LATEST
ARTICLES
NHS faces a crisis of beds and
money
11 December 2015
As the peak weeks for “winter pressures” in the NHS edge
closer, the health care system is facing a second crisis – an
imminent clampdown on overspent trusts.
In a careful dissection of the evidence of why winter routinely
causes serious problems, the Nuffield Trust tries to explain why
an extra £250m over winter two years ago, and a huge £700m
last year, failed to deal with the issue.
It stresses that the problems in winter are not caused by more
people turning up at A&E – in fact, fewer attend in cold weather
– but admission rates are relatively high and, among other
factors, there is a growth in people with breathing problems
who need to spend longer in hospital. But the underlying cause
is that bed occupancy is too high – often above 90% – so
systems soon topple over as more patients are admitted.
Nuffield estimates that it would take another 14,000 beds to get
occupancy down to the widely-accepted safe level of 85% and
hit the four-hour A&E wait target. The alternative is to focus on
that very small proportion of patients – less than 4% – who
account for more than a third of the time in NHS beds.
Read the full article on the Guardian Healthcare Network
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NHS leadership needs swift
treatment
4 December 2015
There are too few NHS staff willing to take on the toughest
leadership roles, and too few of those that do survive.
Successive reviews have exposed the failures in NHS
leadership development, but progress in addressing them is a
long way from matching the scale of the problem.
The review of NHS leadership by former Marks & Spencer
executive chairman Lord Rose, published in June, pinpointed
one of the central difficulties facing the health service – the
organisation is committed to a vast range of changes but does
not have sufficient management and leadership capability to
deliver them.
The Rose review was followed within weeks by Ed Smith’s
review of centrally-funded leadership and improvement work.
Smith, who has been appointed chairman of NHS
Improvement, praised the quality of NHS Leadership Academy
programmes, but his assessment of leadership work across the
system was coruscating. He concluded the current approach is
“remote, fragmented and unclear” and “difficult to access and
navigate”.
Work intended to support clinical leadership came in for
particular criticism, not least the fact that few people
understood the improvement roles of clinical senates, strategic
clinical networks and academic health science networks.
Read the full article on the Guardian Healthcare Network
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Osborne offers NHS relief but no
cure
27 November 2015
The chancellor’s promise of more cash for the NHS masks
substantial cuts outside the core funding, while the increase
fails to keep pace with rising demand. The spending review
might mitigate some of the worst extremes of the immediate
crisis, but it will not secure long-term sustainability or changes
to the way care is delivered.
As Anita Charlesworth, chief economist at the Health
Foundation, pointed out, substantial areas of critical spending
have been stripped out of the definition of the NHS and the
wider health system will suffer a real-terms cut of more than
20% by 2020-21. This includes junior doctor training, health
visiting, health education, sexual health and vaccinations.
On top of this public health is being hit hard, with a 4% cut
every year in real terms. The government is also going to
consult on whether public health spending should be fully
funded by business rates.
Government grant to councils will be more than halved by
2020, although the Treasury claims this will be covered by
increased revenue from council tax and business rates.
Allowing councils that provide social care to impose a 2% levy
on council tax to help pay for it will provide some relief, but it is
far from a solution.
Read the full article on the Guardian Healthcare Network
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Hunt shares responsibility for
NHS crisis
6 November 2015
Jeremy Hunt’s confrontation with junior doctors over seven-day
working adds to a growing list of problems beginning to engulf
the health secretary. Will he still be at the department’s
Richmond House headquarters at the end of this parliament?
It is just over three years since Hunt replaced Andrew Lansley.
It quickly became clear why David Cameron was so determined
to keep Hunt in government despite the controversy
surrounding his handling of News Corporation’s bid for
BSkyBwhile he was culture secretary. Immediately burying any
mention of the toxic health reforms, he shrewdly repositioned
the role of health secretary from representing the NHS to
government, to representing the interests of patients to the
NHS.
His relentless focus on the Mid Staffordshire scandal allowed
him to be seen as the champion of patients and safety, while
ensuring media attention was locked on to a failure he could
convincingly portray as the fault of the Labour government.
But his insistence on “safe staffing levels” for nursing has
propelled hospitals down the route of employing agency staff
they cannot afford to fill newly-created posts. Balancing the
risks between going into deficit or being accused of unsafe
staffing, hospital managers have invariably decided to spend
the money, which is why the deficit for hospitals in the current
year is heading towards £2bn.
Read the full article on the Guardian Healthcare Network
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Time to scrap the four hour A&E
target?
26 October 2015
One month before the comprehensive spending review, data
from the King’s Fund have revealed the shocking impact of
social care cuts on NHS hospitals. The financial distress in
trusts can no longer be allowed to crush every other funding
demand across the care system.
The King’s Fund’s latest quarterly monitoring report shows
nearly 90% of acute trust finance directors surveyed say social
care cuts are affecting the performance of local health services.
Around 64% of trusts – and 88% of acute trusts – predict they
will end the financial year in deficit, and not a single trust
finance director is “very confident” of being able to balance the
books in 2016-17.
When it came to clinical performance, delayed transfers – the
strongest indicator of the impact of social care cuts – were up
by a fifth on a year ago, and there is little confidence in
delivering promised cuts to emergency admissions on the back
of the Better Care Fund.
There is no sign of the rise in A&E attendances slackening off;
according to NHS England there were more than 5.7m A&E
admissions in the three months to June; seven years ago it
was under 5 million.
Read the full article on the Guardian Healthcare Network
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Community services need their
voice
9 October 2015
Community services should be at the centre of debate about
the future of the NHS. Patient focused, cost-effective and at the
forefront of prevention and early intervention, they are crucial to
making the health service sustainable in the face of rising
demand. Health secretary Jeremy Hunt even described
transforming care outside hospitals as his “biggest priority”. But
community services are being held back by the relentless focus
on hospitals and their own failure to make themselves heard.
There is a huge spectrum of community services, from
children’s care to re-ablement, mental health support, falls
prevention, podiatry, speech and language therapy, wound
care, continence, dementia care and palliative care. It includes
community nurses, therapists, pharmacists, and sometimes
social workers. Most of it takes place in people’s homes.
The NHS Confederation says there are more than 100m
community health contacts with patients every year. This
compares with around 85m hospital outpatients appointments
and 340m contacts with GPs.
Read the full article on the Guardian Healthcare Network
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New regulator faces an
impossible task
9 October 2015
Jim Mackey is an outstanding choice as first chief executive of
the new provider regulator, NHS Improvement. The problem is
that, in the face of a deficit of £930m in just three months this
financial year, he has been given an impossible task.
Mackey’s work as chief executive of Northumbria healthcare
foundation trust embodies key areas where the NHS needs to
succeed. The trust is demonstrably patient focused, it has an
impressive level of integration with social services, it is making
good progress on working more closely with primary care, and
it found a novel solution to its PFI problems – getting help from
Northumberland county council, which could access low
interest rates. Mackey has also been working on a provider-led
“accountable care organisation” to manage population health
and is an enthusiast for hospital chains.
But an impressive leader and a beguiling new name to replace
Monitor and theNHS Trust Development Authority are scant
comfort in the face of the growing and apparently
uncontrollable deficit. It is far from clear that yet another
reorganisation of the central bodies is going to deliver the scale
and speed of change required to avoid a complete loss of
financial control.
Read the full article on the Guardian Healthcare Network
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Addenbrooke’s falls into a CQC
trap
2 October 2015
The Care Quality Commission’s (CQC) decision to condemn
Cambridge University Hospitals NHS Foundation Trust as
inadequate forced out its physician chief executive and opened
up serious questions about the inspection process.
The chief executive, Keith McNeil—a former sniper in the
Australian special forces who became a transplant pioneer at
Papworth—quit shortly before the commission published its
inspection report last month and the regulator Monitor put the
trust into special measures.
With a deficit running at around £1.2m (€1.6m; $1.8m) a week,
staff shortages, major difficulties getting patients in and out of
the hospital, and disruption caused by the implementation of its
new electronic health record system, the inspectors must have
expected to find serious problems. Yet overall the outcomes at
Cambridge—better known by the name of its largest hospital,
Addenbrooke’s—are impressive by national and international
standards; its mortality rates are low and its safety record is
strong.
Read the full article at the BMJ
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Public Policy Media
Richard Vize