A new scheme will charge foreign patients in the NHS for emergency treatment, possibly even for calling out an ambulance.
New government plans will attempt to raise more cash for the health service, as the Conservative party continues to address the gulf in funding of the NHS.
It is already predicted that there will be a £30 billion deficit by the end of the decade in the health sector, and despite increasing spending by £8 billion, it is clear that there is still a massive gap to plug.
This is before the Tory plans for a seven-day NHS working culture are implemented, which would seem to inevitably place more pressure on the service as a whole.
So the new plan to raise funds from overseas patients must be seen in the context of the wider NHS financial picture.
Certainly some critics of the scheme have simply suggested that this is an unnecessary and unjustified measure merely intended to raise revenue.
Nonetheless, visitors from outside the European Economic Area already pay for planned hospital care.
The Health Secretary Jeremy Hunt indicated that he believed it would be possible to save millions of pounds for the NHS by extending these charges to accident and emergency care.
Yet the British Medical Association was critical of the scheme, indicating that doctors were in no position to deal with the plans.
Overseas visitors can currently receive A&E treatment, ambulance services and GP visits free of charge, but it is possible that such individuals will now be unable to receive treatment until fees are paid.
The Department of Health has indicated that refugees and asylum seekers will be exempt from this scheme, and various other vulnerable groups will be excepted.
Commenting on the plans, a spokesman for the Department of Health outlined the position of the government.
“International visitors are welcome to use the NHS, provided they pay for it – just as families living in the UK do through their taxes. This government was the first to introduce tough measures to clamp down on migrants accessing NHS care and have always been clear we want to look at extending charges for non-EEA migrants.”
But the Royal College of Emergency Medicine questioned the pressure that the scheme would place on doctors.
A spokesman for the Royal College of Emergency Medicine stated that A&E doctors “cannot reasonably be expected to take on the burden of identifying who is eligible for free treatment, and who should be charged”.
Meanwhile, the British Medical Association commented that “a doctor’s duty is to treat the patient in front of them, not to act as border guard. Any plans to charge migrants and short-term visitors need to be practical, economic and efficient.”
New regulations in April ensure that non-EU citizens settling in the UK for longer than six months pay a health surcharge as part of visa applications.
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.”
Experts are warning that a series of crucial health services in England could be under threat due to funding issues.
In particular, services aimed at smoking, obesity and sexual health are especially vulnerable.
The news can be placed in the context of a decision by the Chancellor of the Exchequer, George Osborne, to cut the existing public health budget.
Osborne announced that £200 million would be shaved off the overall budget beginning in January.
This fund is currently held by councils, and thus is not part of the government’s overall promise to protect the NHS.
Yet experts operating within the health service believe that the money is vital in order to ensure that pressure is relieved on the NHS as a whole.
A total of 11 groups, including the Academy of Medical Royal Colleges, Royal College of Nursing, NHS Confederation and Faculty of Public Health, have signed a letter to George Osborne urged the Chancellor of the Exchequer to reverse his plans.
The letter particularly suggested that reducing the funding would lead to increased ill-health and inequality in the general population.
Another subject touched upon by the letter was the fact that the Chief Executive of NHS England, Simon Stevens, had called for extra funding for the health service ahead of the general election.
Prof John Ashton, of the Faculty of Public of Health, stated: “The legacy of a decision to cut the public health grant will be major further burdens on the health service within the foreseeable future. Avoidable ill health, heart disease, sexual health problems, unplanned pregnancies – these are the kind of things which are being affected by this irrational cut to funding.”
The letter comes in the light of the recent fiscal results of the NHS that suggest that the publicly funded health service will be £2 billion in deficit by the end of the financial year.
It is clear that the NHS faces massive funding difficulties despite the promise of the Conservative government to increase spending by the end of the decade.
In addition to the financial problems related to this issue, it is also suggested that the spending cuts will significantly exacerbate inequality in the UK.
Rob Webster, chief executive of the NHS Confederation, is particularly concerned about this prospect.
“There is an unprecedented consensus that we can only address the problems facing the NHS if we invest in the future of our nation’s health by helping people to stay well. Open any report from any director of public health in any part of the country and you can see health inequalities and poor health putting pressure on NHS services and blighting people’s lives. We need the upcoming spending review to protect public health budgets,” Webster asserted.
The government responded by stating that the health service is indeed a priority for investment, but also indicated that difficult decisions need to be made across government departments to reduce the overall spending deficit.
Monitor has announced new measures decided to support trusts across the NHS in managing workforce challenges.
According to the healthcare regulator, data acquired by Monitor just last week on Q1 trust and foundation trust financial performance highlighted the need for concerted further action in the coming months and years.
This data indicated that the NHS is likely to face a deficit of at least £2 billion in the existing financial year.
In particular, Monitor has stated that it is important to address workforce challenges.
Thus, it is critical, according to the regulator, to address the rapid growth of spending on agencies, and to develop a more holistic approach to staffing decisions.
With this in mind, the healthcare regulator has announced that it is to take two important steps in order to address the situation.
These have been taken with the support of the national system leaders in the NHS, and it is hoped that this will enable healthcare professionals throughout the system to meet these challenges more effectively.
A joint letter from Sir Mike Richards, Mike Durkin, Jane Cummings, Sir Andrew Dillon and Ed Smith, has already been distributed to NHS employees, setting out Monitor’s view on how providers should approach the need to ensure safe, quality care for patients on a sustained, financially stable basis.
It was also considered important in the content of the letter to reinforce the need to use guidance and best practices in order to support local judgements regarding the best usage of resources.
Following on from this letter, Monitor has been encouraged by providers to take urgent national measures in order to address pay for agency staff.
It is hoped that this would help encourage workers back into substantive roles within the NHS.
Considering this to be an important issue for the health service, the health regulator has just taken the decision to accelerate the timescale regarding this process.
Subject to consultation, Monitor proposes to introduce hourly prices for agency staff across all staff groups, namely doctors, nurses and all other clinical and non-clinical staff.
Subject to the consultation process, the price caps would ratchet down in two further stages so that from 1st April, 2016, agency staff would not be paid any more than the equivalent substantive worker.
The intention is to put this process in place by 23rd November, 2015.
All trusts would be expected to limit and reduce their spending on agency staff over time, and Monitor will continue to work closely with all trusts to monitor and limit levels of agency use across the sector as the measures are implemented.
The proposed price caps have been developed with, and are fully supported by, clinical leaders in Monitor, TDA, Care Quality Commission (CQC) and NHS England.
Clearly action needs to be taken in order to address the huge deficit that the NHS faces, but many critics of government policy will suggest that increased funding would be more effective than cost-cutting, regardless of the legitimacy of these measures.
The GMB union has indicated its opposition to significant cuts in services at Barnsley Hospital.
Members of the union are said to be extremely concerned about the potential risk to patient safety.
And the hierarchy of the GMB union has issued a statement indicating their view that it is “only a matter of time before there is a serious incident”.
The cuts in question are effectively worth £3.5 million of services at the South Yorkshire hospital.
In particular, services related to women and strokes have been targeted.
With Barnsley Hospital attempting to fulfil the decision made by the NHS regulator, the organisational structure of the hospital is currently assessing the possibility of reducing bed numbers.
This has resulted in the Stroke Ward facing a bed reduction from 20 to 14, with the GMB union warning that patients will have less opportunity to gain access to specialists as a result.
Meanwhile, the Gynaecology Ward will go from a seven-day to five-day service, also with a reduced bed capacity from 20 to 14.
Consequently, potential issues such as ectopic pregnancy, miscarriage and emergency surgery on a weekend will be dealt with by general nurses and not a specialised nursing team.
Pregnancy services and a specialised surgical ward are also affected by the multi-million pounds cuts.
Barnsley Hospital has suffered since financial irregularities were discovered by the regulator Monitor last year.
Monitor has already instructed the hospital to disregard the maximum patient waiting time of four hours for accident and emergency, with other cost-saving targets to be employed instead.
Currently on the cuts, Martin Jackson, GMB Branch Secretary and Staff Nurse at Barnsley Hospital, expressed his concern about the level of care in the hospital declining as a result.
“Members are extremely concerned about the risks to patient’s safety and fear it is only a matter of time before there is a serious incident.”
Jackson also suggested that the cuts were indicative of the lack of realism in the government’s highly publicised seven-day NHS plans.
“So much for the Tory claim to be making the NHS a seven day per week service. Staff are under immense pressure to deliver high quality patient care but are at breaking point. To make matters worse GMB representatives are being denied proper consultation with hospital management to address patient care concerns. Senior NHS managers keep informing GMB that the quality of care is their first priority while their actions speak of the reverse.”
Stacey Booth, GMB Lead Officer for the NHS, suggested that there had been a lack of transparency in this process.
“There has been minimal consultation about the proposals. Hospital management is making changes at a time when the Trust is under severe pressure. The hospital is already stretched and has introduced an Escalation Ward to deal with the high turn-over of patients, but the ward doesn’t have a dedicated medical team and this is leading to a lack of consistency in patient care. Lives are being put at risk,” Booth commented.
GMP is opposing the cuts, and could choose to ballot its members on industrial action in the foreseeable future.
According to a recent investigation, a raft of general practitioners in England are being offered significant sums of money in order to cut the numbers of patients being referred to hospitals.
The investigation carried out by Pulse found that some doctors are being offered thousands of pounds as an incentive to make such decisions.
Naturally this is incredibly controversial considering that patients should simply be referred for hospital treatment based on its necessity or otherwise.
But the doctors’ publication Pulse found that GP practices across the country are being paid in order to help local NHS groups limit the overall number of patient referrals.
Rather than being a logistical issue, this is seen as being a cost-cutting exercise, according to the publication.
Among the issues being deferred were scans and consultations with specialists, and most troublingly these even included cancer patients.
Despite the seriousness of the allegations made by the Pulse survey, this was found to be a relatively widespread practice.
At least nine clinical commissioning groups (CCGs) were offering GP practices payments for hitting targets, according to Pulse’s investigation.
Perhaps the most notable case discovered by the publication related to Birmingham South Central CCG.
This particular clinical commissioning group was offering practices in excess of £11,000 in order to reduce new outpatient attendances, follow-ups, A&E attendances and emergency admissions.
The CCG even set a target of reducing figures by 1 per cent compared with the previous financial year.
While Pulse found that the scheme run by the Birmingham organisation could be attributed to fiscal motivations, the organisation has defended itself since the allegations came to light.
The Birmingham South Central CCG stated that the program of payments was intended to “incentivise best quality practice” and “drive improvements in the quality of primary medical care”, with a spokesperson on behalf of the organisation suggesting that the priority of the organisation “is to ensure that patients have access to services that they need, when they need them.”
Elsewhere, another organisation suggested that the full impact of the scheme had been considered diligently before it was put in place, and the CCG believes that there is no conflict in trust inherent in the programme.
Nonetheless, despite the rhetoric from the CCGs, many people will undoubtedly view the payment of general practitioners to refuse referrals as being a disturbing and sinister development.
And the news has drawn harsh, but what many will see as warranted, criticism from prominent medical figures.
Dr Chand Nagpaul, chairman of the GPs committee of the doctors’ trade union the British Medical Association, described the scheme as a “financial contaminant” to patient-doctor trust.
“It’s short-sighted and misguided of CCGs to introduce such mechanisms, because they do lead to the potential for patients questioning the motives of GP referrals. We believe it is far more appropriate for CCGs to introduce clinical pathways that ensure patients are referred appropriately rather than these crude, salesman-like bonuses which pay GPs simply to make reduction to referrals in numerical terms,” Nagpaul stated.
The outcome of the investigation by Pulse can be placed in the context of pressure being placed on the NHS to make efficiency savings.
£22 million of such savings have been targeted by the government by the end of the decade.
But many will view this news as indication that the balance between efficiency and medical ethics is not being conducted appropriately.
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].”
The government body Monitor has announced that is it to undertake an investigation into the financial conduct of Mid Cheshire Hospitals NHS Foundation Trust.
Finances at the trust have deteriorated significantly, and the regulator will examine the reasons for this, and also attempt to establish an approach that will lead to an improvement.
Monitor intervened after it became evident that the trust was experiencing financial difficulty.
The Mid Cheshire Hospitals NHS Foundation Trust had, in fact, reported a surplus during last year’s accounting period, but its financial position has since declined significantly. Reports suggest that the trust will accrue a £5.4 million deficit for the 2015/16 financial year.
The trust is responsible for Leighton Hospital and the Victoria Infirmary, and plays a major role in one of England’s largest and most prosperous counties.
Speaking on the issue, Paul Chandler, Regional Director at Monitor, stated that the government body is concerned about the financial health of the Mid Cheshire Hospitals NHS Foundation Trust.
“The trust’s finances have deteriorated and the most recent projections show that things could get worse over the coming year,” Chandler warned.
“Patients in and around Crewe, Northwich and Winsford rely on the services this trust provides, so we’re investigating to find out more about the problem and what can be done to improve the situation,” Chandler continued.
Chandler emphasised that no decision has yet been made on whether regulatory action would be necessary, but he did indicate that such a decision could be expected imminently.
Independent NHS trust are intended to provide care on a sustainable basis, and it is a major part of Monitor’s duties to ensure that this remit is being met adequately.
In the case of the Cheshire trust, the degrading financial position of the trust has been a massive red flag to the government body that further investigation is vital.