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NHS : Privatisation Issues And Related News : Failings / Scandals / Rip Offs / Continuing Meltdown - Page 21 - 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
I implore people to stop using private healthcare : it’s killing the NHS.

By going private, patients are buoying a sector that is poaching precious NHS staff – and may be harming their future selves.

Imagine you had a job that you love doing – but year after year, the hours get longer, the size and complexity of the workload gets greater, the pay doesn’t really improve, and you see your colleagues leave without being replaced. On top of that, you have to give up more of your life outside of work, while morale in your workplace sinks and mistakes creep in.

This is life working in the NHS. And it doesn’t end there. Imagine you then see another job opportunity advertised. It has a controlled workload with sociable and predictable hours (because the NHS cannot control the volume or timing of patient demand), an easier mix of patients to care for (the private sector can “cherry-pick” the less needy patients), better pay (private hospitals do not have the overheads of running A&E departments), and less risk of verbal or physical abuse because these patients are happier.

Do you take it?

For all the talk of Donald Trump acquiring the NHS in a trade deal and headline-grabbing, multimillion-pound procurements for private companies, this is one of the most insidious and immediate ways privatisation is affecting our universal healthcare system – by poaching staff from their NHS jobs.

Private hospitals, private diagnostic testing services, private general practices and other privately run services are creating a vicious cycle of detriment. It is a major contributor to the some 100,000 vacancies currently in the NHS today.

This is my professional view based on my extensive senior commissioning experience in the NHS. As a result, I strongly encourage people not to use private healthcare services. I ask people to think carefully about the impact of prioritising themselves at a high cost to not only other people who do rely on the NHS, but to their future selves who may rely on the NHS one day because they have an accident or emergency, or become really quite unwell, or can no longer afford to pay privately.

It is a complete fallacy that by using a private service you are relieving the NHS of a little bit of their workload – every nurse or doctor that “defects” to treat private patients could have cared for many more (and needier) NHS patients in a given year.

And it’s not just a case of wealthier patients. Increasingly, those who have operations and diagnostic tests at private hospitals are not “self-funders”. They are NHS patients who were sent there by the NHS because their local hospital is struggling to manage the demand and backlog of patients on the waiting list. The NHS is a significant consumer of many private healthcare services. Although exact figures are hard to determine, the NHS spent £9.2bn on services delivered by the private sector in the last financial year.

Under pressure to meet targets and avoid harm coming to patients while they wait for unacceptably long periods, there is a government diktat that NHS GPs and hospitals should offer private operations and tests to patients on the waiting list. And why are so many hospitals struggling with waiting times so severely and so frequently these days? Lack of staff.

This is all an act of self-harm, bolstering the profit margins of the private sector and sending away with the patients those very staff who would have contributed to resolving the waiting times in the NHS. More and more private healthcare providers are springing up, seeing a great commercial opportunity.

If left unchecked, it is difficult to see a long-term future for the NHS. It is buckling under extreme workforce shortages not with every year that passes, but now, with every month. This is not a problem that can be solved with money alone. Even if the government commits additional millions to recruitment, as it has done in recent years albeit with non-recurrent monies, this is not going to magic up 100,000 ready-to-serve, genuinely additional staff within the next year or two.

The country needs to recognise that staff retention is the NHS’s top priority. We need to listen to and understand thoroughly why doctors, nurses and others are leaving or reducing their work in the NHS. It is not because all of a sudden they do not believe in the ethos or noble work of the NHS any more. It is because they cannot continue without jeopardising their own wellbeing, and that feels both unjust and irrational if we believe, cross-party, that the life of the NHS is worth saving.

I implore anyone who uses private healthcare to be aware that they are effectively privatising the NHS by doing so. I also call for a repeal of the government’s obligation for clinical commissioning groups and hospitals to send NHS patients to private providers in a superficial effort to reduce long waiting lists. A policy change is needed to stop these vicious cycles and the burgeoning opportunistic growth of private providers, who will not be there for us “from cradle to grave”, and especially not when we are in greatest need.

• Jessica Arnold is the associate director of primary care for NHS Bromley clinical commissioning group, and has held a number of senior roles in the NHS and public services across London and north-west England
Glaucoma patients going blind due to treatment delays, watchdog finds

Healthcare Safety Investigation Branch highlights case of woman, 34, losing sight due to delay in seeing NHS consultants.

People with glaucoma are going blind because NHS eyesight services have “inadequate capacity” to follow up such patients properly after diagnosis, an investigation has revealed.

An estimated 22 patients a month are suffering severe or permanent loss of sight because of long delays in getting follow-up appointments, the patient safety watchdog found.

The investigation by the watchdog, the Healthcare Safety Investigation Branch (HSIB), highlighted the problem after a 34-year-old woman lost her sight completely due to delays she experienced in seeing specialists over the course of 11 months. The woman, a mother of three, has not been named. She was awarded £3.2m by the NHS last year as compensation for the life-changing consequences of the delays in her treatment.

In a hard-hitting report the HSIB warns that patients who have glaucoma are regularly losing some or all their sight because hospital eye services are too oversubscribed to be able to give them follow-up appointments quickly enough.

Keith Conradi, the HSIB’s chief investigator, said: “Glaucoma is the world’s leading cause of irreversible blindness. We know that delay to appointments once patients are diagnosed exacerbates the risk of sight loss in patients across England.

“Our case highlighted the devastating impact. Our patient has suffered immeasurably, living with the effects each day, including not being able to see the faces of her young children or read books to them.”

The woman saw seven ophthalmologists after being referred to Southampton eye hospital in 2016 by an optician. She was given eyedrops and told she would have follow-up appointments. However, she did not have laser eye surgery for 11 months after her referral, by which time she already had severely impaired sight which could not be reversed.

A subsequent NHS inquiry found that 15 other patients at the same hospital had also either gone blind or suffered loss of sight because of delays, and that, in all, 4,000 glaucoma sufferers had not had appointments as quickly as needed.

Research in 2017 found that an estimated 22 patients every month suffer severe or total sight loss as a direct result of delays in their treatment.

Conradi criticised the NHS inaction over the problem, which has been evident for many years. “Despite some national recommendations being made 10 years ago this continues to happen and will only worsen as the population ages. A 44% increase in the number of people with glaucoma is predicted by the year 2035,” he said.

HSIB’s report said: “There is inadequate hospital eye services capacity to meet the demand for glaucoma services. A shortage of ophthalmologists is a particular problem.”

Helen Lee, policy and campaigns manager at the sight loss charity RNIB, said the HSIB findings had shown “a serious and dangerous lack of specialist staff and space in NHS ophthalmology services across the country”.

She added: “Thousands of patients are experiencing delays in time-critical eye care appointments, which is leading to irreversible sight loss for some. Suggestions on how to tackle the problem have been continually ignored. Without immediate action we’re very concerned that more people will experience avoidable sight loss.”

The HSIB has recommended a series of changes to reduce delays. Specialist eye doctors, especially locums and trainees, need to stop their “risk averse behaviour” in referring too many patients for a follow-up appointment, it said. And hospitals should give greater priority to those who have already been seen at least once, rather than new referrals, as they are at the greatest risk of their glaucoma taking away their sight, it added.

The NHS did not respond directly to the findings. A spokesman said only: “Fortunately the number of NHS-funded cataract operations is now at a record high, and by streamlining referrals and assessment as the NHS will be doing this year, it should be possible to further speed up access to expert eye care.”
A&E patients face long waits as winter bites.


The NHS England December data showed record delays in A&E with one in five patients waiting more than four hours.

A key problem seems to have been a shortage of beds on wards.

The figures show nearly 100,000 of the sickest patients faced hours stuck on trolleys and waiting in corridors while beds were found for them.

Some hospitals were even forced to introduce emergency protocols and turn away walk-in patients deemed not to need immediate help, while many have postponed routine operations to fee up space.

Mark Newton's 83-year-old father-in-law, George Bufton, was taken to a hospital in the Midlands in the first week of January.

He had a chest infection and a suspected gall bladder problem - and this came just over a month after he'd had a major bowel cancer operation.

He spent 25 hours waiting for a bed to be found.

Mr Newton said he was "gobsmacked" by what he saw.

At one point around 20 trolleys were stuck waiting in the corridor, with queues of ambulances outside A&E.

He said staff were doing an "admirable" job in the circumstances, but there was just not enough money or staff to cope.

"It was utter mayhem. This can't continue. Something must be done about it," Mr Newton said.

What is the cause of the pressures ?

Hospital bosses acknowledged it had been one of the most difficult months they had seen - and this comes despite the extra money the government has put in this year, which saw the NHS budget grow by 3.5%.

There are a variety of reasons behind the problems.

Prof Joe Harrison, chief executive of Milton Keynes Hospital, said his staff had been seeing some very sick patients.

He said it had mainly been a combination of older patients and children, who seemed to have been particularly hard hit by flu and respiratory problems.

Although the figures also show that the number of beds that have had to be closed to contain vomiting and diarrhoea outbreaks has risen by more than 60% compared to last year with 760 beds closed on average each day last month - that is closed to 1% of the bed supply lost.

Prof Harrison also said the social care system in the community, which hospitals rely on to discharge patients into, seemed to have been struggling more than it was last year.

"Keeping people safe has been our main priority. There is significant pressure, not just in this hospital, but across the NHS system as a whole," he said.

Ambulance crews have been reporting severe pressures, with the number of hours lost queuing outside A&E units waiting to handover patients to hospital staff rising.

One in six crews had to wait longer than 30 minutes - the target is 15.

A number of ambulance trusts have taken paramedics off ambulances and deployed them to manage the queues in attempts to keep delays to a minimum.

There have been reports of some hospitals ordering staff not to talk to journalists about the mounting pressures.

Routine operations have been cancelled in many places in an attempt to relieve the pressure on wards.

In the most under-pressure hospitals, emergency protocols have seen A&E units refusing to treat walk-in patients so they can focus on patients brought in by ambulances.

There were more than 120 cases of this happening last month - with some hospitals instigating the measure, known as an A&E divert, multiple times.

And in the West Midlands, ambulance bosses have ordered crews to avoid taking care home residents in Worcestershire and Shropshire to local hospitals unless it is an absolute emergency because of the "extreme difficulties" being experienced.
Who do I treat first : a cancer patient or the woman with a bleed on her brain ?

Every time I tell a patient in intensive care their treatment is to be delayed , I’m angry and ashamed.

It’s a sunny Friday morning. I find a parking space easily, just as a song by my favourite band ends and I turn off the ignition. It’s 8.15am when I see the night consultant in the corridor: the past 13 hours caring for critically ill patients in the intensive care unit (ICU) has taken its toll. Their long night is over. My long day is just beginning.

By 8.25am that sunshine, that easy parking spot and that feelgood song are long gone. Three sick patients and yet just one bed. Three cancer patients needing an operation yet just one bed. Then three nurses sick, now no bed.

Mary is a smiling, delightful woman in her 70s who is waiting for her cancer to be cut out. But today she’s on a spreadsheet highlighted in red; her cancer is urgent, but not as urgent as countless others.

She, like other surgical patients on the waiting list, are an easy metric to measure. She will be counted clearly on a list, a number that needs an operation. But what about the young man with sepsis who stays in the emergency department for an hour longer, and the woman with a bleed on her brain whose scan is delayed? These people are the uncounted. They are the emergencies, unplanned yet still urgent, who cannot wait and will have to take Mary’s bed in the ICU.

Which means I now have to do the hardest part of my job. I look at Mary and say “no” and “sorry”. She smiles back and says: “It’s OK, I understand.” But how can it be OK?

Then at the last moment, another breach in waiting list targets comes to light. Clipboards arrive, pens scribble, solutions are shaken out of the air. I see Mary wheeled towards her operation. The counted must not wait, yet this means the uncounted will.

People are not just operations or numbers on waiting lists. I remember how the weeks felt while my mum waited for her cancer to be removed. I also remember how it felt when my brother-in-law was critically ill, cared for in an emergency department with no bed to move to. That experience changed me – it makes me question every time I say sorry, because I don’t mean it. I am not sorry. I am angry and ashamed.

What does this really mean for that young man with sepsis and the woman with a bleed on her brain?

Why should they wait until their condition worsens before another bed can be found?

It means they will get sicker, need more help to survive, stay in hospital longer and have worse outcomes. It means their care will be less efficient and more expensive.

These experiences make me want to stand up for the uncounted who lay on beds waiting longer than they should because all we can prioritise are red numbers on waiting list spreadsheets.

For the ICU, saying no to the uncounted is demoralising. Our staff deliver what people need, but they need the resources and the workforce to stop saying sorry. The patients are willing to hold on but they need an eventual respite from what will be another winter of waiting.

As I walk back to my car 13 hours later, though, I remain hopeful.

With ideas like enhanced care areas, the efficient use of resources coupled with innovation can help ease the strain.

Yet good ideas on pieces of paper solve nothing: ideas need to be built, funded and nurtured.

The Welsh Assembly’s investment of £15m for intensive care to transform ideas into patient lives will significantly help.

Meanwhile, those of us treating patients will carry on working to the best of our ability.
Redbridge hospitals worst in London for A&E waiting times.

Accident and emergency waiting times in London are now at their worst ever, new Government figures reveal.

In December, just three in five patients were seen within four hours at major emergency rooms in the capital.

Emergency services include major A&Es in hospitals and trauma centres, specialist emergency services such as at Moorfields Eye Hospital, and urgent care centres dealing with less serious problems.

For major A&Es, not a single NHS trust in London hit the national waiting time target – that 95 per cent of patients are seen within four hours.

And these centres dealt with 8,000 extra patients last month compared to December 2018.

In total, more than 245,000 people visited major A&Es over the festive period, compared to almost 237,000 the previous year.

But just 60 per cent of patients were seen within four hours – down from over 78 per cent in December 2018.

This means almost 100,000 people waited more than four hours for emergency care at major centres last month – nearly double the 2018 figure.

Barking, Havering and Redbridge Trust – which runs King George Hospital in Ilford and Queen’s Hospital in Romford – had the worst waiting times in the city. Just 44 per cent of patients were seen within four hours.

Homerton University Hospital Trust performed best, with almost 92 per cent of people seen in the four-hour window – but it still fell short of the Government target.

The London Ambulance Service also faced problems over Christmas – almost 2,000 ambulances were stuck outside A&Es for more than an hour waiting to discharge patients between 3 December and 5 January.

Over the same period last year, less than 500 ambulances waited more than an hour.

Labour’s London Assembly health spokesperson, Dr Onkar Sahota, said: “Our A&Es are busier than ever, and they’re getting further and further away from meeting their targets.

“This is as serious as it gets because it leaves patients struggling to get access to the emergency care they often desperately need.”

Dr Sahota said hospital funding has been “pressed mercilessly in recent years” and staff were now “pushed to their limits”.

He said: “What we’ve seen so far is the Government falling short of the mark when it comes to making up for almost 10 years of serious and damaging underinvestment.

He added: “They must take their opportunity to put this right at the upcoming budget, because our services really cannot carry on this way.”

A spokesperson for the NHS in London said: “A&Es across the country are currently very busy and London is no different – in December, London A&Es treated over 25,000 more patients compared to December 2018.”

This figure refers to all emergency centres, including specialist and urgent care.

She said: “We have got more hospital beds open than last winter, but flu has come early and is around twice as high as this time last year.”

She added: “The continued increase in people’s need for care underlines the need for more beds and staff across hospital and community services

“This is why the Government’s commitment to increase the number of nurses by 50,000 and invest in new and expanded facilities will be crucial over the coming years.”
The hospitals in England with the most expensive A&E daily parking costs - with the priciest charging £77.

Review of 154 A&E parking fees were reviewed to find the highest daily charge.

The 6 most expensive are in London, though we've included a list of the priciest outside the capital too.

Just 7 hospitals in England offer free A&E parking, the analysis found.

The NHS made a record £154million from car parking charges in 2019.

https://www.dailymail.co.uk/money/cars/ ... arges.html

10 most expensive daily parking rates at A&E in England

1. Guy's and St Thomas' NHS Foundation Trust (London) - £77

2. Whittington Health NHS Trust (London) - £72

3. Imperial College Healthcare NHS Trust (London) - £52.80

4. Chelsea and Westminster Hospital NHS Foundation Trust (London) - £40

5. King's College Hospital NHS Foundation Trust (London) - £29

6. St George's University Hospitals NHS Foundation Trust (London) - £25

=7. Sussex Community NHS Foundation Trust (Sussex) - £20

=7. Sheffield Children's NHS Foundation Trust (South Yorkshire) - £20

=7. Luton and Dunstable University Hospital NHS Foundation Trust (Bedfordshire) - £20

10. Portsmouth Hospitals NHS Trust (Hampshire) - £18.20
The Tories must learn from the Orkambi victory and keep drug-pricing off the table.

To match its rhetoric on the NHS, the government has to legally commit to preventing drug-pricing being a part of trade deals.

In October 2019, the NHS finally struck a deal with pharmaceutical company Vertex to provide access to the cystic fibrosis drug Orkambi. After four years of heartbreak, thousands of children and adults finally got what they had been fighting for: the chance of a longer life.

While news of the announcement was quickly displaced by the election, the story behind the deal – and why Vertex capitulated – is a rich and meaningful one, and one we must take lessons from if we are to secure the future of the NHS. Despite overseeing a decade of collapsing standards of care, the Conservatives have won power with commitments to protect the NHS. But amid a growing global drug-pricing crisis, what can they learn from the Orkambi saga?

Orkambi is a new drug, protected by patents, giving Vertex a monopoly for years to come. In 2018, the NHS offered £500m over five years for Orkambi, but that was not enough for the company, with Vertex’s monopoly price far in excess of what the National Institute for Health and Care Excellence (Nice), deemed to be cost-effective. As the negotiations dragged on, people waited, and more than 200 who might have benefited died without access.

The NHS has significant buying power, and regularly negotiates discounts, but up against a monopolist with billions in the bank and an extraordinary tolerance for reputational damage, there was only so much it could do. Despite a spirited public campaign, the talks eventually collapsed.

Faced with the terrifying prospect of losing their children to the disease, a group of families decided to change strategy. Working with Just Treatment, they took a more confrontational approach by launching a campaign to force the government to use its power to break Vertex’s monopoly through a crown use licence, so that the NHS would be free to buy cheaper versions of the drug. For those patients who needed the drug immediately, they formed a “buyers’ club”, using an exemption in patent law that permits individuals to buy the medicine. This allowed the families who could afford it, or fundraise sufficient amounts, to import generic Orkambi from Argentina at a fifth of the price.

Under pressure, the government admitted it had a “moral obligation” to explore providing access to cheaper versions of the drug, and Labour committed to doing so if it won power. Confronted with the real possibility that the government might break its monopoly, the public relations disaster of desperate families flying to Argentina to keep their children alive, and with an election looming, Vertex gave in and struck a deal.

The battle for Orkambi was won, but the problem is not going away. Whether it’s Trikafta, the successor drug to Orkambi, or any of the new wave of extremely expensive immunotherapy treatments for cancer, many more crucial yet overpriced drugs are coming on to the market. The country cannot be held to ransom every time the NHS needs to buy another medicine from another monopolist.

The Orkambi campaign took many years and cost lives in the process. It should not have to be repeated. Instead, health secretary Matt Hancock, or his successor, should exercise their moral obligation to protect the health of NHS patients. They have the power to break medicine monopolies to rein in the greed of drug companies, and they must be prepared to use it.

But rather than learn the lessons of the victory on Orkambi by moving to a more open, innovative and equitable pharmaceutical system, such as that proposed by prominent economists Joseph Stiglitz and Mariana Mazzucato, and the Labour party at the last election, the government seems all set to move in the opposite direction: a pro-industry trade policy that would make challenging drug prices much more difficult.

Leaked reports of talks between the US and UK on a post-Brexit free trade agreement (FTA) confirm what we can already deduce from the ambitions of the pharmaceutical industry and US demands in past deals with other countries: the mechanisms we have in place to control NHS drug prices are at grave risk.

Any trade deal, with any country, that limits the NHS’s ability to negotiate drug prices could sink it. It is vital that the Conservatives back up their rhetoric stating they’ll keep the NHS and drug pricing off the table in the talks with Trump by making this commitment legally binding. But the devil is in the detail and talks must be opened up to public and parliamentary scrutiny. Sadly, the government seems set to use its majority to shield such trade deals from MPs and the public until they’ve been signed.

The NHS can only continue to deliver world-class treatment if it reforms medical innovation and shifts power away from the pharmaceutical industry and towards patients. If the Tories truly want to become the party of the NHS, as their rhetoric suggests, they must change course.

• Diarmaid McDonald is the lead organiser of the campaign group Just Treatment

• Achal Prabhala is the coordinator of the AccessIBSA project, which campaigns for access to medicines in India, Brazil and South Africa

Safety fears as hospitals redeploy nurses to care for patients in corridors.

Overcrowding forces ward staff to spend part of shift looking after patients without a bed.


Hospitals are having to redeploy nurses from wards to look after queues of patients in corridors, in a growing trend that has raised concerns about patient safety.

Many hospitals have become so overcrowded that they are being forced to tell nurses to spend part of their shift working as “ Corridor nurses ” to look after patients who are waiting for a bed.

Nurses, doctors and hospital bosses have all voiced unease about the practice, which has risen sharply in recent weeks as the NHS has struggled to cope with the extra pressures of winter.

The disclosure of the rise in corridor nurses comes days after the NHS in England posted its worst-ever performance figures against the four-hour target for A&E care. They showed that last month almost 100,000 patients waited at least four hours and sometimes up to 12 or more on a trolley while hospital staff found them a bed on the ward appropriate for their condition.

“Corridor nursing is happening across the NHS in England and certainly in scores of hospitals. It’s very worrying to see this,” said Dave Smith, the chair of the Royal College of Nursing’s Emergency Care Association, which represents nurses in A&E units across the UK.

“Having to provide care to patients in corridors and on trolleys in overcrowded emergency departments is not just undignified for patients, it’s also often unsafe.”

A nurse in south-west England told the Guardian how nurses feared the redeployments were leaving specialist wards too short of staff, and patients without pain relief and other medication. Some wards were “dangerously understaffed” as a result, she claimed.

She said: “Many nurses, including myself, dread going into work in case we’re pulled from our own patients to then care for a number of people in the queue, which is clearly unsafe. We’re being asked to choose between the safety of our patients on the wards and those in the queue.

“When in the queue we are expected to cannulate and take bloods in corridors while patients are in chairs, on the floor or on trolleys.

“Some of our main concerns [include] ward patients [being] left in pain due to understaffed wards [and] late or missed administration of medication due to low staff numbers on the wards.”

At her own hospital some nurses who usually work on specialist wards now have to spend four hours of their shift in a corridor looking after often very sick patients.

“This is not only leaving the wards short but also putting huge amounts of stress on staff. It has hit staff morale as many staff don’t want to leave their own patients that may be acutely unwell or in pain.”

Dr Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, which represents A&E doctors, said: “Looking after people in corridors is demoralising and shameful for staff. People do feel that it’s a failure when they have to look after people in corridors.

“If we had enough beds at the right time we wouldn’t have to do corridor care.”

Growing numbers of patients are being delayed either with ambulance crews outside an A&E unit because staff are too busy to allow a handover to take place or, once they have been dealt with in the emergency department, on a trolley while they wait for a bed.

Hospital bosses voiced their concern about the rise of corridor nursing.

“The fact that some trusts may have to redeploy nurses away from other wards to look after patients who are temporarily waiting in hospital corridors shows the level of strain the health service is now under,” said Saffron Cordery, the deputy chief executive of NHS Providers, which represents NHS trusts in England.

“Long waits or being treated in corridors or waiting rooms is not appropriate for patients, risking their dignity and safety. Although staff will do everything they can to provide the best possible care, these are extremely difficult working conditions. Corridor wards and other temporary arrangements add stress to an already pressurised working environment.

“We must not allow this to become the new normal.”

An NHS spokesperson said: “While the NHS has more beds open this winter than last, our A&Es have had to treat more than a million extra patients over the past year. So as well as 50,000 more nurses and extra hospital beds, over the next few years it’s also going to be necessary to rebuild and expand most A&E departments across England.”
Millions left unspent on NHS as councils fail to cash in on money from housing developers.

The health service has a £6 billion backlog on infrastructure spending – but easy funds are not being obtained.

The NHS is missing out on tens of millions of pounds from housing developers because councils are failing to ask for the funds, it has emerged.

And even when councils do collect the funds, the NHS often fails to spend it – £34m is currently unused.

Property developers are required to stump up this cash to obtain planning permission. The funds are intended to be spent on developing and creating buildings to alleviate pressure on the health service after an influx of residents.

But the money isn’t being spent – despite the NHS facing a backlog of more than £6bn for spending on its buildings and equipment, with £3.4bn representing an urgent risk to patients.

The failure to secure funding from developers was revealed by the right-wing think tank Reform, which is calling for clearer guidance for the NHS and councils, better communication between them, and more transparency.

Lead author of Reform’s report, Claudia Martinez, said: “The NHS estate is in dire straits and yet millions are being left unspent or untapped. Given the scale of the government’s house building ambitions, and the pressure it will put on local services, it must urgently act to rectify this.

“A new year’s resolution for local authorities and the NHS must be to cash in on the money available from developers to fund vital improvements across the estate.”

Under planning rules, councils can force developers to invest millions of pounds in local public services to mitigate the impact of their planning application. For example, the money can be used to fund a new health centre for a large housing estate.

The funding is obtained using legal requirements outlined in Section 106 regulations.

Data obtained by Reform using the Freedom of Information Act showed that between 2014 and 2019, only 36 per cent of local councils, 105 out of 293, had secured investment for healthcare projects.

Of the £87m that was promised, almost £41m has yet to be allocated and handed over to the NHS. In Lewisham, south London, more than £2m of S106 funds have not been allocated.

Twenty councils had more than £500,000 yet to be allocated to the NHS since 2018-19 and, of those, 12 had more than £1m. Exeter City Council holds more than £10m.

Many councils were not using their powers to collect money for healthcare infrastructure at all.

Newcastle City Council, which had one of the highest property development rates in the UK in 2016-17, had not collected any S106 money for healthcare in that period. It has recently started to collect money for the health service.

Maidstone Borough Council in Kent held £1.82m of unspent funds and Tamworth Council in Staffordshire told Reform it did not collect S106 contributions for healthcare because the local NHS had not identified any projects in need of funds.

The NHS was also shown to have failed to spend the money in time. After Blaby, Swindon and Oxfordshire councils obtained S106 funds, the cash had to be returned to the developer because it was not spent within the agreed legal time limit.

Reform said communication about the use of money was often poor between councils and the NHS. The think tank cited the example of Chorley Council and Lancashire County Council, which both said the other was responsible.

The think tank has called on the Ministry of Housing, Communities and Local Government to produce standardised business cases to support the NHS to engage with developers and local councils.

NHS England has issued guidance to trusts to help them secure more money. On its website, it said Section 106 was “an important opportunity for trusts to secure additional revenue and capital to support services and sites when housing growth places additional pressures on them”.

It added: “This needs to be closely coordinated to optimise outcomes.”

The Local Government Association said: “Councils want to see money from Section 106 agreements spent on delivering the infrastructure and services that communities need.

“This can be a complex process and can take time, which is why we would urge individual NHS bodies to work with councils at an early stage in the planning process to make sure that infrastructure needs are fully understood.

“It is really important the NHS engages with councils when local plans are being developed, not when individual planning applications are brought forward.”

A pretty damning report ... to say the very least ?
Cornwall hospital to discharge patients early despite saying it may be harmful

Royal Cornwall hospital move to cut overcrowding described as " Morally repugnant. "


A major NHS hospital is under such pressure that it has decided to discharge people early even though it admits that patients may be harmed and doctors think the policy is unwise.

The Royal Cornwall Hospitals NHS trust has told staff to help it reduce the severe overcrowding it has been facing in recent weeks by discharging patients despite the risks involved.

In a memo sent on 8 January three trust bosses said that the Royal Cornwall hospital in Truro, which is also known as Treliske hospital and has the county’s only A&E department, “has been under significant pressure for the last two weeks and it is vital that we are able to see and admit our acutely unwell patients through our emergency department and on to our wards”.

It had agreed a plan to relieve pressure with unnamed “health and social care partners” after discussing “ a number of possible mitigations”.

The memo added: “One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern.

“It was agreed, however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm.”

The message was signed by Dr Allister Grant, the trust’s medical director, Kim O’Keeffe, its director of nursing, midwifery and allied health professionals and Susan Bracefield, its director of operations.

The hospital has come under some of the most intense strain seen in the NHS this winter and has spent part of it on “black alert”, which is an admission that a hospital cannot cope with the demand for care. Some people arriving at the A&E unit have had to wait for up to 12 hours and it has asked those with minor ailments to seek care elsewhere, for example at a GP surgery or pharmacy.

The trust’s move has increased concern that hospitals are having to make tough decisions about how to respond to the intense pressures that winter has brought. The Guardian disclosed last month that the Norfolk and Norwich hospital had told its senior doctors to make “the least unsafe decision” when treating patients to help it reduce the intense overcrowding it was facing.

EveryDoctor, a network of frontline NHS doctors, voiced alarm at the Cornish trust’s plan.

“It is incredibly concerning that NHS staff are being instructed to override their expert clinical judgment for patients and provide potentially unsafe care to patients, due to a lack of resource,” said Dr Julia Patterson, the lead for EveryDoctor.

“The NHS has never had a wealth of either beds or staff; resource management has always involved intricate management of budgeting and prioritisation of patient need. This problem in Cornwall is a direct consequence of 10 long years of relentless austerity cuts made to NHS services by the Conservative government.”

However, the Royal College of Physicians said that prioritising beds and specialist care for the sickest patients would benefit those in the greatest need.

“Clinical staff make decisions on a daily basis that consider the risks and benefits to the individual patient and to other patients. Physicians will always put the safety of the individual patient they are caring for first,” said Dr John Dean, its clinical director for quality improvement and patient safety.

“For patients in hospital, if they can be safely supported at home and their treatment and recovery continued there, this should occur as soon as possible. This means that other patients can get hospital care who might otherwise have to wait and be at risk of worse outcomes.”

One doctor at the Royal Cornwall said it gets so busy that medics sometimes have to examine patients who are lying on trolleys in the A&E unit, which compromises their privacy. “There is only one outdated hospital in Cornwall. It simply cannot cope anymore.

“In A&E there are many patients lying on trollies and I am forced to examine and clerk on those trollies as there is simply not enough cubicles.

“There is a heavy workload at the moment. There are always red gaps on the rota. There is absolutely a privacy issue here, I discuss what happened to them and plans in front of many other people.”

Dr Rinesh Parmar, chair of the Doctors’ Association UK and an intensive care doctor, said: “This is morally repugnant and against the very fibre of what doctors stand for. We care for our patients and respect their dignity, not simply dispatching them early into the community to already over stretched struggling services. Our patients deserve better than these short-sighted ploys to generate beds at the expense of their health.”

NHS England has been approached for comment.
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