Monthly Archives: March 2014
The Royal College of Physicians (RCP) has welcomed the conclusions of a working group report: ‘Joined up Clinical Pathways for Obesity’. Professor John Wass, the RCP academic vice president and representative on the working group, said:
“The RCP first highlighted the complexity of commissioning obesity services in the 2013 report Action on Obesity. The unclear role of commissioners has led to a patchwork in the provision of obesity services which has prevented individuals from accessing vital services.”
Whilst health promotion campaigns and other preventative measures attempt to stem the tide of obesity, the NHS must better manage the large numbers of patients presenting with severe complex obesity. The RCP is working to support commissioners to understand their responsibilities and will soon be publishing guidance on the commissioning of tier three – primary care and hospital specialist services.
The Royal College of Nursing (RCN) has warned that patient care is being put at risk as the NHS has lost nearly 4,000 senior nursing posts since 2010. The void includes ward sisters, community matrons and specialist nurses and has been brought about by cost saving reorganisation, it says.
The NHS is in the middle of a tough drive to save £20bn by 2015 and the government has claimed this can be achieved through efficiency savings without harming the frontline.
The public inquiry report into Mid Staffordshire Foundation Trust by Robert Francis QC, highlighted the importance of having the right staffing numbers and skill mix on wards. The Department of Health says it is putting more nurses on wards. They say that an extra 2,400 hospital nurses have been hired since the Francis report, with over 3,300 more nurses working on NHS hospital wards and 6,000 more clinical staff overall since May 2010.
However, according to the most recent data, in November 2013, the NHS was still short of 1,199 full time equivalent (FTE) registered nurses compared with April 2010. The RCN says that hidden within wider nursing workforce cuts are a significant loss and devaluation of skills and experience in the NHS, with 3,994 FTE nursing staff working in senior positions.
Dr Peter Carter, Chief Executive and general secretary of the RCN, said: “As more patients require complex care from specialist nurses, letting so many years of skills and experience vanish from the NHS is an utterly reckless policy.”
Health Minister Dr Dan Poulter said:
“We know clinical leadership by healthcare professionals matters – that’s why we’re investing £40m in leadership training for ward sisters, senior nurses and midwives to create a new generation of leaders in our nursing workforce.”
MPs have voted through a controversial measure that gives the Health Secretary special powers to close local hospitals, even if they are performing well.
Clause 119 in the Care Bill allows a hospital to be closed or downgraded if a neighbouring trust is struggling financially. The clause gives special administrators the power to make changes to neighbouring services while trying to rescue failing NHS trusts. It was inserted into the bill after the High Court ruled last October that Health Secretary Jeremy Hunt had acted outside his powers when he decided the emergency and maternity units at Lewisham Hospital, in south-east London, should be cut back to save a neighbouring Queen Elizabeth Hospital Woolwich which was failing financially.
A total of 297 MPs voted in favour of Clause 119, while 239 voted against it.
There have been several high-profile campaigns to save hospitals and services earmarked for closure in recent years, including the Save Lewisham Hospital campaign.
Labour shadow health secretary Andy Burnham told MPs that Clause 119 was dangerous and wrong. He said:
“It creates an entirely new route for hospital reconfiguration – top-down, finance-led.”
“It subverts the established process in the NHS which requires that any changes to hospitals should first and foremost be about saving lives, rather than saving money, and it puts management consultants, not medical consultants or GPs, in the driving seat.”
Health Secretary Jeremy Hunt said the clause would help drive forward changes to ensure patient safety when trusts were found to be failing. A Department of Health spokesperson said the clause would only ever be used as a “last resort”. A spokesman said:
“Changes to the special administrator regime will ensure that patients get safe care, and these powers have only ever been used in extremis twice since 2009. It is a process of last resort, when a hospital trust faces very serious financial or quality risks.”
Six mental health organisations in England have warned that cuts to NHS funding are putting lives at risk, with young people especially affected. The Mental Health Foundation, Rethink Mental Illness, Mind, the NHS Confederation Mental Health Network and the Centre for Mental Health and the Royal College of Psychiatrists have warned that planned cuts for next year will put lives at risk as the system is already underfunded.
It comes as figures reveal that early intervention schemes to help young mental health patients have been reduced over the past 12 months. Early intervention schemes are intended to reduce suicide rates, prevent patients from becoming more ill and to keep patients out of hospital and in work, and were praised last week by the Chief Medical Officer for England.
Sean Duggan, Chief Executive of the Centre for Mental Health, said early intervention programmes were “very good value for money” and the prospect of budget cuts was “very worrying”. He added:
“Early intervention in psychosis services are known to be highly effective in helping young people to negotiate their first episode of psychosis. They offer hope of a brighter future by helping young people to stay in education, to get and keep work, and to support their physical health.”
Research by the London School of Economics suggests that 30,000 people with mental health problems have lost their social care support since 2005, following a £90m shortfall in funding. A separate report from the charity Mind also shows that mental health patients are losing social care support in greater numbers than elderly or physically-disabled people. It also found that one in three local authorities in England halved the number of people with mental health problems receiving social care support.
NHS England says it has put procedures in place to ensure that mental and physical health are treated equally in the future. In a statement NHS England say they have been “working solidly in its first year now to ensure that mental health no longer inhabits the silo that existed in the old system but is fully embedded in all the work we’re doing to deliver outcomes and high quality care”.
The price of NHS prescriptions is set to rise by 20p in April and then again next year. From the 1st April, the prescription charge for each medicine or appliance dispensed will be £8.05, increasing to £8.25 in 2015.
In a statement, Health Minister Norman Lamb said the increases were justified given the increasing demands on the NHS, with spending on medicines alone almost doubling since 2000.
Currently, around 90% of prescriptions in England are dispensed free of charge as there are exemptions for people on low incomes, children and the over 60s. Wales, Scotland and Northern Ireland have scrapped the prescription charge entirely. Fellow Health Minister Earl Howe said:
“This government has made tough decisions to protect the NHS budget and increase it in real terms, but charges for some items remain an important source of revenue to support the delivery of high quality NHS services.”
NHS dental charges are also set to rise from the 1st April. The charge payable for a band one course of treatment will increase from £18 to £18.50. The charge for a band 2 course of treatment will increase from £49 to £50.50 and the charge for a band 3 course of treatment will increase by £5 from £214 to £219.
The cost of prescription prepayment certificates, known as ‘season tickets’ that can be bought to cover prescription costs for 3 or 12 months, will remain unchanged at £29.10 and £104, respectively.
The Royal Pharmaceutical Society called for greater flexibility in repeat prescribing for patients with stable long-term conditions – linking prescription charges to the repeat authorisation, rather than to each prescription form.
Katherine Murphy, Chief Executive of The Patients Association, has said:
“The government’s decision to increase the cost of prescriptions for two years running has a huge impact on patients with low incomes who are already struggling to make ends meet. They will now have to dig even deeper into their pockets to pay for sometimes vital and life saving medicines.”
The Health Secretary, Jeremy Hunt, has demanded answers over the case of an NHS whistleblower threatened with dismissal after raising concerns about death rates. Mrs Haynes Kirkbright, a ‘health coder’, was suspended after accusing Royal Wolverhampton Hospitals NHS Trust of manipulating records and hiring her in the belief she would do the same. The NHS worker received a letter from the hospital saying she had breached her contract by talking to the Press, and warning that she faced a hearing which ‘may result in formal disciplinary action, not excluding dismissal’.
After Mr Hunt met urgently with hospital watchdogs to demand an investigation into the case, managers at Wolverhampton Hospitals NHS Trust were later instructed to postpone any planned action against Mrs Kirkbright.
In a letter to Mr Hunt, David Flory, chief executive of the NHS Trust Development Authority, wrote:
“I have today written to the chief executive of the Royal Wolverhampton NHS Trust, David Laughton, asking him to clarify what action the Trust has taken to address the whistle blowing allegations and to assure us that any further action they plan does not impede Mrs Haynes Kirkbright’s rights as a whistleblower.”
It has been just over a year since the Francis inquiry into poor standards at Mid Staffordshire NHS Trust, and in that time there has been a huge amount of discussion surrounding the quality of health and social care services. However, despite the issue of quality being pushed to the top of the agenda, a report by the Nuffield Trust has suggested that although there is universal agreement that quality is important, there are questions as to whether or not we can actually afford it.
The QualityWatch programme was set up to understand what is happening to quality during periods of financial constraint. Much of the information is sourced from performance measures used within a service, but we also need to look across services too.
Martin Bardsley, director of research at the Nuffield Trust, has said we need to focus on models of integration around the obvious pressures on services like A&E, and on issues surrounding public health indicators – particularly the ones linked with prevention.
He explains that both these issues suggest the need to collate information, sometimes from providers, at a population level. Where information like this was once analysed by primary care trusts, it now resides between three new organisational types – clinical commissioning groups, commissioning support units, health and wellbeing boards and Public Health England. He adds:
“As money gets tighter it’s increasingly important that we watch carefully to ensure that economies do not adversely affect the quality of services and the well being of disadvantaged subgroups of the population.”
Professor Keith Willett, director of acute care for NHS England, has said that the NHS is in an unsustainable position and is running at full capacity. He said fundamental change is needed within the NHS to improve healthcare and ease pressure on hospitals which are already at capacity.
Professor Willett added that urgent changes need to be made as hospitals struggle with the burden of the large number of people going to A&E. He dismissed the mild winter as the reason for easing the pressure on emergency care, and warned that hospitals are already running on stretched resources.
“It’s in an unsustainable position in terms of urgent care for the future. We will have to make substantial changes to the way our patients are cared for outside hospital.”
“The majority of people do seem to recognise that A&E is under pressure, but one in four said they would go again if they couldn’t access their GP. In the long term we will run into problems again.”
Professor Willett said the problem facing A&E departments is not the number of people attending but the volume who now need to be admitted because care outside hospital is not good enough – emergency admissions to hospitals have increased by 47% in the last 15 years.
Margaret Hodge, chairwoman of The Public Account Committee (PAC), said:
“Any attempt to improve emergency admissions services in the NHS is being completely stymied by the chronic shortage of specialist A&E consultants. Nearly one fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012. There are also major problems in training enough doctors in emergency medicine.”
A poll commissioned by patient watchdog Healthwatch England has revealed that almost one in five patients in England have misused Accident and Emergency departments. The survey of over 1,700 people found that 18% owned up to visiting A&E when they needed non-emergency care outside of normal GP opening hours.
The survey also showed a widespread lack of awareness about the other options available. About a third of those who responded said they did not know where their nearest minor injury unit or walk-in centre was, while just one in five said they had used the non-emergency number 111 and NHS Direct when in need. Nevertheless, the survey did show that two-thirds of patients were worried about the pressures on the system.
Anna Bradley, chair of Healthwatch England, said:
“A&E has become NHS Express. The problem is it was never designed to be a catch-all service and nor should it be allowed to become one. But blaming people for going to the ‘wrong place’ when we need care and support is the wrong way of looking at the problem.”
“I’m not absolving us of our responsibility not to clog A&E whenever we get the sniffles, but until the health and care sector offers a more consumer-friendly experience, things are unlikely to improve.”
Katherine Murphy, Chief Executive of the Patients Association, said:
“The NHS drastically needs to improve the out-of-hours care to ensure patients in acute emergencies are able to receive the high quality of care that A&E departments provide. Until then people will turn up at A&E in desperation with everyday medical problems.”
The release of the survey comes as MPs call for emergency care doctors to be paid more to work at struggling hospitals.
The Royal College of GPs (RCGP) have highlighted that GP services will be under huge pressure this year due to funding cuts. They are predicting that patients will fail to get a GP appointment when they are unwell on at least 34 million occasions in England.
The professional body says that GP practices are being “brought to their knees” by an unprecedented fall in money for healthcare in the community and rising demand for their services. This will inevitably result in further pressure on A&E departments, because more patients are likely to turn up at emergency wards if they are unable to get appointments at their local surgeries.
Dr Maureen Baker, chair of the RCGP, said:
“GPs and practice nurses can’t keep doing more for less and now that funding for general practice in England has slumped to just 8.5% of the NHS budget the service we provide is in crisis.
“All three political parties say they want to see more patients being treated in the community, where care can be provided to patients more economically, in their own surroundings, and yet resources are increasingly being diverted away from communities and into hospitals.”
Successive governments have promised to make it easier for people to get GP appointments, amid persistent complaints about unavailability in some areas. David Cameron last year said he would like to force surgeries to open from 8am to 8pm and over the weekend to ease pressure on A&E units, a scheme currently being piloted.
The RCGP said it calculated the 34 million figure from data in the GP Patient Survey, which found that 10% of patients who sought a consultation with a GP or practice nurse failed to get one. They added that almost 11% of the NHS budget was spent on general practice in 2005, compared with 8.5% in 2011.
However, the Department of Health accused the RCGP of using partial and conflated data, confusing the number of people and consultations. They say:
“The GP survey showed the vast majority of patients are satisfied with their GP and rated their experience of making an appointment as good.”