Civil servants representing the Department of Health have stated that seven-day NHS plans may cause workforce overload, with the lack of GPs particularly problematical.
A risk register emanating rom the Department of Health, and dated late July, lists 13 major risks with the planned seven-day NHS rollout.
Thus, despite the rhetoric from the Department of Health, it seems quite clear that the practicalities of a seven-day NHS are far from clear.
Senior civil servants have apparently openly stated that the NHS has both insufficient staffing and money in order to implement the ambitious initiative.
There are a wide range of concerns in this area, with the failure to improve hospital care at weekends central to them.
Additionally, it is all believed that Brexit could be negative, “particularly with regards to workforce and finances’ because the NHS employs 55,000 staff from around the EU; and a risk that ‘patients do not report any difference/improvement in their experience [of] out of hours and at the weekend”.
BMA chair Dr Mark Porter said the risk register demonstrated succinctly that the Government pledge for a seven-day NHS was “nothing more than a headline-grabbing soundbite set to win votes rather than improve care for patients.”
“To see in black and white that the Government has disregarded its own risk assessment’s warnings about the lack of staffing and funding needed to deliver further seven-day services, is both alarming and incredibly disappointing. If the Government wants to make more services available across seven days, then it needs to urgently address how it will staff and fund them rather than continue to mislead the public and brand doctors – who already work round the clock, seven-days a week – as a roadblock to their plans.”
Labour’s shadow health secretary Diane Abbott was scathing about the issue, speaking strongly on what she perceived to be the nefarious motives of the government.
‘This is a scandal. The Government is undermining the NHS with plans it knew to be unworkable. I will be writing to Jeremy Hunt to ask him to explain how why has contravened his civil servants advice and to ascertain whether he has misled Parliament.”
But a Department of Hhealth spokesperson suggested that the risk register is “entirely routine” and only listed “worst-case scenarios”.
“We are confident our programme for a safer seven-day NHS is on track, and will deliver real benefits for patients. Over the past six years eight independent studies have set out the evidence for a “weekend effect” — unacceptable variation in care across the week. This Government is the first to tackle this, with a commitment to a safer, seven- day NHS for patients and £10 billion to fund the NHS’s own plan for the future, alongside thousands of extra doctors and nurses on our wards.”
A new fast-track scheme will attempt to ensure that more graduates enter social work in community mental health teams.
The Department of Health is backing this new initiative, with £10 million to be invested in the social work-focused scheme.
However, it must be noted that £10 million is not a huge amount of money in health terms, and there must be question marks regarding how successful it will be in attracting graduates.
And the number of graduates actually being targeted by the initiative could be considered pretty paltry.
The scheme run by charity Think Ahead aims to recruit 300 graduates by 2018 to work with nurses and psychiatrists.
Each graduate entering the scheme will be subjected to specialist training on supporting individuals and families with mental health problems.
And the good news for graduates entering the scheme is that they will be paid throughout the training course, and will qualify as social workers a year earlier than would be normal.
The scheme has already attracted 2,300 applicants, with 100 places to begin working in July. Funding will provide 200 further places by 2018.
Sarah Carr, who chairs the National Service User Network, indicated that the FastTrack program will have a significant influence on social work in the United Kingdom.
“Support from a social worker with the right skills and expertise can be transformational for people living with mental health problems. The programme gives graduates the skills to empower the individuals they work with – so that they can manage their mental health, stand up for their rights, and find their own paths towards personal recovery.”
The social worker profession has particularly struggled in recent years, with many vacancies not being filled satisfactorily, and continual caps in local government funding.
Social workers also face massive pressure from heavy workloads, and it is hoped that this fast-track scheme can ease the burden on the existing quotient of professionals.
Mental health minister Alistair Burt opined that social work is an extremely demanding and important profession, and hence hoped that the fast-track scheme would enable more people across the country to lead independent and fulfilling lives.
“This is a great initiative to attract the brightest and best into the profession,” Burt commented.
Each year in the Health and Social Care sector around 5% of workers suffer from an illness they believe to be work-related, while 2% of workers sustain a work-related injury.
It has been announced that the Department of Health is to cut about 650 jobs to reduce running costs.
The Ministerial Department of the United Kingdom Government responsible for policy on health and adult social care matters in England currently employs nearly 2,000 staff.
Yet it seems that this decision has been made in order to help the department stick to budgetary requirements.
It may be suggested that this is something of a piecemeal move, considering the vast deficits that the Department of health and the NHS are facing.
Non-senior staff numbers will fall from 1,800 to 1,200-1,300 by April 2017 and staff at three London offices will move to a single site in Westminster.
It appears that this downsizing will make a significant contribution to the clerical functions of the department being reduced in both scope and expenditure.
While £22 billion of efficiency savings have been sought in the NHS, and this can be viewed as indicative of this process, it in fact fits into a general pattern within government in general.
Most Whitehall budgets were cut in last November’s spending review and the Department of Health is attempting to make efficiency savings of 30% in the next five years.
Critics will suggest that cutting staff rarely turns out to be cost-effective, and it would have been more sensible to streamline processes within the organisation, while maintaining existing headcount.
Yet the chancellor announced a cut in the budget of the Department of Health, although NHS spending was protected.
This made some review of staffing in the Department of Health pretty much inevitable.
Commenting on the decision to reduce the number of employees in the department, a spokesman on behalf of the Department of Health indicated the ethos behind the decision.
“The priorities for the new Parliament are clear and the spending review has confirmed financial expectations. The Department of Health will begin a new programme of modernisation, starting now.”
Permanent Secretary Una O’Brien added that the staffing decision was a sensible one, and would contribute to the financial targets that the department has been set.
“The Department of Health has an important role leading the health and care system in England to help people live better for longer. It is only right that the Department of Health should take its fair share of the efficiency savings.”
It has been widely reported that the NHS is expected to run up a deficit of £2 billion by the end of this financial year.
This is unquestionably a massive logistical problem, as Prime Minister David Cameron has already indicated his intention to switch the culture of the NHS to a truly seven-day service.
The ABPI and the Department of Health have announced their intention to underwrite the growth in the medicines bill for the second quarter of 2015.
This initiative will be taken under the Pharmaceutical Price Regulation Scheme (PPRS) that was agreed last year.
The PPRS is a purely voluntary agreement between the two parties involved, although the existing understanding between the Department of Health and ABPI will run until the end of 2018, having come into effect on 1st January, 2014.
Under the terms of the payments, the ABPI and the Department of Health will make a payment of £209 million during the current financial quarter.
In 2015, the industry has already contributed £416m in PPRS payments to support the ongoing usage of branded medicine in the NHS.
During 2014, the pharmaceuticals industry paid a total of £310 million to the Department of Health under the PPRS, and it is anticipating payments totalling £800 million for 2015.
But as funding becomes an increasing challenge, figures released indicate that the growth in branded medicine is slowing down significantly.
In the second quarter of 2015, the growth rate of branded medicines utilised in the scheme was 2.41 per cent.
To put this figure into perspective, this was half the rate for the same period last year.
Speaking about the issue, David Watson, Director of Pricing and Reimbursement for the ABPI proclaimed the scheme to be a success story. “As an industry, we want to see patients getting access to the best high value medicines across all therapy areas. This Scheme provides the NHS with a unique opportunity to give patients in the UK greater access to new and innovative treatments at minimal cost,” Watson claimed.
However, Watson was also forced to concede that the growth rate in branded medicines was less than ideal.
“We are deeply concerned that the reduced growth rate shown in the second quarter suggests that patients in the UK are still losing out. Whilst industry is underwriting the medicines bill, patients are still not getting access to the right medicines at the right time,” Watson admitted.
The sub-par figures in this area can be underlined by comparing the United Kingdom to mainland Europe.
The UK, in fact, lags significantly behind the rest of Europe with regard to investment in medicines, if one uses the measurement of expenditure on pharmaceuticals per resident.
Figures released related to the PPRS agreement would seem to suggest that this situation is declining further still.
Watson acknowledged this, and made a plea for action to be taken to address the situation. “This is bad news for patients – we urge the NHS to ensure the PPRS payments allow clinicians to prescribe the medicines that they believe are right for their patients.”
In total, 134 companies, representing 93 per cent of the UK branded industry, have joined the voluntary PPRS.
As the revelations regarding the amount of bailout cash made available to NHS trusts sinks in, more information has seeped out regarding the Department of Health’s scheme.
It seems that the department proffered bailout money to a raft of particularly troubled hospitals in the form of loans, according to official figures.
A group of foundation trusts were informed in the latter months of the 2014-15 financial period that bailout would be converted to debt.
This is part of an overall policy of encouraging financially distressed organisations within the NHS to manage their finances more adequately.
The identities of the organisations involved in the scheme have now also been made public. 11 trusts effectively borrowed a total of £167 million in what are described as “interim deficit support” loans during the previous financial year.
Monies acquired by the trust contributed towards a raft of different expenditure, including staff wages and pharmaceutical products.
The five biggest recipients of loans from the Department of Health were the Milton Keynes Hospital Foundation Trust, Medway Foundation Trust, the University Hospitals of Morecambe Bay Foundation Trust, the Barnsley Hospital Foundation Trust and the South Tees Hospital Foundation Trust.
Each of these organisations received loans totalling at least £17.7 million, with Milton Keynes having acquired a payment in excess of £25 million.
Repayment terms for the loans presented to the NHS trusts have been set at a five-year period. It is not clear at the time of writing whether the Department of Health is likely to accept negotiation of these terms.
The decision to offer bailout packages as a form of credit represents an alteration in Department of Health policy.
Previously, bailouts were provided to NHS trusts in the form of “public dividend capital”. These monies were bailouts in the truest sense of the word, as there was no expectation on behalf of the government that they would be repaid.
According to the Department of Health, the shift in ethos is intended to ensure that departmental support can be provided with the condition of a recovery plan being put in place.
The apparent intention to recover money offered as bailouts will perhaps alter perception of the scheme, even though questions still clearly need to be answered regarding NHS funding and budgets in general.
Figures published today indicate that the Department of Health paid out a staggering £1.2 billion on bailouts in 2014-15.
The ten-figure sum was earmarked in order to assist no less than fifty troubled NHS providers, all of whom faced difficulties in meeting pay commitments, along with remunerating creditors and other expenses.
It is also telling that some of the £1.2 billion figure was required in order to address structural deficiencies in the health service. The replacing of ageing equipment and need to cut fiscal deficits in existing NHS budgets also contributed to the overall bailout.
Not only is the figure paid out by the Department of Health a large one, but there is also strong evidence that the bailout situation within the department is deteriorating.
The £1.2 billion total was in fact double the amount that was paid out by the department during the previous fiscal year.
Additionally, it is clear that the acute sector is becoming ever more dependent on bailouts. The proportion of this tranche of the NHS that required bailouts rose to one-third in 2014/15, a significant increase from the one-quarter equivalent from twelve months previously.
And some NHS trusts are evidently struggling significantly to meet costs. Over a dozen NHS trusts received bailout money that was worth more than 10 per cent of their annual income.
With three trusts having received funding in excess of £50 million, the level of bailouts within the NHS certainly cannot be described as trivial.
Commenting on this issue, King’s Fund policy director Richard Murray, a former senior analyst and economist for the Department of Health, pulled no punches in describing the figures as “horrific”.
Murray opined that the picture was one of irrevocable structural disintegration. “It just strikes me again how much the payment system in the NHS looks fundamentally broken – if you’ve got this many [providers] now reliant on an alternative source of funding to their commissioners.”
The NHS is, of course, not the first organisation of significant size and scale to receive bailout money in what is this age of austerity and economic malaise.
To give one example, the HBOS banking and insurance group received £37 billion of public money to prevent its collapse in October 2008.
But the figures reported with relation to the Department of Health do paint a picture of a gulf in funding in the health service that will need to be addressed in the immediate future.
And a particularly troubling aspect of this news is that the £1.2 billon figure does not convey the true extent of the bailout.
This does not include the £239m that the DH paid out last year in ‘dowries’ to struggling trusts, nor £177m in ‘non-recurrent’ payments to specialist acute providers to which NHS England agreed last year.
The serious nature of the budgetary problems that have been succinctly illustrated by these revelations led the aforementioned Murray to muse rather gravely on “whether the department will run out of cash [in 2015-16].”
Northern Lincolnshire and Goole NHS Foundation Trust has committed itself to developing a short-term plan to improve its current financial position – a move approved by the healthcare regulator Monitor.
The trust, which provides services to patients at three sites – Diana, Princess of Wales Hospital in Grimsby; Scunthorpe General Hospital; and Goole and District Hospital – was put in special measures following the July 2013 Keogh review into trusts with higher than average mortality rates.
Then following an inspection by the Care Quality Commission which found that the quality of care had improved significantly, the trust was taken out of special measures by Monitor in July 2014. Since then, however, the trust’s finances have deteriorated significantly and a plan to request short-term emergency funding from the Department of Health is imminent.
Monitor has stated that it recognises there are underlying financial issues which Northern Lincolnshire and Goole NHS Foundation Trust can’t fix alone. The regulator has therefore agreed further measures which will see the trust working with commissioners, local authorities and patient groups to develop a separate plan to ensure high quality, sustainable services in the longer term.
Monitor has confirmed that it will continue to scrutinise the trust’s performance and will take further action if it is deemed necessary.
Three million pounds of funding to help improve stem cell services in the UK has been announced by the Department of Health (DH).
The funding pledge, in support of a partnership between NHS Blood and Transplant (NHSBT) and blood cancer charity Anthony Nolan, has been made to provide extra help for patients with leukaemia and other life-threatening blood disorders.
The £3m announced by the Mr Freeman means that £19m has been invested in stem cell services since 2010.
“This funding is vital to help improve stem cell services and ultimately save lives”, said Mr Freeman. “It will increase the number of young male donors and allow a targeted collection of cord blood from those groups who currently find it difficult to find a suitable match.”
The DH funding will also be used to help increase the number of young adult stem cell donors and particularly those from black, Asian and ethnic minority populations.
Andrew Hadley, General Manager of Specialist Services Operations at NHS Blood and Transplant, said: “It’s great the Department of Health has decided to provide us with more funding to continue our work saving and improving lives through stem cell and cord blood donation. By 2020 we hope to have 150,000 adult stem cell donors typed to a high resolution which will reduce not only the time it takes to match patients with donors, but for people in desperate need of a transplant to receive lifesaving treatment.”
The Department of Health (DH) has announced that the responsibility for planning and paying for public health services for 0 to 5-year-olds, including health visiting, will transfer from the NHS to local authorities in October 2015.
The DH has also said that, as part of the transfer, a number of universal health visitor reviews, which form part of the 0-5 Healthy Child Programme, will be mandated for a period of 18 months, depending on Parliamentary approval.
These reviews are: (i) antenatal health promotion review; (ii) new baby review (which is the first check after the birth); (iii) 6-8 week assessment; (iv) one year assessment; and (v) two to two-and-half year review.
A DoE spokesperson said: “It is intended that these mandation arrangements will help ensure that a universal health visiting service continues as it is a service that is essential to supporting the health and wellbeing of families and children at a crucial stage of development.”
Mandation factsheets explaining the responsibilities of local authorities after the transfer and how and why the commissioning and associated funding are being transferred are available on the DH website.
The mandation arrangements will be reviewed after one year
The Department of Health (DH) has launched a new consultation on proposed changes to the NHS Constitution.
The proposed changes are a direct response to the recommendations made by Sir Robert Francis QC in his Freedom to Speak Up Review (published on 11 February).
Amongst several proposals, the Government is looking to amend the NHS Constitution to: (i) give greater prominence to mental health; (ii) reflect the importance of access to transparent and comparable data; (ii) include the Armed Forces Covenant: and (iv) reflect the new fundamental standards.
The consultation document states: “By April 2015, we will see changes to the way hospitals are inspected, with the introduction of new fundamental standards. Failure to meet these standards, and an inability to meet the high standards patients expect and deserve, will result in decisive action to protect patients. It is also of upmost importance to promote a culture of openness within our NHS, which we hope to achieve through the introduction of the duty of candour.
“We need to close the gap between physical and mental health, and we believe that the NHS Constitution should make it clear that both are of equal importance. We believe that these important policies deserve to take their place amongst the core principles, values and responsibilities of the NHS – and should be set out clearly in the rights and pledges we make to patients.”
The consultation on the changes to the NHS Constitution – a set of principles which encompass patient, public and staff rights and the ‘responsibilities owed to each other to ensure the NHS operates fairly and effectively’- will formally close on 11 March 2015.