. Two such companies are Envision and TeamHealth, who:
    "increase charges when they enter into contracts to manage emergency department services, either directly or by agreeing new rates with insurance companies, according to an analysis by Yale University. 
    "Eileen Appelbaum, senior economist at the Center for Economic and Policy Research, Washington, DC-based think-tank, said the business model of private equity managers was geared to driving up the costs of patient care. 
    “Emergency medical practices are a perfect buyout target for private equity managers because demand does not decline when prices go up,” said Ms Appelbaum.
    "Ambulance services owned by private equity managers are another problematic area."

  • The Rich Really Do Pay Lower Taxes Than You Brilliant New York Times article and interactive graphic confirming the way the US elite has reduced its taxation rate since the 1950s:
    "Almost a decade ago, Warren Buffett made a claim that would become famous. He said that he paid a lower tax rate than his secretary, thanks to the many loopholes and deductions that benefit the wealthy.
    "His claim sparked a debate about the fairness of the tax system. In the end, the expert consensus was that, whatever Buffett’s specific situation, most wealthy Americans did not actually pay a lower tax rate than the middle class. “Is it the norm?” the fact-checking outfit Politifact asked. “No.”
    "Time for an update: It’s the norm now.
    "For the first time on record, the 400 wealthiest Americans last year paid a lower total tax rate — spanning federal, state and local taxes — than any other income group, according to newly released data."

  • Government promises £3bn hospital building programme A rather more realistic version of the new hospitals story from the (£)HSJ, noting the timescale more most of the "new hospitals" is 15 years:
    "Phase one will inject £2.7bn of cash into six hospital trusts to carry out major rebuilds of hospitals by 2025. Projects lined up for the cash include Barts Health Trust to rebuild its dilapidated Whipps Cross hospital and Leeds Teaching Hospital, to replace the Victorian Leeds General Infirmary.
    "The second phase, the party says, will set out to deliver 34 hospital rebuilds between 2025 and 2030 by providing £100m of seed funding to support the development of business cases for 21 building projects around the country. It includes Hillingdon Hospitals Foundation Trust and Imperial College Healthcare Trust, the top two trusts for backlog of maintenance costs in England. The Conservatives’ statement indicates full funding will be forthcoming for these between 2025-30.
    "The announcement – made by Boris Johnson as the Tory party conference gets under way today – indicates that it accepts further capital development funding is needed beyond these tranches, and says there will be a subsequent third phase of building from 2030 to 2035. “Today’s announcement is the start of much longer hospital building programme,” it says.
    "The party said the capital would be funded via taxation not “private finance initiatives”.

  • Tory pledge to build 40 new hospitals under fire as minister admits funding in place for just six Independent reports: "health secretary Matt Hancock confirmed that while some £2.7 billion has been allocated to six hospital trusts for building projects for completion by 2025, the other 34 projects for delivery by 2030 have so far been promised just £100 million of “seed funding”.
    "The first six projects include extensions to existing hospitals, as well as new buildings on separate sites, and will not require the demolition of facilities to provide land for construction."

  • Response to Johnson's announcement on capital spending and building new hospitals A thread of tweets by NHS Providers boss Chris Hopson in which he seeks to welcome any new money but also point out what is being ignored by the latest twist of pre-election government policy.

  • Boris Johnson: I will spend £13bn and build 40 new hospitals Telegraph, the paper that employed Johnson till be became PM, reals out the unadulterated spin of his statement on 40 "new hospitals". It turns out £10bn of the £13bn would have to be allocated by a government after 2025, and only six projects are set to start soon -- several of which are rebuilds and refurbishments rather than new hospitals. The 21 other projects involving 34 hospitals are allocated just £100m between them to work up plans over the next six years -- or more. Many of them turn out to be in marginal seats targeted by Tories.

  • Patients, bodies detention ban to cost taxpayers Sh2.3bn report from Kenya of a new law that threatened to fine hospital bosses who use the detention of patients in hospital or refusal to release bodies as a way to bully people into paying bills for treatment:
    An estimated 1,000 patients per month fail to pay their medical bills at the time of discharge in Kenya's main national referral hospitals. "The Bill sponsored by Nyando MP Jared Okelo wants hospitals pursue the recovery of debts through legal means instead of arbitrary detention of a patient or body."

  • The Blithering ICS newsletter Brilliant spoof writing from @jtweeterson which echoes so many similarly inane publications up and down the country -- until we realise it really is a genuine one with a few names changed: "I didn't write this. I just got hold of an ICS newsletter and changed a few names. I'm not kidding. I'll post a link to the original later."

  • U-turn as ministers reconsider financial aid for student nurses Guardian report of story also covered by HSJ (see below) on possible moves to reinstate government financial support for student nurses:
    "Until 2015 nursing attracted an high number of mature students, who often already had debts totalling tens of thousands of pounds from paying tuition fees for their first course. Applications have declined since then.
    "Sources close to the discussions say ministers are cautious about endorsing “debt forgiveness” as an inducement because it would cost too much money.
    "Any financial incentives for nurses are likely to be made available only to certain groups, and not to everyone starting a three-year nursing degree. They would be targeted at mature students and those seeking to specialise in mental health and learning disability nursing, two areas in which workforce shortages are particularly acute."

  • Government preparing for nurse funding U-turn (£) HSJ report suggesting the failed policy of scrapping bursaries, which has collapsed recruitment of student nurses from mature age groups, could be dropped:
    "Options being discussed at a high level include a radical cancellation of student debt and a new style bursary in the form of a cost of living grant, which could be between £3,000 and £5,000. It is hoped such measures will increase the domestic pipeline of nurses.
    "However, sources told HSJ only certain cohorts of students – such as mature students, learning disability nurses, mental health nurses, and those on other courses where student numbers are very low – might benefit from the support due to financial constraints."

  • Worker and Employer Contributions for Premiums More reminders from the Kaiser Family Foundation of the soaring costs of health insurance in the US, described in one tweet as "An anvil tied to the ankles of companies and workers alike."

  • DYING QUIETLY: The Babies Killed by Poverty Important reminder in Byline Times of the dreadful toll taken by poverty:
    "Poverty … during pregnancy and in the early days of a baby’s life can have a devastating impact. Infants are more than twice as likely to die if they are born into a poor family rather than a wealthy one. And the situation is getting worse. Figures by the Office for National Statistics (ONS) show that infant mortality rates in England and Wales have increased for the past three years, with the rates highest in the most deprived areas.
    "In Manchester alone, the infant mortality rate has soared by 40% in the past decade.

  • NHS privatisation to be reined in under secret plan to reform care hugely overoptimistic Guardian headline for a story on NHS England's latest proposals for new legislation -- at a time when government has neither the majority nor the inclination to push through another reorganisation of the NHS.

  • Spread of Health-related Misinformation on Social Media Fascinating and scary review of the damage being done by social media, by a team including Prof Martin McKee

  • Inspectors discover poor standards at 28 mental health units Guardian report notes the disclosure of "widespread substandard care in mental health facilities run by non-NHS providers has prompted psychiatrists to call for a public inquiry to investigate.
    "The Care Quality Commission (CQC) has rated 16 independently run mental health units as inadequate so far this year. It put four others in the same category last year, and eight in 2017."

  • GP surgeries deny care to vulnerable people without ID documents Guardian report on the way GPs have begun to implement damaging aspects of Theresa May's "hostile environment" for migrant workers;
    "Three-quarters of 100 London GP surgeries are breaching NHS guidelines by insisting on their websites that people need proof of identity and residence in the area before they can be admitted to their list of patients."

  • Statements on NHS funding Stiff note from Official Statistics Authority to Department of Health challenging accuracy of PM Johnson's claim to be giving an "extra" £1.8 billion to the NHS - most of which was money trusts already had.
    "So far, we have been unable to identify an authoritative official statement describing how the £1.8 billion is funded, and the mechanisms that led the £1 billion capital expenditure to be withheld and then subsequently released to trusts. I encourage DHSC to release such a statement as soon as possible in order to enhance transparency and support public understanding."

  • The Downsizing of Ealing Hospital is a Past, Current and Future Threat Local campaigner gives overview of long process of running down busy DGH in west London, with prime responsibility on local commissioners:
    "Ever since the establishment of the Ealing Clinical Commissioning Group (ECCG) in 2013, this planning and purchasing body has shown little support for Ealing Hospital. In 2015 the ECCG closed down the hospital’s Maternity service and in 2016 it did away with Paediatrics."

  • Countries must invest at least 1% more of GDP on primary health care to eliminate glaring coverage gaps Important WHO report with a warning:
    "The world will need to double health coverage between now and 2030, according to the Universal Health Coverage Monitoring Report.
    "It warns that if current trends continue, up to 5 billion people will still be unable to access health care in 2030 – the deadline world leaders have set for achieving universal health coverage. Most of those people are poor and already disadvantaged."

  • Universal health coverage For those concerned with widening global access to universal health care: a collection of articles exploring how to achieve effective 'universal health coverage' (UHC).
    "The collection highlights the importance of quality in UHC, potential finance models, how best to incentivise stakeholders, and some of the barriers to true UHC."
    "The articles in this collection were commissioned by The BMJ based on an idea from a steering group including members of The BMJ and The Harvard Global Health Institute. The BMJ retained full editorial control over external peer review, editing, and publication of all articles. The Harvard Global Health Institute paid the open access fees for the Analysis articles."

  • Virgin Care and NHS partner win £85m contract Depressing (£)HSJ report reveals North East Hampshire and Farnham and Surrey Heath clinical commissioning groups -- not far from the Surrey CCG which forked out millions in an out of court settlement having been sued by Virgin – have given a five-year contract to "incumbent providers Frimley Health Foundation Trust and Virgin Care Services Limited."

  • Departing CEO received £53k overtime payment Put away those violins and save your sympathy: (£)HSJ report points out that hospital chief executive Siobhan McArdle whose recent resignation letter to staff saying “life is just too short” triggered a debate on the pressures on senior staff picked up highly unusual overtime payments in addition to her far from insignificant base salary of between £235,000 and £240,000.

  • Health cover for retired Britons in EU to last six months in no-deal Brexit Guardian reports just six months to get NHS ready for potential tidal wave of health care refugees, elderly British migrants in Spain and elsewhere who will not be able to afford or buy health insurance and will be forced to come back to Britain if there is no deal. Many of them voted for Brexit!

  • All elderly people to get free personal care under £6bn Labour plan Sky news reports Labour's commitment to National Care Service begins with a first step, only covering personal care for older people. It's progress, but much more to be done to cover other age groups of service users before a full plan is in place.

  • Hundreds of nurses march in protest over pay RCN gets militant in Guernsey: ITN report

  • NHS bed shortages cause late cancellation of cancer surgeries Guardian reports of system failure in Leicester: "One of the NHS’s biggest hospital trusts has apologised to a 78-year-old man after it had to cancel his cancer surgery twice in a month because of a lack of beds. On both occasions the patient, who has liver cancer, waited in the hospital for six hours and was ready to go into the operating theatre to have his tumour removed when he was sent home."

  • 'Medication or housing': why soaring insulin prices are killing Americans Another grim Guardian warning against the horror show that passes for a health care system in the USA and reminds us why we need to keep the NHS off the table in any trade negotiations, especially with the US:
    "In 1922 Frederick Banting and Charles Best, the Canadian scientists who discovered insulin, sold their patent to the University of Toronto for $1, hoping it would be a cure for diabetes. Today a vial of insulin – which will last 28 days once opened – costs about $300 in the US.
    "Black, Hispanic and Asian adults have been hit hardest by escalating prices. They are more likely to have diabetes than white adults and are less likely to be insured. One in four diabetes patients ration their insulin, according to a study published in the Journal of the American Medical Association."

  • Worker and Employer Contributions for Premiums More reminders from the Kaiser Family Foundation of the soaring costs of health insurance in the US, described in one tweet as "An anvil tied to the ankles of companies and workers alike."

  • Prime Minister pledges funding for cancer screening overhaul Department press release trumpeting Johnson's announcement of just £200m extra for MRI and CT scanners across England. the Health Foundation has estimated an extra £1.5 billion would be needed to bring provision up to the EU average. see https://www.health.org.uk/news-and-comment/news/new-funding-for-diagnostic-equipment-falls-considerably-below

  • SALFORD ROYAL HOSPITAL LOW PAID STAFF VOTE TO STRIKE Salford Star reports another strike to come against another cheapskate private contractor: "Staff employed by private contractor Engie Services Ltd within Salford Royal NHS Foundation Trust have unanimously voted to take strike action over their employer's failure to pay NHS rates."

  • Hospitals relying on 'emergency' loans to cover costs BBC catches up with the reality of NHS deficit funding, propped up on billions worth of loans, although the figures are much lower than those calculated by the Health Service Journal.
    "Hospitals in England are "lurching" from month to month on "emergency" government loans to cover costs, a think tank has said. The Nuffield Trust said some NHS hospitals had to cut spending on patients to pay the interest.
    "Trusts owed £10bn to the government in 2018-19 for "interim revenue support" and paid £185m in interest last year.
    "The Department of Health and Social Care (DHSC) said the money went back to the NHS.
    "The amount of money loaned by the government to NHS trusts in England doubled between 2016-17 to 2018-19, BBC analysis of official figures shows."

  • Hospital 'trolley waits' increase by 1400% since Tories came to power Mirror repost NHS England figures showing the number of so-called 'trolley waits' has increased from 3,697 in August 2010 to 56,499 in August 2019.
    "Across the whole year, there were 108,314 ‘trolley waits’ in 2011-12 - which rose to 625,678 in 2018-19.
    "The government’s target is to admit 95% of patients within four hours. But they have not hit this target for four years."

  • Eight CCGs to merge to make ‘really tricky decisions’ HSJ report confirms and underlines concerns of campaigners that mergers of CCGs into vast new monolithic bodies is aimed at forcing through controversial policies by overriding local opposition:
    "System leaders have drawn up plans to merge eight clinical commissioning groups into one organisation, to take some “really tricky decisions”.
    "The plan would see all the CCGs in Lancashire and south Cumbria form a single “strategic commissioner” by April 2021, after operating in shadow form from next year.
    "The region has already been classed as an “integrated care system” by NHS England, and has a substantial leadership team in place. …
    "Gary Raphael, executive director of finance and investment for the ICS, outlined the plans during a small session at the NHS Expo event last week.
    "He said: “The place we need to get to is where we can enforce decisions on a majority basis. …
    “But to get to some of the really tricky decisions to meet the requirements of the long-term plan is to break this glass ceiling and we think the way to do this is to move from eight CCGs to one."

  • GPs reject merger ‘driven by NHS England’ HSJ reports on a rebuff for health bosses seeking to push through the merger of CCGs in Staffordshire:
    "GPs have voted against proposals to merge six clinical commissioning groups in Staffordshire, after being told the plans were “driven by NHS England”, HSJ has learned.
    "The CCGs’ shared management team outlined the intention to merge last year, but various concerns have been raised among the GP members.
    "The outcome of the vote is due to be formally announced after an extraordinary meeting this evening, but HSJ understands members in a clear majority of the CCGs have voted against the proposals."

  • Exclusive: Region ordered to hold back ‘risk reserve’ of almost £100m HSJ report reveals "Providers and commissioners in the East of England will be required to hold back a financial “risk reserve” of almost £100m for the next four years, to combat the risk of overspending.
    "The regional directorate for NHS England and NHS Improvement wants to create the contingency fund from its £11bn allocation, in case of overspending against local financial plans.
    "It effectively means funding that might have been committed for patient services will instead be held back."

  • We Asked Prosecutors if Health Insurance Companies Care About Fraud. They Laughed at Us US non-profit Pro Publica reports:
    "Escalating health care costs are one of the greatest financial concerns in the United States. And an estimated 10% of those costs are likely eaten up by fraud, experts say. Yet private health insurers, who preside over some $1.2 trillion in spending each year, exhibit a puzzling lack of ambition when it comes to bringing fraudsters to justice."

  • Where not to live if you want a good care home BBC report underlines the dysfunctional nature of the "market" in social care.

  • 84% of care home beds in England owned by private firms Guardian reports: "The disclosure of the private sector’s huge market share has raised concerns because some of the biggest operators have large debts, are alleged to use tax avoidance schemes and drive down staff pay. The Care Quality Commission (CQC) watchdog has said inadequate staffing levels at care homes can lead to elderly residents receiving poor-quality care.
    "For-profit companies own 381,524 (83.6%) of England’s 456,545 care home beds, research by the IPPR thinktank (in partnership with Future Care Capital) has found, based on analysis of data from the CQC and Companies House, an increase on the 82% in 2015."

  • David Oliver: £25m for hospices won’t go far BMJ article by David Oliver deconstructs Boris Johnson's "extra" £25m for hospice care:
    "Last month the prime minister pledged a one-off payment of £25m (€28m; $31m) to boost hospices and palliative care services. Boris Johnson’s words were warm and supportive, hinting at more money soon. But was this more than a gesture?
    "Certainly, the pledge is there in a Number 10 press release, including some positive reaction from the health secretary and charity chief executives at Hospice UK and Thames Hospice. Within a day of Johnson’s announcement, however, the chair of NHS Clinical Commissioners told the Health Service Journal that the £25m would come from ringfencing existing NHS budgets, inevitably at the expense of other cash starved services. Not new money after all, then."

  • Children's mental health wards to close because of staff shortages Eastern Daily Press report on yet more evidence of the chronic problems in child and adolescent mental health, which is hugely dependent upon poor quality private providers:
    "The two children's wards at the private Ellingham Hospital, near Attleborough, will close once new placements have been found for patients, NHS Improvement confirmed on Wednesday.
    "The NHS sends children with complex problems to the two 10-bed wards and the closure is another blow for mental health provision in Norfolk.
    "In a letter to staff, dated September 9, Lorraine Ahern, operations director at Priory Group, which runs the hospital, said the Care Quality Commission (CQC) had imposed conditions on the hospital after a visit earlier this month."

  • Why do one in five home health aides live in poverty? Guardian reports "[US] Home health aides work long hours, often with no benefits, paid vacation or sick leave and without the backing of a union. The job entails everything from helping patients with their daily personal tasks, assistance with basic medical care, to light housework and keeping patients company.
    "… And yet many of these workers fail to earn a living wage. According to government data, healthcare support occupations such as home health aides had a median annual wage of $24,060 in May 2018, lower than the median annual wage for all occupations in the economy.
    "According to a report by Paraprofessional Healthcare Institute (PHI), a not-for-profit organization based in New York City that works to improve long-term services and support for elders and individuals with disabilities, in 2017, one in five home care workers lived below the federal poverty line and over half relied on some form of public assistance."

  • The harsh reality of underfunding at my hospital? Swept away for Johnson visit Guardian comment by a doctor at Whipps Cross Hospital where PM Johnson was famously accosted by an anxious and frustrated father of a sick child:
    "It just wasn’t true that there were no press there. It was all being filmed. It was very staged.
    "We were told yesterday that there was a special guest coming and nobody knew until this morning that it was Johnson. All the staff were lined up in a row in front of a team of camera crew and photographers. When I saw it was him I wanted to say something, but I didn’t want to lose my job.
    "I’ve been thinking about it all day and felt I had to say something because NHS hospitals today can be unsafe places. Whipps Cross [in Leytonstone, north-east London] is particularly understaffed and under-resourced so people don’t get the care that they need as promptly as they need.
    "And this visit was not reflective of the realities of working at this hospital. Johnson was taken to the nicest ward in the hospital; there were flowers on display and classical music was playing in the background. I wish the prime minister could have seen some of the other wards, which are nothing like what he saw today. He should come on a night shift and see how everything doesn’t function at two in the morning."

  • Nurse numbers rise 'eclipsed by jump in patients' BBC reports the rise in hospital nurses in England has been dwarfed by a jump in patients.
    "The Royal College of Nursing research points to data showing the nurse workforce has increased by 4.6% in five years.
    "But hospital admissions have jumped by 12.3% - nearly three times the rate.
    "The union says this shows more needs to be done to ensure safe staffing, but the government says the rising NHS budget will ensure high-quality care."

  • Healthcare is not universal if undocumented migrants are excluded Compassionate BMJ article points out among other things:
    "Policies should build on evidence of the behaviour of migrants seeking healthcare and the consequences of poor health literacy, unawareness of rights, and language and cultural differences. Migrants may avoid seeking care for fear of arrest or deportation, or they may believe that they are “undeserving.” Discrimination and extortion by authorities, such as police or immigration officials, adds to migrants’ stress and discourages them from seeking care."

  • Union warns Edinburgh's £150m hospital may never open BBC reports "The new £150m hospital for children in Edinburgh may have to be "ripped down" amid safety concerns, a senior trade union official has warned.
    "[UNISON's] Tom Waterson said drainage at the building is a more pressing matter than the ventilation issues which saw the postponement of its official opening.
    "He also claimed NHS Lothian had paid millions of pounds in a settlement to help resolve some of the problems.
    "The health board said reviews into the delay are already under way."

  • Government says it has no duty to secure food supplies in a no-deal Brexit (nor any other crisis) Just in case anyone has the illusion the current government has any real interest in your welfare, a useful corrective from Sustain spells out the reality of neoliberal government:
    "Two official documents this week reveal that our Government feels no legal responsibility for securing our food supplies in an emergency – neither fire, flood, disease epidemic, conflict, supply chain disruption, nor no-deal Brexit."

  • Ian Hamilton: Prescription drugs are no cure for deprivation BMJ blog argues: "For many patients, clinical depression and pain are more than a solitary psychological or physical problem. Yet as clinicians we can feel as impotent as those we treat to effect a change in the numerous other factors that may influence the course of physical or psychological pain. Depression, for example, can be triggered and maintained by poor housing, unemployment, and grief. None of these medications are cures for social deprivation but they do inoculate against lack of hope—they are effective in making you feel different. If you’re in a place physically, psychologically, and socially that you can’t escape and your chances of ever doing so are minimal then feeling different is attractive."

  • Life in the home counties brings 16 more years of good health… Guardian gives latest on growing health inequalities which are compounding the problems for NHS services in deprived areas:
    "The gap in healthy life expectancy between parts of Britain has widened over the past decade to become as large as that between the UK and Sudan, a leading group of parliamentarians has warned.
    "In a sign of growing inequality in Britain, residents in Blaenau Gwent in south Wales can now expect up to 16.4 fewer years of good health than those in Wokingham in Berkshire, according to a report from the All-Party Parliamentary Group (APPG) on Inclusive Growth."

  • Half of NHS trusts use obsolete radiotherapy machines far less effective at treating cancer Times reports: "46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.
    "Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

  • Promotion of cheap tobacco and alcohol runs counter to the government's stated objective of preventing ill health and reducing inequalities Responding to the announcement from the Chancellor and HM Treasury, Dr Jennifer Dixon, Chief Executive at the Health Foundation said:
    "The promotion of cheap alcohol and tobacco by the Treasury is at best ironic given that reducing alcohol consumption and smoking is a central plank of government health policy – tobacco use remains the leading cause of death in the UK. The promotion of tobacco and alcohol in this way runs counter to the government’s stated objective of preventing ill health and reducing inequalities."

  • What’s Really Going On With Brexit Medicine Shortages? Huffington Post report notes:
    "A key section of the Yellowhammer report suggested that medicine distribution flow across the short Channel straits (the main English Channel crossing into Dover) could be as low as 40% with “significant disruption lasting up to six months” after the withdrawal date.
    "Three-quarters of medicines come via the short straits."

  • Funding for councils' child addiction services slashed Guardian reports Labour Party research that shows
    "Councils across England have made £2.4m of cuts to specialist drug and alcohol misuse services for children and young people this year. Spending is falling from £40.9m to £38.5m as part of steps taken by local authorities to cope with a £72m Whitehall cut to their public health grant.
    "The disclosure prompted warnings that highly vulnerable children with complex addiction problems are being denied the treatment they need at a time when under-18 drug use is rising."

  • Government says it has no duty to secure food supplies in a no-deal Brexit (nor any other crisis) Frightening analysis from Sustain, the campaign for better food, which reveals:
    "Two official documents this week reveal that our Government feels no legal responsibility for securing our food supplies in an emergency – neither fire, flood, disease epidemic, conflict, supply chain disruption, nor no-deal Brexit.
    "In one of the documents (Defra’s answer to a Parliamentary Question), the Government places the main responsibility for securing our food supply in an emergency squarely with the commercial food industry. Yet the other document (Yellowhammer) clearly acknowledges that “Private sector companies’ behaviour will be governed by commercial considerations, unless influenced otherwise.” In a food crisis, we are caught between a rock and a very hard place."

  • Funding for councils' child addiction services slashed Guardian reports Labour Party findings that
    "Councils across England have made £2.4m of cuts to specialist drug and alcohol misuse services for children and young people this year. Spending is falling from £40.9m to £38.5m as part of steps taken by local authorities to cope with a £72m Whitehall cut to their public health grant.
    "The disclosure prompted warnings that highly vulnerable children with complex addiction problems are being denied the treatment they need at a time when under-18 drug use is rising."

  • Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’ New York Times article highlights the private equity takeover of US health corporations:
    "TeamHealth was acquired in 2016 by the private-equity firm Blackstone Group in a deal valued at $6.1 billion. And last fall, in one of the largest takeovers of the year, the private-equity giant KKR spent $9.9 billion to acquire Envision Healthcare."

  • Hospitals need way out of 'toxic' NHS mortgages BBC picks up on IPPR report which belatedly notes the scale of payments and outstanding debts left over from PFI deals signed off with IPPR support in 2000s!
    "More than 100 schemes were signed off over the past 20 years in England under PFI contracts where private firms paid for new hospitals and centres.
    "In return, NHS trusts have to make annual repayments like a mortgage.
    "The Institute for Public Policy Research (IPPR) said some of the fees were extortionate - and with £55bn still owed, action was needed.
    "Chris Thomas, a health fellow at the think tank, said the worst deals were the equivalent of taking out a mortgage from a "loan shark charging high rates of interest that could not be renegotiated".

  • Why some eastern Idahoans are being served, arrested and sometimes jailed over medical debt East Idaho News offers another grim slice of life under private healthcare in the USA, and highlights the role of the debt collectors:
    "MRS is Medical Recovery Services, an Idaho Falls debt collection company. The company files several thousand lawsuits each year seeking to collect on medical debt in Idaho. In hundreds of these cases, they attach attorney fees, which double or triple the amount of the original debt. Additionally, while the numbers are much smaller, sheriff’s office records show MRS is responsible for requesting a majority of civil arrests in eastern Idaho."

  • What can England learn from the long-term care system in Germany? Nuffield Trust report argues that:
    "The German system has much to be admired: it is an example of fundamental reform, implemented with high levels of public and political support, that has provided the foundations for a system that has been able to adapt and respond to changing circumstances. However, it is not without its challenges and limitations. It is these challenges, as well as the successes, that provide rich learning for England."

  • Chancellor announces return of duty-free HM government appalling public health experts by cynically arguing that the possibility of buying "duty free" crates of beer and cigarettes offers compensation for a no-deal Brexit:
    "Passengers travelling to EU countries will be able to buy beer, spirits, wine and tobacco without duty being applied in the UK, thanks to the lifting of EU rules.
    "The decision on duty-free shopping in UK ports, airports and international train stations will mean:
    "•UK excise duty will no longer be due on alcohol and cigarettes bought when leaving the UK. A bottle of wine purchased in Heathrow duty free on the way to the EU could be up to £2.23 cheaper
    "•At the point of leaving the EU, people can continue to purchase and bring home unlimited alcohol and cigarettes in Europe if they pay duty on it there – as is the case currently
    "People will now also have the alternative option to buy limited amounts of duty-free alcohol and cigarettes at duty free shops in Europe instead. For example, a holidaymaker could save more than £12 on two crates of beer. The travel industry has been calling on the government to re-introduce duty-free, which stopped when the EU Single Market was introduced."

  • End NHS maternity charges for vulnerable migrants, say midwives Guardian highlights report commissioned for Royal College of Midwives emphasising the impact on poor migrants of NHS charges brought in as part of Theresa May's "hostile environment":
    "The safety of vulnerable mothers and newborn babies is being put at risk by NHS fees that deter undocumented migrant women from accessing care, a new report from Maternity Action backed by the Royal College of Midwives (RCM) has warned.

    NHS packages for overseas pregnant women start at £7,000 for antenatal, pregnancy and postnatal care, but can rise to thousands of pounds if the mother or child experience complications. Midwives said some women delay accessing help or fail to have scans over fears that they will be charged or detained."

  • Large provider of 999 support enters administration HSJ reports on yet another private sector contract failure -- this time for a company delivering frontline emergency ambulance services.
    "One of England’s largest providers of 999 support to the NHS has gone into administration, affecting several NHS trusts, HSJ has learned.
    "SSG UK Specialist Ambulance Service Ltd was put in administration last week. The company mainly provides emergency and non-emergency transport services for the NHS.
    "HSJ understands the news has forced South East Coast Ambulance Service Foundation Trust to approach other private ambulance companies to make sure it has capacity to respond to patients if SSG’s services are disrupted."

  • London GPs told to restrict specialist referrals under new NHS 'rationing' plan Guardian reports on the cash-driven plans to ration care being driven through in NW London, where the intention is to merge 8 CCGs into a single bureaucratic monolith unaccountable to local communities:
    "Health chiefs hope the programme, which will affect millions of Londoners, will plug a gaping hole in healthcare budgets by saving more than £60m in the next few months.
    "The sweeping changes, some of which will take effect immediately, will affect essential hospital care rather than treatments sometimes considered more peripheral. They include significantly reducing referrals to consultants, axing some outpatient appointments and replacing them with a phone conversation, and urging GPs to find “alternative ways” of dealing with patients who need hospital referrals.
    "The changes were communicated in a letter from the North West London Collaboration of clinical commissioning groups (NWLCCCG), which funds NHS health services for more than two million Londoners, to key individuals including local MPs"

  • CQC threatens enforcement action for ‘inadequate’ hospital HSJ highlights CQC intervention: but the NHS has been paying out money for a sub-standard private sector hospital where 90% of staff are unqualified.
    "A private hospital for learning disability patients has been rated “inadequate” and placed into special measures, with the Care Quality Commission finding nine in 10 staff were “unqualified”.
    "The CQC inspection of Elysium Healthcare’s The Woodhouse hospital in Cheadle, near Stoke-on-Trent in Staffordshire, uncovered serious staffing concerns within the unit. The hospital is an NHS-commissioned service, which caters for up to 39 male patients with learning disabilities, autism and forensic histories, including sexual offences.
    "Following an inspection in June, the CQC found the majority of the hospital’s staff were “unqualified support workers”.

  • NHS stockpiling body bags to prepare for no-deal Brexit reveals Tory minister Reminder from the Metro back in February of the arrangements designed to put minds at risk in the expectation of leaving the EU on March 29:
    "Health minister Stephen Hammond wrote a letter to a fellow Tory MP revealing that the NHS had taken the measure in a bid to stop shortages, in case the UK crashes out of the EU without a deal. The macabre information was revealed to reassure one of the MP’s constituents that the NHS will continue to run as normal in the event of no-deal."

  • Time to rebuild the NHS and create a 21st century health service Blog from NHS Providers CEO Chris Hopson kicking off a campaign for capital investment that allows more than emergency backlog maintenance.

  • A no-deal Brexit under Boris Johnson remains a threat to public health Guardian letter from 29 public health experts who warn:
    "We, the undersigned, express concern over the increasing likelihood of a no-deal Brexit and the risk this poses to public health. We have sought to mitigate the very real risk of Brexit exacerbating the devastating consequences of health inequalities, and are concerned about the impact that a no-deal Brexit would have on the public health of all four nations of the United Kingdom, including placing at risk the Good Friday agreement and the peace and stability it has brought to Ireland.
    "Brexit is proceeding at a time when the long-term improvement in life expectancy has slowed and, for some age groups, gone into reverse, while the most vulnerable in our population face growing insecurity of income, employment and even food. We believe that all of these would be exacerbated by a no-deal Brexit."

  • Rural hospital closures lead to higher mortality rates North Carolina Health News with findings that may well also apply to Britain:
    "When a hospital closes in an urban area, mortality rates don’t change. But when a rural hospital shuts its doors, according to a new study, mortality rates increase nearly six percent.
    "The new study helps clear up a question about the impact of hospital closures on health. Earlier studies at times have shown that a closed hospital didn’t seem to have much impact on health.
    "In this study researchers at the University of Washington studied 92 hospital closures in California between 1995 and 2011. As a group, the closures, in fact, didn’t show much impact on mortality rates.
    "But when the hospitals were divided between rural and urban, the researchers found a distinct difference. Mortality rates in rural areas increased 5.9 percent. This matched earlier studies, which found mortality rates increasing from 3 to 10 percent after a rural hospital closes."

  • Joint letter to Members of Parliament on no deal Brexit Statement to MPs from Nuffield Trust, the King’s Fund and Health Foundation to lay out the impact for health and social care of leaving the EU without a deal .

  • Doctor dares 'muppet' Rees-Mogg to report him after no-deal clash Guardian reports that "The consultant neurologist who clashed with Jacob Rees-Mogg over contingency plans for a no-deal Brexit has challenged the politician to report him to the General Medical Council.
    "David Nicholl, who drew up a risk register of epilepsy and neurology drugs for the government’s Operation Yellowhammer plans for no deal, said he was not going to take lessons from a “muppet” who had no medical qualifications.
    “If he has got doubts about my probity, I am more than happy to be referred to the GMC,” said Nicholl.
    “I am not bothered about Jacob Rees-Mogg. I’m not going to take a single word of health lessons from a muppet like him. What does he know about epilepsy or neuropathic pain?” he added.
    “What I am worried about is my patients. To suggest I am wrong in what I say is defamatory. When, as I have done, I look people in the eye and say some of the drugs they are on might be in short supply and who are understandably worried, what he says about me is ridiculous.”

  • Social care services in England under extreme duress, says Age UK Guardian highlights Age UK report which reminds us of the scale of the cuts inflicted on social care:
    "The failure of funding to keep pace with rising demand – nearly £8bn has been cut from council adult social care budgets since 2010 – meant 1.4 million people went without help with basic activities such as getting out of bed, washing and going to the toilet.
    “Growing levels of desperation described by those individuals, families and professionals on the sharp end bear testament to a system working at full pelt, stretched to its limit and still failing people left, right and centre,” the report said."

  • Assessing the health effects of a “no deal” Brexit Detailed and evidence based analysis from experts in a major BMJ study:
    Key messages
    "*Leaving the EU without a deal threatens health and the NHS in many ways, but the scale of the threat remains unclear
    "*We propose a framework that could be the basis for the comprehensive health impact assessment to inform politicians and the public
    "*The government’s claims that it is prepared for no deal are implausible and, at best, might mitigate some of the worst consequences"

  • Labour drawing up plans to offer all pensioners state-funded care in their homes Sunday Telegraph shoots itself in the foot by revealing a potential Labour policy that many of its ageing readers will find appealing:
    "Labour is drawing up plans to offer all pensioners state-funded care in their homes, as Jeremy Corbyn attempts to steal a march from Boris Johnson on a key election issue, The Sunday Telegraph can disclose.
    "Mr Corbyn's party is preparing to pledge "free personal care" for over-65s, after a similar policy was endorsed by a panel of influential peers, including two former chancellors."

  • They Got Estimates Before Surgery — And A Bill After That Was 50% More Another reminder from Kaiser Health News of the chaos and cost inflation that would await us if a Johnson government opened up the NHS to US-style health care.

  • No-deal Brexit could 'devastate' NHS by disrupting supply of life-saving medicines, health leaders warn Evening Standard highlights concerns of health professionals:
    "The British Medical Association, Royal College of Nursing and the Royal College of Nursing are among organisations to join forces and issue the strong warning.
    "They said that leaving the EU without a deal could also intensify the staffing "crisis" in the NHS, adding that thousands of EU staff have already left since the 2016 referendum."

  • Doctors will not be the agents enforcing a new “hostile environment” Dr David Wrigley, vice chair of BMA, in uncompromising BMJ blog:
    "It is a doctor’s job to treat the patient in front of them, not determine how the treatment is being paid for—and we have significant concerns that healthcare staff would be expected to be familiar with and to administer these complex arrangements.
    "Since the guidance was published, campaigners for the rights of EU nationals have warned that they risk creating a new “hostile environment”. Let me be clear, doctors will not be the agents enforcing this.
    "The BMA has longstanding concerns about the impact current upfront charging regulations have on both patients and healthcare workers. Earlier this year, the BMA reported on survey results that found many doctors had faced pressure from admin staff when making clinical decisions over an overseas patient’s need for care, while there was serious concern that the regulations were negatively impacting public health. So, to see them extended to 27 more countries come Brexit day could be potentially disastrous."

  • More than 120,000 NHS patients kept on ‘hidden waiting lists’ for mental health appointments Independent reveals research dug out by Labour confirming the continued under-funding of mental health:
    "People seeking help with their mental health are being kept on “hidden waiting lists”, with more than 122,000 patients waiting more than eight weeks to see a doctor again after their first appointment, The Independent can reveal.
    "Patients who received an initial talking therapy session were then told to wait longer for a follow-up appointment in 90 per cent of NHS clinical commissioning groups (CCGs) in 2018-19, according to the Labour Party. CCGs are responsible for the planning of health services in local areas; there are currently 191 across England."

  • IEA: think tank funded by big business rejects public health policies and the NHS Analytical article in The Lowdown on the right wing lobby group run as a "charity" takes a critical look at the countries the IEA's Kate Andrews claims have preferable health systems to the NHS:
    "Andrews always works to the same basic list of countries whose systems she points to as more effective and preferable to the British NHS. The list includes Australia, Belgium, Netherlands, Germany and Switzerland.
    "All of these countries spend much more money per head of population than the UK. According to the latest OECD figures, Australia spends 12% more per head; Belgium (never cited by anyone other than the IEA as a model health care system) spends 15% more; Netherlands 28% more, Germany 32% more and Switzerland – one of the highest spending countries after the USA – 89% more per head than the UK. And of course the UK average is higher than spending in England."

  • Johnson ‘cash-bombs’ the electorate – with fictional NHS funding increases Report in The Lowdown written before the extraordinary events in Parliament notes:
    "Soon after selecting his cabinet Johnson began making announcements about the NHS which have proved to be misleading.
    "In early August news media trumpeted the story that he had “announced a one-off cash boost of £1.8 billion for NHS hospitals in England – about a tenth of the extra £350m a week the Leave campaign and the famous bus promised would flow to the NHS after Brexit.

    "But within hours this story started to unravel: just £850m could be claimed to be extra spending, and this is far less than the billions that have been squeezed out of hospital budgets in so-called savings in recent years."

  • Campaigners challenge NHS shakeup without consultation Lead article in The Lowdown warns of CCG mergers and summarises the legal basis on which campaigners can demand each merger be subject to a full public consultation: It warns that CCG mergers threaten "to marginalise any local voice or accountability for patients and the public in dozens of areas.
    "Many if not most of these mergers are going ahead without any public consultation. This is important because the scrapping of locally based CCGs would remove the already limited level of public democratic accountability. At present each CCG must meet in public, publish board papers, and consult on changes."
    However the current regulations governing CCGs require NHS England, before authorising mergers, to assess: “The extent to which the CCG has sought the views of individuals to whom any relevant health services are being or may be provided, what those views are, and how the CCG has taken them into account”.
    This means a public consultation is required and not the partial “engagement with stakeholders” that is currently taking place.

  • Legal basis for public consultation on CCG mergers Louise Irvine of Save Lewisham Hospital campaign and Secretary of HCT highlights the elements of the existing legislation on CCGs that requires a public consultation on the widespread plans to merge several CCGs at a time into bodies covering vast populations of up to 2.2 million. Behind the antics in the Commons 86 CCGs are planning to apply for merger to take effect from April 2020.
    They have to get their merger applications to NHS England by this month, or October at the latest. This process is being rushed through without public consultation.

  • Infographic on health impact of no-deal Brexit A picture that's worth a thousand words.

  • Rural hospital closures lead to higher mortality rates US study highlights the contrast between urban and rural populations:
    "When a hospital closes in an urban area, mortality rates don’t change. But when a rural hospital shuts its doors, according to a new study, mortality rates increase nearly six percent.
    "The new study helps clear up a question about the impact of hospital closures on health. Earlier studies at times have shown that a closed hospital didn’t seem to have much impact on health.
    "In this study researchers at the University of Washington studied 92 hospital closures in California between 1995 and 2011. As a group, the closures, in fact, didn’t show much impact on mortality rates."

  • Joint letter to Members of Parliament on no deal Brexit As major decisions about Brexit are taken, the Nuffield Trust has written to MPs with the King’s Fund and Health Foundation to lay out the impact of leaving without a deal for health and social care.

  • Social care services in England under extreme duress, says Age UK Guardian report: "Social care services in some areas of England are so fragile that they face complete collapse next year unless the government commits substantial extra investment in next week’s one-year spending review, Age UK has warned.
    "In its biannual report on the state of care, the charity said services for older and sick and disabled people were under extreme duress and unable to respond to rapidly growing need."

  • Cancer patients in England 'diagnosed too late' due to staff shortages Guardian picks up Cancer Research UK study showing "At least 115,000 cancer patients in England are diagnosed at an advanced stage each year, too late to have the best chance of survival.
    "Efforts to improve people’s chances, by spotting tumours early on when they can be more easily treated, are being hampered by a chronic lack of skilled diagnostic staff."

  • Police 'dealing with more mental health incidents' BBC Radio 5 Live reports "The number of mental health incidents dealt with by police has risen by more than a quarter in four years.
    "While there were 385,206 incidents flagged as mental health-related in 2014, in 2018 that figure was 494,159, a rise of 28%."

  • More than 120,000 NHS patients kept on ‘hidden waiting lists’ for mental health appointments Independent reports: "People seeking help with their mental health are being kept on “hidden waiting lists”, with more than 122,000 patients waiting more than eight weeks to see a doctor again after their first appointment.
    "Patients who received an initial talking therapy session were then told to wait longer for a follow-up appointment in 90 per cent of NHS clinical commissioning groups (CCGs) in 2018-19, according to the Labour Party. CCGs are responsible for the planning of health services in local areas; there are currently 191 across England."

  • Labour drawing up plans to offer all pensioners state-funded care in their homes Unexpected plug for new Labour policy from the Sunday Telegraph reveals:
    "Mr Corbyn's party is preparing to pledge "free personal care" for over-65s, after a similar policy was endorsed by a panel of influential peers, including two former chancellors.
    "Shadow ministers are even considering nationalising some care homes as part of a radical package of measures designed to show that Labour would tackle the social care crisis facing the country's aging population. One claimed that the record of homes run by "profit-making" organisations was "appalling"."

  • They Got Estimates Before Surgery — And A Bill After That Was 50% More Kaiser Health News gives us another insight into life under the ghastly US health care "system":
    "Hospital estimates are often inaccurate and there is no legal obligation that they be correct, or even be issued in good faith. It’s not so in other industries. When you take out a mortgage, for instance, the lender’s estimate of origination charges has to be accurate by law; even closing fees — incurred many months later — cannot exceed the initial estimate by more than 10%. In construction or home remodeling, while estimates are not legal contracts, failure to live up to them can be a basis for liability or “a claim for negligent misrepresentation.”

  • Clock ticking on Midland Metropolitan Hospital re-start Express and Star with an update on the massively delayed PFI hospital in Birmingham becalmed since the collapse of Carillion:
    "The clock is ticking on the future of the Midland Metropolitan Hospital, with health chiefs desperate to avoid further delays on the £475m project already scheduled to be completed three years late.
    "Balfour Beatty has been lined up for months to take over building work.
    "It stalled following the collapse of Carillion last year and Government red tape holding up the project has caused frustration for Sandwell NHS bosses."

  • Doctors will not be the agents enforcing a new “hostile environment” BMA vice chair David Wrigley writes in the BMJ:
    "It is a doctor’s job to treat the patient in front of them, not determine how the treatment is being paid for—and we have significant concerns that healthcare staff would be expected to be familiar with and to administer these complex arrangements.
    "Since the guidance was published, campaigners for the rights of EU nationals have warned that they risk creating a new “hostile environment”. Let me be clear, doctors will not be the agents enforcing this."

  • Assessing the health effects of a “no deal” Brexit BMJ article shows with evidence what the dangers are:
    "Leaving the EU without a deal threatens health and the NHS in many ways, but the scale of the threat remains unclear
    "We propose a framework that could be the basis for the comprehensive health impact assessment to inform politicians and the public
    "The government’s claims that it is prepared for no deal are implausible and, at best, might mitigate some of the worst consequences"

  • New government must act to end the shameful policy failure at the heart of adult social care Health Foundation analysis sets out five priorities for the new government for social care:
    "To stabilise the current social care system, which is at risk of collapse. The Health Foundation estimates this would cost £4.4bn by 2023/24. In 2020/21, this would cost £1bn.
    "To protect individuals against unfair and catastrophic care costs. A range of approaches could be used here. The Health Foundation recommends a Dilnot-style model where the government can set the maximum amount individuals would be required to pay over their life time. An approach whereby the maximum cost was capped at £46,000 would cost government an additional £3.1bn per annum by 2023/24.
    "To increase eligibility and access to social care. To reinstate levels of access to 2010 levels would cost an additional £8.1bn, according to Health Foundation analysis.
    "To see the capped cost model as a flexible approach to reform. The principle of a cap on care costs was included in the 2014 Care Act and could be put in place without new legislation.
    "To explore a range of options for raising revenue. After a decade of austerity in public finances, cutting other services to pay for social care is not feasible or desirable. Increases in tax revenue is likely to be needed, although borrowing could also play a part."

  • REBUILD OUR NHS - Our asks of the government 2 page Briefing from NHS Providers sets out:
    ● why there is a problem with NHS capital funding
    ● what needs to be done to address the problem
    ● the positive impact that addressing the problem will have.

  • Scandalous lack of capital investment has put patients at risk (£) HSJ article from NHS Providers boss Chris Hopson pulls no punches:
    "The NHS buildings and equipment budget has been relentlessly squeezed year after year. Over the last five years, we’ve had to transfer nearly £5bn of that money to prop up day-to-day spending.
    "As a result, the NHS now has a maintenance backlog of £6bn, £3bn of it safety critical. The NHS estate is crumbling and the new NHS long-term plan can’t be delivered because we don’t have the modern equipment the NHS needs.
    "It’s scandalous that, as a nation, we’re now spending less than half the amount on these items than comparable countries. The impact on patients is tangible and real. Take the number of modern scanners that are so crucial to 21st century medicine as they enable rapid and effective diagnosis of a range of conditions from cancer to heart disease."

  • No-deal Brexit: Flu vaccine delays 'likely' BBC reports "Doctors and NHS leaders have warned that a no-deal Brexit would make it "likely" there will be a delay in flu vaccine supply this year.
    "They say the EU departure date coincides with the winter season in a way that creates "a perfect storm for the NHS".
    "Major flu vaccine manufacturer Sanofi said delays in deciding what strains of flu to use in the vaccine mean over a million doses will have to be imported after 31 October."

  • 'Crumbling' hospitals putting lives at risk, say NHS chiefs Guardian report on the desperate shortage of capital funding:
    "Hospital patients’ safety is being put at risk by fires, floods and crumbling, overcrowded buildings caused by a £4bn government squeeze on capital funding, NHS bosses are warning.
    "Hospitals say they do not have the funding to replace outdated scanners, fix leaking roofs and boilers, or remove ligature points that suicidal patients may attempt to use to try to end their lives.
    "Four out of five (82%) chief executives and chief finance officers at NHS trusts in England fear the lack of capital funding poses a medium or high risk to patient safety."

  • Two trusts forced to close 170 beds over fire safety concerns (£) HSJ report highlights the growing problems of poorly built and maintained hospital buildings: "Two large teaching trusts have been forced to close more than 170 beds due to concerns over fire safety, while significant sections of one hospital can only remain open if hourly checks are carried out.
    "Sheffield Teaching Hospitals FT and Oxford University Hospitals FT have both been issued with fire safety notices by their local fire authority in the last two years, requiring improvements to be made to the relevant facilities.
    "The Sir Robert Hadfield Wing at Northern General Hospital, part of Sheffield Teaching Hospitals FT, opened in 2005 but has been closed since November last year."

  • Pensioners set to swamp NHS after no-deal Brexit as 260,000 expats return from Europe for healthcare The (£) Times gives migrant British pensioners in Europe the kind of hostile coverage normally reserved for non-British migrants:
    "Up to 260,000 British nationals living in the EU — many of them pensioners — are expected to return to Britain if there is a no-deal Brexit, placing a huge burden on the NHS and other services.
    "Boris Johnson’s no-deal war cabinet was told last week that “gaps” would open in the healthcare provided to British citizens living in the other 27 member states in the event of no-deal and that healthcare was the “most immediate risk” facing them."

  • Suicides among nurses are on the rise. Here's why one of America's fastest-growing jobs is facing a major crisis US magazine Business Insider reports "Researchers from the University of California at San Diego recently conducted what they said is the first nationwide investigation into nurse suicides in more than 20 years. They found that both male and female nurses had higher rates of suicide than men and women in the US.
    "The findings are consistent with the increasing rates of suicide across the country. The US suicide rate has risen in recent years, increasing by 28% in the past two decades, to the highest it's been since World War II."

  • £92m bill for private ambulances and taxis Northern Echo picks up on PA news agency research based on data from the 10 ambulance trusts in England via the Freedom of Information Act.
    "It detailed how much they spent on private ambulances and taxis, and whether these were used for 999 calls or non-emergency patient transfers. The data showed the East of England Ambulance Service NHS Trust spent £9,535,027 on private ambulances for 999 and non-urgent work in 2018/19, double the £4,791,155 the year before."

  • Food review will ‘unclip caterers’ wings’, says chair (£) HSJ interviews Philip Shelley, who is leading the new government review of catering. He says it will aim to stop NHS catering staff feeling “boxed in” and help to “unclip [their] wings”.
    "Mr Shelley, who is a former head of the Hospital Caterers Association and current catering lead at Taunton and Somerset Foundation Trust, said the review would need to consider whether the NHS can increase the number of hospitals catering in-house and if changes to kitchen facilities are needed to reduce reliance on outsourced catering. It is believed just over half of trusts run their catering in-house, with the rest having outsourced the service."

  • Blackpool Victoria Hospital workers set to begin two days of strike action Blackpool Gazette reports "Staff employed by private contractor Compass within Blackpool Teaching Hospitals NHS Foundation Trust were due to begin two days of strike action today over pay rates and working conditions.
    "The cleaners, caterers, porters, receptionists and security workers are paid the minimum wage rate of £8.21 an hour, yet work alongside colleagues who are employed directly by the NHS, where the lowest rate is £9.03 an hour."

  • ‘Demoralising’ three-tier workforce creates £1,000 pay gap for Luton & Dunstable Hospital cleaners UNISON press release noting "Many cleaners at Luton & Dunstable Hospital are more than £1,000 a year worse off than their colleagues doing the same job because of a “confusing and demoralising” three-tier workforce created by outsourcer Engie".

  • A no-deal Brexit under Boris Johnson remains a threat to public health Guardian reports call by Prof Maggie Rae, president of the Faculty of Public Health, and 28 others on the government to give clear commitments on public health protection

  • New alliance formed to tackle Health Inequalities in the North of England LEADING health experts across the North have joined together as a response to worsening health inequalities between the North and the rest of England showing over half of the North has a lower life expectancy than the worst area in the South.
    "In 66% of areas in the North, female life expectancy is lower than the area with the lowest female life expectancy in the South. The figure is 46% of areas for male life expectancy."
    "The figures also show that 88% of Northern Local Authorities have a lower female life expectancy than the England average and 86% have a lower male life expectancy.

  • Predicting missed hospital appointments using machine learning - what are the risks? Substantial and thoughtful article taking a critical view of the current mania for misnamed "artificial intelligence" which is in fact machine learning.
    Data specialists from the Health Foundation explore the social impact of data-driven tools, and ask:
    "When it comes to missed appointments, what are the potential pitfalls in developing prediction models? And, if we want to maximise attendance, are we even asking the right questions?" Well worth a read. The new gimmicks are by no means a sure fire solution.

  • What’s the verdict on personal health budgets? BMJ blog from David Oliver raises fresh debate on the long-running issue of personal health budgets:
    "The National Audit Office reported on personal care budgets in 2016. Its conclusions were mixed, showing that care budgets could improve the holder’s experience and save money, but they sometimes increased costs when compared with usual care and were hard for local authorities to administer.
    "It concluded that any benefits were likely to come from improved outcomes for service users and not from any savings.
    "Critics question whether it’s prudent to spend parts of the NHS budget on relatively poorly evidenced models of support when we’re systematically failing to provide well proven services.
    "Some fear that the move towards giving money to individuals is ideologically driven and represents further fragmentation and stealth privatisation of public services, using more consumerist approaches.
    "There’s also concern that direct payments may leave already vulnerable people with heavy responsibility that may add to their stress, especially without adequate professional support. And, without sufficient safeguards, people could use their money frivolously or buy substandard care from poorly regulated sources that put them at risk. Advocates see these issues as a paternalistic failure to cede control."

  • Suicides among nurses are on the rise. Here's why one of America's fastest-growing jobs is facing a major crisis. Report from Business Insider that
    "Researchers from the University of California at San Diego recently conducted what they said is the first nationwide investigation into nurse suicides in more than 20 years. They found that both male and female nurses had higher rates of suicide than men and women in the US."

  • Prue Leith's son Danny Kruger is revealed as a key aide to Boris Johnson after Bake Off star was hired to tackle hospital food scandal Interesting sidelight from Daily Heil on recent government news propaganda on hospital food reveals the link between Johnson cabinet and celebrity cook (and Tory) Prue Leith

  • TEXAS STATE AFL-CIO DEMANDS MEDICARE FOR ALL More signs of a sea-change in political attitudes in the USA, with the main union confederation in Texas now backing Medicare for all:
    "Just a few years ago, this conversation was always an uphill battle in Texas. But this experience was dramatically different, as airline mechanics, teachers, refinery workers, and electricians clambered to be the first to address each hesitation voiced at the convention. It was apparent that the Democratic primary debates -- and Bernie’s consistent support for Medicare For All -- have sharpened the contrast between corporate-friendly half-measures and a true single-payer system that would eliminate private insurance. The attacks on Medicare for All from forgettable primary contestants like Reps. Tim Ryan and John Delaney, even when invoking union members as opponents to the demand, have also seemed to backfire, offering Bernie the opportunity to explain:
    “...many of our union brothers and sisters [...] are now paying high deductibles and co-payments and when we do Medicare for All, instead of having the company putting money into health care, they can get decent wage increases which they are not getting today.”

  • Hospital food review announced by government Government press statement re-announcing a review that Matt Hancock previously called for, together with cosy pictures of Prue Leith with Johnson.
    "The review will also look at how to increase the number of hospitals with their own kitchens and who have their own chefs.
    "Chair of the Hospital Food Review, Phil Shelley, will meet with catering managers at trusts across the country, looking at best practice from those leading the way in food quality and innovation.
    "Restaurateur and celebrity chef Prue Leith CBE will act as an adviser to the review, drawing on her experience working in catering, high-quality restaurants and as a former chair of the School Food Trust. Leith has previously spoken out on the need for hospitals to provide healthy options that aid recovery and for meals to be tailored to the individual needs of the patient."

  • The Dialysis Duopoly Spends Big to Protect Profits in California Interesting insight into commercial medicine in the US from The American Prospect magazine, which reports:
    "Two companies dominate the American outpatient kidney dialysis market: Denver-based DaVita and German-owned Fresenius. But their stranglehold on this sector is currently being challenged by an obscure bill in the California legislature, one they’ve poured a whopping $100 million into lobbying operations to oppose. The bill would crack down on a scam the dialysis duopoly has routinely engaged in, using a shadow charity called the American Kidney Fund to significantly juice their reimbursement rates from private insurance plans."

  • Hospital strikes halted Bradford Telegraph and Argus report on pausing of indefinite strike action by support staff at Bradford Hospitals trust:
    "A union has agreed to suspend the upcoming indefinite strike action by hospital staff in Bradford amid an apparent climbdown by hospital bosses.
    "Staff who work in the estates, facilities and clinical engineering departments at Bradford Teaching Hospitals NHS Foundation Trust, which includes the Bradford Royal Infirmary (BRI) and St Luke’s Hospital, have been embroiled in a bitter industrial dispute as they fight to “stay within the NHS”.
    See https://healthcampaignstogether.com/newsroundup.php

  • Nurses And Doctors Fear Boris Johnson's Plans To Immediately End Freedom Of Movement Will Cause “Untold Disruption” To The NHS Analysis from Buzzfeed reports the responses of health unions:
    "Doctors and nurses have warned that Boris Johnson's plans to end free movement for European Union citizens on day one of Brexit could devastate a health system that is already facing chronic staffing shortages.
    "The Royal College of Nursing (RCN) called for "urgent clarity" from the government on its immigration policy to ensure more nurses do not leave the UK due to growing uncertainty over their future.
    "The British Medical Association, which represents doctors and medical students, said the policy could cause "untold disruption" to both patients and the NHS workforce.
    "And union Unison — which represents hundreds of thousands of NHS workers including nurses, midwives, health visitors, paramedics, cleaners, and porters — warned of "an acceleration in the numbers of health staff departing our shores".

  • Work until 75? Many people won’t even live that long Guardian comment article by Dr Frances Ryan deconstructing Iain Duncan Smith's latest idea to make working class people work till they drop dead.

  • No evidence that online consultations save time, says CCG Pulse magazine digs out board papers from NHS Hammersmith and Fulham CCG on the recent evaluation of Babylon GP at Hand.
    It reports CCG managing director Janet Cree noting that there were digital pilots being carried out in London. "Primary care lead Coral Skeldon added that currently, the pilots ‘were not showing any evidence’ of saving time." "

  • NHS told to follow government line on Brexit (£) HSJ highlighting the way in which the government is seizing control of the flow of information on the impact of no-deal Brexit on the NHS.
    "NHS arm’s-length bodies, including NHS England, have been told to make sure all their communications are “aligned” to the government’s stance on Brexit.
    "A memo from the Department of Health and Social Care to all ALBs explains that they will be sent Downing Street’s “top lines from the core EU exit script” on email every week.
    "The memo, seen by HSJ, added: “Please can you use this script to ensure that all comms you are compiling are aligned to this script before sending them to DHSC for clearance.”

  • Royal College of Physicians and 16 other signatories send open letter to PM calling for health to be at heart of Brexit negotiations Statement from 17 professional bodies warning of the consequences of a no-deal Brexit:
    "If not properly planned for, even the smallest of problems could have huge consequences for the lives and wellbeing of millions of people and our economy.
    "The public rightly expects candour from us, and we are simply unable to reassure patients that their health and care won’t be negatively impacted by the UK’s exit from the EU. For example, despite welcome ongoing engagement with DHSC, we still have significant concerns about shortages of medical supplies."

  • Funding boost for hospices promised by PM is not new money (£) HSJ gets in a swift response to government claims of finding extra money for hospices, and adds a comment from Tracey Bleakley, chief executive of Hospice UK, who said: “While this funding boost is welcome and timely, many charitable hospices are facing grave, financial challenges in the long-term and need to raise over £1bn a year in a very tough fundraising climate. As demand grows and costs increase, the need for funding rises every year. The support pledged today is an important first step to help protect the vital care provided by charitable hospices for people with life-limiting conditions and their families.”

  • Prime Minister announces £25 million cash boost for hospices to secure their future More misinformation from the government, claiming "new money" that is in fact coming from the NHS budget. The happy clappy government handout tries to persuade us it is new largesse from Johnson:
    "The future of hundreds of hospices and palliative care services which provide vital treatment and support for patients at the end of their life will now be protected thanks to a multi-million-pound funding boost from Prime Minister Boris Johnson.
    "The Prime Minister today announces that £25 million will be pumped into the sector, building on funding already provided by the NHS.
    "The funding follows a reception hosted by the Prime Minister at Downing Street last week, to thank hospice front line staff for their work."

  • Putin's anti-vaxx trolls and the dark war on vaccines which snuffs out children's lives Important article by Dr Rachel Clarke in the Mirror dissects the sinister sources of anti-vaxx propaganda:
    "Yet in the increasingly toxic debate over whether children should be vaccinated against infectious diseases, little lives are being put at risk by one of the most powerful men in the world.
    "At first sight, this darkest twist in the anti-vaxxer saga – that President Vladimir Putin may be partly responsible for the exponential rise in cases of measles across Europe and America – appears scarcely credible.
    "Yet Russian trolls and bots have been systematically tweeting disinformation about vaccines to create social discord, according to research published in the American Journal of Public Health last year.
    "The analysis of thousands of tweets sent between 2014 and 2017 showed that Russian troll accounts termed “content polluters” deliberately sought to undermine public faith in science by aggressively promoting anti-vaccine messages. As a medic, I find this prospect horrifying."

  • 'New' capital funds will come from trust's own reserves (£) HSJ report confirms that "new money" announced by PM Johnson was not new at all:
    "The capital spending announced by Boris Johnson will be largely funded by cash reserves already held by NHS providers, a letter to the service confirms.
    "In a letter to trusts, seen by HSJ, NHS England and NHS Improvement said the government has agreed to raise the Department of Health and Social Care’s capital spending limit by £1bn. This means trusts can revert to their original spending plans in 2019-20, having previously being told to cut them by a fifth.
    "It comes after prime minister Boris Johnson announced £1.8bn of additional capital for the service earlier this month. He later insisted this was “new money” following criticism of its presentation by the Nuffield Trust think tank."

  • If leaked Operation Yellowhammer document is wrong, then the government must publish the right one Informed BMJ blog by public health expert and campaigner Martin McKee concludes:
    "It is simply not good enough for ministers to say that these documents are wrong. They must provide ones that are right. It is still unclear whether the Health Secretary Matt Hancock actually did say that people will die in the event of a no deal Brexit, but we must hope that, somewhere in his Department, someone has undertaken an assessment of whether this is true, as seems extremely likely. If so, it should be published forthwith, especially as Theresa May’s government, under pressure from the Faculty of Public Health, agreed that the Brexit process would “do no harm”."

  • NHS trusts owe government £14bn (£) HSJ update on a running story unearthed from NHS trust accounts:
    "Trusts’ combined debts to the department reached £14bn by the end of 2018-19, with more than half relating to around 30 providers.
    "The debt has risen steeply over the last three years, as dozens of trusts with budget deficits have become reliant on interest-bearing loans to maintain payments to staff and suppliers.
    "Last year, the debts surpassed trusts’ combined private finance initiative liabilities, which now stand at £9bn.
    "Although the interest rates on the loans vary, interest payments totalled £292m last year, which is an average rate of around 2 per cent.
    "Ian Dalton, the former chief executive of NHS Improvement, previously said national leaders would “have to have a serious look” at writing off some of the debts, as it was “deeply unlikely” they could be repaid."

  • Tory's plan to raise the state pension age to 75 over the next 16 years Latest brutal neoliberal idea from Iain Duncan Smith to lumber future generations with impossible burdens. In many working class areas average life expectancy is lower than 75. Policy is clearly dreamed up by youthful ideologues and office workers who have never tried doing manual work at 70 or 75. Iain Duncan Smith makes £5k for 4 hrs of non-parliamentary (non-manual) work.

  • UK to end freedom of movement for EU citizens on day one of Brexit, under new government plan Independent report confirms earlier (£) Times story on plans to immediately introduce hostile environment for EU citizens after no deal Brexit, with charges on those accessing NHS treatment:
    "Free movement for EU citizens will end on day one of a no-deal Brexit, under new Home Office plans – despite warnings of chaos and of people trapped in legal limbo.
    "Priti Patel, the new hardline home secretary, is pressing for border restrictions to be imposed immediately on 31 October, even though no replacement system is ready, The Independent has been told.
    "Previously, ministers had intended to delay scrapping free movement until new rules are in place, with a bill stuck in the Commons and fierce rows over what those rules should be."
    Ministers are silent on the implications of reciprocal moves on British migrants in Spain and elsewhere and the threat of 1.5 million coming back to Britain for NHS care.

  • GP surgeries ordered to stop half-day closures during the week or face £40,000 funding axe The Sun reports the latest ignorant thinking from government after nine brutal years of austerity funding have piled unprecedented pressure onto GPs. The midday closures of some surgeries are of course not random siestas but as Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said, there are good reasons for why surgeries close:
    “It is not time ‘lost’ to patients, it is usually time spent conducting telephone or online consultations, or making home visits.
    "Or some of the other vital tasks that GPs and our teams are required to do, such as complying with mandatory or statutory training.”

  • Ports logjam could make vaccines go out of date in no-deal Brexit (£) Times report picks up on the health aspect of the leaked Yellowhammer report on the consequences of a no-deal Brexit:
    "Patients with diabetes and children suffering from cancer are among those who risk being hit by drugs shortages.
    "A no-deal Brexit is expected to cause heavy disruption to the UK’s supply of medicines, and the government concedes in the Yellowhammer document that it “will . . . not be practical to stockpile products to cover expected delays of up to six months”.
    "Three-quarters of medicines come via the main Channel crossings into Dover and Folkestone. This leaves drug supplies “particularly vulnerable to severe extended delays”, it states.
    "Some drugs — including insulin, flu vaccines and certain new leukaemia treatments — need to be transported under temperature-controlled conditions, and so could become unusable in the event of delays. Other drugs have short shelf lives and cannot be stockpiled."

  • UK elderly suffer worst poverty rate in western Europe Guardian report highlights a chronic problem:
    "The proportion of elderly people living in severe poverty in the UK is five times what it was in 1986, the largest increase among western European countries, according to a new study.
    "The rise, from 0.9% of the elderly population to around 5%, is attributable to Britain’s state pension system and its “low basic payments and means-tested supplements”, says the author of the report, Pension Reforms and Old Age Inequalities in Europe.
    "Professor Bernhard Ebbinghaus, of the University of Oxford, will tell a European Sociological Association conference this week that the UK is one of five countries out of 16 that he has studied where there has been an increase in people aged 65 and over who are living in “severe poverty”, which is defined as having an income of 40% or less of the median average."

  • PM’s new health adviser says ‘ill-equipped’ NHS does not need ‘more money’ (£) HSJ highlights the arrogance and ignorance of PM Johnson's new advisor Will Warr, an ex-McKinsey neoliberal ideologue. Echoing Johnson's vague statement that the NHS needs "reform", he appears to question the announcement of allegedly extra money for the NHS by Johnson:
    "The prime minister’s new senior healthcare policy adviser believes that “more money is not the solution” to transforming the “hopelessly ill-equipped” NHS from “the monolith we have today”.
    "Will Warr also slammed the service’s “feeble” attempts at introducing new technology and claimed NHS “staff have been brainwashed by the financial targets introduced under [Tony] Blair”.

  • Drug deaths in England and Wales at highest level since records began, figures show Independent reports "Drug deaths in England and Wales have hit a record high, with around 56 people now dying every week from illicit substances, new figures show.
    "Ministers have been accused of “clinging to their failing policies on drugs” after data published by the Office for National Statistics (ONS) revealed there were 4,359 deaths related to drug poisoning last year, the highest number since records began in 1993."
    Behind these grim figures we need to remember a decade of cutbacks and privatisation of drug and alcohol units and mental health services.

  • NHS in Scotland will stay free for Europeans (£) Times report highlights yet another progressive challenge to Westminster policies by the Scottish government

  • Council charge breast cancer screening van £1,500 to see patients in pay car park Mirror story highlights this latest example of 'partnership' working between cash-strapped NHS and even more impoverished local government.

  • New service to deliver urgent medicines and medical products into UK Government press release reveals the amount of money that has had to be ear-marked to keep supplies of drugs going in the event of a no-deal:
    "The service will provide an additional level of contingency as part of necessary preparations to leave the EU on 31 October whatever the circumstances, supported by an additional £2 billion from the Treasury across government.
    "This money includes £434 million to help ensure continuity of vital medicines and medical products through freight capacity, warehousing and stockpiling."

  • NHS bill for private out-of-area mental health care rises to £100m Guardian covering Labour Party research showing the scale of under-provision of NHS mental health services:
    "NHS spending on private firms nursing people with mental health problems outside their local authority area has risen by almost 30% in a year to £100m.
    "Adults in mental health crises were sent as far as 300 miles from home last year – a situation NHS chiefs have admitted reduces the chances of recovery because vulnerable people are separated from their loved ones."

  • West Midlands Ambulance Service staff ‘in tears’ with 80 jobs 'at risk' as private firm awarded patient contract Birmingham Mail reports the scandalous decision of Worcestershire CCGs to privatise patient transport services which had been delivered for 30 years by award-winning West Midlands ambulance services.

  • Record demand for emergency care reflects year round pressure for the health service NHS Providers once again warning of the continued record high levels of demand for emergency services:
    "Trusts have not been able to use the summer months to catch up and clear waiting lists as they used to do in the past. The waiting list has now grown to over 4.4 million people and we have missed the key cancer standards for the second month in a row. With over 100,000 staff vacancies and rising demand putting pressure on services, this is leaving more people waiting longer for care."

  • Get ready to charge EU citizens under no-deal Brexit, NHS bosses told (£) Times report reveals government plans to crank up the hostile environment for EU citizens immediately after a no-deal Brexit.

  • NHS bosses have recruited 4,000 Asian nurses to replace EU staff who quit after Brexit referendum, new figures show Daily Heil winds up its small-minded readers with the news that largely white EU staff are being replaced by Asians, although the short article does not explain whether this is a welcome reprieve for the NHS or a new tide of migration:
    "The NHS has recruited 4,000 Asian nurses to replace EU staff who have quit since the 2016 Brexit referendum, figures show.
    "The number of EU nurses plunged by around 3,000 – but that gap has been filled by the arrival of nurses from the Philippines and elsewhere in Asia.
    "Six per cent of all NHS staff and one in ten doctors were from the EU in March this year, according to the Office for National Statistics."

  • Mother, twin babies detained in hospital over N3m bill Story about Nigerian experience from Orient Daily News highlights what could be happening in British hospitals if the government persists with its hostile environment policies and levying charges on overseas patients requiring NHS treatment.

  • 'Considerable risk’ over trust’s future warns NHSI (£) HSJ article flagging up the parlous state of the Brighton and Sussex University Hospitals Trust, noting NHS Improvement's warning that:
    "“It is therefore critical that the trust has a robust and stretching medium-term financial recovery plan in place.”
    Despite NHS Improvement agreeing that the trust has taken "effective action" to address its governance failures since the undertakings of March 2017, it argues that "further improvements are required."
    Indeed the trust reported 160 12-hour trolley waits in January and February this year while performance against the four-hour accident and emergency standard dropped to 76 per cent in February.
    There are so many other unresolved failures and poor standards that the question arises of how the Trust could have been let out of special measures and categorised as "good".

  • STP plans to axe all trauma services at DGH (£) HSJ picks up on yet another irresponsible plan from the cash-strapped and poorly-led Cambridgeshire and Peterborough STP, which after touting round the begging bowl to help reduce its deficit is now moving to finally kill off the A&E at Hinchingbrooke Hospital (which local people were promised would be preserved in the 'merger' with Peterborough City Hospital 20+ miles away).

  • NHSE declares emergency over IV shortage Shaun Lintern in the (£) HSJ breaking a story only later picked up by the BBC:
    "The shortage of intravenous feed supplies affecting hundreds of patients across the country has been declared a national emergency incident by NHS leaders.
    "The situation is so serious the NHS is considering importing supplies from other countries to meet the needs of patients who depend on the feed for survival.
    "Patients whose bodies can no longer digest normal food are reliant on intravenous feed known as total parenteral nutrition, or TPN. Some are already enduring long waits for deliveries of their prescriptions.
    "HSJ has spoken with some patients who have gone several days with no feed at all after restrictions were imposed on the manufacturer, Calea, by the Medicines and Healthcare products Regulatory Agency last month. Several patients, including one child, have been admitted to hospital because they were effectively being starved of vital nutrients."

  • Ebola now curable after trials of drugs in DRC, say scientists Guardian story highlighting the immense progress that can be made where sufficient resources and new drugs can be deployed against Ebola:
    "One of the biggest obstacles in fighting the year-long DRC outbreak, the second biggest ever and now with 2,800 cases, has been the reluctance of those who fall sick to seek treatment.
    "It has not helped that the chances of survival have been low – up to 70% of those infected in the DRC have died. Muyembe said many people saw family members go into an Ebola treatment centre and come out dead.
    “Now that 90% of their patients can go into the treatment centre and come out completely cured, they will start believing it and building trust in the population and community,” he said.

  • Summer in the City Is Hot, but Some Neighborhoods Suffer More New York Times reminder to climate change deniers that ill health from excess heat is a problem that affects the poor more than the rich:
    "As the United States suffers through a summer of record-breaking heat, new research shows that temperatures on a scorching summer day can vary as much as 20 degrees across different parts of the same city, with poor or minority neighborhoods often bearing the brunt of that heat."
    ...
    "Buildings and paved surfaces – like major roadways, uncovered parking lots and industrial zones – amplified heat, while large parks and other green spaces cooled down the surrounding areas. In cities like Baltimore and Washington, some of the hottest temperatures were recorded in dense residential neighborhoods with little tree cover and plenty of asphalt to absorb and radiate solar energy.
    "As climate change makes summers hotter, the health risks associated with these hyperlocal heat islands will grow. "

  • This is the power of nurse solidarity! Video from California Nurses Association shows how, even though Nevada state doesn't have SafeStaffing laws, solidarity from California union RNs helped nurses at Saint Rose Hospital in Henderson, Nevada win nurse-to-patient ratios in their union contract.

  • NHS staff face growing violence in east London's hospitals Shocking figures from research by the East London Advertiser reveal a rising tide of violent incidents against hospital and NHS staff:
    "There were 331 assaults against staff at the five Barts Health hospitals from April 2018 to March 2019 - 60 per cent more than the 12 months from April 2015, which saw only 206.
    This April to June has been the most violent over the past five years, with 98 recorded assaults. In 2018 there were 84 over the same period and only 50 during that period in 2017.
    The figures, obtained through a Freedom of Information request by this paper, revealed that Newham Hospital has seen 231 assaults since April 2015, Mile End saw 22 and St Bartholomew's saw 89."
    Over the past five years the worst hospital for assaults was the Royal London Hospital in Whitechapel, which had 504 incidents.

  • Australian junior doctors launch legal action against managers over working conditions (£) BMJ report on "The alleged plight of the doctors at Melbourne’s Sunshine Hospital", which has become "the latest instalment in a growing list of complaints among doctors in training over excessive workload pressures, exploitation, harassment, and bullying across the country’s public hospital system."
    According to the Australian Medical Association in Victoria, under the enterprise agreement setting minimum terms and conditions with the hospital, registrars are contracted to work 43 hours a week: but this total includes five hours that must be used for clinical training time.
    "AMA Victoria is now representing the registrars by taking Western Health, which runs Sunshine Hospital, to the Fair Work Commission."

  • Privatisation by stealth Fabian Society platform for a hard hitting article by Oxfordshire KONP campaigner Liz Peretz, slamming the ruthless top-down privatisation of PET-CT scanning services in Thames Valley by NHS England, riding roughshod over any serious consultation and near-unanimous protest from local politicians of all parties.

  • Does Boris Johnson’s NHS funding boost add up? Critique in Prospect magazine by Ruth Thorlby of the Health Foundation indicates how wide is the distrust and disatisfaction with Johnson's cynical pre-election handout to the NHS from the magic money tree.

  • Get ready to charge EU citizens under no-deal Brexit, NHS bosses told (£) Times reports yet another unpleasant xenophobic policy that is threatening to undermine our NHS in the event of a no-deal Brexit. It's bad enough diverting front line staff and admin resources into checking passports and IDs: medical royal colleges and campaigners have already been campaigning against this policy and its potential impact on health. But if this petty nastiness also triggers a retaliation and charges imposed upon the millions of citizens cashing in on free care in Spain and other EU countries, it could trigger a wholesale influx of expats and a massive new unfunded burden on our NHS and other public services.

  • NHS staff in Bradford go on ‘indefinite’ strike over ‘backdoor privatisation’ fears Extended article giving the background to the Bradford hospital strikes which are set to escalate to indefinite action from August 26. Health Campaigns Together is holding a solidarity rally outside Bradford Hospital that day (see Calendar of events)

  • Average GP waiting times exceed two weeks for first time ever Another excellent and widely repeated story from Pulse magazine, flagging up findings from their annual survey:
    "The average wait for a routine GP appointment is now more than two weeks, for the first time ever, according to Pulse's annual survey of waiting times.
    "A midpoint analysis of data from the survey of 901 GPs across the UK found that the average waiting time is now 15 days - the first time it has ever exceeded a fortnight.
    "More than 22% of GPs said that the wait for a routine appointment was more than three weeks, with 6% said that it was longer than four weeks.
    "This follows the news earlier this year that there was a 15% increase in month-long waits for GP appointments, according to the BMA."

  • For sale to the highest bidder? Future trade deals and the NHS Discussion piece by Kate Ling for the NHS Confederation, which includes private providers, correctly points the main finger of responsibility at government:
    "Operating on World Trade Organisation (WTO) terms after leaving the EU won’t force commissioners to invite bids from overseas companies to provide NHS services. It will be for the Government of the day to choose, when negotiating, what kind of services foreign providers can bid to supply. "
    But of course many people would be less than confident that a right wing Johnson-led government would have any hesitation in signing over sections of the NHS if that seemed to them useful in a post-Brexit trade deal with Trump's USA.
    Ms Ling goes on "Ideally, exclude publicly funded healthcare services completely from the scope of a future free trade agreement (FTA)."
    Sadly she then weakens the statements to concede "Or, if they are within scope, explicitly exempt them from commitments that would, for example, oblige the NHS to allow the trading partner’s companies to bid for NHS business (we would prefer this to be a choice, not an obligation)."
    Campaigners have seen too many CCGs and trusts choosing to privatise, despite strong arguments and protests from staff and public. We can't rely on the Confed to stand up for a publicly-owned and accountable NHS.

  • UNISON BRADFORD HEALTH-STOP THE WOS-STRIKE FUND Link to contribute to the biggest current set-piece confrontation with trusts' plans to hive off NHS support staff into tax-dodging "wholly owned subsidiaries"

  • Boris Johnson pledges £250m for NHS artificial intelligence Guardian reports that despite huge unresolved backlog maintenance and many staff struggling to cope with clapped out and painfully slow computers, the government has "announced its third successive hand-out to the NHS in as many days with a pledge by Boris Johnson of £250m to be invested in artificial intelligence."
    However in a critique of this decision Roy Lilley quotes Rashik Parmar, a the leader of IBM's European technical community and previously President of IBM's Academy of Technology, who has spent his whole career immersed in technology and artificial intelligence arguing “... there is no such thing as 'artificial intelligence'... not yet and not in the foreseeable, that we can use to improve healthcare.”
    Lilley comments: “Machines digest the people's data we feed them along with our prejudices, preconceptions and predilections. They swallow it all and regurgitate facts, analysis, history and take a stab at the future. They can make predictions. It doesn't make them intelligent.”

  • Suicidal student jumped off building after crisis team told her 'sound, you can go' Worrying Mirror report on case of a student who tried to leap to her death from a hospital car park after being discharged in the middle of the night by mental health workers she claims she had warned she was suicidal.
    The Mirror points to the link with previous failures by Mersey Care NHS Foundation Trust adequately to assess or respond to the distress, resulting in further suicide attempts:
    "another woman … had thrown herself from the building after being admitted following an overdose. … a man in his 40s fell from the second floor after being sectioned.
    "Sophie, who hopes to work as a mental health nurse, said she would have been seen as high risk after a similar suicide attempt around three months before the fall, when she took an overdose while an inpatient at Clock View Hospital in Walton."

  • Leading ophthalmologist vows to stamp out “unjustified” screening for cataract surgery (£) BMJ article publishes research to show that:
    "patients with cataracts are being screened and that those who don’t meet visual acuity thresholds are being denied surgery. This is despite NICE’s guideline, which says that cataract removal is cost effective and should not be restricted to the more severe cases.
    "In 2018-19 more than a fifth (22%) of patients in England who needed cataract surgery were screened, three times the proportion of 7% in 2016-17."
    It quotes Mike Burdon, president of the Royal College of Ophthalmologists, who also chaired NICE’s guideline committee, ho now says it is his mission before he steps down as president in a year’s time to convince clinical commissioning groups (CCGs) to stop rationing cataract surgery and not to label it a procedure of “limited clinical value.” He tells the BMJ that this approach is “unjustified whatever way you look at it.”

  • John Radcliffe Hospital trust 'crisis' as bed occupancy hits 100 per cent Oxford Times highlights the latest phase of the chronic crisis of the county's main hospital, making the point that the problems are exacerbated by huge shortages of staff, including almost 600 nurses:
    "Along with high demand, staffing levels were also so stretched that 16 beds were consistently being temporarily closed for safety reasons due to shortages.
    "As of the end of June there were 1,091 vacancies across the trust, with 588 of them for nursing and midwifery roles."

  • Next week... Roy Lilley puts the boot into Matt Hancock (No. 18), the superficiality of his policies and the fraudulent claims of "artificial intelligence" being used in the NHS.

  • Old Matt, new Matt: Mr Hancock’s diary Some light relief from the gloom of a Johnson dash to no-deal chaos: a very amusing spoof blog by Matt Hancock -- or is it really him?

  • US will be 'on doorstep' ready to sign UK trade deal after Brexit, says Pompeo Guardian article underlines determination of the Johnson government to turn to the US after Brexit, regardless of the cost and onerous strings attached.
    "The secretary of state, Mike Pompeo, has said that the US will be “on the doorstep, pen in hand”, ready to sign a new trade deal with the UK as soon as possible after Brexit.
    Pompeo was speaking alongside Dominic Raab, who was making his first trip to Washington as UK foreign secretary. Raab restated the British government’s determination to leave the EU at the end of October, and claimed that Donald Trump, whom he met at the White House on Tuesday evening, “was effusive in his warmth for the United Kingdom”.

  • Vital asthma and diabetes drugs could cost 7 times more in new Donald Trump deal Mirror article underlines another potential nightmare aspect of a no-deal Brexit forcing a supplicant British government to sign an exploitative trade deal with the US:
    "President Trump and senior members of his cabinet have said they are tired of ‘foreign freeloading.’
    "They say any new trade deal should bring prices into line with those in the US - which is bad news for the NHS.
    "Stats show the world’s top twenty best selling prescription were over three times more expensive in the US than in the UK."

  • Treat NHS patients in private hospitals to cut waiting lists, government urged For some reason The Independent has chosen to rehash the latest press release and PR spin of the private hospital sector, seeking to cash in further on the growing delays and waiting lists for NHS treatment:
    "According to analysis of council tax data by the Independent Healthcare Providers Network, […] about one in six households in England are likely to contain someone stuck on an NHS waiting list.
    The body is calling on the government to make better use of spare capacity in the private sector to cut waiting times."
    They would wouldn't they? With numbers paying for individual private health insurance static, and private hospitals dependent on NHS-funded patients to fill their otherwise empty beds, you would expect their trade association to lobby for even more lucrative work.
    The Indie report initially referred to the profit-hungry IHPN lobbyists as "campaigners", but has, fortunately corrected this error, as a footnote admits.

  • Combined Performance Summary: June – July 2019 The Nuffield Trust's Jessica Morris updates us with yet another series of summaries and graphics indicating the continued crisis of NHS provision. Note especially that:
    "In July 2019, 13.5% of people attending A&E spent more than 4 hours from arrival to admission, transfer or discharge – the worst performance for any July on record. There has been a sustained worsening of about 3 percentage points over the last four months compared to the same time last year.
    "The total number of A&E attendances exceeded 2.2 million in July 2019 – the highest number ever recorded. The average number of A&E attendances per day spiked at over 73,000."

  • NHI Bill to be released on Thursday Business Live magazine highlights historic moves in South Africa towards a much-needed universal health coverage:
    "The long-awaiting National Health Insurance (NHI) Bill will be introduced to parliament on Thursday, according to the health minister’s spokesperson, Lwazi Manzi.
    "The bill is important because it is the first piece of enabling legislation for the government’s ambitious plans for implementing universal health coverage, which it calls NHI.
    "A draft NHI Bill was released for public comment in June 2018, and then revised before being submitted to cabinet. The updated version, which has yet to be released to the public, was approved by the cabinet on July 10. It is expected to contain proposals for establishing an NHI fund, which will purchase services on behalf of patients from accredited public and private sector providers."

  • Babylon’s GP at Hand model risks ‘destabilising’ care, professor warns Digital Health turns to expert Prof Martin Roland for a sensible assessment of the impact of GP At Hand:
    "Babylon’s GP at Hand model risks “destabilising” care for patients with the “greatest need” if it continues to expand, a professor of health services has warned.
    He has warned the digital provider only attracts the “fittest patients” and that this leaves traditional GP services "struggling to look after those with more complex needs."
    "The problem lies in the way GP surgeries are currently funded, he told Digital Health.
    “GPs are largely paid by capitation, for example, for the number of patients on their list. Now imagine a situation where all patients attracted an equal capitation fee and the fittest half of a practice’s patients suddenly joined GP at Hand,” he said.
    “The practice would be left with half their income but would still have to look after the sickest patients. That would clearly destabilise care for those in greatest need as GPs would no longer have the income to support the doctors, nurses and other staff needed to look after them.”

  • Boris Johnson’s pledges on NHS investment need a full examination (£) Financial Times comment from Health Foundation boss Anita Charlesworth argues that new buildings should not be a priority for the capital-starved NHS:
    "Since 2017, 145 new spending schemes for hospital beds, buildings, medical equipment and information technology have been announced — that’s an average of more than one a week, totalling £2.5bn. But a recent analysis by the Health Service Journal found that less than £100m of this promised funding has actually reached the front line. There have been few, if any, ribbons to cut."

  • NHS needs reform, not another cash boost, to fix its ails Yet another reactionary blast of neoliberal ideology from the obscurely-funded IEA and its annoying American spokesperson Kate Andrews, which will almost certainly be further amplified by repeated appearances on various BBC 'news' outlets.
    The only unusual aspect of this latest re-run of the same old hackneyed nonsense is that the IEA is having a pop at Prime Minister Johnson's pre-election bribe of a £1.8 billion increase in NHS capital funding. While every analyst who knows anything argues it is not enough, Andrews argues the NHS should not even get this much!

  • The next Windrush: Relentless Home Office immigration fees try to drive out young Brits Politics.co.uk highlights the growing scandal of institutionalised racist policies implemented by government departments following on Theresa May's brutish "hostile environment".
    "Young migrants who've grown up in the UK are being driven into poverty by soaring fees, a neverending application process and kafkaesque examinations of national identity.
    "Fees have trebled since 2014, driving some young people into poverty. "They are charging people who are already vulnerable and have little money an extortionate amount," says Andrella, 20.
    "Limited leave to remain is granted in 30-month chunks, and has to be renewed to a strict timetable, each time with a new extortionate fee of £2,033. If a form is submitted late or incomplete in any way, it will likely be refused and the applicant loses their lawful status. It is only after ten years of unbroken limited leave to remain, that people can apply to be officially recognised as permanently settled in the UK."

  • Treasury makes pensions U-turn with review of doctors’ tax trap (£) Financial Times reports on the pensions policy that has been disrupting the work of senior NHs consultants (few of the other senior public sector staff are required to work such a high level of overtime). The FT reports:
    "The Treasury has agreed to reconsider the “taper” — the rate at which tax relief is withdrawn on pensions savings — not just for NHS workers but across the public sector. The taper sometimes saw doctors facing marginal tax rates of more than 100 per cent when they were caught in the pensions trap.
    "The change was welcomed by doctors’ leaders who have been grappling with an exodus from the profession as experienced clinicians have retired or cut back hours to avoid steep tax charges.
    "The announcement was a striking policy reversal. The tapered annual allowance was introduced in 2016 by George Osborne when he was chancellor as a means of clamping down on pensions tax relief for the very highest earners. Ministers had previously defended the policy as a way of ensuring the highest paid contributed towards the public purse."

  • 'Tax trap' pension rules to change in effort to halt NHS crisis Guardian reports on government apparently making concessions in an effort to undo the damage of ridiculous tax rules affecting the most senor doctors, meaning that they lose large sums of money for working additional shifts

  • Queensland nurse ratio legislation ‘saving lives and money’ Nursing Times article highlighting the experience of improved staffing levels on the ward in Queensland, Australia.

  • In that order... Roy Lilley bangs the drum correctly for the absolute centrality of workforce issues and the need to reduce the patient:nurse ration to improve outcomes.

  • Royal College of Physicians responds to capital funding announcement One of the more conservative Royal Colleges notes that:@
    "'But while 20 more upgraded hospitals may seem a significant investment, it is unfortunately a drop in the ocean. Research by the Health Foundation estimates it would take an extra £3.5bn a year to bring capital spending on the health service in England up to the OECD average."

  • Works for me... Roy Lilley adds his contribution to those challenging Johnson and Matt Hancock over the spurious claims to have found "new money" for the NHS.

  • Boris Johnson’s £1.8bn for the NHS isn’t what it seems – just ask the trusts Guardian comment by Nuffield Trust financial sleuth Sally Gainsbury drags out the truth of where the "new" money has really come from

  • Boris Johnson accused of misleading public over NHS money pledge Channel 4 journos put minister on the rack till he has to admit that the money was already there, but trusts were blocked from spending it.

  • Why the NHS is at risk from a no-deal Brexit While opinions among campaigners vary on the merits or otherwise of Brexit, there is universal concern at the dangers that would be posed to the NHS by a no-deal Brexit. Jeremy Corbyn has insisted no-deal would be “disastrous” and said Labour will vote against it and call for a referendum. Health Campaigns Together editor John Lister offers some analysis.

  • Leading trust warns NHS England over patient safety (£) HSJ feature from March highlighting the dire need for investment in Mersey Care's Learning Disabilities unit at Calderstones which had had an application for £35m capital funding turned down. It is included in the new list of 20 projects.

  • £1.8bn funding boost 'just a down payment' (£) HSJ response to the "new" funding makes clear it is not so new after all:
    "More than half the £1.8bn spending boost announced by the prime minister yesterday will be enabled by the reversal of last month’s demand from NHS England that trusts cut capital spending plans by 20 per cent.
    "The remaining £850m has been allocated to 20 specific capital schemes.
    "HSJ also understands that a separate “technology fund” will be announced later in a week, which is expected to feature a series of government announcements on the NHS.
    "In July, HSJ reported NHSE finance director Julian Kelly had written to trusts telling them to cut their spending plans because they threatened to bust the Department of Health and Social Care’s capital expenditure limit. "

  • The 20 hospitals in line for Boris Johnson's 'drop in the ocean' NHS cash Mirror response to the PM's announcement on capital funding for the NHS, quoting :
    Ben Gershlick, Senior Economist at the Health Foundation charity, who said:
    "The government’s expected announcement of a £1.8bn short-term funding boost for upgrades to 20 hospitals and NHS capital infrastructure projects is welcome.
    “But while the Prime Minister might be looking forward to cutting the ribbon at a new hospital ward, years of underinvestment in the NHS’s infrastructure means this extra money risks being little more than a drop in the ocean.
    "He added: "What the NHS needs is a comprehensive, long-term funding settlement for capital that is driven by the needs of patients and staff."

  • Children turned away from mental health help unless 'acutely suicidal', psychotherapists warn As Johnson pours two thirds of the "new" capital investment into acute hospitals, this Telegraph report again highlights the growing crisis in children's mental health, which will barely benefit from the new money:
    "A survey by the Association of Child Psychotherapists found that members were concerned that seriously mentally ill children were not being offered help unless they were threatening to kill themselves.
    "Child and adolescent psychotherapists working within the NHS said that cases were "having to be re-referred several times and reaching a crisis point before being accepted", its report found.
    "One in three of the 416 psychotherapists who responded to the survey said they felt the service they were working within was "mostly inadequate or completely inadequate", and 73 per cent felt there had been a negative change in staff morale. "

  • Plans to close Cheltenham's A&E department confirmed by town's MP ITV report shows that as the local Tory MP rants about a plan driven by his own party in government, the Lib Dem candidate for the seat is pointing out he has changed his tune completely:
    "Before Alex Chalk was the MP, he criticised Cheltenham people on his leaflets for signing a local petition to stop the downgrade of the A&E department, saying it made no difference. He told us a plan of action was needed and he was elected on a platform of getting the A&E department reopened fully. But now he’s admitted that the hospitals trust is ignoring him and planning to close the A&E department anyway."

  • NHS chiefs 'plan to close Cheltenham A&E department' says furious MP Alex Chalk Gloucestershire Live reports that Cheltenham's Tory MP is furious that his government is apparently planning to do to Cheltenham what they have been doing to so many other hospitals up and down the county.
    "Mr Chalk says he been told that Cheltenham could become an appointment-only GP led Urgent Treatment Centre rather than a walk-in casualty department.
    "That would mean blue lighting all emergencies from the Cheltenham area at least eight miles down the road to Gloucestershire Royal in the daytime as well as during the night.
    "Mr Chalk issued a statement on his website saying: "I have been reliably informed that Trust managers in Gloucestershire are about to publish plans to downgrade the A&E at Cheltenham General Hospital.
    "I am absolutely furious about this news, which flies in the face of specific assurances the managers made to me as well as the substance of the plans which are contrary to government policy."
    He said he had phoned the Secretary of State, Matt Hancock, who was himself "very surprised" by the proposal. But then Hancock hasn't been in post long.

  • First chief chosen to lead both trust and CCG HSJ report flags up that in crisis-ridden Croydon NHS chiefs have been possibly the first to appoint a single chief executive to lead the commissioners and the main local acute provider trust:
    "Croydon CCG and the trust announced in May that they would be appointing a joint executive leader. It is thought to be the first area in England to take this step. Several other CCGs around the country share a chief executive/accountable officer with their local council."
    However the celebrations in Croydon are likely to be limited by the fact that the new health supremo is Matthew Kershaw, the main appointed by Jeremy Hunt as the Trust Special Administrator to drive through the attempted closure of A&E and acute services at Lewisham Hospital.
    Only a judicial review and subsequent successful ruling in favour of campaigners and against Hunt's appeal blocked their attempt to make Lewisham pay the price for the failure of its neighbouring South London Hospitals Trust, and leave SE London with a huge shortfall of acute services. Since then Mr Kershaw has been trailing not very successfully from job to job.

  • We won! UNISON at King's College London celebrates a hard-won victory against privatisation:
    "After years of campaigning, organising and a huge amount of hard work, all formerly outsourced workers in cleaning & security from CIS and Servest will come back in-house to be directly employed by King's College London from today."

  • Hospitals choose between 'fixing roof or paying nurses' as Tories let NHS crumble Strong Daily Mirror story in the run-up to PM Johnson's anticipated statement on "extra" capital for NHS reveals £4.3m has been milked out to prop up trust revenue budgets:
    "The stark reality of the NHS funding crisis is laid bare today with new figures which show a staggering £4.29 billion has been cut from capital budgets to prop up day-to-day spending.
    "It comes after 76 hospital trusts reported incidents due to building failures in the last year, including sewage and water leaking onto hospital wards, broken lifts and ceilings collapsing.
    "One hospital trust reported faeces seeping through the floor in an ultrasound corridor."

  • US health giant Centene invests in NHS 'chatbot' app Babylon Sky News reveals that a US health corporation is taking a small but significant stake in an expanding private sector company that has been backed by Matt Hancock.
    "One of America's largest healthcare companies is investing tens of millions of pounds in Babylon Healthcare, the British technology start-up behind a new chatbot service being used by the National Health Service.
    "Centene Corporation, which is based in Missouri and has a market valuation in New York of more than $21bn (£17.3bn), is taking a $50m (£41m) stake in Babylon.
    "Centene's investment will form part of a funding round expected to be announced in the coming days by the ‎creator of the GP At Hand service, which was publicly endorsed by Matt Hancock, the health secretary, last year.
    "According to information circulated to Babylon's investors this week, the round, which is being led by Saudi Arabia's Public Investment Fund (PIF), will value the company at $1.5bn prior to the new funding.
    "The Saudi sovereign fund is investing $200m, with Centene contributing $50m and Munich Re, the German reinsurer, becoming a third new shareholder by handing over $7m."

  • Bradford hospital strikers appeal for funds as they strike again UNISON explains the reason why 600 support staff are staging another 2 weeks of strike action to stay 100% NHS:
    "Bradford Teaching Hospitals NHS Foundation Trust want to create a Wholly owned subsidiary company to run the Estates & Facilities department which will mean the transfer of 600 staff out of the NHS into a company effectively stripping staff of their NHS status.
    The Trust have offered 25 year ‘guaranteed’ protection on terms and conditions of employment in the new company, a 'guarantee' which has been rubbished by union solicitors who confirm that these so called ‘guarantees’ are not legally binding. Terms and conditions can be changed lawfully 12 months after the transfer especially under new Trust leadership.

  • A war of attrition against hospital services in South Tyneside and across the country Allyson Pollock in a detailed article for Open democracy argues:
    "Hospital mergers uncouple services from residents’ needs as the financial interests of the trust come before the needs of patients. Moreover there is no local accountability, as the Health and Social Care Act 2012 abolished locally accountable geographic planning bodies."

  • Twenty big NHS building projects that need Boris’ cash (£) HSJ highlights 20 major projects -- total cost in excess of £3.5 billion – which is says "need Boris's cash":
    "HSJ’s list is not an attempt to identify projects which the government will select, nor to pick out the ones that are most deserving.
    "But it highlights some of the biggest schemes which would involve replacing some of the worst estates in the NHS, or enable important clinical service reconfiguration.
    "Some have already been allocated funding but are still trying to get final Treasury sign-off. Others are more embryonic and are looking for an indication of what capital funding could be available for them."
    Only one of these was on the actual list when it was published

  • GPs should have power to veto CCG mergers, BMA warns GP Online reports BMA statement expressing frustration that CCG merger plans are paying no more attention to GP views than they are to local communities as they force through changes that will massively reduce any local voice or influence over services.
    "In a letter to NHS England, the BMA's GP committee has called for GPs and primary care networks (PCNs) to have in effect a power of veto over decisions to merge CCGs.
    "The number of CCGs has already dropped from 211 in April 2013 when NHS England became operational to 191 at the start of the current financial year - a fall of more than 9%.
    "This decline could be set to accelerate rapidly under NHS England's long-term plan, which suggested that in future there could be a single CCG for each emerging 'integrated care system' (ICS) area. These are expected to 'grow out of' sustainability and transformation partnership areas - of which there are just 44 across England."

  • Pharmacies to provide same-day patient appointments to cut pressure on GPs GP Online reveals that:
    "The service will be expanded over the next five years to include direct referrals from GPs and A&E. The DHSC said that up to 6% of all GP consultations, some 20m appointments a year, could be safely transferred to community pharmacy."

  • Staff at Bradford Hospitals Trust stage 2-week strike over privatisation plans More than 300 porters, domestics, security and catering staff at the Bradford Teaching Hospitals Trust will strike for two weeks from 1 to 15 August, to oppose plans to outsource their jobs.
    The workers believe pay and pensions will suffer as part of a drive to cut costs if roles are transferred to a wholly owned subsidiary company (subco), being set up by the trust.
    These companies don’t have to honour NHS contracts and are free to pay employees less than NHS staff doing the same jobs, creating a damaging two-tier system that’s no good for staff or patients, says UNISON.
    The August strike follows a week of industrial action in July that saw workers come together with the local community to oppose the backdoor privatisation of health services across the trust.

  • Labour councillor responds to Hancock's green light to cut local services Facebook post raising strong objections to Matt Hancock's decision to reject the call from Southend's scrutiny panel for the planned "centralisation" of stroke services in Basildon to be reviewed by the Independent Reconfiguration Panel.

  • Saudi Arabia's sovereign wealth fund to invest in NHS chatbot-maker Babylon Health Telegraph article showing that a controversial firm peddling a flawed app and undermining existing NHS primary care is now attracting support from unsavoury regimes, notably the bloody and repressive Saudis:
    "NHS provider Babylon Health is set to receive an investment from Saudi Arabia's Public Investment Fund to help fuel its international expansion, according to a new report. Babylon, which developed an app that lets people book virtual appointments with their GPs and order prescriptions, is in the midst of raising capital to expand its operations in North America and expand in the Middle East and China."

  • A new global health strategy for Germany (£) BMJ article shows again that while the British government and sections of the electorate are becoming more insular, xenophobic and racist in the run up to Brexit, Germany's far from left wing government has been moving in the other direction:
    "In recent years, Germany has strengthened its commitment to global health by increasing its political voice through its G7 and G20 presidencies and through enhanced support for multilateral and bilateral partnerships. Germany has become one of the strongest supporters of the World Health Organization and other international agencies.
    "The federal government has approached its commitment to global health with openness, seeking out a wide range of perspectives by establishing an international advisory board in 2017. The board includes experts from Africa, South Asia, Europe, North and South America, as well as Germany and was asked to advise the federal government on developing a new global health strategy.
    "Germany stands out internationally in choosing to bring outside perspectives to strategy development in this formalised way. The board met with a wide range of German stakeholders, parliamentarians, and ministries over two years and submitted its recommendations to the government on 7 June. The full statement is now publicly available."

  • Queensland nursing home crisis Public Services International highlights a familiar story of greed and dysfunctional systems in nursing home services in Australia:
    "70 elderly patients were thrown out when Earle Haven, an aged care centre in Queensland was abruptly shut down on 11 July.
    "It took eleven hours for paramedics to evacuate the senior citizens, about 90% of whom suffer from dementia. The immediate cause was that HelpStreet Group, a subcontracted firm which operated the home had disputes on payments with People Care Pty Ltd., the care facility provider. It thus stripped the retirement home of valuables, drugs and patient records, amongst other materials!
    "The Australian federal government has ordered a full inquiry into this disgraceful development. And the Queensland Nurses and Midwives Union called for criminal charges to be considered and subcontractors banned from running aged care facilities.
    "It is clear to the union and all well-meaning persons that we cannot allow the lives and dignity of aged people to be treated with such disdain by for-profit interests."

  • Home births at risk as midwife service collapses BBC reports that a profit-hungry private midwifery service has begun to cut back services where insufficient money is to be made: of course the BBC lamely claims it has been "forced to close"!
    "Hundreds of mothers-to-be have lost access to their midwives after a community service was forced to close.
    "Women across the north-west of England and in Essex have been affected after One to One announced it was withdrawing the services it provided for the NHS.
    "The company said the contracts it had did not pay enough to make the service financially viable."

  • Rural Hospitals Are Shutting Down in States That Didn’t Expand Medicaid US website Mother Jones points out that "Rejecting the Obamacare program has come with a cost."
    Of the 106 rural hospitals that have shut down since 2010, 77 were located in states that hadn’t expanded Medicaid, the study found.
    "Most closures have happened in places where people came out in droves to vote for Donald Trump—and yet his administration hasn’t done much to turn the tide. Legislation sponsored by Rep. Sam Graves (R-Mo.) would expand funding and create more protections for rural hospitals. But the bill hasn’t gained much momentum: It has sat dormant in the House since 2015, though it was reintroduced last year."

  • A&E at Queen's Medical Centre had its busiest month ever in June Nottingham Post report underlines the continued failure of plans to reduce reliance on A&E services in Nottinghamshire:
    "On average there were 462 patients arriving at the A&E every day throughout June resulting in the highest ever demand at the hospital in its existence.
    "Nottingham University Hospitals has said the huge number of patients it was seeing through the doors resulted in some long waits at the emergency department.
    "The original A&E unit was designed to treat 350 to 400 patients a day but it now regularly sees 550 to 600 a day."

  • Lord Forsyth: ‘Private insurance won’t fix the social care crisis’ Guardian reports Lord Forsyth, one time minister for John Major and now chair of the Lords economic committee on social care talking about their recent report's call for an extra £8 billion of public funding:
    "The committee’s proposals were built on solid evidence, he says – “which I suppose these days is something of a novelty in terms of public policy”. So, social insurance solutions favoured by many in his own party were quickly dispatched, after the insurance industry told the committee they wouldn’t work.
    "Half the social care budget is spent on people of working age, so insurance schemes would not help them. They were just a diversion from the reality that a properly functioning social care system is the expensive duty of the taxpayer, not of markets, says Forsyth.
    “The people who are looking for some easy way out of this are in search of a holy grail which does not exist.”

  • Exclusive: Capital billions promised by ministers fail to reach ‘front line’ (£) HSJ flags up the massive squandering of historic NHS capital assets to prop up flagging revenue budgets after nine brutal years of austerity funding:
    "Only a fraction of the £2.5bn of capital funding announced and allocated by the government for the NHS since 2017 has actually been released to the service.
    "Research by HSJ suggests less than £100m has been distributed to local providers over the last two years – equating to just 3 per cent of the total funding listed in several headline-grabbing media announcements.
    "The findings are supported by data in published Department of Health and Social Care accounts. …
    "HSJ’s findings reveal how the impression given by ministers’ announcements in recent years contrast with the reality of relatively small amounts actually being released."

  • CQC places two Priory Group hospitals in special measures Guardian reports on more damning CQC findings on Priory group private mental health hospitals, which are largely dependent on NHS-funded patients:
    "Two hospitals run by the Priory Group have been placed in special measures in a fresh controversy over state-funded private contractors’ treatment of people with mental illness or learning disabilities. …
    "The Care Quality Commission (CQC) found both hospitals – Priory Hospital Blandford in Dorset and Kneesworth House in Royston, Hertfordshire – unsafe and uncaring and declared them inadequate. They have been given up to six months to show improvement or face closure."

  • NHS and future trade deals: Our campaigning has Boris worried. Update from Keep Our NHS Public notes:
    "Boris Johnson, our new unelected prime minister, is leader of a fractured party with a weak majority in Parliament. The backlash over the idea that the NHS could be part of a Trump trade deal is something he cannot afford to ignore.
    "In response to the huge public outcry, the government has now debated the parliamentary petition demanding that the NHS be excluded from any future trade deals after Brexit. The petition has attracted over 160,000 signatures meaning that the petition had to be tabled for discussion.
    "Meanwhile, a petition by Keep Our NHS Public launched on Change.org during President Trump’s state visit entitled Keep our NHS out of US trade deals went viral and gained more than four times that number (over 700,000 signatures to date) making it one of the most popular petitions Change.org has seen."

  • US healthcare is literally killing people (£) Financial Times article by Tim Harford notes:
    "Not before time. The US healthcare system is a monument to perverse incentives, unintended consequences and political inertia. It is astonishingly bad — indeed, it’s so astonishingly bad that even people who believe it’s bad don’t appreciate quite how bad it is."
    He goes on:
    "… mortality rates for middle-aged white Americans have stagnated or perhaps even risen in the US, while falling fast in other rich countries.
    "I recently had the opportunity to ask Prof [Anne] Case and Sir Angus [Deaton] to what extent the US healthcare system was to blame. Their answer, in a nutshell: it would be an exaggeration to blame the system entirely but not a gross exaggeration."

  • NHS abandons plan to let healthy people pay for DNA sequencing Guardian reports on quiet ditching of controversial plan as one of the few positive outcomes in the otherwise largely empty Green Paper on public health:
    "Government plans to sell DNA sequencing to healthy people on condition that they share their results for medical research have been scrapped amid concerns it would create an inequitable two-tier health system.
    "Matt Hancock, who survived Boris Johnson’s cabinet makeover to keep his job as health secretary, announced the “genomic volunteers” plan in January, which included a paid-for option that would be offered to healthy people in England to boost medical knowledge and uncover new treatments."

  • Dominic Cummings: Tory MPs do not care about poor people or NHS Guardian's Rowena Mason reminding us of comments by Johnson's adviser Cummings at a Tory conference 2 years ago:
    "Voters are right to think Tory MPs largely do not care about poorer people or the NHS, according to Dominic Cummings in comments that have emerged from two years ago.
    "Boris Johnson’s new senior adviser and a key architect of Brexit gave his damning view on Conservative MPs at a conference in 2017, where he said: “People think, and by the way I think most people are right: ‘The Tory party is run by people who basically don’t care about people like me.’"

  • Abbey Meads GP practice in special measures after damning report highlights safety fears Swindon Advertiser highlights yet another GP practice pushed into failure to meet CQC standards by Bahamas-owned IMH:
    "URGENT overall improvement is needed after a fifth IMH-managed Swindon surgery received a damning CQC report.
    "The GP practice in Abbey Meads Village Centre has been placed into special measures after inspectors found significant issues with patient safety, service quality, leadership and governance."
    See also an earlier background report in The Lowdown https://lowdownnhs.info/news/swindon-primary-care-left-stranded-by-contract-failure/

  • Telford street poll shows support for keeping both A&Es in Shropshire Shropshire Star report of Green Party campaigning to highlight public support for keeping both A&E units open in Shropshire as the Independent Reconfiguration panel gets set to report.
    "Hilary Wendt, co-ordinator of South Shropshire Greens, said: “This result is entirely consistent with and most emphatically reinforces the results obtained from the same balloting that the Green Party has previously carried out across six south Shropshire towns.
    "In each town more than 90 per cent of people balloted voted to keep both of Shropshire’s A&Es open.
    “What people have told us repeatedly is that ‘in an emergency every second counts’ to get emergency patients to emergency care soonest.
    "Royal Shrewsbury should have its Future Fit planned bright new hospital with A&E but Telford and surrounding people must keep their A&E."

  • General practice by smartphone (£) BMJ article by Cambridge professor Martin Roland underlines previous warnings on the dangers, inequalities and limitations of relying on "digital first" primary care. He notes:
    "The evaluation confirms that GP at Hand caters principally to a healthy, affluent, young, and working population: 98.5% of patients are aged 20-64,3 two thirds live in affluent areas, and only 0.1% are cared for by the service’s “chronic care team.”

  • More women found to have missed cervical screening invitations in new Capita “administrative error” (£) BMJ article highlighting yet another in the never-ending series of contract failures by privatiser Capita:
    "Capita has admitted that failure to process the emails led to delays in 16 women receiving their invitations to cervical screening. Requests from 99 women to be removed from the screening programme were also not acted upon.
    "Richard Vautrey, BMA General Practitioners Committee chair, said, “Less than a year after tens of thousands of women missed vital correspondence about cervical screening, this is a further example of patient safety being put at risk because of Capita’s incompetence."

  • Map: Which parts of England have most patients aged over 75 per GP? Interesting interactive map from GP Online shows that problems are greatest in rural areas, and ranks proliferation of over-75 residents with numbers of GPs as well as numbers of 75+ per GP. Will this influence STP/Long Term Plans or CCG decisions? Unlikely -- they have largely ignored such issues up to now, and STPs in 2016 notoriously lacked equality impact assessments, serious needs assessments -- and almost everything else needed to make them serious plans.

  • Emergency admissions to hospital from care homes: how often and what for? Health Foundation research has found that given sufficient additional investment in nursing homes large numbers of hospital admissions can be avoided:
    "A large number of these emergency admissions may be avoidable: 41% were for conditions that are potentially manageable, treatable or preventable outside of a hospital setting, or that could have been caused by poor care or neglect.
    "Four evaluations of initiatives to improve health and care in care homes carried out by the Improvement Analytics Unit (IAU) in Rushcliffe, Sutton, Wakefield and Nottingham City show reductions in some measures of emergency hospital use for residents who received enhanced support."

  • Only public funding can guarantee universal health coverage Valuable Guardian article by veteran campaigner for universal health coverage Rob Yates

  • Who’s Matt Hancock? The health secretary’s only legacy will be how quickly he’s forgotten Denis Campbell of the Guardian offers what has turned out to be a sadly premature obituary on the tenure of Matt Hancock as health secretary

  • Nurse-to-Patient Ratios save lives and money, study finds Nurse Uncut reveals an Australian study of great interest for those campaigning here for safe services:
    "In a world-first study, researchers have found legislated ratios not only save lives, but also save governments millions of dollars.
    The research found that, in its first year of operation, Queensland’s nurse-to-patient ratios scheme saved 145 lives, and avoided 255 readmissions. It also found that 29,200 hospital days were avoided.
    "In total, this resulted in an estimated cost saving of over $80 million for the Queensland Government."

  • Save South Tyneside Hospital Campaign submit two petitions against potential money-borrowing deal Chronicle Live reports "Save South Tyneside Hospital Campaign (SSTHC) submitted two petitions with a combined total of nearly 2,000 signatures. The petitions opposed any council financing for the Path To Excellence scheme which, campaigners claimed, would "downgrade" South Tyneside Hospital services further."
    Roger Nettleship, chairman of the SSTHC said.
    "The health bosses might get a cheap loan off the council if they arrange it but we think that the main reason that they're doing it is because they want the council to buy-in to this second phase without knowing what it's going to be," he said.
    "If they buy into it, then they're most likely to not oppose the services that will be lost. The scrutiny committee did a brilliant job to oppose the phase one when they referred it to the secretary of state.
    "There won't be that same impetus to do that if they're funding phase two. That's the main reason for us to do this emergency motion."

  • Advancing our health: prevention in the 2020s The public health 'consultation paper' that was stripped of any serious content to fuel Matt Hancock's doomed bid for a different job under Boris Johnson.

  • Three-quarters of money from NHS land sales went into revenue After 9 years of falling real terms funding now even the fire sale of assets can't bail out the capital budget fast enough. According to the HSJ:
    Just 22 per cent of money raised from NHS property sales went back into capital budget for reinvestment
    This was despite government commitment for disposal proceeds to be reinvested in new estates’ projects

  • Private firms given £9.2bn of NHS budget despite Hancock promise Guardian article collates last few years figures on spending on private health care providers and warns that cash spent continues to rise despite promise from Matt Hancock of "no privatisation on my watch".

  • The new health tourism debacle: NHS fails to recover nearly three-quarters of bills run up by ineligible foreign patients Daily Mail as most virulent proponent of continued "hostile regime" against anyone who does not look and sound "British" fails to recognise that campaigner have always warned amounts recovered would be trivial and unlikely to cover the costs and dislocation involved. Daily Heil also remains oblivious to suffering caused by this futile and reactionary policy.

  • Long delays to NHS cataract operations leave elderly at risk Guardian reveals that:
    "People with poor eyesight are being forced to wait almost six months for operations on the NHS to remove cataracts, official figures reveal.
    "Patients in Herefordshire are facing average delays of 168 days – five months and 17 days – for cataract surgery, according to data collected by NHS Digital, the health service’s statistical arm. Waiting times in Great Yarmouth and Waveney in Norfolk are the second worst in England at 163 days, while they now average 154 days in North Lincolnshire."

  • Ex-NHSI directors receive payouts of up to £300k HSJ reports that four directors who you will probably never of heard of, who left NHS Improvement amid its effective merger with NHS England, received exit packages worth between £150,000 to £300,000.
    Once again it seems those at the top have pain-free exit strategies for themselves, while front line staff get treated very differently.

  • Lincolnshire health visitors stage 48-hour strike action in pay row BBC report and photo of 58 Unite health visitor members who walked out because they had not received a pay increase for two years.
    "Workers lost more than £2,000 a year compared with NHS staff after their contracts were switched from the NHS to the council in 2017, the union said."

  • Democratic Alliance calls NHI Bill a “disastrous piece of legislation” Despite the criticism, note the conclusion: South Africa's NHI Bill "seeks to form a single state-owned and run medical healthcare fund that would cover the entire population, effectively instantly remove the need for private medical funds"

  • How One Community Brought Child Mortality Down From 154 To 7 Per 1,000 Live Births Some welcome good news from Mali and a reminder of the kind of approach that delivers effective health care, and saves lives: pity austerity England is headed in opposite direction.

  • Blithering Stakeholder (BS) News Much needed light relief from a parody that is so close to the reality it almost seems lifted from an actual CCG website: choice extract:
    "The hospital’s chief executive Sir Trevor Longstay took personal charge of the project to digitise patient records in 2016 and famously asked “How hard can it be to install a few computers?” before firing the project team.
    "After 18 months during which the project missed three completion deadlines and costs more than doubled, auditors finally advised the trust to write off the entire cost and abandon the programme.
    "Blithering Hospital spokesman Martin Plackard said: “Sir Trevor takes full and unequivocal responsibility in principle for a few areas where success was less than fully achieved due to circumstances beyond our control,” but pointed out that not all of the investment had gone to waste. The server racks had been “strategically redeployed” in the laundry for storing bed linen and the purpose-built computer room had played a vital part in the hospital’s winter management plan, relieving the pressure on corridors and waiting areas, Plackard said."

  • ARE UHC KIDDING ME? 5 ALTERNATIVES TO EQUITABLY FUND HEALTH FOR ALL Dutch campaigners Wemos note the need for progressive solutions to the problems of funding health care in Low Income Countries:
    "Development assistance for health can play an important role in LMICs to fill a part of the funding gap. However, up until today, the financial flows leaving LMICs are way higher than the flows entering countries through aid. Therefore, we need to reconsider the global economic system if we want to achieve UHC globally.
    "I dare say there are alternatives. Let me share five ideas that could actually contribute significantly to UHC."

  • A&E waiting times in England record 'worst June ever' Sky news reporting on the latest figures notes "The NHS says pressure on staffing and beds is damaging performance, as Labour claims there's now a "year-round crisis".

  • NHS England hired consultancy to find out what it is responsible for Brilliant sidelight on the confusion and uselessness of NHS England in this story from HSJ's Shaun Lintern. Not only did they need to inquire into their own duties, they paid through the nose for it:
    "NHS England paid external consultants more than £200,000 to ‘map’ its responsibilities ahead of the merger with NHS Improvement, HSJ has learned.
    "The national commissioning body used PA Consulting to carry out a ‘function mapping exercise’ in the first three months of 2018.
    "An NHSE insider passed HSJ a copy of the PA Consulting invoice which detailed the daily rates charged by the team of seven. One of the PA Consulting staff, partner Tony Wood, was charged out at a daily rate of £1,900, or £5,700 for three days’ work."

  • NHS fees: 'Couple couldn't take baby's body home' Shocking revelations from the BBC's Derbyshire programme of the consequences of levying charges on "foreign" patients, many of whom live and work here.

  • NHS bosses respond to key questions over £367m hospital transformation plans Leicester Mercury reports on a meeting which despite the headline left more unanswered questions than it gave answers as health chiefs keep their key plans and documents under wraps.
    "Members of the Patients Panel and Save Our NHS Leicestershire say they have repeatedly asked for more details about £367m transformation plans and to see the pre-consultation business case. So far, Leicester’s Hospitals have refused.
    "Mr Adler said: “We would like nothing more than to be able to start consultation now.
    But we’re not allowed to start public consultation."
    Maybe not: but there is nothing to stop them publishing the pre-consultation business case since by any definition we are in a pre-consultation period.

  • Fire chiefs threaten to close dangerous hospitals After nine brutal years of austerity under-funding of the NHS revenue and capital budgets, the chronic failure to carry out backlog maintenance have let to this:
    "The fire brigade has warned four NHS trusts that they plan to shut down parts of their hospitals because they are so decrepit that they pose a threat to patients and staff.
    "Fire chiefs have made plain to the trusts that they must make urgent improvements to the units concerned in order to improve safety or face legal action to close them down."

  • 'I feel like my hands are tied' - Health visitor lifts lid on struggling profession as workforce dwindles Lincolnshire Live report as health visitors prepare for strike action says:
    "One of Lincolnshire's top health visitors says the profession is understaffed and struggling to cope with demand amid massive funding cuts and dwindling staff numbers.
    "Dozens of health visitors - nurses or midwives who are frequently the first point of contact with families, connecting them with vital community services - are employed by Lincolnshire County Council."

  • New report shines a welcome light on the perilous state of adult social care As the government repeatedly postpone the long-promised green paper on social care the Health Foundation response to the House of Lords Economic Affairs Committee report on social care funding underlines the scale of the crisis.

  • Minister attacked for refusing to act on evidence that overseas patients are dying because of upfront NHS charges Independent report on the bizarre appearance of health minister Stephen Hammond in front of the Commons Health Committee:
    "In an evidence session – likened to an episode of Yes Minister – Mr Hammond first argued a government review had taken place, before backtracking after being corrected by his top civil servant.
    "To the disbelief of MPs, he then argued that they, or local NHS leaders, should carry out any such inquiry, denying it was the responsibility of the Department of Health and Social Care (DHSC)."

  • NHS hospital staff to strike over 'back door privatisation' in Bradford Guardian report as more than 300 hospital staff in Bradford began a week of strike action in a dispute over what union leaders have described as the “back door privatisation” of the NHS:
    "Porters, cleaners and security staff voted to take industrial action over plans by Bradford teaching hospitals NHS trust to set up a new company to run the facilities."

  • No vision for health, healthcare in Union Budget: Docs Indian doctors slam the lack of government proposals to move towards Universal Health Care: "The medical care is left to unregulated private healthcare sector. And sadly, the Finance Minister does not even think of health when presenting the highlights in Parliament.
    "So, the sad story of passive privatisation that began 30 years back continues, rather with enhanced zeal. Healthcare has been left to market forces, hence the government is only bent on increasing coverage. "

  • David Oliver: The NHS doesn’t need more “restructuring” Good BMJ blog from David Oliver who links B. Johnson's leadership campaign claim the NHS “needs reform,” as it was “not getting the kind of support and indeed the kind of changes and management that it needs” with similar vague calls for "restructuring" from the so-called "think tank" the Institute of Economic Affairs -- and demolishes the notion.

  • Full text of Aneurin Bevan's important book "In Place Of Fear(1952)" Important reminders of the progressive principles on which the NHS was founded in a bankrupt post war economy, and why is was not set up as any kind of "insurance" scheme. Great summer reading.

  • NHS doctors are protesting the hostile environment Excellent article in Huck magazine explains:
    "The current situation is the result of years of restrictions that have escalated since the 2014 immigration act. Then, the government introduced an immigration health surcharge – now pegged at £400 per year – for people with limited visas. Since, a statutory requirement has been placed on NHS Trusts to charge migrants up to 150 per cent of costs upfront for most types of medical care, withholding it if a patient can’t pay.
    "It’s a policy that health workers and policy experts say undermines the role of doctors and nurses, stops migrants accessing the care they need and, ultimately, risks harm and even death."

  • 'Abysmal': Patient in SEVEN-HOUR wait for ambulance in Shropshire Shropshire Star article quotes ambulance boss pointing out the obvious problem in a large county with scattered population:
    "“We only have a certain number of vehicles in Shropshire and if one of those vehicles, even from a relatively urban area, is pulled away, it can be a long way away and take a long time to arrive back."
    Just imagine how much worse it could be if many of these ambulance journeys were extended by only having one A&E in Shropshire.

  • Great Ormond Street Hospital is chasing £45MILLION of debt from foreign patients and may have to write much of it off, shocking figures reveal Daily Mail story which underlines the folly of major NHS hospitals relying so heavily on attracting wealthy overseas patients to bolster their budgets. Given the chronic high level of default by well-heeled scroungers, do these private patient units actually make any profit at all?

  • Special report: How Oxford’s cancer scanners are being handed to a profit-seeking company Banbury Guardian again leading the field in probing this scandalous privatisation and the process by which it is being imposed by NHS England despite near unanimous all party opposition in Oxfordshire.

  • Efficacy of population‐wide diabetes and obesity prevention programs: An overview of systematic reviews on proximal, intermediate, and distal outcomes and a meta‐analysis of impact on BMI The evidence that neoliberals claimed to want to see on the effectiveness of a sugar tax in improving public health

  • 'Sin taxes': Boris Johnson vows to review sugar levy Forewarning from the leadership campaign of the reactionary policies and outright pig ignorance we can expect from the Jonson government, especially given that Matt Halfcock remains as health secretary having already buried his own public health proposals in a desperate bid to show obedience.

  • Why poverty is bad for the nation’s health Common sense reminder from a Health Foundation blog that without getting the basics right, the NHS will never be able to keep up with rising demand.
    "Government data released today on households below average income show that many families in the UK are struggling to achieve a decent standard of living. In 2017/18, there were 14 million people living in households with an income below the poverty line (after housing costs). This is 22% of the UK population."

  • Expansion of controversial 'GP by Skype' service to be offered to every patient by 2021 risks worsening GP crisis across the UK, warns Cambridge professor Shock news: Daily Mail quotes real expert. Cambridge Prof Martin Rowland explains why Matt Halfcock's beloved apps and NHS England's "digital first" plans coulkd end badly.

  • KONP calls for taking hospital catering back in-house A blast of sound policy from Keep Our NHS Public, which points out that we need to unpick over three decades of privatisation and disintegration of services:
    "The process of outsourcing food production from hospitals has been ongoing since the 1980s. Most of the new-build PFI hospitals were only provided with kitchens suitable for reheating pre-prepared meals, not cooking from scratch. The drive has been to cut costs. Staff in private food production firms are frequently paid only the minimum wage. They do not receive NHS pay and conditions. They are not part of the NHS family and cannot be expected to have the same loyalty, and understanding, of the NHS that directly employed staff do."

  • Martin Plackard’s implementation framework Great antidote to the mega serving of bullsh*t in NHS England's Long Term Plan and more recent Implementation Framework. You may weep, but from laughing rather than the straight-faced nonsense that passes for planning.

  • You Tube video of ground-breaking NUJ meeting in Oxford An important meeting challenging secrecy and threats of legal action in NHS England's efforts to privatise specialist PET-CT scanning services in Oxfordshire, Milton Keynes and Swindon

  • 'Abysmal': Patient in SEVEN-HOUR wait for ambulance in Shropshire Shropshire Star article with self explanatory headline: with a change of chief executive in the acute hospital trust it must now be time to drop the plan to axe one of the county's A&E units.

  • Special report: How Oxford’s cancer scanners are being handed to a profit-seeking company More splendid reporting from the Banbury Guardian makes you wish more of the local news media had the staff, resources and know-how to get stuck in and investigate scandals like this.

  • Boris Johnson vows to FREEZE sugar tax on fizzy drinks to reduce food bills for poorest families Daily Mail predictably lining up enthusiastic support for a policy that can shorten the lives of its readers, describing Jonson's questioning of the effectiveness of the sugar tax as "one of his most significant policy announcements to date."

  • Efficacy of population‐wide diabetes and obesity prevention programs: An overview of systematic reviews on proximal, intermediate, and distal outcomes and a meta‐analysis of impact on BMI Ideal answer to Johnson on sugar and prevention.

  • 'Sin taxes': Boris Johnson vows to review sugar levy Sugar Daddy Johnson revealing a combination of ignorance and reactionary politics that can cost lives

  • One in five councils face drastic spending cuts within months The Guardian picks up the latest bad news from the Local Government Association, revealing not even social care and children's services are safe:
    "The deteriorating financial prospects for local government mean that within months nearly one in five councils in England may be forced to impose drastic spending controls to stave off bankruptcy, council leaders have warned.
    "The Local Government Association (LGA) said councils had little confidence that they would be able to deliver the already tough savings targets they had set themselves for this financial year, and would have to go back for extra cuts to meet their legal requirement to balance their budgets.
    "A further one in three councils surveyed said prospects were so bleak that within three years they would be unable to meet their statutory obligation to provide an adequate service in core areas such as adult social care, child protection and homelessness prevention."

  • SARNIE BUG CALL Matt Hancock urges NHS trusts to hire their own chefs after ‘killer sandwich’ listeria outbreak The Sun reports "An exhaustive review of hospital food will be launched in a matter of days as the Health Secretary urges management to end a reliance on outsourcing companies - and cooking back in-house." Great idea - first floated recently by Jonathan Ashworth, shadow health secretary: but obstacle is the number of hospitals left without full kitchens after 35 years of privatisation and 22 years of PFI hospitals being largely built without them. Let's have NHS kitchens staffed by NHS cooks: and let's see the government money up front to make this happen!

  • NHS oncologists are being offered shares in private hospitals. This must stop CHPI's David Rowland on the important new report showing the conflict of interest for hundreds of NHS consultants with shares in private medicine.

  • NHS consultants can refer patients to private hospitals in which they have a stake Good Guardian plug for report from independent CHPI think thank which has found that:
    "Almost 400 NHS consultants own shares in private hospitals to which they refer patients, exposing them to a potential conflict between their income and patients’ best interests, new research reveals.
    "In all, 371 senior doctors have a stake in some of the private hospitals that are earning more than £1bn a year from NHS trusts. These doctors are referring growing numbers of patients because understaffing and the soaring demand for care means the NHS is struggling to treat people quickly enough."

  • NHS patients will be able to log anonymous complaints via smartphones under safety plans Telegraph with more uncritical guff on so-called digital solutions, which are leaving millions of poorer, less confident and less able patients on the outside looking in. When will there be an app that properly records people's impatience with NHS apps?

  • UN rapporteur: tax cut plans of Johnson and Hunt 'a tragedy' Guardian reports comments from the Tories' least favourite UN representative telling the real grim story of austerity and mounting inequality since Cameron first took office in 2010.

  • Norfolk and Suffolk mental health trust crisis care 'not safe' BBC reports yet another critical CQC report of the failing Norfolk & Suffolk Foundation Trust, with yet more empty words of response from managers who have done nothing to improve things.
    "A mental health trust in special measures has been told its crisis treatment team is "not consistent in providing safe care".
    "The Care Quality Commission (CQC) carried out an unannounced inspection at the Norfolk and Suffolk NHS Foundation Trust.
    "Staff told inspectors they were unable to keep up with demand and failed to visit patients as planned."

  • Bedford Hospital accused of risking hygiene standards in order to save money More on the impending privatisation of cleaning services at Bedford -- privatisation with a track record since 1984 you could smell a mile away.

  • High-Performance Health Financing for Universal Health Coverage (Vol. 2) : Driving Sustainable, Inclusive Growth in the 21st Century World Bank, which spent two decades at least attempting to screw down public spending on health care and force through maximum privatisation and user fees in developing countries now laments insufficient government spending!

  • Bedford Hospital chief exec ‘unable to sign pledge’ to protect cleaners’ jobs Another sign of desperate times for NHS managers in the Bedford Independent, where domestic staff look set to be privatised as part of the overhead cost to care as the Bedford Trust is set to merge with "i.e. be taken over by) the much larger Luton & Dunstable FT -- where cleaning is already privatised. 'Harmonisation' the wrong way!

  • Care for the elderly is a scandal – but don’t expect a solution from Hunt or Johnson Polly Toybee in the Guardian gets stuck in to the two unsavoury front runners for the Tory leadership and PM post.

  • Patients are being routinely cared for in ‘temporary’ beds as hospitals are ‘full-to-bursting’ Nursing Notes picks up on a BMA report on inadequate numbers of front line beds.

  • Social care chiefs: funding crisis puts tens of thousands at risk Guardian picks up on hard-hitting report from directors of social services warning that:
    "In a withering assessment, Adass said social care in England was adrift in a “sea of inertia” caused by years of budget cuts and Brexit-related Whitehall policy paralysis. “The system is not only failing financially, it is failing people,” it concluded."

  • Information released does not explain OUH’s U-turn over PET-CT Banbury Guardian continues to lead the charge seeking the real facts and hidden correspondence and documents to explain NHS England decision to privatise specialist scanning services in Oxford.

  • CQC rates private sector Cygnet mental health hospital in Colchester as inadequate on safety The location Cygnet Hospital Colchester is a 57-bed hospital for men and women aged 18 and above.

  • Children's mental health: Is Suffolk getting a raw deal? East Anglian Daily Times report warning follows on CQC report:
    "Vulnerable youngsters are being "failed by the system", a parent group is warning after a watchdog identified disparities in children's mental health provision across Suffolk and Norfolk."

  • Scrap upfront NHS charges for migrants, says BMA Guardian report of important decision of BMA conference and correctly points out that
    "The British Medical Association has become the first body representing medical staff to call for the complete abolition of the charges, which have been heavily criticised by MPs and health charities.
    Delegates gathering in Belfast for the annual conference of the union, which represents 155,000 doctors, overwhelmingly backed a motion which called for “the policy of charging migrants for NHS care to be abandoned and for the NHS to be free for all at the point of delivery”.
    Medical bodies such as the Academy of Medical Royal Colleges have previously only demanded that the regulations be suspended pending an inquiry into how they were working."

  • We need a social care system that is as much a source of national pride as the NHS (£) Ambitious BMJ blog by Health Foundation's Anita Charlesworth.

  • Four CCGs looking at 1 million population merger (£) HSJ report on one of the bigger plans for merger of CCGs outside of the mega mergers proposed in NW, SW and SE London. In each of these mergers the big issue is the loss of any local voice for the communities affected as they are lumped into bodies covering much larger populations, and showing little concern to hear local public views.
    "A paper which will be considered by the three Surrey Heartlands CCGs tomorrow says: “After 18 months of working closely together across the ICS, the question of a merger seems to be the logical next step.”
    East Surrey CCG joining the three – Surrey Downs, North West Surrey, and Guildford and Waverley – in a merged organisation would also be “logical,” it says. East Surrey CCG’s governing body is expected to discuss the potential merger on Thursday.
    The three existing Surrey Heartlands CCGs already work closely together, including holding governing body meetings in common and sharing a joint accountable officer, Matthew Tait."

  • NHS pays firms £181m to care for patients with serious mental illness Guardian highlights figures from a BMA report, noting:
    "The NHS is paying private firms an “eye-watering” £181m a year to look after people with serious mental health problems in units often hundreds of miles from their homes.
    A shortage of NHS mental health beds in England means it is being forced to hand companies such as the Priory and Cygnet Health Care larger sums each year, official figures show.
    The amount those firms receive to provide residential rehabilitation for those with high-level mental health needs has risen from £158m in 2016-17 to £181m last year – an increase of £23m. Their share of the money spent by NHS clinical commissioning groups (CCGs) on such care has also grown from 54% to 57% over the same period, a British Medical Association (BMA) investigation found."

  • District nurses are the hidden heroes of the NHS – so why are they being cut? Independent long read on district nursing points out that:
    "The Queen’s Nursing Institute and Royal College of Nursing have warned that district nurses, the hidden heroes of the NHS, are under siege. Numbers in the profession have fallen by almost half since 2010 (from 7,055 to 4,031)."

  • Food safety inspectors have failed 439 hospitals, care homes and nurseries (£) Times flags up shocking statistics on scale of poor food hygiene
    "More than 400 hospitals, care homes and nurseries have failed food hygiene and safety inspections, a Sunday Times investigation reveals. Reports obtained by this newspaper show inspectors found out-of-date chicken, dirty fridges and mouldy food in hospital kitchens. The findings were released last week under information laws after a listeria outbreak caused by chicken sandwiches killed five hospital patients."

  • NHS hospital stops plan to charge patients almost £20k for operations after outcry Mirror follow up to its front page 24 hours earlier
    "A hospital trust has dramatically shelved plans to charge patients up to £20,000 for treatments - previously available for free - in a huge victory for the Daily Mirror.
    "Warrington and Halton Hospitals (WHH) Trust announced the U-turn after we reported it was touting hip replacements for £18,143 among a list of 71 treatments.
    "Our front page story sparked a national backlash against the first trust to brazenly embrace privatisation of much of its life-changing treatments."

  • Anger as NHS price list shows hospital operations will cost patients up to £8,000 each Liverpool Echo take on Warrington & Halton Trust "My Choice" scheme to charge for 71 different elective treatments, adds another warning:
    "There are further privatisation fears concerning Halton General Hospital.
    "Weaver Vale MP Mike Amesbury said he has been informed that the contract for the urgent care unit at the hospital would no longer be provided by its existing NHS supplier."

  • Warrington warning – NHS says no, then offers private care Front pager from The Lowdown with analysis of attempts by Warrington and Halton Hospitals Foundation Trust to cash in on frustration at the growing list of treatments excluded from the NHS by cost-cutting CCGs in Merseyside and Warrington, by launching its own private NHS patient service.
    "There are fears that this is the increasingly commercial face of the NHS that is emerging from almost a decade of austerity on funding, and six years of legislation that urged Foundation Trusts like Warrington to make up to 50% of their income from private medicine."
    The Lowdown points out "this is not a Private Patient Unit. Patients are warned not to expect any special treatment: they are simply paying for NHS treatment that was once free.
    “There are no private rooms and they will join the same waiting list as NHS patients. The major benefit is access to outstanding NHS treatments at a fraction of the cost of those undertaken by private providers.”
    It may not be long before other NHS trusts in the area and elsewhere in the country are following the Warrington model, excluding large numbers of elective treatments from the NHS for those without the money to pay.
    The same long list of 71 excluded services has been imposed by all seven CCGs in Merseyside and Warrington, under the pretext of helping to “reduce variation” of access to NHS services in different areas (“sometimes called ‘postcode lottery’ in the media”) and “allow fair and equitable treatment for all local patients.”

  • Hospital bed cutbacks have gone too far, NHS England boss says Guardian reports on a speech by Simon Stevens to NHS Confed conference, which appears to mark a change of direction after a decade of pressure to reduce acute bed numbers.
    "Shutting beds has left hospitals unable to cope with the growing number of patients needing care and needs to stop, the head of the NHS has admitted.
    "In a surprise U-turn, Simon Stevens, chief executive of NHS England, said the policy had gone too far and that hospital beds had become “overly pressurised” as a result of years of closures."

  • Babylon's Birmingham patients will be registered with London network Pulse exclusive: "Patients registering at the new GP at Hand expansion in Birmingham will be on the Babylon primary care network patient list in London, the CCG hosting the digital service has confirmed.
    "NHS Hammersmith and Fulham CCG has confirmed that new patients registering with GP at Hand in the Midlands will be registered with the Babylon network, which just comprises GP at Hand patients and will be based in west London.
    "GP local leaders said the news 'makes a mockery' of PCNs, which are meant to be regionally based.
    "NHS England said that these were 'temporary' arrangements."
    In fact there have been no moves by NHS England so far to address the consequences in West London of Babylon's expansion.

  • Care staff forced to sleep in offices and not wash UNISON press release:
    "Care staff on overnight shifts are having to bed down at work in offices or on dirty mattresses – sometimes without anywhere to wash, according to a UNISON report.
    The report Sleeping in, losing out – released to coincide with the opening day of the union’s annual conference – presents a shocking picture of ‘sleep-in’ conditions, with staff abused physically and verbally including being punched and threatened with knives.
    The findings are based on a survey of more than 3,000 people UK-wide caring for the vulnerable and elderly by staying overnight, including in residential homes, in the accommodation of those living independently, or at the properties of those receiving home support."

  • NHS England ‘buried’ concerns over child cancer services Hard-hitting exclusive for (£) HSJ reveals:
    "NHS England covered up serious problems with paediatric cancer care in London – which had seen children dying in “terrible agony” – and has “buried” attempts to overhaul the services, an HSJ investigation has established.
    "The former NHS medical director for London accused NHSE, his former employer, of “burying” an expert report, commissioned in the wake of child deaths, which showed fragmented services across London were providing poor quality care.
    "It highlighted particular shortcomings in children’s cancer services for south London and south east England, which centre on the Royal Marsden Foundation Trust’s Sutton hospital."

  • Birmingham NHS maintenance and facilities staff to strike in ‘transfer to tax avoiding company’ row Unite press release: About 40 NHS maintenance and facilities staff at Birmingham and Solihull Mental Health NHS Foundation Trust, who face being transferred to a wholly owned subsidiary (WOS) designed to avoid paying tax, will strike for three days later this month.
    Unite said porters, housekeepers, domestic assistants and maintenance staff, who are being transferred to Summerhill Services Ltd from 1 July, will strike on 24-26 June.

  • NHS needs extra £8bn or long-term plan will fail, say hospital bosses Guardian reports findings of Health Foundation, as endorsed by normally docile NHS Confederation:
    "Ministers must spend an extra £8bn a year on health, on top of the NHS’s £20.5bn budget boost, or the service’s long-term plan will fail, according to hospital bosses and NHS experts warn.
    "Waiting times will keep getting worse, hospitals will remain overstretched and efforts to reduce ill-health will falter without a further major injection of cash, they claim in a new analysis."
    "Health Education England will need at least £900m extra a year to recruit and train health professionals to help tackle the NHS’s chronic staffing shortage. Despite that, the agency’s budget is being cut every year so the NHS can be given more money.
    "Capital spending – which hospitals use to build and renovate buildings, buy equipment such as scanners, and invest in IT – will require an extra £4.4bn, taking its budget up from £5.9bn to £10.3bn."

  • Urgent call for £1bn a year to reverse cuts to public health funding Press release.
    "Two leading health charities say that the government must make a clear and urgent commitment to restoring £1bn of real-terms per head cuts to the public health grant which enables local authorities to deliver vital preventative services that protect and improve health.
    "With the government’s spending review, which was expected to outline long-term funding for the public health grant, likely to be delayed, the Health Foundation and The King’s Fund say that government cannot continue to put off decisions on public health funding and must signal its intention to restoring cuts and ensuring there are no further reductions in funding."

  • Basildon Hospital nurses 25 per cent pay cut will affect how they 'support their families' Essex Live report reveals Basildon Hospital nurses are set to receive a massive pay cut for work on bank shifts, under the guise of "harmonisation".
    "The nurses, who spend at least 12 hours on their feet on each shift, were told of the huge wage reduction in an email during half term."
    A letter from NHS Professionals (NHSP) sent to staffreveals that the hourly pay rate for flexible workers within the Basildon and Thurrock University NHS Foundation Trust will be cut by up to 25 per cent.
    "The new system will see existing day rates go from £17.50 to £14.08, night rates and Saturdays from £22.29 to £16.72 and then Sunday and Bank Holiday rates will decrease from £26.14 to £20.43."

  • Britain's shame as 70 children treated for mental illnesses in A&E EVERY DAY Mirror report:
    "Seventy children are treated at A&E for mental illness every day – four times as many as ten years ago. Shameful statistics reveal 26,582 under-18s were rushed to casualty units in England and treated for psychiatric problems in the year to the end of April.
    "The year before it was 22 per cent lower, at 21,814. And 10 years ago, the number was a comparatively low 6,192. The distressing figures cover children with conditions such as depression, anxiety, eating irregularities, personality disorders and addictive behaviours."

  • Fears for new mothers as Suffolk slashes health visitor numbers The Guardian reports:
    "Health visitors will be made redundant by a local council, sparking fears that new mothers will get less help with mental health problems, breastfeeding and babies’ sleep.
    "Suffolk County Council – the area in which health secretary Matt Hancock is an MP – plans to cut as many as 31 full-time posts from its 120-strong health visitor workforce, through a combination of redundancies and not filling vacancies, despite the team’s key role in family health.
    "Internal council documents seen by the Observer show that the Conservative-controlled authority intends to push through the controversial plan by September in order to save £1m from its health visiting, school nursing and family nurse partnership services."

  • Minister orders review into hospital food after more listeria deaths The Guardian reports "health secretary, Matt Hancock, ordered a review of hospital food on Friday as he came under pressure from opposition MPs, who demanded that he make a statement to parliament on the scandal."
    This followed the deaths of two more people after eating pre-packaged sandwiches and salads linked to a listeria outbreak, taking the total number of deaths to five, according to Public Health England.

  • Fourteen trusts to be excused from reporting A&E target during controversial trial (£) HSJ report notes that "The Nuffield Trust and the King’s Fund both questioned the analytical approach being taken by NHSE, and queried an apparent lack of transparency, after it emerged the 14 trusts piloting the new standards will not publicly report their four-hour target performance during the trial.
    "NHSE said in a note published on its website that the 14 pilot trusts (see full list below), which began testing new metrics last month, were being omitted from the four-hour data for May published today, “as not to contaminate the study design”.
    "The hugely significant trial follows a major review of NHS targets and represents the foundations on which NHSE will potentially build the case for scrapping the four-hour A&E target."

  • Phone call cuts hospital readmissions (£) Times article revealing the unsurprising fact that supporting older people after discharge from hospital reduces the chances of them needing readmission.
    "The researchers acknowledged that more work was needed to look at the wider effects, including those of referring patients to other services. They said, however, that despite this “the study shows early promising findings that reductions in readmission rates could be achieved by offering community nurse follow-up after discharge”."

  • FT loses £59m windfall to other trusts (£) HSJ report flags up mysterious case of the Foundation trust that was expecting receive around £59m of national incentive funding, but has instead seen the money distributed to dozens of other providers.
    "University Hospitals of Derby and Burton Foundation Trust was in line for a bumper payment from the national “provider sustainability fund”, as it expected to significantly surpass its 2018-19 financial target thanks to a major asset sale.
    "But NHS Improvement’s year-end performance report said the trust’s accounts were subject to a “late audit adjustment” which resulted in the “reversal of an accounting treatment used to record an asset sale”.

  • Draft memorandum of understanding relating to the arrangements regarding participation in the Clinical Review of Standards field testing of national urgent and emergency care access standards NHS England guidelines for trusts testing new reporting of A&E performance urge keeping data secret from the public:
    "Performance against these metrics should not, however, be publicly reported. This includes at Public Board Meetings.
    "If forums in which performance is discussed are subject to release of minutes under Freedom of Information legislation, then minutes are to be redacted."

  • The worst places for cancer care waits revealed BBC News reports thatBut 94 out of 131 cancer services in England failed to start treatment within 62 days of an urgent referral by a GP in 85% of cases during 2018-19 - compared with 36 five years ago.
    "The worst performer was Maidstone and Tunbridge Wells NHS Trust, which saw fewer than 61% of patients within 62 days."

  • California to become first state to give free healthcare to undocumented immigrants The Independent reports "California is set to become the first state to extend health care coverage to young, undocumented immigrants with a $98 million plan that would help some 100,000 low-income people in the state.
    "The policy is being considered by the state's legislature, and would expand coverage for the state’s Medicaid program — known as Medi-Cal — to those undocumented immigrants between the ages of 19 and 25."

  • Swindon campaigners say it 'beggars belief' firm got massive NHS patient transport contract Swindon Advertiser reports that campaigners' accusations that Swindon NHS commissioners have failed to do their homework after awarding a multi-million pound 10-year transport contract to a company once branded “diabolical” by councillors.

  • Delays for cancer treatment are the worst on record as it emerges one in five patients has to wait more than two MONTHS to start hospital treatment Daily Mail report tells us delays in cancer waiting times are at their worst level on record – with one in five cancer patients forced to wait more than the target of 62 days to start hospital treatment.
    "A report by the Public Accounts Committee said waiting times have ‘steadily worsened in recent years’ for both cancer treatment and routine surgery."
    A key 18-week target for planned operations for other ailments has effectively been scrapped, and ‘more and more patients are being let down by the continued failure of the NHS to meet waiting times’.

  • GMC chief executive admits Bawa-Garba legal advice was wrong Pulse magazine report reveals the GMC's chief executive has admitted the legal advice the regulator received during the Dr Hadiza Bawa-Garba case was wrong and if the same case were to take place now he would not try to have a doctor barred from practice.

  • Full spending review ‘unlikely’ in time for 2020-21 (£) HSJ picks up an important news item swamped beneath reams of coverage of Trump, Brexit and Tory chaos. A delay to next year in the spending review will leave all NHS plans on hold.

  • GP at Hand’s primary care network application to be ‘considered’ Digital Health reports more signs of undermined values and weakness in the NHS as it is assaulted by the slick marketing opportunism of GP at Hand.

  • Health and Social Care Committee invites Secretary of State to justify refusal of information The Health and Social Care Committee has called the Secretary of State for Health and failed Tory leadership contender Matt Hancock MP to appear before it to explain his refusal to provide it with information on the Government’s review of NHS overseas visitor charging.

  • Forget trade deals – there’s another attack on our NHS happening right now As another health trust prepares to offload its services to a 'SubCo', Richard Bourne's blog for Left Foot Forward looks at an under-reported threat to the NHS

  • Victory for Princess Alexandra domestics on eve of strike Good news story from UNISON, of a 99% vote for strike, determined call for 6 days of action, and a management retreat that will keep staff firmly in the NHS.

  • GP workforce increasingly fragile as reliance on older doctors grows Analysis by GP Online reveals that
    "In September 2015, 20.3% of the permanent, fully-qualified FTE GP workforce was aged 55 or over. By March 2019, 23.6% of GPs in this category were aged 55 or over".

  • Care For America’s Elderly And Disabled People Relies On Immigrant Labor US journal Health Affairs points out the obvious: "our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans"

  • Chief executive to leave troubled trust (£) HSJ report of Simon Wright, CEO for the failing Shrewsbury and Telford Hospital Trust, to step down next month – but found a cosy job "working with sustainability and transformation partnerships”.

  • Woman ordered to find work while lying in coma dies aged 48 Not the first such scandal, or sadly the last, but still shocking barbarism from DWP bureaucrats.

  • Could the NHS be the price of a US trade deal? Nuffield Trust's Mark Dayan warns that "Any trade deal with the USA will be a tough negotiation, with goals traded off carefully against one another. If we prioritise imaginary problems over real ones, the NHS risks getting the short end of the bargain."

  • Trump wavers after saying NHS must be on table in US-UK trade talks Back-tracking by Trump on his demands to open up the NHS to US health corporations after a rush of Tory leadership contenders and other politicians to make clear their opposition to this being part of any US trade deal. US-style commercialised health care is politically toxic: not even the Tories can explicitly accept any association with it,

  • NHS England to offer 'up to' £200k per selected network 'accelerator' site GP leaders have criticised "divisive" NHS England plans to give a £200,000 bung to up to 14 areas which launch Primary Care Networks. The BMA response is that
    "We have previously made our reservations about early-adopter schemes clear, which can often lead to a minority securing unfair additional funding that others are denied, and we would be concerned if this latest plan led to inequity across England."

  • IPPR 60-SECOND SUMMARY of report on social care 2 page whistle stop tour through IPPR plan - cuts out some of the waffle.

  • Implementing the NHS Long Term Plan: Ten key issues for the proposed legislative changes Just as everyone seems to have forgotten the Long Term Plan published less than six months ago the NHS Confederation (representing senior NHS managers, public and private providers and commissioners) wakes up with a jolt and fires off a response.

  • English 'short-changed on care funding' BBC report based on health Foundation research notes that:
    "Public spending on care for the elderly and disabled is much higher in Scotland and Wales than England, figures show.
    "In England, £310 per person is spent each year on services such as care homes and home help for daily tasks such as washing and dressing.
    "But in Scotland, £445 is spent - 43% more than in England - and in Wales it is £414 - 33% more."

  • Council spending on local services down 21% over past decade Guardian reports:
    "In a reflection of the austerity drive imposed on local authorities by Conservative-led governments during the past decade, the Institute for Fiscal Studies said spending on services in England had fallen by 21% between 2009-10 and 2017-18.
    "In a sign of the increasing difficulties facing local authorities across the country, the leading tax and spending thinktank also said the funds available to councils would become increasingly inadequate in the 2020s, rendering the current financing system for the country’s local authorities through council tax and business rates unsustainable."

  • Government pledges more NHS bailouts amid growing audit concerns (£) Exclusive story from HSJ on the parlous and worsening financial plight of many NHS trusts. It reminds us that:
    "Year-end accounts for 2017-18 showed trusts owed a combined £11bn to the department - more than total liabilities relating to the private finance initiative. Accounts for 2018-19 are expected to show another rise in these debts.
    "In 2017-18, 82 providers received audit reports containing paragraphs highlighting “material uncertainty” in relation to their going concern …"
    However NHS England are still conniving at massive and growing deficits: see for example https://lowdownnhs.info/news/debt-ridden-eastern-england-stp-shakes-a-collecting-tin/

  • Tory council chief warns of social care funding shortfall Somerset county council leader tells the Guardian that failure to find funding to cover soaring demand for social care would lead to increasingly difficult decisions about who would be eligible for state help: there will be less funding for complex cases, and those with lower needs will go unfunded.
    "His comments came as a report predicted that English councils risk insolvency if government does not move rapidly to fill a £50bn funding black hole opening up in local authority budgets, in large part because of the spiralling cost of paying for services for vulnerable older adults and children."
    [Obviously nine years of massive cuts inflicted by his own party colleagues in government are also a factor.]
    "The report published by the Conservative-dominated County Councils Network (CCN) ahead of the promised government public spending review says that without extra funding, rising demand for social care will see council finances “plunged into disarray” and services cut to legal minimum levels."

  • English councils warned about 'exhausting' reserve cash BBC report noting that as a result of systematic and deliberate central government austerity in council funding cutbacks since 2010:
    "Some councils in England have been warned they risk running out of cash reserves if recent spending continues.
    "Analysis by the BBC has identified 11 authorities the Chartered Institute of Public Finance and Accountancy (Cipfa) said would have "fully exhausted" reserves within four years unless they topped them up.
    "The Local Government Association said councils faced "systemic underfunding"."
    All of which is exceedingly bad news for social care and public health.

  • Croydon hospital's performance got worse after new £21.5 million A&E unit opened My London report shows Croydon's hospital swamped with a rising tide of emergency patients needing beds. A gleaming new A&E unit in itself was never going to solve that problem.
    "A spokesperson for the trust said: "Growing demand on our emergency department means it now provides about 6% more major consultant-led care than it did in February a year ago.
    "Those are known as 'Type 1' cases. When we include all other types of cases, our emergency department now sees 21% more patients than it did a year ago."

  • In Greece, a life-transforming thyroid pill costs just £1 a month, but in Britain it’s £204 - so how can firms justify the drug daylight robbery? Daily Mail waxing indignant at capitalism rampant and a "market" for pharmaceuticals that forces prices ever upwards rather than down.

  • New issue of The Lowdown Issue 3 includes 4-page overview of privatisation, updates on Circle's defeat at High Court, Cambridge & Peterborough STP passing the hat, GP At Hand, strikes called against privatisation at Princess Alexandra Hospital - and much more

  • The absurdly high [US] cost of insulin, explained Interesting article on Vox.com begins by pointing out that:
    "When inventor Frederick Banting discovered insulin in 1923, he refused to put his name on the patent. He felt it was unethical for a doctor to profit from a discovery that would save lives. Banting’s co-inventors, James Collip and Charles Best, sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it."
    It goes on: "The US is a global outlier on money spent on the drug, representing only 15 percent of the global insulin market and generating almost half of the pharmaceutical industry’s insulin revenue. According to a recent study in JAMA Internal Medicine, in the 1990s Medicaid paid between $2.36 and $4.43 per unit of insulin; by 2014, those prices more than tripled, depending on the formulation."

  • Essex council proposes £25.92 'lifting charge' to help elderly up when they fall Independent report on the latest short-sighted efforts at "savings" by social care at the expense of increased demand on NHS services.

  • NHS bosses accused of breaking law in cancer scanning privatisation Guardian reports latest twist in the ongoing scandal of NHS England's attempts to privatise specialist scanning services in Oxford, Swindon and Milton Keynes. Tory-led Oxfordshire County Council has penned a powerful rebuke, accusing NHSE of ignoring legal duty to consult.

  • Major trust opens talks with Babylon, claiming GPs unable to stem demand (£) HSJ report on University Hospitals Birmingham (which has just recently gone into partnership with US-Based HCA to built a large new private hospital on its main site) now linking up with the firm behind GP at Hand.
    The deal is supposed to centre on ways of reducing demand for hospital services: by the new report on GP at Hand shows its subscribers make MORE than average use of hospital and other services.

  • Cuts may leave NHS short of 70,000 nurses, leaked report warns Guardian on a leaked report showing devastating projections:
    "The NHS could be short of almost 70,000 nurses within five years, according to a leaked copy of the government’s long-awaited plan to tackle the staffing crisis.
    "Blaming the government’s decision to abolish bursaries for nursing students, a draft of the NHS people plan says: “Our analysis shows a 40,000 (11%) shortfall [in the number of nurses needed in England] in 2018-19 which widens to 68,500 (16%) by 2023-24 without intervention, as demand for nurses grows faster than supply.”
    "That would mean that the NHS’s shortage of nurses increases from one in nine of the workforce to one in six, adding to the rising pressures on hospitals, GP surgeries and mental health care."

  • Sustainability of GP at Hand model questioned in major independent report Good, swift analysis by GP Online of new report on GP at Hand, which points out:
    "An independent report on the impact of GP at Hand on patients, the wider health service and the workforce - carried out by Ipsos Mori on behalf of the CCG hosting the service - was unable to conclude whether the service was affordable and sustainable in its current form.
    "It warned that the model required 'considerable numbers of GPs' to sustain and that a national rollout of digital-first services may need 'fundamental large-scale redesign of primary care services, which may require substantial changes in the way in which primary care is funded'."

  • NHS looks to cash in on worried patients with £24 blood-test kits (£) Times reports that
    "The NHS has entered the market to sell consumer blood tests that look for signs of serious illness in a controversial moneyspinning venture.
    "A leading hospital laboratory hopes that online shoppers will pay from £24 for tests that can prevent disease by assessing people’s risk of conditions such as heart disease, diabetes and osteoporosis.
    "But GPs fear it will lead to an influx of the worried well to overstretched surgeries and insist that “curiosity is simply not a good enough reason for medical testing”.

  • Babylon’s GP at Hand service runs up £21.6m deficit FT report highlights another dimension to the continuing rip-off of NHS resources to give preferential treatment to a needy group of wealthier, younger and healthier patients, leaving less resource for those with greater needs.
    "
    Please use the sharing tools found via the share button at the top or side of articles. Copying articles to share with others is a breach of FT.com T&Cs and Copyright Policy. Email licensing@ft.com to buy additional rights. Subscribers may share up to 10 or 20 articles per month using the gift article service. More information can be found at https://www.ft.com/tour.
    https://www.ft.com/content/93843cfc-788c-11e9-bbad-7c18c0ea0201
    "Hammersmith and Fulham CCG expects that NHS England will reimburse it for the costs of GP at Hand, but declined to comment on when that would happen."

  • Princess Alexandra Hospital domestics to strike for six days against ‘insulting’ outsourcing plans UNISON press release:
    "Domestics at Princess Alexandra Hospital in Harlow will take six days of strike action to stop plans to kick their jobs out of the NHS.
    UNISON warns that plans to move 220 cleaning and domestic staff at the hospital out of the NHS would damage the Trust’s excellent infection control rates and hit staff pay and conditions.
    A massive 99% of domestics backed strikes on an 84% turnout in the ballot.
    They will now walk out for 24 hours on Thursday 6 June, the date of the next Trust board meeting."

  • Princess Alexandra Hopsital Domestics - Save our Domestics Campaign Go Fund Me appeal for financial support for the courageous NHS domestics working at Harlow's PAH. They are out on June 6.

  • Whorlton Hall: Hospital 'abused' vulnerable adults BBC's shocking exposure of abuse of NHS-funded patients at privately-run Cygnet owned hospital.

  • Hospitals are swimming in cash (US) Axios website analyses financial statements of 31 prominent 'not for profit' hospitals to find a (perhaps) surprising result.
    "America's rural hospitals are dying. But large not-for-profit hospital systems in cities and suburbs are doing extremely well as premiums rise and as patients struggle to afford their medical bills.

  • How NHS staff are fighting back against the ‘hostile environment’ Open Democracy response to misleading Daily Mail article notes that:
    "Despite the claims made by the Daily Mail, the policy of charging migrants for NHS care has not been reversed.
    "The article mentions the pausing of a pilot scheme run in 18 Trusts that required people to bring 2 forms of ID to their outpatient appointment. No evaluation of these pilots is available, though we know through freedom of information requests that of 8900 people checked only 50 were found to be eligible for charging."

  • Judge green-lights award of CCG's disputed £320m contract (£) HSJ report on result of Circle's legal challenge to 16 CCGs as the company tries to cling on to its main lucrative NHS contract. More info also on this from https://lowdownnhs.info

  • Stop the UK blocking global efforts for affordable medicines Appeal from Global Justice Now points out:
    "The UK government is trying to undermine the resolution at this week's World Health Assembly – and is even pushing for all references to “high prices” to be taken out. This is an outrage, and we need your help to expose it.
    "High prices are a big reason why people are not getting the essential medicines they need, in the UK and around the world. Denying that they exist is not an option. The UK should be backing, not blocking, this global effort to make medicines more affordable."

  • 'Taking food out of patients' mouths' - Norfolk health bosses criticised for bailout to Midlands trusts The bizarre Eastern Daily Press headline relates to NHS England's Regional Director requesting five other East of England STPs contribute to help bail out indebted Cambridgeshire & Peterborough STP. None of the STPs involved is in the "Midlands", but the journalist is referring to the previous Midland and Eastern Strategic Health Authority, which has since been divided back again. Last time we checked Cambridge was not in the Midlands: but the health economy is deep in the red, projecting a £192m shortfall this year.

  • England’s social care models harm the poorest areas Useful BMJ blog by David Oliver pointing out inbuilt inequality of funding and resources:
    "A 2018 analysis showed that 25% of services in England’s most deprived local authority areas were rated inadequate by the Care Quality Commission, compared with only 15% in the 10 most affluent areas. It was published by the Labour Party’s research team, but the conclusions are compelling."

  • 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
    https://www.healthcampaignstogether.com/newsroundup.php

  • 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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