Hospitals to undergo Ofsted-style inspections
Health watchdog sets out proposals to restore public confidence in the NHS. Read more…
Children’s heart surgery review shatters confidence in NHS reconfiguration
Jeremy Hunt, the health secretary, hears of a failure to recommend a safe, sustainable and accessible way forward. Read more…
Hospitals have spent £2m on gagging orders for staff, figures show
Tory MP criticises NHS chief after freedom of information request uncovers scale of use of confidentiality clauses. Read more…
Outgoing NHS England boss attacks coalition over reforms
Sir David Nicholson says coalition wasted years pursuing pro-market reforms instead of carrying out the changes needed. Read more…
Health minister forced to clarify remarks on female doctors
Anna Soubry insists she supports women GPs after appearing to agree with claims that they are a huge burden on the NHS. Read more…
NHS needs major changes to avoid disaster, say managers and charities
Coalition of clinicians and campaigners says health service risks being paralysed by resistance to change. Read more…
NHS Confederation report says 64% of senior officials believe £20bn of ‘efficiency savings’ will worsen patient experience
Waiting times for treatment and the rationing of care have worsened and will get worse still because of the NHS’s £20bn savings drive, health service bosses have warned.
Seven in 10 chief executives and chairs of hospital trusts, clinical commissioning groups and other NHS care providers fear that the length of time patients have to wait for treatment and their ability to obtain it will be hit hard in the coming year.
A report by the NHS Confederation says half of health service bosses think the two politically vital areas of NHS provision have already been affected over the last year as the service has sought to make £20bn of “efficiency savings” demanded by Whitehall.
A survey of leaders of 185 NHS organisations shows that 64% also believe that patients’ experience of the NHS will suffer, while 27% expect the availability of particular treatments or drugs will be hit and 16% fear patient safety will be compromised.
This gloomy view of the NHS’s prospects is compounded by 62% describing the financial situation confronting them as “very serious” (40%) or “the worst I have ever experienced” (22%).
Asked what would stop their organisation realising its share of the £20bn target in the next year, 64% identified rising demand for healthcare and 56% local councils’ cuts to social care, which helps keep mainly elderly people out of hospital.
Six out of 10 NHS leaders think financial pressures or cost saving targets are risks inherent in the coalition’s NHS shakeup, which took effect on 1 April, found the survey conducted by the NHS Confederation, which represents hospital bosses. A similar proportion see finance as one of the top three challenges facing the service over the next two years.
The NHS in England has been increasingly delaying or denying patients access to operations such as hernia repairs, hip and knee replacements and removal of varicose veins since 2010 as it experiences rising demand for care but flat budgets.
Over half (54%) cited the need to integrate health services and social care as a key challenge, although 93% believe either only slight (59%) or no (34%) progress is being made, despite widespread agreement it is an urgent priority. Failure to co-ordinate both types of care will lead to “an unsustainable service”, 61% believe.
Asked if the government recognised the challenges the NHS is facing, 71% said no and only 29% said yes – an effective vote of no confidence in Jeremy Hunt, the health secretary. Those running NHS care providers also strongly rejected (by 71%) David Cameron’s plan for creating a new chief inspector of hospitals, who was confirmed last week as Prof Sir Mike Richards, and Hunt’s push to bring in tough Ofsted-style ratings for hospitals (73%) – both of which were key elements of the coalition’s response to Robert Francis’s report into the Mid Staffs scandal.
However, many support Hunt’s plan to make would-be nurses spend time doing basic chores in hospitals before they begin training (67%) and for NHS organisations to be put under a statutory “duty of candour” to admit when patients are harmed (68%).
Two quarterly assessments of NHS performance due out on Tuesday, from the NHS regulator Monitor and the King’s Fund thinktank, are expected to confirm that performance in key areas, notably A&E care, is slipping.
But Lord Howe, the health minister, rejected the NHS leaders’ gloom and painted a much rosier picture. “The NHS is performing well with waiting times overall low, satisfaction high and budgets overall doing well. Overall waiting times remain low and satisfaction with services remains high,” he said.
While acknowledging it faced “pressures”, he promised that the coalition’s care bill would “help integrate services, drive up standards and make sure people get the are they need when they need it.”
He dismissed NHS bosses’ concerns about the service’s financial health. “We have protected the NHS budget and funding will increase by £12.7bn over the course of this parliament.
“Even so we know the NHS is facing pressures, but it is in good financial health with the vast majority of hospitals expected to finish the year in surplus,” he said, adding that ministers would press ahead with a new hospital ratings system and a new chief inspector of hospitals.
“We are determined that the Francis report and the terrible events at Mid Staffs will bring about real change in the whole health system. We believe culture change is vital and NHS leaders must do everything they can to help create the open, caring and compassionate service we all want to see,” he said.
Dr Peter Carter, general secretary of the Royal College of Nursing, said the NHS Confederation was “right to draw attention to the scale of the challenge the health service faces. This survey reflects real and profound anxieties felt throughout the system about the current financial pressures, pressures which most believe are going to get much worse.”
Shadow health secretary Andy Burnham said the survey confirmed the NHS was “seriously struggling with the side effects from the coalition’s toxic medicine of budget cuts and top-down re-organisation. The ‘real-terms increases’ promised by David Cameron have failed to materialise while social care has been cut to the bone. This explains hospitals are full and A&Es are in crisis.”
Hunt should ensure that £1.2bn of the NHS’s £2bn annual underspend n its £100 billion budget is used to improve social care and provide integrated, home-based support for the frail, elderly people who occupy a large and growing number of hospital beds, Burnham added.
Company specialising in promotions for childcare products allowed on to wards – and gives out child benefit forms
NHS officials have been criticised for allowing salespeople access to mothers shortly after they have given birth.
New parents have been approached on postnatal wards by employees of a promotional company who often fail to identify themselves as such, a doctor has revealed.
Dr Margaret McCartney, a Glasgow GP, questioned whether it was “desirable” for representatives from a promotions company, Bounty, to be allowed on NHS wards.
In an editorial, published by bmj.com, McCartney writes that Bounty profits by selling parents’ details. She said the hours after birth are “hardly an optimal time” to obtain consent for giving out data.
A spokesperson for a parenting charity, the National Childbirth Trust (NCT), expressed anger that some NHS hospitals allow Bounty access to new mothers.
“Within hours of giving birth, they are being asked questions – their name and address, details of life insurance – and they give them in good faith, thinking they’re speaking to a hospital person,” said Belinda Phipps, the NCT’s chief executive.
“In fact it’s a commercial person. The NHS is condoning a sales team collecting data from mothers in order to sell their name on to commercial interests.”
When parents fill out their contact details, the form says: “By providing your email address and/or telephone number you agree to be contacted by these channels as well as post.” But Phipps said many parents have told her they did not understand what they were signing up to.
McCartney said commercial advertisers are also getting access to new parents through “baby bags” containing sample products and flyers, which are given out by Bounty.
She writes that some 2.6 million Bounty bags are given to new parents every year. Some are distributed by Bounty’s representatives on wards and other are handed out by NHS workers.
The packs have an “air of officialdom” because they also contain application forms for child benefit, she wrote.
The article says that HM Revenue and Customs pays £90,000 a year to Bounty to distribute the forms – even though they are available online.
“So families supply their details, which can be sold on by a commercial company, which in turn is paid by the government to supply freely available child benefit claim forms,” writes McCartney.
A spokesman for Bounty told the BMJ: “Over a decade ago Bounty offered to conduct a small-scale pilot, which satisfied HMRC that Bounty could distribute child benefit forms directly and quickly into the hands of parents as soon as they need them.”
He added that a poll of 4,000 parents earlier this year found that 90% were “satisfied” with the packs.
A HMRC spokesman added: “We are committed to keeping our costs as low as possible. Bounty distributed 82% of all child benefit claim forms in 2012, [at an average cost of] around 10p for each claim. If HMRC posted the forms individually the cost would rise to 33p for each claim, making this option much cheaper and more direct than the alternative.”
In her article, McCartney said the NHS, the Royal College of General Practitioners (RCGP), Royal College of Obstetricians and Gynaecologists (RCOG), and government have “embedded commercial advertising into routine contact with pregnant women during antenatal and postnatal care”.
She also raised concerns that pregnant women are handed a free booklet called Emma’s Diary by their GPs, which has an RCGP stamp of approval and which contains 25 pages of medical information and 119 pages of advertising.
The RCGP told the BMJ: “All content is quality assured by our RCGP editorial board, who do a sterling job in ensuring that it is updated to reflect any changes to medical working practices, latest research findings [and] government guidelines.”
Jeremy Hunt should have engaged politically with the problems
Aneurin Bevan, the architect of the National Health Service, would have been alarmed at the escalating blame game played out between the secretary of state for health and general practitioners last week. Bevan was no stranger to doing battle with family doctors, then and now one of the strongest professional interests in Britain. In his own words, he had to resort to stuffing their mouths with gold in order to sign them up to the establishment of the NHS.
What Bevan would have found difficult to understand, however, is why modern-day ministers seem unable to pick the right fights. Bevan’s bribe was surely a price worth paying: without the support of GPs, the NHS would never been more than a proposal on paper. Fifty years later, the Labour government again went to war with GPs over performance-based contracts. At least there was a point of principle at its heart: financial concessions exchanged for what in theory should have been greater transparency and accountability, but which in practice worked out much better for surgeries than taxpayers. Ten years on, and the latest unedifying skirmish is perhaps the most pointless fight we have seen yet: an attempt to blame GPs for rising pressures on A&Es that has left the government isolated.
Health experts and political strategists alike are scratching their heads as to how Jeremy Hunt ended up engaging in a game of blame-shifting he had no chance of winning. In health, Labour has been playing some of its smartest opposition politics, calling the government out on recent breaches of the NHS target for 95% of people visiting A&E to be seen within four hours. Conservative ministers are all too aware that the NHS is one of their weakest spots and that a brewing health crisis could give Ed Miliband the next election.
But Hunt’s decision to lay the blame for this squarely at the door of GPs for shunning out-of-hours provision smacks of panic. There is an immediate flaw in a member of the political class trying to engage GPs in a war of words. Just one in five members of the public trusts politicians to tell the truth; for GPs, the figure is 91%. Given this huge integrity gap, one would expect the government to avoid picking fights lightly, particularly one that is so reliant on GPs to deliver its signature healthcare reform. When respected arbiters such as the health thinktank the King’s Fund quickly call the government out as wrong, ministers are in trouble.
A cocktail of complex factors lies behind recent breaches of the 95% target, but lack of out-of-hours GP provision is unlikely to be significant. Contrary to popular perception, relatively little traffic into A&Es is out of hours. Moreover, performance on the 95% target is most affected by the more complex cases coming through the door: people with more minor ailments, who could have seen their GP, can relatively quickly and easily be moved into the holding bay of a clinical decisions unit within four hours. There are a number of shorter-term and seasonal factors that have squeezed capacity in recent months: the longer and colder than average winter; higher incidence of norovirus; and cuts to social care, resulting in longer stays on wards for the elderly.
The 95% target by itself is a poor measure of quality of care; it is best viewed as an NHS pressure gauge. The alarm goes off when the target is breached. But the truth is that pressure has been building steadily over the last decade. A&E demand has risen steadily due to demographic change and medical advances: more people, predominantly elderly and frail, are surviving what were once life-threatening conditions, with complications that require more ongoing medical attention. At the same time, the number of NHS beds has gone down by a third over the last 25 years. Bed occupancy rates on wards are now often above 85%, the level above which the provision of safe care is jeopardised.
Against this backdrop, there are big challenges facing primary care, which has had to take up the slack. Primary care remains stuck in a fragmented model of provision no longer fit for purpose and there is too much variation in the quality of care. It needs to evolve into a system that blends continuity of care, so the growing number of patients with complex conditions see the same GP, with the benefits of working on a larger scale.
The answer is neither sticking with village-style GP practices, nor moving towards the medical hypermarket model of polyclinics. Instead, the government needs to prod GPs into consolidating themselves into a hub-and-spoke model, with hubs that allow the benefits of scale and specialisation, and satellite surgeries that ensure care remains grounded in the community. Surgeries also need stronger and smarter incentives to improve not just the quality of care but system management. For example, moving to telephone-first consultations with a patient’s GP has been found to increase patient satisfaction, increase surgery capacity and reduce local A&E attendance by up to 20%. Yet only a tiny minority of surgeries have adopted this practice.
The government should have concentrated its political capital and reforming zeal on tackling these real challenges. Instead, it has wasted goodwill on a pointless fight and exhausted energy on a top-down reorganisation unlikely to achieve anything other than distracting managers and clinicians from what really counts: improving the quality and efficiency of care.
This is a theme echoed across government. Over an education, Michael Gove has chosen to pick fights with teachers over the detail of the history curriculum rather than making it easier to sack poor teachers, and undertake a structural reform on the basis of ideology rather than evidence. It is not a uniquely Conservative problem. Tony Blair rolled back GP fundholding only to reintroduce it a few years later. Ed Miliband’s Labour has yet to set out how it would make the necessary but difficult trade-offs to achieve more for less in health.
The politics of responsible, long-term public service reform is toxic: closing wards and hospitals to invest in better acute and community care; letting class sizes creep up to invest in the quality of teaching. Bevan once said he regarded politics as the arena of interest, not morals. But if he had allowed interests to rule over what was right, we would have been left with a messy, highly fragmented system of hospital care today.
As the NHS moves into its seventh decade, the complications it faces are greater than ever. It desperately needs a political version of the continuity of care that ministers expect from our GPs. To protect Bevan’s legacy, we need a visionary willing to put the national interest above party politics. The questions is: are our politicians equal to the task?
Jeremy Hunt accused of demoralising GPs and causing fear among patients before speech attacking ‘inaccessible’ doctors
Doctors’ leaders and the health secretary are on a collision course over claims the government is using “anti-GP rhetoric” to mask its own failure to effectively reform the NHS.
In a speech on Thursday at the King’s Fund Jeremy Hunt, the health secretary, will attack “inaccessible” GPs for leaving the frail and the elderly with no alternative but to fill up hospital accident and emergency waiting rooms. Hunt will call for a new chief inspector of GPs to crack down on poor performers.
Hunt points to “GP surgeries where it is often impossible to get an appointment the next day; same-day appointments but only if you call at 8 o’clock in the morning sharp and are lucky getting through; long waits on the phone to get through, sometimes at premium rates”.
The health secretary will also call for a new Ofsted-style rating system for hospitals, pointing out that the King’s Fund found almost three-quarters – 73% – of NHS professionals do not think that quality of care in the health service is given enough priority. In its first look at the NHS since the Francis report into scandalous levels of poor care at the Stafford hospital, said trust boards “must demonstrate that they give sufficient priority to quality and patient safety”.
However, doctors have hit back – and are producing posters to be placed in surgeries defending the profession, emblazoned with the words: “GPs want to spend more time with you, not red tape” – a dig at the health reforms which have increased their managerial responsibilities.
Michelle Drage, the leader of London’s GPs, wrote on her website: “No doubt you are as sick as us of the anti-GP rhetoric in some of the media. We think it’s time we put the record straight about general practice.”
Drage said the health secretary’s comments were demoralising GPs and causing fear among patients. “GPs are on the edge and we are seeing this when no one appears to be getting a grip on the NHS. Who is running the NHS? Is it the GPs? Is it NHS England? Is it the secretary of state?”
Hunt’s speech will come as GPs gather for their annual conference, which Drage says will be “electric”. She said: “Either [Hunt] does not get [the NHS] or he gets it and does this deliberately. Either way it’s a pretty bad situation out there.”
Hunt has already faced criticism for linking the crisis in hospital A&E departments with GPs opting out of out-of-hours care. Mike Farrar, the chief executive of the NHS Confederation, the body representing organisations commissioning and providing health services, questioned Hunt’s assertion that Labour was to blame for a public loss of confidence in alternatives to casualty by agreeing a new contracts with family doctors in 2004. Farrar was the person who negotiated the contract with GPs.
A spokesperson for the Department of Health said the health secretary was not “doing GP bashing. We are not proposing to tear up the GP contract. We want to work with the GP community to reduce bureaucracy and get rid of the targets that make it difficult for them to get on and treat patients quickly.”