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NHS : Privatisation Issues And Related News : Failings / Scandals / Rip Offs / Continuing Meltdown - Page 15 - Carers UK Forum

NHS : Privatisation Issues And Related News : Failings / Scandals / Rip Offs / Continuing Meltdown

Discuss news stories and political issues that affect carers.
237 posts
Chris From The Gulag wrote:
Fri Oct 04, 2019 10:17 am
Neglected NHS cancer hospital is unfit for purpose, says report.

Mount Vernon so dilapidated and short-staffed that it cannot provide basic elements of treatment.

An NHS cancer hospital has such crumbling buildings, out-of-date equipment and staffing problems that patients’ safety and quality of care are at risk, a bombshell report for health service bosses has warned.

Patients at the Mount Vernon Cancer Centre who are acutely unwell or dying are receiving substandard care because it lacks the medical expertise and facilities needed to manage them properly, and its services need to be moved, an inquiry has found.

Mount Vernon in Hillingdon, north-west London, is one of the NHS’s specialist cancer hospitals, along with London’s Royal Marsden and the Christie in Manchester.

The impending loss of most or all of Mount Vernon’s services will be of concern to Boris Johnson, as his Uxbridge and South Ruislip constituency is nearby. Voters in the seat are among the 2 million people in London, Hertfordshire, Bedfordshire and Berkshire for whom Mount Vernon is their nearest specialist cancer centre.

However, despite its decrepit physical infrastructure, it is not one of the six hospitals the prime minister this week said would be rebuilt over the next five years with a £2.7bn injection of NHS capital funding.

The 117-year-old London hospital is so dilapidated and short of doctors and nurses that it cannot provide modern cancer care or even basic elements of treatment such as consultants undertaking daily ward rounds, new inpatients being reviewed within 14 hours of arrival and rapid access to diagnostic testing and their results.

The group of experts who undertook the urgent review on behalf of NHS bosses have concluded that Mount Vernon has been neglected for so long that it can no longer operate safely as an important regional centre of cancer care, is unviable and as a result its services need to be moved and rebuilt from scratch elsewhere.

“Maintaining safety of patients cannot be guaranteed in the near future. Status quo is not an option. There is a need for urgent action. Current estate is not fit for purpose, particularly ward buildings for acutely unwell and end of life inpatients,” the report says.

Leaking roofs have forced Mount Vernon’s management to move some services from one part of the hospital to another, the 34-page report reveals. The wards containing its 37 inpatient beds – where people are treated for complications of cancer or recover from radiotherapy or chemotherapy or are in their last days – are in “very poor” condition. And its lack of an intensive care or high dependency unit and operating theatres means that “large numbers” of patients have to be transferred from Mount Vernon to other hospitals because it is unable to look after the very sick.

“Much of the existing estate used by MVCC is dilapidated and not fit for purpose,” the report says. An “urgent backlog maintenance of existing clinical facilities” needs to be tackled.

Its lack of staff has become “critical” and means that some patients are not getting helped by a nurse who specialises in their form of cancer. Shortages are being exacerbated by an exodus of experienced doctors and nurses.

The report found: “Staff losses are impacting upon the service. There are additional clinical risks such as the backlog of patient letters and notes as a result of inadequate administrative support.

“Recruitment and retention of expert staff is an increasing problem and is becoming critical.” In addition, personnel “are, in the main, demoralised and frustrated” over the hospital’s uncertain future.

It is thought to be the first time in the NHS’s 71-year history that a major facility specialising in the country’s second biggest killer disease has been deemed to pose a risk to patients and been declared unfit for purpose.

Cancer charities said the hospital’s shortcomings were “deeply worrying” and reflect the serious workforce shortages and reliance on old equipment that are increasingly common in NHS cancer services after almost a decade of austerity funding of the health service.

“Time after time we’ve heard about staff shortages causing crises in NHS cancer services, and this is yet more evidence of the unbearable pressure on the system,” said Matt Case, Cancer Research UK’s policy manager.

“Recent government commitments to investing in NHS buildings and equipment are a welcome first step, but must be met by significant investment in cancer staff, or stories like this will continue to emerge and cancer patients will not receive the care that they deserve.”

Prof Nick Slevin, a consultant clinical oncologist at the Christie hospital, led the clinical advisory panel of experts which undertook the urgent review in May at the request of NHS England’s east of England region.

Slevin states in the report that it was undertaken because “acute support services have been progressively depleted on the site over many years such that there is current and increasing concern regarding patient safety”.

He adds: “Services continue to be provided within very poor quality accommodation with much equipment reaching the end of its life without a replacement plan.” For example, one linear accelerator (linacs) machine used to deliver radiotherapy has been temporarily upgraded so the hospital can continue using it because it cannot afford to buy a new one.

Other problems highlighted by the panel’s report include:

Information technology and electronic patient record systems are so poor that they constitute “a clinical risk”.

Staff provide excellent care in difficult circumstances but are struggling due to “excess workload”.

Doctors cannot access the results of CT and MRI scans out of hours.

Delays of up to six weeks in typing up letters detailing patients’ latest condition means that nurses staffing Mount Vernon’s 24-hour telephone chemotherapy advice line may inadvertently give wrong advice.

The experts have recommended that Mount Vernon is either replaced in full beside an acute hospital, or that that happens but some radiotherapy and chemotherapy services remain on the existing site.

With Mount Vernon’s days numbered, three major London NHS trusts – the Marsden, University College London Hospitals and Imperial College Healthcare – as well as Addenbrooke’s hospital in Cambridge – are interested in its replacement being built on their site. Whichever gets it will take over running it from East and North Hertfordshire trust.

Gwyneth Tyler, Macmillan Cancer Support’s head of services for south and east England, said: “The findings from the recent review into the Mount Vernon Cancer centre are deeply worrying. People living with cancer deserve access to the best possible care from the moment they are diagnosed and cancer centres cannot provide this without capital investment in their infrastructure and workforce.”

An NHS spokesperson said: “The review of Mount Vernon Cancer Centre is ongoing to ensure the service is able to respond to the significant advances in cancer treatment over recent decades. This includes identifying a specialist cancer provider to run the centre.”
You would make a excellent health and social care reporter! Seriously.
New report reveals alarming shortage of country doctors.

Just 15% of consultants take jobs in hospitals serving rural or coastal areas.

Hospitals in rural and coastal Britain are struggling to recruit senior medical staff, leaving many worryingly “under-doctored”, a major new report seen exclusively by the Observer reveals. Some hospitals in those areas appointed no consultants last year, raising fears that the NHS may become a two-tier service across the UK with care dependent on where people live.

Disclosure of the stark urban-rural split emerged in a census of consultant posts across the UK undertaken by the Royal College of Physicians (RCP), whose president, Andrew Goddard, has warned that patients’ lives may be at risk because some hospitals do not have enough senior doctors.

Just 13% of consultants appointed in England last year went to hospitals serving mainly rural or coastal areas, with the other 87% being hired by those with mainly urban populations.

In Northern Ireland no consultant recruited in 2018 served a non-urban area. Only Wales bucked the trend, with 39% of newly appointed consultants in such places. No comparable figures were collected for Scotland.

“The results of our census are an incredibly alarming indication of the huge disparities in care across the country. Some rural areas are so severely ‘under-doctored’ that patient lives could potentially be at risk,” Goddard told the Observer.

“The sheer dearth of senior doctors in rural communities goes to the heart of the crisis facing our NHS; there simply aren’t enough doctors to treat the number of people in need.”

The trend was consistent in different regions of England. For example, just 13% of consultants recruited last year in the south of England went to work in rural or coastal areas, while only 14% of those hired in the north ended up in such places.

Across England, Wales and Northern Ireland hospitals serving mainly urban areas hired 866 senior doctors, 85% of the total; those with rural and coastal populations made just 153 (15%) senior appointments.

The research did not explore why so many non-urban hospitals find it much harder than those in conurbations to recruit consultants. But local housing shortages, existing doctor shortages at those hospitals putting extra pressure on those who opt to work there, and the fact that many are district general hospitals, rather than teaching hospitals or centres of excellence, may be key factors.

NHS regulators are also concerned by evidence suggesting that geographically remote hospitals are more likely to become embroiled in scandals over the quality of care.

There is a growing divide between London and the rest of urban England, too. Last year the Midlands had more than twice as many vacancies for consultants that hospitals could not fill (161) as the capital (62), while in the north 85 posts remained empty.

Hospitals everywhere are finding it increasingly hard to find suitably qualified consultants. Overall last year hospitals could not appoint someone for 43% of posts advertised. Unfillable consultant vacancies included 25% of posts for cardiologists, 44% for neurologists and 47% for oncologists.

The FCP fears that hospitals are giving up bothering to advertise some consultant posts, as there are so few senior doctors to fill them. The NHS in England alone is short of almost 10,000 medics, official figures show.

Goddard called on Boris Johnson to ramp up the supply of homegrown doctors to ease the NHS’s recruitment problems by doubling the number of places in medical schools. He said: “A major part of the problem stems from the fact that medical schools don’t have enough places to offer those who are keen to study the subject.”

Also urging action on doctors’ pension problems, he added: “Only then can we move closer to providing a National Health Service that is fair and timely for everyone, wherever and whenever they need it,” he said.

Last week Simon Stevens, the chief executive of NHS England, added to growing pressure on the prime minister. He welcomed as “real progress” the recent creation of five new medical schools and a 25% increase in young doctors being educated there.

However, he told the annual conference of NHS Providers, which represents hospital bosses: “Since we’ve also now got an expanding NHS, coupled with more part-time working by doctors with family responsibilities, we’re going to need some combination of a further expansion in UK medical school places or more international recruitment.

“Fortunately in Britain we currently have many more bright and committed young people applying to study medicine and wanting to work as NHS doctors than our universities currently have places for. So the obvious answer is a further increase in medical schools, particularly in parts of the country where there are doctor recruitment shortages.”

A spokesperson for the Department of Health and Social Care said: “The NHS [in England] has more consultants now than at any time in its history, with over 17,300 more doctors working in the NHS since 2010 delivering excellent, safe care to patients.

“We also have record numbers of doctors in undergraduate training, recently adding 1,500 training places by opening five new medical schools across England – the majority in rural areas.

“The upcoming People Plan will address how we can ensure all NHS services have access to the doctors they need, including a national programme to tackle geographic and specialty shortages in medicine.”
More than half of A&Es provide substandard care, says watchdog.

Hospitals struggling to cope with rising numbers of patients who cannot get help elsewhere.

More than half of A&E units are providing substandard care because they are understaffed and cannot cope with an ongoing surge in patients, the NHS watchdog has said.

The Care Quality Commission (CQC) said 44% of emergency departments in England required improvement and another 8% were inadequate, its lowest rating. Last year 48% of A&Es fell into the two ratings brackets combined.

Ian Trenholm, the CQC’s chief executive, said A&E was “the department in a hospital we are most concerned about”. The regulator said units were struggling because of increases of as much as 10% a year in the number of people seeking care.

Prof Ted Baker, the CQC’s chief inspector of hospitals, said A&Es were getting overloaded because too few NHS services existed outside hospitals, meaning patients’ health could worsen. He said: “There needs to be a system-wide change: people need to get the care they need in the community …so they do not need to attend A&E unnecessarily,.

“For many of those patients, going to A&E is not the best place for them to go. But it is the only part of the system that has ever-open doors and it is the part of the system they can access most easily.”

Children undergoing a mental health crisis, for example, too often ended up in A&E because there were no specialist mental health services in their area, Baker said.

Patricia Marquis, the Royal College of Nursing’s England director, said: “In A&E in particular, nursing staff have been left to pick up the pieces of a health and social care system that is failing to meet need outside emergency department doors.”

The CQC found that 40% of outpatient departments, 35% of medical care units and 27% of surgical departments provided substandard care. However, it said hospital care was getting slightly better overall.

Dr Katherine Henderson, the president of the Royal College of Emergency Medicine, said: “As well as more patients coming to emergency departments due to a lack of accessible alternatives, there are fewer and fewer staffed beds in hospitals to admit sick patients to, which results in long waits for patients and overcrowded emergency departments. It is little wonder just over half of urgent and emergency services are rated as needing to improve.”

Too many people with mental health problems, autism or learning disabilities received inadequate care, especially in inpatient units, the CQC said in its annual report. It said there had been an “increasing and accelerating deterioration” in the care they experienced.

The proportion of units for people with learning disabilities, autism or both that the CQC rated as inadequate rose from 1% last year to 10% this year. Similarly, 7% of child and adolescent mental health inpatient services were deemed inadequate this year, compared with 3% last year.

The proportion of wards looking after adults with acute psychiatric illness and psychiatric intensive care units that were rated inadequate rose from 2% to 8%.

Paul Farmer, the chief executive of the mental health charity Mind, said it was “disturbing” that the CQC kept finding poor-quality mental health care.

“The promise of more money at a national level is not enough. People are still reaching crisis point because they are aren’t getting the help they need. We know that even when people are able to get help, it is delivered in sub-standard facilities which limits the quality of their care,” he said.

Inpatient mental health units for people with autism, learning disabilities or both that are run by private firms appear to be a particular problem. Since last October the CQC has rated 14 such hospitals as inadequate and put them into special measures, including units run by the Priory and Cygnet, a major provider of NHS-funded care.

The number of nurses who specialise in caring for people with learning disabilities has fallen by 8% in the last year, NHS figures show.

Oonagh Smyth, an executive director at the learning disability charity Mencap, said: “As local authorities struggle to fund sufficient provision in local communities, vulnerable people are ending up sectioned in inpatient units, which are not only inappropriate environments for meeting their needs but also costly and ineffective.”
Tens of thousands of operations cancelled because of staff shortages and faulty equipment, NHS figures show.

Labour blames " Tory cutbacks running our NHS into the ground. "

Tens of thousands of people have have had their operations cancelled because of staff shortages and faulty medical equipment, according to newly revealed NHS figures.

The number of procedures called off by hospitals for non-clinical reasons has increased by 32 per cent in the last two years, the statistics obtained via a freedom of information (FOI) request. Almost 4,000 more were scrapped in 2018 than in 2016.

They also show that of the 79,000 operations to be cancelled last year, 20 per cent were scrapped because of staffing issues and equipment failures.

It comes as the staff vacancies continue to put the health service under strain, with the NHS reporting last year it was short of 100,000 staff including, 10,000 doctors and 35,000 nurses.

Meanwhile, the Nuffield Trust charity puts the amount needed to repair faulty equipment across the service provider at £6bn.

Boris Johnson pledged to spend an additional £350m of government funding for capital projects like new equipment as part of £1.8bn additional funding for hospital infrastructure in August.

But after the figures were revealed, Jonathan Ashworth MP, Labour’s shadow health and social care secretary, said: “That so many more people in pain and distress are forced to endure cancelled operations, including increasingly on the day they were supposed to have treatment, is a shameful indictment of a decade of Tory cutbacks running our NHS into the ground.

“The simple truth is under the Tories, patients wait longer and longer for vital care. This general election is about the future of the NHS and ensuring quality care for all. Labour will fully fund our NHS, recruit the doctors and nurses we need and safeguard our NHS from a Trump deal sell off that could cost the NHS £500m a week.”

The figures were compiled by the Labour party and are based on responses from 82 per cent of hospital trusts.

They come shortly after doctors accused Mr Johnson of only recognising an “unprecedented” NHS winter crisis, because of fears it will hamper the Conservative party’s chances in the general election.

“Under this government’s watch, patients and staff working in the NHS have endured winter after winter of overcrowded emergency departments, long delays and pitifully low staffing levels,” said British Medical Association chair Dr Chaand Nagpaul.

“It should not take an election to take stock of just how bad the situation has become.”
NHS " Tax trap " pensions led to 18-week closure of intensive care unit.

London hospital shut ICU due to consultants working fewer shifts to avoid hefty tax bills.

A leading teaching hospital had to shut an intensive care unit for 18 weeks because of a doctor shortage caused by medics working fewer shifts to avoid the NHS pensions “tax trap”.

Guy’s and St Thomas’s trust in London closed one of its intensive care units over the summer after some of its consultants reduced their hours to avoid hefty tax bills linked to pensions.

The closure is part of a dossier that the group representing Britain’s 220,000 doctors has sent to ministers to show how seriously the pensions problem is disrupting care.

In Nottingham, consultant radiologists at the city’s NHS trust have halved from 1,200 to 600 the number of CT and MRI scans they read at home every month to help stop a backlog building up. This has forced Nottingham University Hospitals trust to outsource the work, which is costing them more money.

Many other hospitals have also been forced to cut the number of operations they perform and outpatient clinics offered. Doctors are reducing the number of “programmed activities”, or four-hour sessions, they undertake to avoid being hit with bills for tens of thousands of pounds due to rises in the value of their pension linked to the amount of extra hours they take on.

Rule changes introduced in 2016 meant rising numbers of consultants and other senior staff were facing unexpected tax bills linked to the value of their pensions. Some NHS staff were reported to have had to remortgage their homes to cover their tax bills, while others were faced with the choice of cutting their hours, opting out of the pension scheme or taking early retirement.

The Academy of Medical Royal Colleges has sent its dossier to Sajid Javid, the chancellor, and the health secretary, Matt Hancock, to show how the rise in doctors cutting their workloads is imperilling quality of care and causing longer delays for care.

It has urged them to push through urgent changes to the pensions tax regime for doctors so they can return to doing the routine extra work that keeps NHS services running normally.

In a letter, the academy chair, Prof Carrie MacEwen, said: “It is evident from the findings that, due to severe medical staff shortages, the NHS has become entirely dependent on consultants delivering service provision over and above their existing contracts. This service is being put at risk because of the current pension taxation problem.”

NHS leaders fear the loss of so much labour by consultants will leave hospitals struggling to cope even more than usual with the service’s winter crisis when it strikes. Failure to act will exacerbate the NHS’s already serious shortage of doctors, which is estimated to involve vacancies for 11,000 medics across the UK, according to MacEwen.

“Furthermore, our findings indicate that pensions taxation is undermining staff morale, which is detrimental to the recruitment and retention of the medical workforce. Staff shortages in the NHS are a significant concern and we must ensure these pressures do not intensify further as a result of the pension arrangements”, she said.

Boris Johnson has pledged several times to solve the problem. However, medical groups including the British Medical Association, the doctors’ trade union, have rejected proposals put forward by the department of health and social care as inadequate.

In her letter, MacEwen warns Javid and Hancock that their solution, which involves giving doctors greater flexibility over how much goes into their pension every year, is “insufficient to tackle the long-term problems”. She seeks action on a taper introduced in 2016 on the annual allowance doctors have on their pension pot growth, which the BMA and others claim is the main cause of the problem.

“It simply isn’t good enough that patients are paying the price because we have not yet found a national solution,” said Saffron Cordery, the deputy chief executive of NHS Providers, which represents hospital trusts in England.

“Operations are being cancelled as anaesthetists reduce their hours and wards are being closed because the senior staff needed are not there. The impact is longer waits for patients and putting other NHS staff under undue levels of pressure undermining staff morale and chipping away at efforts to address workforce shortages.”
well got to congratulate on the nothing but copy and paste from one sides sources ..
exact same can be done for scotlands NHS under the ever failing SNP.

moaning ginger midget constantly brags its her NHS its SNHS ,,, and they wont privatise it what so ever,

yet paid a private American company over £2 million to run NHS supplies.
they have a hospital that kills in Glasgow , they build a hospital under there version of private funding , and cant even open it as the hospital is riddled with the same faults as the mess in Glasgow .
and over 1000 operations are cancelled in Glasgow due to lack of equipment, but right on time ,, sturgeon cries on tv its england , its tories its wee bobby down the roads fault , its no nuttin tay day way me or the scottish government.

but i am just wasting my time , nothing new
Revealed : private surgery for NHS patients soars under Tories.

Figure show almost threefold increase since 2010 to over 600,000 procedures last year.

The number of NHS patients having surgery in private hospitals has nearly trebled since 2010, sparking accusations that for-profit companies are benefitting from an “enfeebled” health system under the Conservatives.

NHS figures obtained by the Guardian show that it paid for 214,967 people in England to have an operation in a private hospital in 2009-10, Labour’s last year in power. The figure soared to 613,833 last year, a 185% rise in nine years.

The figures come as NHS trusts are increasingly forced to send patients to for private surgery because they are too busy and understaffed to do the operations themselves. The sharp rise in outsourcing has coincided with the waiting-list for non-urgent operations ballooning to 4.6m, the highest figure since records began in 2007.

The privatisation of healthcare has emerged as a key issue in the general election campaign. Labour allege that Boris Johnson will sell large parts of the NHS to private US health firms as part of a post-Brexit trade deal with Washington. The party also says the NHS’s annual drugs bill could soar from £18bn to £45bn if US pharmaceutical firms are given freer access to the British market. The prime minister has dismissed the claims.

Trusts are striking deals with independent providers to carry out surgery, including cataract removals and hip and knee replacements, and also some non-surgical treatments, including for cancer.

King’s College hospital trust in London, for example, sent 216 patients to BMI Healthcare in February and March, either to have surgery or undergo an endoscopy, to help cut its waiting list. It also sent 10 patients to undergo bariatric surgery at the Princess Grace private hospital in central London, and paid £1.3m to 18WeeksSupport to treat patients with eye problems whom it could not deal with fast enough itself.

“A decade of cutting over 15,000 beds and failures to recruit staff under the Tories is forcing more and more patients out of the public NHS into poor quality private hospitals,” said the shadow health secretary, Jonathan Ashworth.

“The failing health secretary has allowed waiting lists to balloon with patients left in pain and distress. A bonanza for the private sector is the consequence exposing Mr Hancock’s famous claim of ‘no privatisation on his watch’ as utterly hollow,” he added, referring to comments Matt Hancock made to MPs in January.

The 613,833 NHS-funded procedures last year were undertaken at 296 different private hospitals by 144 separate providers. BMI Healthcare treated 115,925 patients, the highest number, at its hospitals. Spire hospitals performed 80,095 procedures and Circle Health 41,435.

Dr Tony O’Sullivan, a retired paediatrician and co-chair of the campaign group Keep Our NHS Public, said: “These are totally shocking figures that provide hard evidence that the NHS has been enfeebled after close to a decade of Conservative government and been left desperately short of staff and money.”

The Guardian disclosed in July that private firms were given a record £9.18bn of the NHS budget in 2018-19, up from £8.07bn in 2014-15.

In another illustration of outsourcing, Northumbria Healthcare trust has agreed to send between 120 and 150 people with cancer a year for oncology treatment at the private Rutherford Cancer Centre.

The organisation representing independent providers of NHS care defended their role and said their involvement meant patients were able to avoid spending a long time waiting for the NHS to treat them.

“While there’s been a growth in the use of private provision in the NHS, this still equates to just 7% of the NHS budget, and the recent slowdown in work going into the private sector has coincided with a period where NHS waiting lists have increased substantially”, said David Hare, the chief executive of the Independent Healthcare Providers Network.

“The reality is that without private provision of NHS services patients would wait far longer for their care and have less choice, which is why the public repeatedly report being relaxed over who provides their NHS care providing it is high quality and remains free at the point of use.”

The shadow chancellor, John McDonnell, pledged last week that a Labour government would get rid of all privatisation in the NHS by it taking contracts back in-house as they come to an end. “We believe actually we shouldn’t be allowing people to profiteer from the NHS. The general public feel as though we shouldn’t be pouring money into the pockets of profiteers”, he told the BBC’s Andrew Marr Show.

In a statement, a Conservative spokesperson said: “In the face of rising demand, the NHS is treating more people than ever. There are 2.4m more operations happening every year, compared to 2010. We have committed to the largest financial settlement in NHS history, backing it with an extra £33.9bn in cash a year by 2023/24.”

Meanwhile, the Tories have pledged to increase the number of GPs in England by 6,000 by 2025 and offer patients 50m more appointments if they form the next government. Half of the extra family doctors would come from expanding training places and half from better retention and also recruiting GPs from overseas.

But Labour scorned the announcement. Ashworth said: “[In 2015] Tory ministers promised us 5,000 extra GPs but in fact we have lost 1,600 GPs under the Tories.”
A&E waiting times hit worst-ever level.

One in six patients waited longer than four hours in A&E in England during October - the worst-ever performance since the target was introduced in 2004.

The data from NHS England showed 83.6% of patients arriving at A&E were treated or admitted in four hours.

The target is 95%. It has not been met since July 2015.

Other targets covering cancer and routine hospital treatment are also being missed.

The target to start cancer treatment within 62 days of an urgent referral is also being missed.

The monthly statistics are the worst since targets were introduced over a decade ago, prompting doctors to warn the system was "imploding".

None of the three key hospital targets have been met for over three years.

The figures show:

83.6% of A&E patients were admitted or transferred in four hours - below the 95% target.

76.9% of cancer patients started treatment in 62 days in September - below the 85% target.

84.8% of patients on the waiting list for hospital treatment waiting under 18 weeks - below the 92% target.

A total of 4.42m patients on the waiting list overall.

Doctors fear for NHS

NHS England said hospitals were under pressure, seeing "more older and sicker patients".

A spokesman said, with winter coming, hospitals would be opening extra beds.

But he urged the public to play their part by getting the flu jab and using the 111 phone line and NHS online services "as first port of call for non-emergencies".

Dr Nick Scriven, of the Society of Acute Medicine, said: "These figures are truly worrying as we haven't even reached the 'traditional' winter period yet."

He said urgent action was needed, warning hospitals were "imploding".

"We have heard so many announcements over the last few weeks of half-baked projects that require either thrice promised money or are totally uncosted for the real world."
NHS bosses accused of gagging staff during election campaign.

Staff say some trusts have gone too far in applying rules on political impartiality.

https://www.theguardian.com/society/201 ... n-campaign

NHS staff claim they are being prevented from speaking out during the election campaign because their bosses are applying rules about political neutrality too zealously.

Health workers have been told not to get involved in any political debates on social media during the campaign. NHS organisations have also banned staff from appearing in uniform or featuring any of their equipment, such as an ambulance, in their online posts or profiles.

Doctors, nurses and paramedics have told the Guardian that the instructions from their employers are oppressive and an attempt to stop them highlighting the fragile state of the NHS in the run-up to the 12 December poll.

The health service has been a prominent issue in the campaign so far, with the Conservatives and Labour making a series of pledges about funding and staffing.

Some NHS trusts appear to be imposing tighter restrictions on staff during the purdah period than those outlined in guidance that the NHS England chief executive, Simon Stevens, sent to health service leaders on 5 November.
Revealed : NHS running short of dozens of lifesaving medicines.

Internal document seen by the Guardian shows low supplies for heart, cancer and anti-epilepsy drugs.

The NHS is running short of dozens of lifesaving medicines including treatments for cancer, heart conditions and epilepsy, the Guardian has learned.

An internal 24-page document circulated to some doctors last Friday from the medicine supply team at the Department of Health and Social Care (DHSC), headed “commercial-sensitive”, listed many drugs currently hit by shortages at the NHS.

The document warned: “This information is confidential to the NHS, please do not upload to websites in the public domain.”

The document listed 17 new drug shortages identified last week including drugs for cancer, Parkinson’s, mental health problems and some eye conditions. It also identified ongoing issues with 69 different types and doses of medication including antibiotics for tuberculosis, diamorphine, various cancer drugs, heart condition drugs, Hepatitis vaccines and anti-epilepsy drugs. Eight drugs have been discontinued and supply issues with over 20 drugs, where there were previous shortages, have now been resolved.

The document said that because there are shortages of many licensed medicines, in some cases unlicensed versions may be imported although “lead times vary”.

While shortages of some drugs have been reported previously, doctors have said that the breadth of conditions identified in the list obtained by the Guardian was “unprecedented”.

The document told doctors that some patients would have to be prioritised over others for some lifesaving drugs, a form of drug rationing.

In some cases the document recommended breaking tablets in half, in others finding a way to share dwindling supplies.

While some drugs for which there are shortages have alternatives which could be prescribed, others did not. Switching patients from one drug to another is not always straightforward or safe.

The document stated that in some cases switching drugs would require increased clinical supervision, something which adds to the workload of already hard-pressed doctors.

Dr Nick Mann, a GP in Hackney in London, said: “This situation is absolutely unprecedented. Previously we would have one or two or three drugs that would go offline for a while, but this is something on a different level. It is going to render the day-to-day treatments that doctors provide very difficult.”

The report described one drug for stomach and pancreatic cancer which has no date for resupply provided by the manufacturer and “no alternative supplies of UK licensed [drugs] … are available to support this gap in supply. You may wish to consider the following as a priority: patients completing a course of treatment and those already booked for surgery.”

For procyclidine, a Parkinson’s drug out of stock until March 2020, the document said that doctors should “consider sharing remaining stock locally with the support of your regional procurement lead”.

For a type of eye drops that are currently unavailable the document stated that the Royal College of Opthalmologists “has provided clinical guidance to support local prioritisation of remaining supplies”.

In the case of Relpax, a migraine drug, which is in short supply, there was a recommendation to break the higher dose tablets in half although the document admitted “there are no data on halving or crushing them to deliver a 20mg dose”.

Rachel Cooper, the director of the health initiative at the anti-corruption network Transparency International, said: “Shortages of medicines risk price distortion at the expense of health budgets, disrupt patient drug regimes and can undermine public health objectives. The public deserves full transparency of pricing structures and the reasons for and financial implications of drug shortages.”

Mann added: “The scale and scope of this list from DHSC of currently unavailable prescription medicines is extremely alarming. Beyond Brexit stockpiling and manufacturing diversions, and parallel exporting, there appears to be a change in pharma companies’ behaviour causing a potentially dangerous level of instability in previously reliable, standard treatments.

“This massive increase in supply failure is new, and the reasons for it need to be urgently identified and addressed to prevent inevitable harms to patients. Some treatments, like those for epilepsy, are not interchangeable. Such shortages will have a high risk of harm to patients.”

Dr Tony O’Sullivan, a retired paediatrician and the co-chair of Keep Our NHS Public, said: “The Health Department’s guidance includes an unprecedented list of drugs unavailable or in short supply. Patients and clinicians alike should be on high alert when the advice includes how to ‘share stocks’ to make them last, to ‘prioritise’ patients already on specific treatments including cancer rather than a new patient and effectively how to ration so many vital drugs. Drug companies’ behaviour must be controlled. We must urgently protect the NHS from further risks of loss of control of drug prices and supplies from trade deals with the USA and that requires returning it to a wholly public service.”

A spokesman at the Association for the British Pharmaceutical Industry said: “For new on-patent medicines there is an agreement between the government and pharmaceutical companies to cap NHS spending growth on branded medicines at 2%, with anything over this paid back to the government. Manufacturers know that any medicine shortage is extremely worrying for the people affected by it and they do everything they can to prevent medicine supply problems occurring and to resolve them quickly if they do happen.”

A spokeswoman for the Royal Pharmaceutical Society said: “Medicine shortages are an increasing problem. A range of factors are responsible for shortages, such as manufacturing problems, global demand for medicines and fluctuations in the exchange rate. At the moment pharmacists are working incredibly hard to get the medicines patients need. Pharmacists spend hours tracking down stock and working together to help patients.”

The DHSC has been approached for comment.

Drug shortages revealed in the list

Cyanide poisoning drug : the sole supplier is experiencing long term out of stock issues.

Diamorphine : “insufficient stock to cover full forecasted demand in both primary and secondary care”.

Anti-epilepsy drug : “Patients should normally be maintained on the same brand. However … will be out of stock … until March 2020”.

Tuberculosis medication : two suppliers are out of stock, a third has some stock “but is unable to support any uplift in demand”.

Dementia drug : need to change type and frequency of dose, which could be confusing for dementia patients.
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