The “bottom line for the NHS” this winter is “the financial bottom line”. 

Rishi Sunak’s pledge to slash NHS waiting lists has effectively been downgraded, the Observer has been told, amid an increase in the number of patients in England waiting longer than 18 months for treatment.

Michael Savage www.theguardian.com 

Hospital leaders are warning that morale is low, staff absences are high, and funds for new equipment and repairs are having to be raided ahead of winter. They have now been told to prioritise controlling costs in favour of some of the extra work being done towards the prime minister’s pledge to bring down waits.

The news comes as the latest data reveals that one key waiting time target is heading in the wrong direction. The number of people waiting more than 18 months for treatment climbed back above 10,000 in September – a similar level to that recorded in March, and up from 8,998 in August.

With trusts already frustrated that they will not be fully compensated for costs created by NHS strikes, hospital leaders and analysts said that a memo sent last week effectively signalled the downgrading of No 10’s battle against waiting lists.

The memo said that to show “how you will deliver financial balance”, trusts needed a treatment plan “identifying the insourcing/outsourcing and waiting list initiatives you still consider necessary within a balanced financial plan”. One NHS finance chief said they believed it was the first time in a decade that they had been told the “bottom line for the NHS” this winter was “the financial bottom line”.

Sally Gainsbury, senior policy analyst at the Nuffield Trust, said the NHS was in a “precarious” position going into winter. “The NHS has now been asked to scale back the additional efforts and expenditure it was incurring in order to work through the record-high elective backlog – waiting lists – and focus instead on emergency and urgent cases,” she said. “The message is that further expenditure to reduce the waiting list – such as extra weekend clinics and theatres – just isn’t affordable within the budget constraints, so it is serious, especially for patients who may already have been on a list for months.

“Twelve-hour trolley waits are at the point they were this time last year. Staff sickness absence rate is extremely high ahead of winter. And then there is the issue of ongoing strikes. The small amount of extra cash from the Treasury this week isn’t going to solve the financial problems.” She said that the budget for buildings and equipment was “being raided” to cope.

Wes Streeting, the shadow health secretary, said the government had effectively abandoned its ambitions. “This is the government waving the white flag on Sunak’s pledge to cut waiting lists,” he said. “The PM would rather blame NHS staff than take responsibility and fix the problem himself. No wonder waiting lists have trebled since 2010. The longer we give the Conservatives, the longer patients wait.”

Tim Gardner, assistant director of policy at the Health Foundation, said that if the government was saving extra NHS funding for the forthcoming autumn statement, it would be “far too late to shift the dial on what’s likely to be a challenging winter for emergency departments”.

“There does seem to have been a distinct shift in priorities,” he said. “Financial control seems to be coming through more strongly, along with an increased focus on urgent and emergency care and patient safety, possibly in anticipation of what could be a difficult winter. As a consequence, progress on elective waiting lists appears to be a lower priority than it was.”

With the service struggling, NHS bosses are desperate for further strike action to be avoided. Junior doctors and consultants continue to demand the reopening of the pay deal offered by the government. Radiographers also walked out last month.

The CEO of NHS Providers, Sir Julian Hartley, urged ministers to resolve the disputes once and for all. “We haven’t even hit the worst of winter yet the pressure is being felt right across hospitals and mental health and community services, as demand for care continues to outstrip capacity,” he said. “This hiatus in strike action while talks continue between the government and doctors’ unions couldn’t have come soon enough. The last thing the NHS needs as we head into another challenging winter is more industrial action.”

Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, said he anticipated that the months ahead would be “as difficult as last winter”. “There’s nearly 150,000 people in one month who spent more than 12 hours in emergency departments,” he said. “That’s a bad indicator of us going into a difficult winter, so we’re worried.”

A Department of Health and Social Care spokesperson said: “Cutting waiting lists is one of our top five priorities, and despite disruption from strikes, 18-month waits are down more than 90% from their peak in September 2021. We’re backing the NHS with billions of investment to improve performance, with an additional £800m allocated this winter to support emergency care and tackle the longest waits.”

So let’s demolish the Seaton Hospital Wing! – Owl

The UK faces an ageing crisis and healthcare must step in, England’s chief medical officer, Prof Sir Chris Whitty, warns in his annual report.

By Michelle Roberts www.bbc.co.uk

People are living longer but some spend many of their later years in bad health – and that has to change, he said.

Based on projections, the elderly boom will be in rural, largely coastal, areas and these places are often poor cousins when it comes to provision.

In deprived regions, age-related issues emerge 10 years earlier, on average.

While young people flock to wealthy cities, areas such as Scarborough, North Norfolk or the south coast of England are going to age “rapidly and predictably”, says the report – Sir Chris’s fourth in the role.

He told me: “We’ve really got to get serious about the areas of the country where ageing is happening very fast, and we’ve got to do it now.

“It’s possible to compress the period of time that people spend in ill health…because otherwise we will end up with large numbers of people leading much more dependent lives.”

Providing services and environments suitable for older adults in these areas is an absolute priority, the report says.

Much of the NHS’s work is already caring for an ageing population, and that is set to increase.

The fact that people are living longer compared to a century ago is “a triumph of medicine and public health”.

But the emphasis needs to be on quality, not quantity, says the report.

It says major action in two areas could help turn things around:

• Policies to reduce disease and disability and help people to exercise, eat well and stay fit
• Making housing, transport and other parts of the environment more elderly friendly, so people can live out their lives as independently as possible

Sir Chris explained: “Houses are built for young families…and if you project forward to the middle of the century, a quarter of the population will be over 65, yet we still have a housing stock not designed for that age group.”

He said people should adopt “old-fashioned” methods to stay healthy.

“Having lots of exercise, having mental stimulation and a social network, eating a reasonably balanced diet… these are things which are old-fashioned, but they still work.”

People should also make choices about what care they do and don’t want, and doctors should refrain from over-treating.

Improving quality of life in older age sometimes means less medicine, not more, says the report.

Sir Chris said: “That might be, ‘I want to go to hospital but I don’t want to go to intensive care’. It might be, ‘I want to have treatment but I don’t want to have an operation’. Or it might be ‘I don’t want any more treatment at all’. The conversation needs to be had.”

Prof Dame Carol Black, from the Centre for Ageing Better, said: “Many people are facing enormous challenges and hardship in their later years, as this report makes clear.  

“We don’t all have an equal opportunity to age well. Wealth, work, housing, discrimination; all play a significant role in the huge gap in healthy life expectancy between the richest and poorest areas of the country.”

Paul Farmer, chief executive at Age UK, called for a cross-government ageing strategy, and a minister for older people to help drive forward change.

“We can already see how the failure to invest in delivering the right services and support is leading to worse outcomes for older people and entirely avoidable problems,” he said.

“Older people are isolated at home if the design of our communities means they can’t safely go out. People end up falling, and in the back of an ambulance if our built environment is full of trip hazards.

“Our hospitals are over capacity at least in part, due to the failure to provide adequate social care and community services to enable people to stay safe and well at home. None of this is inevitable. Getting it right would have immeasurable benefits.”