NHS to use private firms to beat the winter crisis


NHS cuts putting patient safety at risk, TUC warns

Funding cuts and staff shortages ‘preventing hospitals from implementing Mid Staffordshire recommendations’

Improvements in patient safety made after the Mid Staffs scandal are being undone amid NHS-wide financial problems and chronic staff shortages, the TUC has warned in a report.

The report claimed that moves to make care in England safer, such as by placing greater numbers of nurses on wards, are under threat as services struggle to reconcile the need to provide high-quality care with growing financial pressures.

The report cites long waits for treatment, the greater rationing of care and patients trapped in hospitals despite being fit to leave. Temporary ward closures are also highlighted as a risk.

“The government’s relentless drive to find savings at a time of rising demand is unsustainable. Each month we are seeing patient safety put at risk by staff shortages, longer waiting times and cuts to services”, said Frances O’Grady, the TUC’s general secretary.

“Ministers need to re-read the Francis Review. You cannot deliver a world-class health service on the cheap,” she added, referring to Robert Francis QC’s warning that cuts in the nurse numbers at Stafford hospital contributed to the mistreatment of patients between 2004 and 2009. His mammoth report into care at the hospital, which followed a 30-month public inquiry, prompted hospitals across England to hire extra staff, especially nurses.

The TUC report, Patient safety: warnings from all sides, claims that what was meant to be a gradual rollout of safe staffing ratios across every area of hospital care was halted earlier this year. By then, the National Institute for Health and Clinical Excellence (Nice) had already recommended a 1:8 nurse to patient ratio in acute and maternity wards to ensure safety. However, equivalent standards for A&E units, which were due to be published late last year, have never appeared and critics say they have fallen victim to the NHS’s £22bn savings drive.

“It is worrying that our NHS still does not have the ability to apply safe levels on staffing. Even after the Francis inquiry, financial targets continue to have an overbearing influence over the approach to patient safety,” said Paul Evans, co-ordinator of the NHS Support Federation, a research and campaign group which drew up the report jointly with the TUC.

The report draws heavily on an unprecedented series of warnings about declining patient safety issued by a number of medical bodies representing doctors, health think tanks, trade unions, NHS bodies and even the watchdog, the Care Quality Commission. The CQC recently stated in its annual review: “The safety of care is our biggest concern. Ensuring consistently safe care remains the biggest single challenge for hospital providers.”

Evidence in the TUC report reveals “a decline in the standards of care but also worrying concerns about the safety of patients”. Dr Louise Irvine, a GP and a member of the British Medical Association’s ruling council, said: “Staff are working flat out and mistakes are already happening. Care is declining in quality. Staff are overstretched – they make mistakes, there are delays in necessary care, and they don’t have the time to talk, listen or explain.” She cites an hour-long delay for an ambulance to come to her surgery to take a male patient with chest pains to hospital as evidence that key NHS services increasingly cannot cope with demand for care growing at 4% a year.


North Central London STP: Plan to save local NHS finances ‘not yet found’, health chief admits

The man overseeing a radical plan to ward off a funding crisis in north London’s health services has said a solution has “not yet been found”. David Stout, director of the "North Central London Sustainability and Transformation Plan" (STP), today told Islington councillors – along with others from Camden, Haringey, Barnet and Enfield – that he did not know how to ward off an impending £876 million health budget deficit.

The five boroughs have been forced to come together to devise a plan to dramatically improve health and social care finances, with one potential move being the “consolidating” of departments across the Whittington, Royal Free and University College hospitals.

Questioned by the cross-council Joint Health Overview and Scrutiny Committee at Hendon Town Hall, Mr Stout said: “If we do nothing, the gap in our finances would grow to something like £900m in five years. “But we’re not going to do nothing – we wouldn’t be allowed to do nothing.” He added: “A solution to that scale of financial gap has not yet been found. We still need to do more work on that.”

Mr Stout also said investment was essential to the future of the health service but stressed “costs could be reduced” and efficiencies implemented.

Former Whittington chief exec David Sloman, now CEO at the Royal Free and accountable officer - "lead" - of the STP, said the future of the trust’s 38 sites would be included in financial discussions.

“When I used to work there, about 50 per cent of the estate of the hospital was good,” he said of the Archway-headquartered trust. “The other half was residual Victoriana.”

The chair of Islington CCG, meanwhile, said she was concerned about the next few months of healthcare in her borough as well as the next five years. “We are about to go into winter and we are holding our heads above water,” Jo Sauvage said. “What we need to do is confront debt, not shunt it away.”

Whittington Health deputy chief exec Siobhan Harrington was later asked about the status of her trust’s Lower Urinary Tract Services (LUT) clinic in Hornsey, which closed last year. “As soon we are in a position to reopen, we will,” she said, adding that should happen “within a year – I hope sooner”. Patient safety was an issue being considered, she said, but discussions between the National Institute for Health and Care Excellence (NICE) and the clinic were taking place.


STPs risk 'starving services of resources' says BMA

by Keith Cooper www.BMA.org.uk  (https://www.bma.org.uk/news/2016/november/discovery-of-cut-plans-adds-pressure-to-fix-stps)


Ministers have been urged to sort out the ‘mess’ of the NHS STPs (sustainability and transformation plans) after BMA analysis found they must slash £22bn from health and social care costs in five years.

The savings figures were found in papers from 42 of the 44 areas across England.

Officials in each area have been asked by NHS England to predict the financial holes STPs face in their budgets in 2021 and set out how they can close them.

A separate survey by the BMA reveals that most doctors (64 per cent) had not been consulted on STPs, despite many plans requiring significant changes to services to balance their books.

BMA council chair Dr Mark Porter said he had serious concerns about the ‘impossible’ scale of savings demanded by STPs by an ‘unrealistic Government’ which had promised no further funding.

‘Improving patient care must be the number-one priority of these plans,’ Dr Porter added. ‘There is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resources and patients of vital care.’

Dr Porter added that it was ‘extremely concerning’ that most doctors have not been asked about their STPs.

‘The STP planning process has turned into a mess. It is crucial that any plans about the future of the NHS must be drawn up in an open and transparent way and have the support and involvement of clinicians and the public from the outset. They have the potential to generate more collaboration and the long-term planning of services based on local need.’


BMA's demands

The BMA is to keep tabs on the content of each STP over the next few months and is calling on ministers to meet five key demands:

  • Plans must be made public as soon as possible
  • Proposals in STPs should be realistic and evidence-based
  • A commitment to full consultation with clinicians, patients and the public on any proposed changes as soon as possible
  • Plans must be properly funded
  • Patient care – not savings – must be priority of each and every plan.

Doctors’ warnings about STPs join a growing list from other health experts and local authority leaders.

The King’s Fund last week warned that STPs were at risk of failure because doctors have been largely excluded from consultations.

The Nuffield Trust has said some involved in STPs compared the creation of their footprints with the ‘British dividing up the Middle East, just putting the lines on the maps’.

NHS Providers chief executive Chris Hopson told members of the Commons health select committee last month that unprecedented financial deficits faced by many hospitals risked ‘blowing up’ STPs.

Even NHSI (NHS Improvement), which oversees Foundation and other NHS trusts, has raised concerns about its ‘extremely challenging’ timetable for checking STPs before they are rolled out next year.

The analysis found huge funding holes in urban and rural areas of England.

Five STPs, including Greater Manchester, north-west London and Hampshire and the Isle of Wight, face falling into the red by more than £1bn each.

Devon faces a deficit of £557m and Kent and Medway a £485m shortfall in health and social care funding unless its STP is successful.