“Nine in 10 NHS bosses say staffing crisis endangering patients”

“Hospitals are so short of doctors and nurses that patients’ safety and quality of care are under threat, senior NHS leaders have warned in a dramatic intervention in the general election campaign

Nine out of 10 hospital bosses in England fear understaffing across the service has become so severe that patients’ health could be damaged. In addition, almost six in 10 (58%) believe this winter will be the toughest yet for the service.

The views expressed by senior NHS figures on Tuesday will heighten the anxiety in Conservative ranks that the health service’s growing problems risk derailing the party’s campaign in an election members hoped would be dominated by Brexit.

The Labour party is seeking to capitalise on public dissatisfaction over delays in accessing treatment and the increasingly visible gaps in staffing.

In a further sign of Tory concern, ministers have agreed an extraordinary deal for the NHS to pay doctors’ pension tax bills this year, which could cost hundreds of millions of pounds.

The scheme is aimed at halting the sharp recent increase in doctors working fewer shifts in order to avoid being hit with unexpected tax bills of up to £100,000. The trend has forced hospitals to cancel thousands of operating lists and outpatient clinics, while further delaying patients’ access to care and exacerbating staff shortages.

Ministers hope doctors in England – the only country the incentive will apply in – will see it as a green light to resume extra shifts before winter pressures ramp up on the NHS, without having to worry that they will be heavily penalised months later.

However, the deal immediately triggered claims that it has been agreed between ministers and NHS England in defiance of “purdah” rules that stipulate that governments must not undertake changes of policy during an election campaign.

It is being presented as an “operational decision” by NHS England, but was signed off – and some believe instigated – by the Treasury, Cabinet Office and the Department of Health and Social Care.

A senior medical source involved in brokering the unprecedented “stopgap” policy suggested it came about because ministers were “desperate” to avoid fewer shifts by doctors compounding hospitals’ struggles this winter.

The source said: “They have so massively breached purdah regulations it’s unbelievable. This isn’t an operational matter. This is policy. It’s outrageous, because purdah rules say that you can’t announce a change of policy during an election.”

The 131 chief executives, chairs and directors of NHS trusts in England expressed their serious concern about the deteriorating state of the service in a survey conducted by the NHS Confederation.

The findings came days after the latest official figures showed that hospitals’ performance against key waiting times for A&E care, cancer treatment and planned operations had fallen to its worst ever level. However, many service chiefs told the confederation that delays will get even longer when the cold weather creates extra demand for care.

“There is real concern among NHS leaders as winter approaches and this year looks particularly challenging,” said Niall Dickson, the chief executive of the confederation, which represents most NHS bodies, including hospital trusts, in England.

“Health leaders are deeply concerned about its ability to cope with demand, despite frontline staff treating more patients than ever.

“There is the very real prospect of gaps in clinical shifts and patients not receiving the quality of care they need because NHS trusts do not have the staff they need.”

“Despite doing everything within their power, 90% of health leaders we surveyed said that understaffing was putting patients at risk.

“We have 100,000 clinical vacancies [in England] and the prospect of ever-rising demand unless we face up to the scale of the challenge,” added Dickson.

Last week’s figures showed that one in four people who attend a hospital-based A&E are waiting more than four hours to be dealt with, record numbers are having to wait on a trolley while they are found a bed and seven of the eight clinically vital cancer treatment targets are being missed.

Dickson added that, even if the next government provided more money to tackle widespread staff shortages, it would take time to reduce the high vacancy rates that are common in many hospitals. The NHS is short of about 43,000 nurses and almost 10,000 doctors as well as paramedics and other health professionals.

He warned political parties not to raise voters’ expectations unreasonably in the run-up to polling on 12 December about how quickly the NHS can get back on track.

“More investment is needed but even with that this is a system that will take time to turn around and the electorate must not be fed with overpromises over the coming weeks,” he said.

The King’s Fund voiced concern at the results of the research. “Amidst the political rhetoric of the general election campaign, these findings underline the stark reality facing patients across the country who are struggling to access NHS services,” said Sally Warren, the thinktank’s director of policy.

“Workforce shortages are already having a direct impact on the quality of people’s care, with national patient surveys repeatedly highlighting difficulties for patients accessing NHS services and performance against key waiting time targets at their worst in over a decade.

“These NHS leaders are correct – without urgent action patient safety will be at risk.”

The confederation’s survey of 131 hospital bosses also found that:

76% say staff shortages are the NHS’s most pressing problem.

83% say the dispute over senior doctors’ pensions is making understaffing even worse.

69% say doctors deciding to work fewer hours is damaging patient care.

98% say the deepening crisis in social care is leading to more older people needing hospital care.”


Ingham digs a deeper hole for himself on Queen’s Drive Exmouth

“Speaking at an exhibition event outlining consultation feedback on a vision for phase three of the seafront regeneration, Councillor Ben Ingham initially claimed residents in Exmouth had a choice between the two.

The suggestion of a four-storey hotel was among those pitched for the final phase during the two-day exhibition at Ocean.

He later corrected himself, adding that if a hotel or a council tax increase were not acceptable, another alternative would have to be found to plug a £3 million gap.

The district council needs to find the money in order to pay for the realignment of the Queen’s Drive road and car park which formed the first phase of development.

Speaking after the event, Cllr Ingham said: “At the moment, the best and most credible option is the hotel but not to build it and sell it, but to build it and lease it.”


“48 of 151 members of elite club [very rich people] have given almost £52m”

” … one-third of UK’s richest people donate to Tories
No fewer than 48 of 151 members of elite club have given almost £52m, Labour analysis finds ..”


Devon Clinical Commissioning Group £66 million in debt and heavily criticised

“One of England’s largest clinical commissioning groups has increased its planned deficit by nearly £40m.

Devon CCG, formerly part of a “success regime”, is now forecasting a £66m deficit in 2019-20, despite initially targeting ending the year £27m in the red.

The £1.2bn-income CCG broke even for the first time in its history in 2018-19, after it achieved a £25m deficit which unlocked £25m of commissioner sustainability funding.

Devon’s problems are compounded by the “increasing expectation” that several of the county’s providers are at risk of missing their control totals, according to the CCG’s latest finance report.

Additionally, Torbay and South Devon Foundation Trust, which was not part of the success regime, has expressed concern about a “top-down approach” by Devon’s sustainability and transformation partnership over the creation of a long-term financial plan.

It comes just two months after HSJ revealed external consultants reported a culture of “learned helplessness” and “crisis mentality” among Devon’s NHS leadership, with individual chiefs “retrenching” back into their organisations when faced with difficult decisions.

Savings plans

Devon’s STP initially forecast a deficit of £115m for 2019-20 against a control total of £43m. However, the area then went through an “intensive programme supported by NHS England/Improvement” to reach an “acceptable position”, according to Devon CCG’s board papers.

This resulted in the forecast deficit being reduced to £70m and was based on “accelerating” transformation programmes across Devon, with the CCG tasked with finding the extra £45m of savings required to hit it.

This meant the CCG’s savings plan rose from £36m to £81m.

The revised plan is yet to be approved by NHSE/I, but the CCG now says it cannot find savings worth £39.5m, leading to the rise in the deficit forecast.

Asked what transformation programmes the CCG had hoped would yield savings, a spokesman said this included:

Revising down the level of forecast demand growth so it was “more closely aligned” with national benchmarking;

Managing demand for hospital services by accelerating planned improvements in productivity; and

Updating “projected increases” in additional funding.

But, according to the CCG’s board papers, it will not be possible to deliver the proposed savings due to pressures within “continuing healthcare, prescribing and independent sector contracts”.

Control totals

The CCG’s finance report also warns Devon’s providers are increasingly at risk of missing their control totals.

Torbay and South Devon FT has moved its forecast deficit from £3.8m to £18.8m after missing out on expected income in relation to social care services provided to Torbay Council, failing to deliver savings schemes such as reducing outpatient follow-up appointments, and spending more money than planned on agency staff.

The trust also reported sickness levels in “key specialties” — such as emergency, respiratory and stroke — adversely affecting the organisation.

This autumn, the trust hired KPMG to review its finances, but the “draft” report has not yet been published.

Additionally, the trust’s finance committee has heard concerns from members about a “top-down approach” being adopted by STP chiefs in charge of preparing a long-term financial plan for the health economy.

According to the committee’s minutes, the approach “does not take account…of the unique position of Torbay and South Devon as an integrated trust which carries the risk of adult social care”.

The minutes went on to state that members felt it is “imperative” the trust “challenges the modelling approach” used by the STP to avoid financial targets which “lack credibility”.

The trust did not answer when HSJ asked it to clarify what the problem was with the STP’s modelling approach.

Asked for a response to the allegation of a top-down approach, Devon STP’s finance lead John Dowell said: “All partners across the Devon system… are fully focused on solving the performance and financial challenges we face.”

Elsewhere in Devon, University Hospitals Plymouth Trust did not comment when asked if it was on track to achieve its finance plan to break even. However, its latest board papers stated it faced a “forecast shortfall” against its £25m savings programme which — alongside other finance pressures — means the trust is facing a “significant challenge to deliver its financial plan”.

Both Northern Devon Healthcare Trust and Royal Devon and Exeter FT are on track to hit their targets (breakeven and £8.6m surplus respectively).

Devon Partnership Trust, which provides mental health services, is also reporting being on track to deliver its planned £1.6m surplus, according to its latest board papers.”

Source: Health Services Journal

Sidmouth hustings – full information

“General Election Hustings 2019: Invitation to Meet Your Local Parliamentary Candidates.

Sidmouth’s Vision Group are please to invite residents to the Sidmouth Hustings, to be held at

All Saints Church Hall in
All Saints Road, EX10 8ES on
Friday 6th December
starting at 7.00 pm.

This will be the third General Election hustings organised and moderated by the Vision Group, providing an opportunity for voters to hear the views of candidates and the policies of their Party.

At the date of writing, the following candidates have confirmed they will attend:

Peter Faithfull (Independent)
Henry Gent (Green Party)
Simon Jupp Conservative Party)
Eleanor Rylance (Liberal Democrats)
Dan Wilson (Labour Party)
Claire Wright (Independent)

The event will be open to all registered voters in the Sid Valley. All Saints Hall can accommodate approximately 300 people, and there will be a limited number of seats provided.

How will the hustings be conducted?

6.30 pm Hall Opens; submission of questions using forms provided.

7.00 Introduction from the Chair, who will introduce each candidate

7.05 Each Candidate will have five minutes to introduce themselves and their campaign.

7.45 Chair will select representative questions from those submitted online or on the door.

8.30 The meeting will draw to a close.

Submitting your questions:

Hustings present an opportunity to find out where candidates stand on issues you care about, and their ability to communicate effectively.

Only questions submitted beforehand can be considered. It would be helpful if you could give your question a topic for reference so that similar questions can be consolidated.”