Jeremy Hunt has come out swinging against criticism of the government’s NHS policy, suggesting that the problems of the health service are not caused by funding alone.
Claims have been made by prominent NHS experts that there is a massive gulf between the government’s claim that the NHS had been awarded an additional £10 billion of funding, and the reality.
Estimates by independent organisations that have put the “true” figure at about £4.5 billion; obviously less than half of the amount claimed by the authorities.
Commenting on the issue, Nigel Edwards, the Nuffield Trust’s chief executive, warned that the winter months could be particularly challenging.
“The NHS is going into its toughest winter yet with the odds stacked against it. Demand for healthcare is on the rise, funding for both health and social care is being squeezed and A&E departments are missing their targets.”
Yet Hunt has dismissed the suggestion that the performance of the NHS Is suffering because of a lack of funding
“We do tend to get in the run-up to the autumn statement a coalition of people who will say that the answer to all the NHS’s problems is more money from government. The big question is: does the NHS have enough money, and the answer to that is that we do need more resources – we are looking after a million more people aged over 75 than five years ago. That’s why we are putting in £4 billion more. It isn’t just about money – it’s also about standards.”
Hunt suggested that a process of learning and best practice could seriously aid the NHS going forward.
“There’s lots of things we can do in terms of helping to ensure we are better at learning from mistakes, so that we don’t have this huge legislation bill of £1.5bn because of some of the mistakes we have made – that all helps on the money front. There are, of course, financial pressures, but I think it’s a mistake to say this is only about money. It’s also about getting the culture right.”
The health secretary also claimed that the NHS is well placed to cope with raised demand this winter.
“I can say I think we are better prepared this year than we have ever been. There’s always the unpredictable, the cold spells, the flu outbreaks and so on…I think it would be wrong for any health secretary in the run-up to winter to say everything’s tickety-boo.”
Yet independent assessments suggest that the NHS will seriously struggle to cope over winter, with the most pessimistic estimates indicating that the entire system could break down in a worst-case scenario.
The Labour Party has been critical of Prime Minister Theresa May’s statement that there will be no additional cash boost for the NHS in the Autumn Statement.
It had been hoped that the outcome of Brexit would force the government’s hand into an investment-based strategy for the healthcare system.
But Jonathan Ashworth, Labour’s shadow Health Secretary has opined that in the NHS is dangerously overstretched, and suggested that the government has failed to address the situation adequately.
Indeed, Ashworth argued that blame for the situation can be reasonably and primarily apportioned to the government itself, stating that the problems are of the “government’s own making”.
“The NHS is facing a funding crisis with hospitals, GP surgeries and social care dangerously overstretched Just last week we were warned the social care sector was on the verge of ‘tipping point’. One in four patients are waiting a week or more to see their GP, or not getting an appointment at all, and thousands of patients are waiting hours in A&E and hospital trolleys,” Ashworth asserted.
“The crisis is of this Government’s own making and it’s up to Theresa May and Jeremy Hunt to take action…the Tories promised during the last election they’d properly fund our NHS. This is yet another example of Tory broken promises,” Ashworth added.
Medics had already warned that critical NHS systems are close to breaking point, and that staff reductions and redundancies are on the cards if further investment is not allocated to the healthcare system.
But an NHS source close to the government told the The Guardian newspaper that there are no plans to increase funding.
“No 10’s message at the meeting was quite blunt and stark: that there will be no more money. Theresa May and Philip Hammond say that they presided over big efficiency programmes at the Home Office and MoD and didn’t whinge about it. Their view is that the NHS is already doing very well, but that’s head in the sand stuff.”
Dr Mark Holland, president of the Society for Acute Medicine, has already made bleak prognostications for the prospects of the NHS this winter.
“The NHS is on its knees and, this winter, areas will implode around the country. There is no reserve left. We coined the phrase ‘eternal winter’ months ago in relation to increasingly poor performance and this data is clear evidence that is what we are now dealing with. Over the coming weeks and months, if we see a major increase in admissions due to flu or bed closures due to norovirus, we will collapse”.
Holland also characterised the attitude of the government as bordering on negligent.
“The Government has failed to acknowledge or address the scale of the crisis in social care and delayed discharges and, at present, I see no plan of action in place to prevent it derailing the health service. If we are unable to discharge patients and release pressure on our emergency departments and acute medical units at the front door, the system grinds to a halt”.
NHS trusts accrued a collective deficit of £2.5 billion during the previous financial year.
A leaked report has indicated that the plans of Jeremy Hunt to introduce a seven-day culture to the NHS may be completely misguided.
The report in question suggests that it is impossible to prove that more staffing at weekends will reduce the number of patients that die.
There have been question marks about the ability of the government to implement this supposed scheme, with many healthcare professionals believing that the culture of the NHS is really one of a seven-day nature already.
Indeed, the report also admits it will be “challenging” to meet the government’s promise to recruit 5,000 more GPs by 2020, a Conservative pledge during the election campaign, and that 11,000 new staff will be needed to run a seven-day service in hospitals.
Considering the reduction in expenditure that the Conservative party has instigated in the NHS, with £22 billion worth of efficiency savings targeted, it would seem to be impossible to recruit this number of staff to key positions.
Additionally, the Tories are also facing ongoing rows with junior doctors and nurses over funding and pay issues.
The increased numbers of deaths among patients admitted at weekends has been the cornerstone for Hunt’s argument in favour of a seven-day health service.
Yet an internal Department of Health draft report indicates that it is impossible for the department to “evidence the mechanism by which increased consultant presence and diagnostic tests at weekends will translate into lower mortality and reduced length of stay”.
This will only strengthen the opinion of those who have been critical of Hunt’s plans, which have been strongly challenge in terms of ethos, but now also seem to be completely impractical and even fundamentally flawed.
Hunt threatened last July to impose a new contract on consultants to help bring about the seven-day NHS, if they did not resume negotiations.
Yet disputes have not found a resolution in the process, with the general public seeming to support the position of junior doctors increasingly strongly.
The Conservative party had previously made it a major manifesto pledge to create what it described as a truly seven-day NHS by the end of this decade.
But these plans would now seem to be increasingly tenuous.
Dr Mark Porter, the British Medical Association’s chair of council, was scathing in his assessment of the leaked report.
“This leaked document makes clear that more seven-day services will require not only thousands of extra doctors, nurses and support staff but an additional investment in both the NHS and community care. Its findings also show no proven link between weekend mortality rates and consultant presence, and suggests that other investment is more necessary.”
A Department of Health spokesperson naturally defended the position of the government.
“There is clear, independent clinical evidence of variation in the quality of care across the week and, working together with the NHS, we are determined to tackle this problem. Making sure the right staff and support is available for all patients seven days a week is a key part of our approach.”
A new initiative will provide the UK government with access to NHS records in order to identify which general practitioners administer the greatest number of sick notes.
But the idea has already been strongly criticised by both doctors and privacy campaigners.
The idea has been dismissed as little more than state nooping, and suggestions that data could be utilised in order to name and shame GPs who are perceived as soft have already been voiced.
Yet despite the controversy around the policy, the government still plans to go ahead with the procedure in the near future.
From next month, the Department for Work and Pensions (DWP) will be able to see information extracted from GP records, including the number of fit notes issued by each practice and the number of patients recorded as “unfit” or “maybe fit” for work.
Responding to criticism of the idea, the Department for Work and Pensions suggested that the information would provide a better understanding of why people take sickness leave in different regions of the UK.
Commenting on the issue, Dr Peter Swinyard, of the Family Doctor Association, was pretty scathing in his assessment.
“I think that is state snooping. I don’t know if patients understand that when I write a fit note, some bureaucrat is going to be able to have a look at it Although I am sure some civil servant thought it was a terrific idea somewhere, I am not entirely sure I agree. I don’t know if patients understand that when I write a fit note, some bureaucrat is going to be able to have a look at it.”
Records acquired by the DWP will provide information on the number of computer-generated footnotes, how many patients are recorded as unfit or maybe fit for work, the duration of footnotes, and the gender of persons involved.
The DWP claims that all sick note statistics are completely anonymous, and that the information will simply provide a better understanding of the sickness absence in the UK.
However, an investigation carried out by Pulse magazine found that the claims of the DWP do not necessarily stand up to scrutiny.
The government organisation previously claimed that the data involved would be published anonymously at Clinical Commissioning Group level.
But the publication instead found that it will be possible for officials working for the DWP to view data for individual GP practices, while data sharing with other bodies will also be enabled.
The data will also indicate what type of health condition the person is suffering with and the location of where the note was issued.
Understandably, this has already generated a great deal of controversy and opposition.
Nonetheless, a spokesman on behalf of the DWP defended the policy of the government department.
“We know the damage that can be done when people are absent from the workplace for extended periods of time, that’s why we want to ensure that people get the best possible support to return to work – or to avoid falling out of work in the first place. All fit note statistics are anonymous, and they will help provide a better understanding of why people take sickness absence in different areas across the country, so we can make the service as effective as possible for businesses and employees.”
While GP and patient privacy has been a cause for concern, it is also suggested that the information will be extremely misleading outside of the context of surgery discussions.
Despite the apparent concerns of the government, the estimated number of working days lost has fallen from around 39.5 million in 2000-02 to 27.3 million in 2014/15.
According to the English chief medical officer, Dame Sally Davies, obesity is a huge threat to women’s health, not to mention the stability of future generations.
Davies has recently submitted her annual support, which represents part of her role of chief medical officer.
And this year’s report particularly focuses on women, with Davies suggesting that tackling obesity should be considered a national priority.
Indeed, the officer went as far as suggesting that the situation related to obesity in the UK can be described as a “growing health catastrophe”.
In particular, Davies focused on the food industry and the recent suggestion of the government that some form of the sugar taxation should be introduced.
England’s top doctor said obesity was so serious it should be a priority for the whole population, but particularly for women because too often it shortened their lives.
Around 60 per cent of women in the United Kingdom are classified as overweight or obese.
This is an extremely serious health situation, as obesity greatly increases the chances that any individual may experience numerous extremely serious conditions.
Obesity increases the risk of many diseases including breast cancer, type 2 diabetes and heart disease.
The report makes 17 recommendations across a range of women’s health issues.
Many factors are suggested to have contributed to the obesity epidemic.
On the one hand, while diet is frequently blamed for the situation, the increasingly sedentary lifestyles of the population also play a serious role.
However, Davies particularly emphasises that responsibility of food manufacturers.
“I think we’re at a tipping point. If industry won’t deliver then we’ll have to look at a sugar tax,” Davies suggested.
Davies also recommends that everyone with an eating disorder should have access to a new and enhanced form of psychological therapy, called CBT-E, which is specifically designed to treat eating disorders.
Speaking to the BBC, Davies outlined some of the important measures that she believes will be central to changing the culture of the United Kingdom.
“I think it is inevitable that manufacturing has to reformulate and resize, that supermarkets and others need to stop cheap promotions on unhealthy food and putting unhealthy food at the check-out, and limit advertising dramatically.”
Dame Sally also stated that she wanted to “bust the myth” that women should eat for two when pregnant, adding a healthy diet with fruit and vegetables and avoiding alcohol was important.
While obesity is just one of the many health problems facing women in the UK, it is also one of the most common.
Many health professionals have compared the obesity situation in Britain to a ticking timebomb.
NHS figures suggest chronic problems related to mental health in NHS England.
According to the latest reports from the health service, as many as 2,000 people suffering from mental illnesses are sent miles from their homes every month.
Of those who are forced move, in excess of 25 per cent ultimately travel over 30 miles from their home area.
This latest information came direct from reports compiled by the Social Care Information Centre.
This is a worrying trend as it has been acknowledged that such moves often cause significant distress for both patients and their families.
The data was published by the Observer newspaper after Norman Lamb, the ex-health minister who obtained the figures, passed them to the publication.
“It’s an outrage what happens. We know that out-of-area placements have a link to an increased risk of suicide. This would never, ever happen with a physical health problem, such as a stroke or heart failure. Why should we accept this for someone with acute mental illness, when we wouldn’t accept it for someone with cancer? It’s complete discrimination at the heart of the NHS,” Lamb asserted.
Figures from the records indicate that in April 2,067 people were looked after as inpatients outside the area covered by their local mental health trust.
This had increased to 2,198 by August.
Particularly guilty of this process were health authorities in Devon, Lancashire and Kent and the Medway.
Bed shortages where considered a particular problem in these regions.
Studies conducted previously have indicated that some patients have been sent as far as 370 miles from their homes in extreme circumstances.
Reflecting on the issue, Mind, the mental health charity, suggested that treatments carried out a significant distance from the home of patients can significantly influence the quality and rapidity of recovery.
“Friends and family can form a hugely important support network, so when someone is sent far away it can have a big impact,” said Vicki Nash, head of policy and campaigns at Mind.
“It is concerning enough having a loved one in hospital with a mental health problem, but the extra stress of travelling to see them adds to the strain.”
Although the government has suggested that it will address the situation, admitted cuts to bed numbers are making the situation considerably more complex.
A Department of Health spokesman defendied the policy towards mental health in the NHS.
“An urgent review of out-of-area acute mental health treatment is currently under way, led by [ex-NHS chief executive] Lord Nigel Crisp. Mental health minister Alistair Burt has said that with this review, and consulting with the Mental Health Taskforce, he will announce targets and an ambition to deal with a situation which has been allowed for too long.
We have made it clear that local NHS services must follow our lead by increasing the amount they spend on mental health and making sure that beds are always available.”
A raft of top medics have written a letter to The Guardian newspaper condemning the policy of the Chancellor of the Exchequer, George Osborne, toward the National Health Service.
The letter suggests that Osborne’s “front-loaded NHS funds” do not represent extra money, but is in fact merely a forwarding of funds already promised by the Parliament to the NHS.
Medics who have signed the letter point out the statistic that has been reported by the Healthcare Times on numerous occasions previously; namely that the NHS requires an additional £30 billion of funding by 2021.
Yet the Chancellor of the Exchequer has only committed an additional £10 billion at the time of writing, basing efforts to address the funding gap on completely unrealistic expectations of £20 billion of efficiency savings.
According to the signees of this particular letter “this is a frighteningly unrealistic expectation for a health system already among the world’s most efficient. Efficiency savings are fast becoming a euphemism for funding cuts.”
The prospect of funding such incredibly high year-on-year efficiency savings is, at best, incredibly logistically unlikely, and at worst potentially disastrous for the health service.
NHS trusts will be expected to push through a deficit of £2.2 billion this year to avoid compromising patient care through cuts.
The medics signing this open letter are of the belief that it is completely unsafe to expect the same scale of savings between now and the end of the decade.
Indeed, independent experts who have commented on the subject have all agreed that the rapid expansion of non-emergency seven-day services will need extra staff and funding, far from it being feasible to cut everyday expenditure.
Furthermore, NHS England CEO Simon Stevens has specifically said seven-day services would need to be gradually introduced, with “careful and disciplined phasing-in”.
Yet the government has already stated its intention to switch to a so-called seven-day culture in the NHS in the foreseeable future.
The letter notes that no additional funds for this proposal have appeared at the time of writing, indicating that further cuts will be required in order to provide something that the writers of the letter claim is little demanded by the public.
It appears that public health, social care and nursing student grants will all be caught in the near future, as Osborne continues to justify his fiscal plan for the health service.
Finally, the letter notes that the Health Secretary has already promised to work with a cross-party political consensus, along with professionals in the NHS, in order to have an open discussion about the future funding of the health service.
The signees conclude: “As NHS staff and students, we urge him to maintain the spirit of this promise, in open discussion with the professions and other political parties. The safety of the public deserves nothing less.”
The letter was signed by over 75 healthcare professionals.
The UK government has stated that it intends to introduce tuition fees and loans for student nurses.
This new policy will enable those studying to become nurses to cover their existing living expenses.
The decision of the government will undoubtedly be considered a controversial plan, as it will leave student nurses facing debts of around £65,000 each.
Predictably, the Royal College of Midwives has been extremely critical of the plans.
The organisation which represents midwives across the UK has suggested that young women are already disincentivised from joining the profession due to financial reasons.
Jon Skewes of the Royal College of Midwives Stated that “many midwives already make huge personal and financial sacrifices and now the burden of future debt will exclude many fantastic potential midwives”.
The college added that it believed that the new funding scheme would deter many nurses from taking up places in the future.
On Wednesday, the Chancellor announced plans to expand the number of training places for nurses, in a bid to plug growing shortages, promising an extra 10,000 places by 2020.
George Osborne indicated that the scheme would ultimately be funded by the replacement of the existing system of bursaries.
The scrapping of this system would raise in the region of £800 million.
However, the Royal College of Midwives has suggested that it believes the scheme will involve funding schemes for students, effectively leaving them liable for costs of £9,000 per annum in tuition fees.
This figure would be additional to the £12,000 pounds per year required to cover living costs.
The aforementioned Skewes continued: “Quite often after CSR announcements such as this, the dust settles and you can see the small print. Today the RCM has unearthed the true cost to now train as a midwife in the UK and it is most unsettling. Our understanding as of today is student midwives and nurses will now also be saddled with seeking a loan for both their student support and tuition fees. The combined cost could potentially burden student midwives with a debt of £65,000 for a three year degree programme.”
Skewes went on to question whether the profession would be able to attract as many midwives in the future.
“These plans are appalling and will deter great future midwives that the NHS so badly needs. Many midwives already make huge personal and financial sacrifices and now the burden of future debt will exclude many fantastic potential midwives.”
Janet Davies, Chief Executive & General Secretary of the Royal College of Nurses also expressed concern.
“Anything which deters people from entering the nursing profession puts the future of the NHS in jeopardy. It is hard to imagine that potential nurses, including those who may be older and have commitments such as mortgages, will not be deterred. They could be presented with the prospect of a debt which is more than double their expected salary.”
While the Department of Health defended the decision, the general consensus of opinion is that this will be a major burden to people wishing to enter midwifery.
It is perhaps indicative of a generally hostile government policy towards NHS workers in general, also illustrated by the furore over the ongoing junior doctors’ contract dispute.
The British government has agreed to enter into talks with ACAS over the ongoing dispute with junior doctors.
This eleventh hour effort is intended to mitigate against the threat of strikes, but the union representing junior doctors has underlined that they have not been called off at the time of writing.
Responding to the threat of strike action, Health Secretary Jeremy Hunt has indicated that he is willing to utilise the conciliation service.
Hunt had initially stated after the strike ballot results were revealed last week that he would be unwilling to enter any form of mitigation process.
At the time, Hunt had said the industrial action, due to start next week, should be cancelled to “avoid harming vulnerable patients”.
The British Medical Association (BMA) had responded strongly to this statement, indicating that the strikes would indeed take place as planned.
And although it seems that Hunt is attempting to avoid strike action, the BMA has maintained its position on the subject, at least for the time being.
The first day of action is Tuesday, starting at 8am and lasting 24 hours.
ACAS is an independent body that can help parties – normally an employer and unions – resolve employment disputes.
Because the two sides in this particular case are simply requesting conciliation, ACAS will merely be required to host the talks rather than offering any meaningful or binding recommendations.
Writing to the leader of the BMA, Dr Mark Porter, Hunt claimed that it was important for the two sides in the dispute to work together.
The Health Secretary claimed that the long running dispute could be resolved amicably were the two sides to work together in a spirit of conciliation and cooperation.
Nonetheless, Hunt also expressed his disappointment that the BMA had refused to agree to the offer that he had made previously.
He also emphasised the potential threat to safety that the strike action that is due to take place next week would represent.
However, despite the apparent intention of Hunt to enter into some form of conciliatory talks, the letter sent by the Health Secretary makes no mention of dropping his previous threat to impose the contract.
The BMA had strongly opposed this policy previously.
Commenting on the letter, the aforementioned Dr Porter stated that the talks would be critical for the future of the NHS.
“We hope to start these talks as soon as possible in order to reach a collaborative agreement for the benefit of patients and the NHS. Importantly, Jeremy Hunt must finally remove his threat of imposition in order to defer Tuesday’s industrial action.”
Chancellor of the Exchequer George Osborne has announced that front line services in the NHS will receive a investment of nearly £4 billion.
The announcement from the government can be placed in the context of growing fears about pressures on the health service.
To be precise, front line services will receive a direct cash injection of £3.8 billion, which is considered to be an above-inflation rate figure.
The funding boost represents a rise of nearly 4 percent on NHS England’s £101 billion front line budget this year.
This can be seen as a precursor to the Autumn Statement, which is scheduled for tomorrow.
However, the Treasury has indicated that this rise will form apart of the overall manifesto promise to provide the NHS with additional funding of £8 billion by the end of the decade.
It is not clear yet whether this £8 billion figure will be adjusted following the cash injection, or whether Osborne still intends to continue with the manifesto plan.
The decision to inject cash into the NHS can be placed in the context of a somewhat failing health service.
NHS trusts are heading for a deficit of more than £2 billion this year as they fight to keep control of costs.
And reports have indicated that occupancy levels throughout the health service are already extremely serious ahead of the anticipated winter surge.
The rise will bring spending to £106.5 billion in 2016-17, which is the equivalent of a 3.7 percent or £3.8bn rise once inflation is taken into account.
Details about precisely how the money will be spent have not been released yet. It will be interesting to see whether this will form part of the statement to be released by the government tomorrow.
Speaking ahead of the Autumn Statement, Chancellor of the Exchequer Osborne claimed that this new funding would cement the future of the NHS.
“This will mean world-class treatment for millions more patients, deliver a truly seven-day health service and allow the NHS to implement its five-year plan to transform the services patients receive,” Osborne stated.
But Anita Charlesworth, of the Health Foundation think tank, was concerned about what had yet to be announced by the government.
“Any move to redefine and shrink the definition of the NHS would be particularly worrying. If some of the new money comes from other parts of the health service – such as public health or training – it would be a false economy.”
Labour shadow health secretary Heidi Alexander echoed this view.
“If new investment in the NHS is to be funded by raiding budgets for nurse training, public health and social care, then it will be robbing Peter to pay Paul.”
It is already known that the NHS will need to plug a £30 billion deficit by the end of the decade, and the Conservative party has previously suggested that this could be achieved via efficiency savings.
The Care Quality Commission (CQC) has suggested that 40 per cent cuts to central government funding of its inspection program could have serious implications.
David Behan of the CQC has stated that the organisation has been asked to incorporate funding cuts of 25-40 per cent into plans for the next financial year.
And Behan warns that this will have a serious impact over the capabilities of the CQC in the forthcoming period.
With this in mind, the regulator has stated that it will defer any decisions related to the delivery of these 2016-17 inspection plan until the spending review has been completed.
The statements of the Care Quality Commission come in the context of the warnings that the Treasury made in redefining the ringfence on NHS spending.
It is particularly expected that some bodies within the organisation will be targeted for efficiency savings.
The Conservative government has set the NHS a target of achieving efficiency savings in excess of £20 billion by the end of the decade.
Yet increasingly a picture is emerging of a conflict between the spending expectations of the government and the reality of delivering acceptable services.
It has already been reported that the Care Quality Commission will miss its deadline to inspect all adult social care, GPs and out of hours services by 30th September next year.
Thus, it is only reasonable to assume that spending cuts will push this deadline back further still.
Commenting on the matter in a board report, Behan writes: “The implications for delivering the [inspection] plan in 2016-17 depend on finalisation of the spending review, CQC receiving a budget allocation for 2016-17, and final agreement on fees for 2016-17. No decisions have been made on these three important influences so I propose that discussing the programme for 2016-17 is deferred until such time it is clear what the decision is in respect of these three issues.”
Treasury officials have already signalled their intention to redefine the ringfence on NHS spending, which would then apply to only NHS England commissioning budgets.
This would mean that numerous Department of Health budgets would be excluded from government commitments to increase NHS spending by £8 billion over the existing Parliament.
Any plans to achieve massive efficiency savings in the NHS can be placed in the context of the recent financial figures related to the health service.
According to these numbers, the NHS will run up a financial deficit of £2 billion during the existing fiscal year.
A CQC spokeswoman commented on the matter: “All government departments have been asked to model scenarios of 25 per cent and 40 per cent of savings from their grant in aid by 2019-20 in real terms. In line with this, the CQC is undertaking an exercise to consider possible implications ahead of the upcoming comprehensive spending review.”