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NHS : Privatisation Issues And Related News : Failings / Scandals / Rip Offs / Continuing Meltdown - Page 22 - 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
Matt Hancock signals A&E waiting targets likely to be scrapped.

Health secretary defends NHS’s performance and says targets should be " Clinically appropriate. "

( First thought ?

Targets unachievable , let's change the goal posts ... then , we can argue that the NHS is functioning correctly ???

In short , a DANGEROUS cop-out ! )

Matt Hancock has signalled that four-hour waiting targets for A&E are likely to be scrapped for the NHS in England after the worst figures on record this winter.

The health secretary said it would be better if targets were “clinically appropriate” and the “right targets”, as he defended the NHS’s failure to meet the standard that 95% of patients attending A&E should be admitted, transferred or discharged within four hours.

The target was put under review by Theresa May’s government and the NHS unveiled plans last March to pilot changes that would prioritise patients with serious conditions while patients with minor problems could wait longer than four hours.

A decision about the flagship four-hour target is due to be taken by NHS England in the coming months.

Speaking on BBC Radio 5 Live, Hancock defended the NHS’s performance even though waiting times in December were the worst since the target began in 2004.

Asked if the target would stay, he said: “We will be judged by the right targets. Targets have to be clinically appropriate. The four-hour target in A&E – which is often taken as the top way of measuring what’s going on in hospital – the problem with that target is that increasingly people are treated on the day and unable to go home. It’s much better for the patient and also better for the NHS and yet the way that’s counted in the target doesn’t work.

“It’s far better to have targets that are clinically appropriate and supported by clinicians.”

In December, hospital-based A&Es only managed to treat and then admit, transfer or discharge 68.6% of arrivals within four hours. That was the smallest proportion in any month since the target was created in 2004 and the first time performance has slipped below 70%.

In all, 98,452 patients spent at least four hours on a trolley in A&E as they waited for a bed.

Hancock said waiting times had deteriorated because there were a million extra A&E visits in 2019 and argued the best way of dealing with this was more money for the NHS. He said the government’s new NHS bill promising an extra £33.9bn a year by 2024 was the biggest cash increase ever.

But Hancock was challenged over his figures as it is nowhere near the biggest funding injection in real terms when inflation is taken into account.

The idea of ending the waiting time target has raised fears it could lead to patients being left untreated for hours and concern that the move might be motivated by political expediency rather than patient safety.
NHS closing ranks ... again ?

Staff say hospital bosses misled them in hunt for whistleblower.

Doctors told a patient’s widower about the failings in an operation that led to her death.

Doctors at Matt Hancock’s local hospital accused bosses of misleading senior staff about their unprecedented demand for fingerprint samples in a bid to identify a whistleblower, it has emerged.

Minutes of a meeting seen by the Guardian show that after managers at West Suffolk hospital used “bullying and intimidatory” tactics to seek out the whistleblower who revealed details of a botched operation to a patient’s widower, they were accused of deliberately misrepresenting their actions in communications with staff.

At the meeting last month, held the day before the revelations were first published in the Guardian, consultants already upset by the issue indicated that their anger had been compounded when the trust insisted in a statement that the demand was only “voluntary” when in their view it was “coercive”.

According to the minutes, Dr Paul Molyneux, the trust’s deputy medical director, read out a section of the trust’s letter demanding both fingerprints and samples of handwriting, which made clear that non-compliance would be seen as proof of blowing the whistle.

One doctor dismissed the trust’s statement about its behaviour that was sent to senior staff, including board members, as “not factually correct”.

An inquest begins on Thursday into the death of a patient at the centre of the “witch-hunt”. Susan Warby died aged 57, five weeks after an operation for a burst bowel at the hospital in Bury St Edmunds, which is used by the health secretary’s constituents.

After her death, in August 2018, her widower, Jon, was sent an anonymous letter highlighting errors in her procedure. Allegations of what went wrong in her surgery are expected to be outlined at the inquest at Ipswich coroners court on Thursday and Friday.

Ahead of the inquest, new details emerged about the lengths the trust went to try to uncover the mole, and the resentment this created amongst medics:

The anonymous whistleblowing letter was first passed to the police and then handed to the coroner.

The trust spent £968 on a handwriting expert and £1,512 on a fingerprint expert to try identify the letter writer.

The investigation was overseen by Louisa Pepper, a former assistant police chief constable, who sits as a non-executive director on the trust’s board.

A senior consultant said the trust should see the letter as a “cry for help” rather than an attempt to “weaponise a patient” as alleged by the trust’s medical director, Nick Jenkins.

The trust’s chair, Sheila Childerhouse, accepted that the trust needed to reflect on the issue and asked whether it highlighted a “systemic problem”.

On 11 December, the Guardian reported that Hancock failed to respond to concerns about the trust’s treatment of staff. The day before the story was published, the issue was a raised at a medical staff (consultants) committee meeting.

Stephen Dunn, chief executive of West Suffolk hospital poses, for a selfie with the health secretary, Matt Hancock, in December 2018. Dunn was wearing a lanyard from the ‘Freedom to Speak Up’ campaign, an initiative to encourage whistleblowing in the NHS. Photograph: @SteveDunnCEO

Senior staff had been warned to expect a story in the Guardian about the incident in a message from chief executive Dr Stephen Dunn. In the message, Dunn repeated a claim the trust initially made to the Guardian, that the demand for biometric data was only “voluntary”.

At the time one doctor told the Guardian that the Dunn’s statement was “received very badly” by staff. Another doctor said: “It’s bollocks. All the doctors asked for fingerprints and handwriting were told that non-compliance suggested guilt.”

These concerns were echoed in the meeting by consultants who felt the “demand [for fingerprints and handwriting] felt coercive”.

Dr Liz Bright, who at an earlier meeting described the trust’s tactics as “harassing and totally at odds with the trust’s stated commitment to a culture of openness and speaking up”, said the communication from the trust was “not factually correct”.

According to the minutes she said: “The request for biometric data was not voluntary, although the most recent communication described it as voluntary.”

At the staff meeting, Molyneux, read out passages from a letter to staff calling for fingerprints and handwriting which doctors felt was threatening. The passage he cited said: “any refusal to provide consent ... would be considered evidence which implicates you as being involved in the the writing of the letter”.

The trust’s medical director, Nick Jenkins, reminded staff to inform the communications teams if they were approached by journalists. Molyneux told the meeting that the trust’s executive team should “not concentrate on who contacted the Guardian, but why they contacted the Guardian”.

Before publication last month the Guardian challenged the trust’s initial description of the request as “voluntary” and read out passages from the same letter quoted by Molyneux. As a result it amended its response to drop the word but it still insisted that staff were not threatened with disciplinary action if they failed to comply.

It has since acknowledged “colleagues involved that it did not necessarily feel that way”.

In a statement to the Guardian, the trust said: “A very serious data breach took place where confidential patient information was accessed and shared inappropriately, causing distress to a patient’s family. We opened an investigation into that data breach, as is our duty.

“We have apologised to our staff. We have no intention of pursuing fingerprint requests further.”

In response to a freedom of information request, by campaigner and former NHS whistleblower Minh Alexander, the trust also revealed that staff involved were all sent a “personal written apology for the stress and upset caused”.
Yep ... as anticipated ... original article posted two postings ago :

Plan to scrap A&E target sparks furious backlash from medics.

Critics claim proposal is driven by ministers’ desire to avoid negative publicity about patients facing longer delays.

Plans to scrap the four-hour A&E target have sparked a furious backlash from doctors and nurses, with some claiming it is driven by ministers’ desire to avoid negative publicity about patients facing increasingly long delays.

A&E consultants led a chorus of medical opposition to the move. They pointedly urged NHS leaders and ministers to concentrate on delivering the long-established maximum waiting time for emergency care rather than finding “ways around” it.

Under the target, 95% of people arriving at A&E in England are meant to be treated and then discharged, admitted or transferred within four hours. But performance against the target plunged to a new record low of just 68.6% last month in hospital-based A&E units as a result of staffing problems, the decade-long squeeze on the NHS budget and the dramatic growth in the number of patients seeking care.

The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, was responding to Wednesday’s apparent confirmation by the health secretary, Matt Hancock, that the target – introduced by Labour in 2004 – is set to be axed because it is no longer deemed to be “clinically appropriate”.

“So far we’ve seen nothing to indicate that a viable replacement for the four-hour target exists and believe that testing [of alternatives to the target] should soon draw to a close,” said Dr Katherine Henderson, the president of the RCEM.

“Rather than focus on ways around the target, we need to get back to the business of delivering on it.”

Hancock told BBC Radio 5 Live: “We will be judged by the right targets. Targets have to be clinically appropriate.

“The four-hour target in A&E – which is often taken as the top way of measuring what’s going on in hospitals – the problem with that target is that increasingly people are treated on the day and are able to go home. It’s much better for the patient and also better for the NHS and yet the way that’s counted in the target doesn’t work.”

At prime minister’s questions Boris Johnson told MPs that delays for NHS care were “unacceptable” and vowed that “we will get those waiting lists down” as he repeated his pledge to recruit 6,000 extra GPs and provide 50m more appointments with surgery staff.

Rachel Power, the chief executive of the Patients Association, warned that any dilution of the four-hour wait would be “premature and unjustified. We would be greatly concerned about what it would mean for patients, and whether it might be happening simply to disguise a collapse in NHS performance due to unnecessary long-term underfunding, avoidable workforce shortages and predictable growth in patient need.”

The Emergency Care Association, to which 8,000 A&E nurses belong, said ministers should exercise “extreme caution” in decisions about the target because “it could cause significant detriment to patient safety within our emergency departments if the four-hour target was abolished”. There are fears that patients thought to have only minor ailments could come to harm by having to wait a lot longer than four hours because they also have a more serious condition.

Many doctors suspect that NHS England’s possible replacement of the 95% target is linked to ministers’ desire to limit the embarrassment the service’s inability to meet it brings every time the monthly performance figures are published. The target is enshrined in the NHS constitution and covers the 25 million patients a year who seek help at a hospital A&E, a minor injuries unit or urgent care centre.

“Changing any target for political expedience alone is plain wrong,” said Dr Nick Scriven, the immediate past president of the Society for Acute Medicine, which represents specialists in hospital care of the very sick.

“If the target were to be removed without [a] clinically-driven data-proven exercise to identify a better one, then it would look like the government removing something purely because it is not now being met by a service under immense strain and would be the wrong thing to to do,” he said.

One consultant anaesthetist said: “They don’t want to hear bad news. It feels like it’s ‘talk to the hand cos the face ain’t listening’.”

Dr Simon Walsh, the British Medical Association’s emergency medicine lead, said: “Targets are an important indicator when services are struggling and there is a very real concern that any change to targets will effectively mask underperformance and the effects of the decisions politicians make about resourcing the NHS.”

The Royal College of Physicians, which speaks for hospital doctors in England, stressed that the target had “played a crucial part in driving improvements in waiting times for patients”.

Many A&E doctors believe that the four-hour wait encourages some people to seek care inappropriately at A&E instead of waiting for a GP appointment but also concede that it has ensured that no one goes without care for too long.

Scriven chided Hancock for appearing to “pre-empt and sideline” the conclusions of NHS England’s review group led by its medical director, Prof Stephen Powis. It may recommend replacing both the four-hour target and the requirement that patients should receive non-urgent hospital treatment, mainly surgery, inside 18 weeks. Hancock has “placed them in an invidious position for what appears nothing more than political posturing”, said Scriven.

Jonathan Ashworth, the shadow health secretary, said the review of targets “must be transparent and based on watertight clinical evidence, otherwise patients will think Matt Hancock is trying to move the goalposts to avoid scrutiny”.

Fourteen NHS trusts in England are trialling a new way of measuring A&E waits as part of NHS England’s review of NHS access standards.

When it first came in the target required hospitals to treat 98% of A&E arrivals within four hours. The Conservative-Liberal Democrat coalition government reduced that to 95% in 2010. The target was last met in July 2015. and performance has dropped 10% in the last year alone.

Simon Stevens, NHS England’s chief executive, made clear last year that the least sick patients, such as those with a sprained finger, may well have to wait longer than four hours as a result of a likely shake-up.
Costs double for stalled Liverpool and Birmingham hospitals, report finds.

Costs of building two new hospitals that stalled with the collapse of engineering giant Carillion have almost doubled, auditors have found.

The Royal Liverpool Hospital is due to open five years late and to cost more than £1bn to build and maintain.

And the Midland Metropolitan Hospital in Smethwick is due to cost at least £998m, some £300m more than expected.

The private sector has borne most of the total 98% increase, the National Audit Office (NAO) found.

Both hospitals are expected to open in 2022, although an opening date for the Royal Liverpool is yet to be set.

Risks of more delays

The construction cost of the 646-bed Liverpool hospital is now expected to come to at least £724m, compared with £350m in the original business case, said the NAO.

This includes an estimated £293m for remedial work with an additional £369m for maintaining the building for a period of 30 years, which was the term of the original PFI contract, bringing the total expected cost to £1,063m.

However, there were "particularly significant risks" of further cost increases and delays, as there were still "some issues which are not yet resolved", warned auditors.

Unite assistant general secretary Gail Cartmail said the report made "grim reading".

"Two desperately needed hospitals are going to be years late and in the meantime local communities are left with facilities that are no longer fit for purpose," she said.

"The responsibility for these delays has to lie squarely at the door of the government, which consistently failed to prioritise the overriding need that these hospitals had to be built.

" Significant risks "

A government spokesperson said: "As this report shows, the private sector has borne the brunt of Carillion's catastrophic failure to complete these two projects.

"To support staff and local communities in Sandwell and Liverpool, we're giving both trusts the funding they need to minimise the delays caused by the collapse of Carillion and get these two new hospitals open."

The beleaguered Royal Liverpool Hospital has been repeatedly delayed and is now expected to be completed in autumn 2022.

There were significant problems during construction - including asbestos on site and cracks in structural beams - before Carillion went into liquidation in January 2018.

The new contractor had to strip out three floors of the building and start major work to reinforce the structure with steelwork and additional reinforced concrete.

The 669-bed Midland Metropolitan Hospital in Smethwick is now expected to open in July 2022 - a delay of three years and nine months.

The £709m bill to the taxpayer was up 3% from the original figure, said the NAO.

Following Carillion's collapse, work on both hospital sites stopped while the trusts, government and private investors attempted to rescue the projects.

When these attempts failed, the government decided to terminate the PFI schemes and provide public financing to complete the hospitals.


Carillion chiefs face " Judgment day " as report into Whitehall's handling of the firm's collapse looms.

The National Audit Office is set to publish the result of its investigation soon.

The report is expected to shed light on the Government's handling of the collapse and how the firm's public sector contracts were awarded.

https://www.carersuk.org/forum/news-and ... 2?start=50
A&E wait times matter. But the key issue facing the NHS is investment.

This review must not be an attempt to water down standards in the hope the media and public will forget the crisis.

Though winter crises are nothing new to the NHS, this one is proving exceptionally difficult. By any measure, patients are waiting longer in A&E. The number waiting more than 12 hours for a bed once it has been decided they need to be admitted to hospital (so-called trolley waits), was up more than eightfold in December 2019 on December 2018. Performance is declining, and doing so increasingly quickly.

The headline measure of performance in A&E is the percentage of patients who are admitted, transferred or discharged within four hours. The target was introduced in 2001, the start of a golden era for the (lack of) waiting in A&E that was to last a decade. Targets of this kind have been criticised for distorting clinical priorities and creating perverse incentives for hospitals to meet the targets at all costs.

But there is a clinical justification for a target that ensures patients in A&E are treated as soon as possible, and this and other targets did contribute to the step change in NHS performance and public satisfaction. Crucially, they did not achieve this in isolation – the decade also saw record-breaking increases in NHS funding and workforce growth that went hand in hand with the targets.

The world has moved on since then, yet the four-hour standard has only been tinkered with. So the current review of the A&E target – being led by NHS England’s medical director, Steve Powis – is perfectly appropriate. The health secretary, Matt Hancock, finds himself in hot water for suggesting, before the review has reported, that the target could be scrapped. Ultimately, the value of the review’s recommendations must be judged on whether they would drive a better experience for patients – and carry the confidence of clinical staff.

What the review must not be is a clandestine attempt to improve wait times by watering down standards in A&E, in the hope the media and public will then forget the current crisis. This would be a self-defeating exercise: the Blair government introduced the target because it had little choice – by 2000 it was perfectly clear to everyone that waiting times in A&E had become unacceptable. The target and the publication of performance data was the response to these unacceptable waits and the accompanying public concern; it did not cause them.

Whatever way we measure waiting in A&E, it is clear it matters to patients. Polling shows that waiting times for treatment are at or near the top of public’s concerns about the NHS; and when asked, people strongly support the four-hour target. Over the coming years, the NHS will need to stop the decline in performance and go some way to reversing it. Clever (or not so clever) redefinitions of the target will not by themselves improve performance.

This can only be achieved by major investment in NHS capacity, which the government is now doing after a decade of underinvestment. Primarily, this means more staff so patients can be admitted safely to a hospital bed.

While investment in general practice and communities may help slow the rise in the demand NHS hospitals are facing (and help get patients out quickly when they have been admitted), the number of hospital beds in England is looking increasingly unsustainable in the light of ever-full, and overfull, wards. Twenty years on from the last national beds inquiry, we need a new review of the number of hospital beds and appropriate staffing levels to cope with rising demand.

The key staff group needed to boost hospital capacity for emergency care is nurses, so the government’s manifesto commitment to finding an extra 50,000 is welcome. But, as the 2000s also showed us, turning round the NHS supertanker takes time. The new government has five years before it faces the electorate again – it must take action now.

• Richard Murray is chief executive of the King’s Fund
Rumoured new fix for doctors' pensions could be a windfall for ALL higher earners... but critics say it still won't solve NHS staffing crisis.

The Treasury is considering raising a key threshold where the controversial " Taper " kicks in, according to a news report.

Pension tax change would benefit higher earners in public and private sectors.

Idea dismissed as ineffective or 'a sticking plaster' by doctors and some experts.

https://www.dailymail.co.uk/money/pensi ... rners.html
Chris, Are there published figures for decrease in capacity, increased demand and number of people who ought to be seeking treatment elsewhere? (re A&E wait times)
Nothing nationwide.

A couple of local reports but ... to extrapolate to a nationwide basis ... one must have an " Average " performing NHS hospital to start with.

( In essence , you would need a nationwide sample , then factor in local variables , even to get an average performing starting point. )

As for the elsewhere bit , I recall a posting some while ago where pressure was being applied on gp surgeries for them to carry out minor work
currently undertaken by NHS hospitals. If needed , I'll have a hunt for it ... could only be in one of two threads.

Suffice to say , The Smoke ... London ... is one of the worst performing regions.

Having said that , it's unique staffing problems ... given the sheer cost of living down there ?

( Even £ 40K per annum wouldn't buy one a patch of ground to pitch one's tent ! )
This mess is crying out for some type of statistical process control. We know the problems of averages, and averages of averages! It's one sorry, finger pointing saga.......
We know the problems of averages, and averages of averages!

Had to chuckle !

Ain't that annual CUK survey due soon ?

Results from a few thousand ... extrapolated to 8.6 million ... and , hey presto , that the state of CarerLand done for another year.

Even within that few thousand , how many have had to use a food bank in the past year ... less than ten ???

Extrapolation ... a word that should be banned on this forum ?

237 posts