More cash would mean tough decisions 23 March 2018 Indications that the government is edging towards a radical, long-term funding settlement for the NHS – as pressure grows from its backbenchers to get a grip on the problem – are raising hopes of a solution to the funding crisis. But more cash will force the health service to address even tougher questions than money. With NHS trusts running an underlying deficit in the region of £3.7bn, there is a serious risk that the acute sector will rapidly soak up any new cash while primary, mental health and community services will again be left fighting over the scraps. It would be folly to take even more taxpayers’ money – inevitably at the expense of other public services – without a concerted effort to drive out inefficiencies in the system, integrate more effectively, deliver on the numerous promises around prevention and early intervention and improve accountability to the public. A new funding settlement could prove the catalyst for yet another round of reforms. The trick will be to make them about patients rather than structures. Many hospitals are beset with serious inefficiencies, from unacceptable variations in clinical performance – exposed by data from the Get It Right First Time drive – to wasting money on everything from pointless outpatient appointments to poor procurement of medical devices. Read the full article at the Guardian Healthcare Network __________________________________________________ Devo Manc - progress, but big obstacles 19 March 2018 Two years after Greater Manchester got control of its £6bn health and social care budget, the bold experiment in devolving power over health services is starting to make a difference to people’s lives. But its long term success is far from assured. The five year devolution deal with the government and NHS England for the area’s 2.8 million inhabitants began in April 2016 and has been followed by a similar agreement in Surrey Heartlands (box). Much of the early work of the Greater Manchester Health and Social Care Partnership— the body that oversees the devolution project—has been hidden from public view. Groundwork includes an immense effort to bind the 37 NHS organisations and local authorities together, and beginning the long journey to shift the staff and leadership culture so that people begin to think of themselves as working for a patient driven system rather than just their own organisation. The big goals are to make the Greater Manchester health and social care system financially sustainable by 2021 and to improve health indicators such as large numbers of low birthweight babies and high cancer mortality under the age of 75. Read the full article at the BMJ __________________________________________________ Staff survey reveals ambulance horrors 9 March 2018 The latest NHS staff survey – the world’s biggest workforce study – is both shocking and uplifting. It highlights appalling communication by senior managers, increasing anger about pay and signs that discrimination is on the increase. But it also reveals extraordinary resilience under pressure. Almost half a million staff responded to the questionnaire last autumn. The growing pressure for action on pay is clear, with just 31% saying they were satisfied with their pay. This is a fall of 6% since 2016, one of the biggest changes in the survey. The number of organisational “never events” remains stubbornly high. Around one in 50 staff experienced physical violence from other staff in the last year and around one in four reported harassment, bullying or abuse from staff. Around one in eight experienced discrimination – and more of it came from colleagues and managers than patients and service users. Just over 84% believe their organisation provides equal opportunities in careers, a figure that has declined steadily over the past five years. One of the most worrying revelations is that the poor performance of ambulance trusts evident in the 2016 survey continues. Read the full article at the Guardian Healthcare Network __________________________________________________ Bawa-Garba case opens safety schism 23 February 2018 The manslaughter conviction and subsequent erasure from the medical register of paediatrician Hadiza Bawa-Garba has opened up a schism over healthcare safety that will harm patients if it is not resolved quickly. On one side is the jury, which gave a 10:2 majority verdict for gross negligence manslaughter over the death of six-year-old Jack Adcock in 2011; the General Medical Council (GMC), which wanted Bawa-Garba struck off; and the high court, which backed the GMC. On the other side is the Medical Practitioners Tribunal, which suspended her for a year, arguing that erasure would be disproportionate; the GMC’s own regulator, which found serious flaws in its arguments; the health secretary, Jeremy Hunt, who has expressed deep unease about the case; and most – but not all – grassroots medical opinion, which is appalled by the implications of her conviction and striking off. Bawa-Garba was found guilty after the jury deliberated for five days. Nurse Isabel Amaro was also found guilty. The medical tribunal subsequently suspended the doctor rather than strike her off, pointing to “multiple systemic failures” that contributed to mistakes in the child’s care and noting her good record before and since. Read the full article at the Guardian Healthcare Network __________________________________________________ Scandal shows bullying harms patients 10 February 2018 The two most shocking revelations to emerge from the investigation into Liverpool community health NHS trust are that every part of the system failed, and it happened even as the trust was considering what it should learn from the Mid Staffordshire scandal. The independent review by Dr Bill Kirkup into events at the trust between 2010 and 2014 shows the root cause of the trust’s problems was an inexperienced and bullying leadership obsessed with achieving foundation trust status, irrespective of the effect on patients. This toxic culture seeped into every part of the organisation, breaking the morale of frontline staff and inflicting serious clinical harm. Those brave enough to raise concerns risked bullying, harassment and suspension. It was a dysfunctional organisation from the moment it was created in 2010 with an inexperienced and inadequate management team. Two clinical commissioning groups and NHS England pushed it to achieve significant savings, which had a serious cumulative impact, but the trust made matters far worse with self-imposed cost cuts in pursuit of its managers’ dream of foundation status. Read the full article at the Guardian Healthcare Network __________________________________________________ Errors worsen nursing workforce crisis 26 January 2018 The health select committee’s report on the nursing workforce is a excoriating critique of the multiple errors in policy and practice that have created a recruitment and retention crisis. Indeed, it is difficult to identify a single aspect of nursing workforce management that is not being mishandled. The UK has relatively few nurses compared with many EU countries – yet there are still 36,000 NHS nursing vacancies in England. Around 33,000 of these are filled with bank and agency staff, which ramps up costs. While the headlines focus on shortages in hospitals, the rush by acute trusts to recruit nurses in the light of the Mid Staffordshire inquiry has fuelled shortages in other parts of the NHS. The result is that since 2010, the number of nurses in general, elderly, adult, children’s and midwifery services has grown by between 7% and 11% – while the numbers working in community services have dropped by a tenth, district nurses have fallen by almost a half, learning disabilities have lost almost 40% and mental health has lost 13%. So despite the rhetoric about “parity of esteem” for mental health, and commitments to move services into the community, in the desperate scramble for staff, the needs of acute hospitals are warping the entire system. Read the full article at the Guardian Healthcare Network __________________________________________________ A Royal Commission would be a mistake 12 January 2018 As patients die in corridors and A&E performance drops to its lowest ever level, calls are growing for a royal commission to address the mounting problems facing the NHS. This would be a big mistake. This week the commission idea was raised in prime minister’s questions and the Centre for Policy Studies has published a remit for one. The attraction of a royal commission is that it offers a chance to cut through the party political noise to allow calm consideration of the issues. But the realities of setting one up far outweigh the potential benefits. Virtually everything about a commission would harm the NHS. If it was announced on the health service’s 70th anniversary in July, by the time the members had been approved, the remit agreed, evidence gathered and the report written, even the most nimble commission would have taken at least three years. (The last one on the NHS, set up under Harold Wilson, took four years.) That would put it within months of the 2022 general election. So legislation would have to wait until at least the first Queen’s speech of the next parliament, which means nothing would change before April 2024. Read the full article at the Guardian Healthcare Network __________________________________________________ What will an NHS winter be like in 2020? 5 January 2018 What pressure will the NHS be under in the first week of 2020, and what will be the consequences? This winter, the NHS finally ran out of road. Among the deluge of data revealing the depth of the current problems, three shocking figures stand out. So far, 23 out of 152 acute hospital trusts have declared black alerts – this means a wet week in January is a “serious incident” preventing them offering comprehensive care. BBC analysis shows that, this winter, more than one in eight ambulances taking patients to hospital on an emergency call have had to wait more than 30 minutes to hand over to A&E staff. People who have had strokes are among them. In the last week of 2017, bed occupancy averaged 91.7%, with virtually every trust in the country exceeding the widely accepted safe threshold of 85%. The pressures are no less in general practice. So there is no safety valve, no reserve capacity, no underused resource. Old- style winter planning – such as opening extra wards – is largely redundant because hospitals need their entire capacity all year round. So in winter they have nothing left to give. Read the full article at the Guardian Healthcare Network __________________________________________________