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

Discuss news stories and political issues that affect carers.
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NHS spending and staffing worse than other Western countries, warns report, with quality of care " Slipping. "



Britain's health service is lagging behind that of other high-income countries, research suggests.

The study by the London School of Economics and Harvard School of Public Health compared

ten countries, examining spending levels, and a range of indicators measuring quality of care,

The study, published in the British Medical Journal (BMJ), said the quality of NHS care appears to be "slipping", with Britons faring worse than their counterparts abroad.

Researchers compared the UK with Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland and the US, using data, some of which came from the Organisation for Economic Co-operation and Development (OECD).

The UK was found to have the lowest healthcare expenditure per person at £2,978, compared with an average of £4,438 in the other countries.

Overall, the UK spent approximately 8.7 per cent of GDP on health in 2017, compared with the average of 11.5 per cent.

GPs in the UK reported spending the least amount of time with patients, compared with similar countries, the study found.

Overall, 92 per cent of family doctors said they spent less than 15 minutes on each appointment, compared with 38 per cent of those elsewhere. None said they spent 25 or more minutes with a patient, compared with an average of 15 per cent in other countries, while 8 per cent spent 15 to 25 minutes per appointment, compared with 45 per cent in other countries.

When it comes to doctors, the UK had fewer, at 2.8 per 1,000 people in 2017, compared with an average of 3.5.

The number of practising nurses in the UK in 2017 was also "considerably lower" at 7.8 per 1,000 people, compared with an average of 11.4 in the other countries.

The UK had the lowest survival rates for breast and colon cancer, and second lowest for cervical and rectal cancer.

And 19 per cent of hospital patients waited two months or more to see a specialist, compared with a 12 per cent average in other countries.

The study also found the UK had fewer hospital beds, at 2.5 per 1,000 people, compared with four per 1,000 in other countries.

However, there were fewer healthcare-associated infections in the UK, fewer people suffered a blood clot after surgery and more over-65s had a flu jab. There were also more women undergoing breast and cervical screening.

The authors said: "Our study suggests that the NHS should look towards improving staffing ratios, long-term care provision, and social spending, which are lower than comparator countries and have been declining in recent years.

"Despite already low levels of labour, the UK is making do with fewer doctors and nurses, a challenge that is likely to be exacerbated in the context of Brexit.

"Although access to care compared favourably to other countries, utilisation was lower than average and quality seems to be slipping. Health service outcomes, as well as heath status, are sub-optimal."

The study's authors said the UK "will almost certainly need to spend more on healthcare staffing, long-term care, and other social services" in the future.

The Conservatives have promised an NHS budget rise of 3.4 per cent a year on average, so that by 2023/24, £149 billion will be spent.

Labour has pledged a 4.3 percent increase in health funding annually over four years - amounting to £6 billion extra a year by 2023/24, which the Lib Dems have pledged to match.

Mark Dayan, policy analyst at the Nuffield Trust, said: "Our work last year with the Institute for Fiscal Studies, King's Fund and Health Foundation showed the UK lags behind on many areas of cancer and in overall avoidable deaths for killer diseases.

"But the NHS does appear relatively efficient, and actually has perfectly normal waiting times despite the complaints we so often hear.

"This report is right to point to low levels of key staff as an underlying concern.”

Jonathan Ashworth, shadow health secretary, said: "It’s clear that years of tory underfunding and under staffing of our NHS has had a huge impact on patient care, with many waiting longer for appointments and treatment.

"Labour will invest in our health service with a £40bn cash boost to help deliver real change, recruit more doctors and nurses, and give patients the standard of care they deserve."
Revealed : Millions to be affected by NHS plan to ration 34 everyday tests and treatments.

List includes hernia repair surgery and blood tests to detect prostate cancer.



Millions of patients will be stopped from having an X-ray on their sore back, hernia repair surgery or scan of their knee to detect arthritis under controversial plans from NHS and doctors to ration “unnecessary” treatment.

The Guardian has seen a list of 34 diagnostic tests and treatments that in future patients in England will only be able to get in exceptional circumstances as part of a drive to save money and relieve the pressure on the NHS.

The sweeping changes they are set to propose include many forms of surgery, as well as ways of detecting illness including CT and MRI scans, and blood tests, for cancer, arthritis, back problems, kidney stones, sinus infections and depression. Three of the procedures have since been dropped from the list.

If implemented, the clampdown would involve an unprecedentedly radical restriction on patients’ right to access and doctors’ ability to recommend procedures, some of which have been used routinely for decades.

It would also see patients told to use physiotherapy or painkillers to dull the pain of an arthritic knee rather than undergo an exploratory operation called an arthroscopy. Kidney stones would no longer be removed in an operating theatre and instead would be treated with sound wave therapy to reduce the pain.

Similarly, in future adenoids would not be removed because evidence now shows that it “is not necessary, doesn’t work well and can cause problems like bleeding and infection”, according to the rationale set out in the document for curtailing that procedure.

Disclosure of the list prompted fears that the move amounts to a major escalation of NHS “rationing”.

An NHS spokesperson said the document was out of date and had not been approved or implemented. They added there was “strong support from senior doctors in the Academy of Medical Royal Colleges for action to eliminate wasteful interventions that don’t benefit patients”.

The Patients Association warned that if implemented the changes would force patients to either endure the pain of their condition or pay for private care to tackle it.

Putting “barriers” in the way of people expecting to have so many previously commonplace tests and treatments would lead to “harm and distress”, said Rachel Power, the association’s chief executive.

“Patients have seen the range of treatments offered by the NHS cut back over recent years, and the NHS has been upfront about this being to save cash. Often there are good reasons for not using these ‘low value’ treatments as a first choice, but they are appropriate for some patients.

“We are unhappy at any new barriers being erected between patients and the treatments they need.”

“This is of a piece with the restrictions on prescribing over the counter medicines [which NHS England brought in last year], and patients have told us of the harm and distress this broad programme of restrictions has caused them,” she added.

“As a result of this rationing, we know that patients who can afford to pay privately are doing so, while those who can’t are going without and suffering. This is exactly what having an NHS is supposed to prevent.”

The 50-page document is the result of months of detailed and until now secret discussions between four key medical and NHS bodies involved in the NHS’s evidence-based interventions programme, which aims to identify procedures that do not work.

They are NHS England; the Academy of Medical Royal Colleges (AOMRC), which represents the UK’s 220,000 doctors professionally; NHS Clinical Commissioners, which speaks for GP-led clinical commissioning groups; and the National Institute for Health and Care Excellence (Nice), which advises the government and NHS which treatments are effective and represent value for money.

They believe many of the interventions should be scrapped, or at most used very sparingly, because they could make patients anxious or even put them in danger. For example, they are suggesting that the prostate-specific antigen test, which is used to detect prostate cancer – the commonest form of cancer in men – is used much less often.

The document says: “Blood tests to check your prostate are not needed except for very specific cases. Blood tests can lead to further investigation that may also be unnecessary and can cause anxiety.”

The four medical bodies planned to put the proposals out to public consultation this month but had to delay because of general election “purdah” rules.

Hospitals would be told not to operate on patients to try to slow the progress of osteoporosis (brittle bone disease), or if they have sinusitis, or to remove a disc from the spine of someone suffering from crippling pain.

Dr Richard Vautrey, chair of the British Medical Association’s GPs committee, said any changes should be based on the best available evidence and not cost-cutting.

“In the current climate, NHS resources must be used wisely but any restriction on treatments must be based on up to date clinical evidence and not solely on cost.

“Doctors must always be able to provide the best care possible and use their clinical expertise to refer patients for the most appropriate treatments when that is needed.”

Prof Carrie MacEwan, chair of the AOMRC, defended the planned restrictions. “Medicine continually evolves and it’s right that we don’t carry out tests, treatments or procedures when the evidence tells us they are inappropriate or ineffective and which, in some cases, can do more harm than good.

“The list is drawn up by medical experts and senior specialist clinicians who have reviewed the latest evidence from around the world and it’s absolutely right we act on that evidence in the best interests of patients and so that we can focus our resources on things that we know do work,” she added.
Private firms handed £15 BILLION in NHS contracts over past five years.

Figures cast doubt on government’s denial of creeping NHS privatisation.


https://www.theguardian.com/society/201 ... five-years


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NHS winter crisis : extra beds created by 52% of UK hospitals.

BTS says 48% are still using overflow beds introduced for the same period last year.



More than half of hospitals have opened extra beds to help them cope with the NHS winter crisis amid an influx of patients with potentially fatal breathing problems.

Many of the so-called escalation beds are already occupied by people suffering from flu, pneumonia or chronic obstructive pulmonary disease exacerbated by the arrival of very cold weather in many parts of the UK.

The British Thoracic Society (BTS), which represents specialist lung doctors and nurses, has found that 52% of UK hospitals have already created extra bed capacity to help them prepare for the imminent surge in winter demand.

In addition, almost half (48%) have kept open and are still using the overflow beds they created last winter, in a sign that the sustained pressure the NHS is under is not confined to December, January and February.

“As the winter season starts, life is already really tough at the coal-face of the NHS,” said Prof Jon Bennett, the chair of the BTS.

“It’s a sign of the intense year-round pressure that the NHS is under that more than half of hospitals have already opened extra ‘winter beds’ to help them cope with the cold season – and that many haven’t closed them from last year.

“We are already hearing of rising numbers of people being admitted to hospital with potentially fatal lung and breathing problems who require specialist support.

“[While] an under-resourced NHS lung workforce is working tirelessly to provide the best possible care in the circumstances … we just can’t carry on like this long term.”

The findings, which are from a survey of 69 senior doctors who report on lung care services in hospitals, reflect the situation in the whole NHS, he said.

Meanwhile, one of the country’s leading NHS experts has warned that flu, Brexit, the general election and the doctors’ pensions dispute are set to combine to create a “perfect storm” of pressures this winter.

“In recent years the NHS has defied the odds and somehow managed to cope despite warnings about the impact of winter pressures. This time it is heading into what is likely to be the worst winter since modern records began in the eye of a perfect storm,” said Siva Anandaciva, chief analyst at the King’s Fund thinktank, in a new blog.

“The NHS is heading into winter in unusually bad shape” because it has not had any respite from an unusually busy summer and also because ministers have provided no extra money for winter pressures, he added.

“Most clinicians I speak to are anxious about the prospects of the punishing early and severe flu season in Australia” – which resulted in the largest number of confirmed flu cases there for a decade, he said.

The Guardian disclosed last week that hospitals in England have the smallest number of beds available on record.

NHS England admitted recently that bed occupancy figures in July, August and September were the worst for the time of year since records began.

Last month Northampton general hospital “reluctantly” cancelled unspecified numbers of planned, non-urgent operations over the next few months to help it cope with winter. Other NHs trusts are likely to follow suit, in order to keep enough beds open for patients who need to be admitted over coming weeks because they have fallen and broken a limb or developed a serious breathing problem.

NHS trusts and NHS England have taken unprecedented steps to minimise the disruption winter will bring by rolling out the biggest-ever flu vaccination programme, freeing up beds occupied by those who are fit enough to go home and improving the 111 telephone advice service.

An NHS spokesperson said: “Our doctors, nurses and other staff are pulling out all the stops to look after more and more people, and a particular increase in patients who are older and have more complex illnesses.

“While hospitals will continue to open more beds as needed over the coming weeks, the public also have a role to play going into winter, and can help NHS staff by getting their flu jab if they’re eligible, talking to a pharmacist for expert advice about winter bugs before they get worse, or using the NHS 111 phone or online service if they need medical help fast but aren’t sure what to do.”
Universities warned Cameron in 2011 that trainee cuts would cause nursing shortage.

Ministers turned down pleas over many years and instead predicted over-supply of British nurses.



Universities warned the government for years that they needed to train more nurses to avert a staffing crisis – but ministers repeatedly refused, saying nurses would end up unemployed, letters seen by the Guardian show.

Now there are 44,000 nursing vacancies in the NHS, and leaked government documents suggest this could reach 70,000 in five years. Universities say they have been unable to attract enough nursing trainees since the bursary for nursing degrees was abolished in 2017. The Conservatives’ manifesto proposals to attract 50,000 new nurses (although 19,000 of those are already working but at risk of leaving) will be unachievable, they say, without a more radical plan.

Prof David Green, vice-chancellor of Worcester University, a leading provider of nursing degrees, says the current staffing crisis was “entirely avoidable”.

“If we had recruited more nurses in 2015, as we were telling the government we needed to do, they would be fully trained and starting jobs on the wards now. Instead, hospital after hospital is struggling to maintain safe staffing, spending a fortune on agency staff and desperately recruiting from abroad.”

Green says the crisis began in 2011 when strategic health authorities slashed the number of nursing degree places they would fund. In the West Midlands there was a 17.5% cut, which meant 457 fewer nursing students. These cuts were maintained for six years, a reduction of nearly 2,750 places in the West Midlands alone.

Green wrote to David Cameron, then the prime minister, and the health secretary in 2011 on behalf of the universities in his region, citing extensive evidence that there would be more demand for nurses in the future, and that the cuts would cause a “major nursing shortage in a few years’ time”.

Anne Milton, then the health minister responsible for the NHS workforce, wrote back saying fewer nurse trainees were needed and that taking on any more would lead to unemployed nurses. She wrote: “A reduction in commissions is necessary to avoid a significant oversupply in the nursing workforce.”

Green says this was “palpable nonsense” and cuts were simply about saving money. He reflects that the student nurses lost in 2011 would now have been working in the NHS for five years. “It is precisely such experienced nurses who are the backbone of the system.”

In 2015 Green stood by the head of the university’s institute of health and society, Jan Quallington, after Health Education England, the government’s health training body, demanded she apologise for criticising training cuts. Quallington wrote in the Health Service Journal that the NHS faced a “ticking timebomb” unless more nurses were trained. HEE said training extra nurses would “not be good value for money for the taxpayer and risks unemployment for the individuals concerned”.

Green says Worcester has turned away many “terrific applicants”. “In 2015 we had 10 applicants per nursing place, and 37 per place for midwifery. We knew that at least four in 10 of the nursing applicants would have made excellent nurses. In midwifery, places were like gold dust.”

Universities say Tory plans to recruit 14,000 new nurses from undergraduate courses may also prove problematic. Until 2017 the government paid nursing students’ fees in England, and students received a means-tested maintenance grant. Since the funding was cut, the Royal College of Nursing says, there has been a 29% drop in the number of applications to study nursing in England. Universities say they are finding it especially hard to recruit mature learners – once a mainstay of nursing degrees and greatly valued by hospitals because of their life experience and loyalty.

Green says this was a “bad and mad policy” and bursaries should be reinstated immediately.

Unlike Labour and the Liberal Democrats, the Conservatives are not promising to ditch nurses’ £9,250-a-year tuition fees but have instead pledged an annual maintenance grant of between £5,000 and £8,000 (£416 to £666 a month). Prof Kevin Crimmons, head of adult nursing at Birmingham City University, says: “That’s a promising start, but you can’t actually live on that.”

Like many universities, Birmingham City will struggle to meet its recruitment targets for nursing degrees starting this January, because debt-averse mature learners are staying away.

Crimmons points out that trainee nurses aren’t typical students because they spend half of their course doing unpaid training in the NHS, working a 37-hour week, often with night shifts.

“They might be carrying out personal care and supporting patients, helping with medication, doing clinical observations. They are working hard and adding value and it would be entirely reasonable to expect the government to pay their tuition,” he says.

Crimmons’ students, many of whom have children, often have to do paid shifts as healthcare support workers on top of their course to make ends meet. As a result they sometimes turn up to lectures unprepared. “If you want a quality workforce you have to support people to have space to learn, and that costs,” he says.

Michael Carter, a 29-year-old nursing student at Southampton University, was one of the last cohort of students to get a bursary. Without it, he says, he wouldn’t have contemplated taking a “£30,000 gamble” and changing career from science to nursing.

“Even with a bursary it can be difficult,” he says. “I get £422 a month to live on and my wife is a PhD student, so it isn’t easy. A lot of my colleagues get less than that and they are doing a lot of extra bank shifts to earn enough to live. They are doing this while working full-time on placement, with uni assignments on top and are working themselves into the ground.”

Carter decided to change career after a spell of being ill in hospital, where he realised how much difference nurses made to patients. “Nurses aren’t only caring for your complex medical needs; they’re also the ones holding your hand when you’re scared,” he says.

Steve Tee, executive dean of the faculty of health and social sciences at Bournemouth University, says it is seeing far fewer mature applicants for nursing and finds it a challenge to meet recruitment targets.

“The removal of the bursary has made it more difficult to recruit into areas like mental health nursing, which have always tended to attract more mature students,” he says.

He adds that there are no quick fixes. “When the workforce supply tap is turned off it takes a long time to recover. Even if we suddenly had a mammoth recruitment next year it wouldn’t resolve the workforce problems for several years.”
Both Labour and Tory migration plans " Would worsen NHS staffing. "

The claim came as it emerged almost one in four hospital staff were born abroad.



https://www.theguardian.com/society/201 ... s-staffing
166 posts