“Andrew Lansley law that forced hospitals to compete could be axed”

Note: this 10-year plan does not tackle the crisis in social care nor the bigger crises of not having enough staff for either service.

[Andrew Lansley’s 2012 act made local GP groups “customers” to buy services from competing hospitals]

“Implementing the new ten-year plan could involve the reversal of market-based reforms introduced in 2012 by the former health secretary Andrew Lansley.

More than 100 local bodies would be merged under proposals to move away from internal health service competition and make parts of the NHS work more closely together.

The request for new laws by Simon Stevens, head of NHS England, sets the government up for a battle in the Commons. The reversal of the reforms is also likely to prove embarrassing for the Conservatives. Labour has already demanded an apology for a “bureaucratic disaster” that it says wasted billions.

The Health and Social Care Act 2012 made local GP groups “customers” to buy services from competing hospitals and other providers. It provoked opposition from health unions who said that it would fragment care. Senior Tories came to regard it as the coalition government’s biggest mistake.

Ministers will seek to present the changes as commonsense tidying up measures requested by the NHS. They hope that this will avoid a divisive political battle, but while opposition to privatisation was a key Labour objection to the act the party is unlikely to back a Conservative NHS reform.

In the ten-year plan Mr Stevens argues that there are too many NHS institutions working autonomously when they need to work together to join up care for patients. While arguing that his plan could be achieved in current structures, he said that changes to the law “would support more rapid progress”.

Matt Hancock, the health secretary, said: “We want to foster a culture of ambition and innovation in the way our health sector organises the services it delivers. I am prepared to make the changes necessary for this to become a reality, including changing the law.”

Jonathan Ashworth, the shadow health secretary, said: “The fact NHS bosses are now proposing significant changes to the Health and Social Care Act confirms what a wasteful, bureaucratic disaster it was in the first place.”

Source: The Times (paywall)

NHS – inequality between regions

“The government must show more urgency in addressing regional health funding imbalances, MPs have warned.

The Public Accounts Committee has also expressed concern about the Department of Health and Social Care’s lack of planning for staffing and medical equipment after Brexit, in a report out today.

The MPs noted there was “significant regional variation” in funding of NHS providers and clinical commissioning groups. DHSC’s 2017-18 annual report and accounts suggest an improvement in finances when taken as a whole but this “masks the underlying deficits at local level”, the PAC report said.

MPs said the department was performing a “balancing act” by offsetting NHS providers’ deficits with a surplus from NHS England’s finances. In 2017-18, 101 of 234 NHS providers were in deficit, although this was mitigated by NHS England’s surplus, the report said. Although, 75 of the 207 CCGs reporting an overspend in the same year.

PAC chair, Meg Hillier, said the number of CCGs overspending was “concerning”.

She added: “The Department of Health and Social Care must show far more urgency in getting to grips with regional funding imbalances and demonstrate it understand the effects these have at the frontline.”

The report was also critical of DHSC’s planning for Brexit, especially around staffing and medical equipment.

It said there is a “lack of a clear plan” for recruiting staff post-Brexit and added: “We are not reassured by the department’s assertion that it has not seen a large exodus of staff since the referendum and that the number of people from the EU working in the NHS has increased.”

Health bodies recently warned that the NHS workforce shortfall could jump from 100,000 at present to almost 250,000 by 2030 without effective planning.

Despite the NHS procuring 56% of medical consumables (gloves, dressings, syringes) from, or via, the EU, DHSC is not putting specific contingency measures in place to stockpile this type of equipment, the PAC revealed.

Hillier said: “The department’s lack of clear Brexit planning could threaten the supply of medical equipment. Staff shortages could deepen. The potential consequences for patients are serious.

“These and other uncertainties are amplified by the continued absence of the government’s promised 10-year plan for the NHS, its promised plans for social care, and its promised plans for immigration.” A DHSC source has confirmed to PF the social care green paper and NHS 10-year plan are now likely to be published in the new year, rather than by the end of this year, as originally intended.

Regional variances in staff vacancies could also be overlooked, the PAC noted. The NHS examines vacancy rates at a national level – rather than a local level – which “hides underlying disparities in specific specialisms and local areas and does not allow them to fully understand the impact of staff shortages,” the report said.

The report also expressed concern that the NHS staff pay rise announced earlier this year would not be distributed fairly. By funding pay awards through the National Tariff the PAC is concerned that NHS Providers in more affluent areas will receive “disproportionately higher share of funding” because the tariff accounts for the cost of operating in different geographical locations.

DHSC has been contacted for comment.”

https://www.publicfinance.co.uk/news/2018/12/government-must-address-health-funding-imbalances-say-mps

“NHS commissioning ‘needs period of stability to transform’ “

Owl says: You cannot make it up – body set up to transform the NHS needs time to transform itself before issuing its transformation policies to transform anything else!

“NHS commissioning needs a prolonged period of organisational stability after almost three decades of change, according to the UK’s spending watchdog.

Continued organisational restructuring causes major upheaval and commissioning in the health services needs stability to transform, the National Audit Office urged in a report released today.

Amyas Morse, head of the NAO, said: “We have seen almost three decades of change to NHS commissioning.

“It would be a huge waste if in five years’ time NHS commissioning is undergoing yet another cycle of reorganisation resulting in significant upheaval.”

He added: “The current restructuring of Clinical Commissioning Groups must deliver balanced and effective organisations that can support the long-term aims of the NHS and deliver a much-needed prolonged period of stability.”

A period of stability would allow commissioning groups to focus on transforming and integrating health and care services rather than on reorganising themselves, the report said.

Since CCGs replaced primary care trusts in April 2013, there have been eight formal mergers, reducing their numbers from 211 to 195 in April this year. Further mergers are expected.

The report also highlighted an increasing number of NHS commissioning bodies in England were exceeding their planned expenditure.

A total of 75 of 207 (36%) CCGs went over their budgets in 2017-18, the NAO noted. The total overspend across the groups was £213m.

This compared to 57 CCGs over spending on their budgets in 2016-2017 and 56 in 2015-2016.

“Many CCGs are struggling to operate within their planned expenditure limits despite remaining within their separate running cost allowance,” the report warned.

Increased pressures, the uncertain futures of CCGs and a lack of access to training and development were cited as reasons for the continuing issue of commissioning bodies being unable to attract and retain high-quality leaders.

Even though “both NHS England and the CCGs stressed [to the NAO] the importance of high-quality leadership”.

The watchdog also warned with further mergers there was “a risk that working across greater areas will make it more difficult for CCGs to design local health services that are responsive to patients’ needs”.

The total net expenditure of CCGs in England in 2017-18 was £81.2bn with net running costs at £1.1bn. Staff costs made up 57% (£693 million) of CCGs’ running costs, the NAO noted.

A 10-year long-term plan for the NHS and how it will spend an extra £20.5m a year was expected to be released by the end of this year.

A source from the Department of Health and Social Care has confirmed to PF it is now “likely” this plan will be release next year.

Responding to the report, chair of the Public Accounts Committee Meg Hillier said: “We should be concerned that increasing numbers [of CCGs] are overspending against their budgets.

“Like previous changes to NHS commissioning, CCGs are going through more change and the NHS is crying out for stability.”

She added: “It is vital that further restructuring supports the 10-year plan and isn’t an unnecessary distraction to addressing the real challenges in the health service.”

https://www.publicfinance.co.uk/news/2018/12/nhs-commissioning-needs-period-stability-transform

Local authority settlement fails to address major funding issues and shortfalls

AND government has said if councils need more money they should hold referendums which might, or might not, agree to further council tax rises to make up for the shortfall.

“Last week’s provisional settlement for local government was predictably disappointing, says Richard Harbord, while the big issues of funding social care and council tax reform wait unaddressed in the political long grass.

The delayed settlement was eventually published last week, leaving local authorities little time to do any detailed work on it before Christmas.

It has to be said it was never going to be earth-shattering, being the last year of an agreed multi-year settlement negotiated four years ago.

The actual settlement says that the government are planning to increase resources by £1.3bn next year, but this seems to include a number of separate issues such as Winter Pressures Funding for social care, the bulk of which comes with conditions, and the removal of the threat of negative grant.

The Local Government Association in a somewhat low-key response says that this settlement will still leave local authorities some £3.2bn short of the resources they require to maintain a reasonable standard of service.

Other announcements were expected at the same time but a number of these did not appear. The amount of time and energy spent on leaving the European Community has left a large void in moving forward to resolve the many problems local government faces.

There was a consultation paper on business rate retention, but this has been so long discussed in the joint working parties between central government and the LGA that it is hardly new. It is now set at 75%, this is somewhat less than Eric Pickles’ 100% and the various other figures talked about over the last few years, and is perhaps a disappointing increase on the 50% which has been the scheme for the last few years.

The announcement says that the government continues to work on the Fair Funding Formula which was also expected to go out to consultation. This was never intended to take effect next year, but local authorities need to know if there are to be major changes to distribution and to account and allow for them in their medium-term financial plans.

We had already been warned that perhaps the most important of all – the options for dealing with the increasing expenditure on social care – had been put back until next Summer. This was, it will be remembered the subject of a bungled announcement during the last general election campaign which had to be withdrawn with a Green Paper promised for immediately after the vote.

This has been delayed several times. It is just too difficult to find options that are acceptable to the majority. If there is to be a central funding solution rather than an insurance solution, it will have to come from additional taxation. Politicians continue to believe that increases in taxation are to be avoided at all costs but a relatively small increase in taxation could produce workable options.

The LGA urges the government to reconsider and to improve the offer by the time of the final settlement early next year. This is extremely unlikely to happen.

The fact is that this settlement does nothing to help local authorities become sustainable and to save them from having to make even more serious cuts in services going forward.

Business rates retention may have been sorted, but the government really needs to address the issue of council tax. Hopelessly outdated and not understandable to owners of properties, it is in desperate need of reform.

The government argue that it is open to local authorities to run referendums to increase council tax by over 3 % , indeed they have encouraged local authorities to do so but the limited gains and negative publicity have put authorities off.

At the very least the values used need to be current values and the banding system needs drastic revision to reflect the fact that so many properties are valued at over £1m and should be contributing more to local services.

We do now look forward to the spending review, but there cannot be widespread optimism that all will be well.”

http://www.room151.co.uk/blogs/provisional-settlement-does-nothing-to-help-local-authorities/

“East Devon has one of the highest rates of excess winter deaths in the South West, official figures show” and stiil community beds close!Disgraceful!

“Around 26% more people died in winter than in summer on average, according to the Office for National Statistics.

Across the rest of the South West, that figure is 18%.

Every year, more people die in winter than in summer – due to colder temperatures, respiratory diseases and outbreaks of flu.

To measure the impact, the ONS compares the number of additional deaths between December and March to the rest of the year.

During the winter of 2016/17, the latest period figures are available, there were approximately 150 excess winter deaths in East Devon.

This meant 26% more people died during winter in East Devon, compared with the yearly average.

This was higher than in the previous year when there were 12% more deaths during winter.

According to the ONS, small population sizes can cause a significant amount of year-on-year variation at a local level.

Across the South West, winter was most deadly for people aged 85 and older.

Out of 3,130 excess winter deaths in the South West, 3,120 were older than 65, and 2,090 older than 85.

Across England and Wales, the rate of excess winter deaths varies from as low as 4% to as high as 51%.

Dr Nick Scriven, president of the Society for Acute Medicine, said that the data raised concerns ‘as to why there is such variation even between areas in a single region’.

He said: “This data must act as a prompt to those in power to look at these trends and recognise that the capacity of the health service is being stretched beyond all measures in winter.

“We have an older, frailer population with increasingly complex medical problems, a lack of funding across health and social care to meet demand, a recruitment crisis and persistently poor performance.”

Provisional data for England and Wales shows that excess winter deaths hit their highest level in more than 40 years during 2017/18.

There were an estimated 50,100 excess winter deaths, 45% higher than the previous year.

Health think tank the King’s Fund said it was concerned that this ‘could be the start of a trend of periodically high winter deaths’.

The Department of Health and Social Care said that the 2017/18 figures ‘were likely the result of a combination of flu and cold weather’.

A spokesman said: “We know flu is difficult to predict – that’s why this year we have a stronger vaccine for over-65s, and have made more vaccines available than ever before.”

https://www.exmouthjournal.co.uk/news/east-devon-winter-deaths-nhs-figures-1-5812512

Another NHS campaigner speaks out

Roseanne Edwards, who is fighting to “Keep Our Horton General” in Oxfordshire writes:

“From our fellow campaigners who are fighting as hard as we are for their local hospital. It is a copy of what is being done to services in Oxfordshire. It is happening all over England.

The background their hospital is set against is the same politically inspired NHS reorganisation we are all victims of.

“Following the 2010 election which returned a Coalition Government of Conservatives and Liberal Democrats, the Department of Health was too busy with the torturous passage through the House of Commons and Lords of the Health and Social Care Bill, which became the Health and Social Care Act 2012, and took their eye off the ball, neglecting to commission training places in Universities for Doctors, nurses physiotherapists and other valuable and essential health professionals.

This resulted in a national shortage which we are seeing today, in A&E surgeons, paediatricians, nurses and other staff.

The outcome may have been intentional. Michael Portillo speaking on the BBC Parliament channel following the election, said that the Conservatives kept quiet about their intentions for the health service because they knew that if their plans became known, they would not be elected.

The intended change was to the fundamental foundation of what used to be the National Health Service, the Secretary of State’s duty to provide, which was removed and a system of contracting services out to tender to enable more profit making companies to siphon off the NHS revenue put in place with competition law operational.

Martin Barkley says that the Care Closer to Home model of service provision will be sustainable. This is government propaganda. What does sustainable mean? The funding for the health service is a matter of choice. Government chooses to fund it or not. This government and the Coalition, chose not to. Even when ‘Care Closer to Home’ is put in place and Dewsbury Hospital downgraded, completely as planned for spring 2017, the government could choose to reduce funding still further.

This is exactly what is happening with the mandatory and secretive Sustainability and Transformation Plan (STP) agenda, being worked up by the Councils, CCGs and Trusts, in West Yorkshire footprint number 5. The West Yorkshire STP has to save money as part of West Yorkshire’s share of the £22billion ‘efficiency savings.’

There is NO EVIDENCE to show that the cuts to hospital provision and services at home, are less expensive than inpatient stays. The pilots in Torbay were inconclusive. In fact they may prove to be more expensive. The expenditure of the National Health Service model as it had been and the treatment it carried out, was consistently found by OECD studies to be the most cost effective in the developed world, treating everyone according to need. This was the case even including the increased costs and associated difficulties caused by the marketised Foundation Trust system.

(The CCG CEP) Dr Kelly outlines what he describes as a “whole system change” in the NHS. What the describes, is chopping the services into tiny bits and letting private profit making companies provide the cheaper, less complex services, such as the dermatology he mentioned http://www.priderm.co.uk and the opticians on the high street. This denies revenue to the Hospital Trust, destabilising it. A new contract announced after the public meeting for Musculo- Skeletal services has gone toprivate company ConnectHealth:

http://www.connecthealth.co.uk

redirecting even more revenue away from the Trust:

https://www.northkirkleesccg.nhs.uk/news/patients-shape-musculoskeletal-service./.

The ‘Right Care ‘ initiative mentioned is an import from the US. What does ‘redesigning therapies’ mean? The Right Care programme, is looking at money. Is this the first step to withdrawing what was once available?

The Royal College of Surgeons has criticised the policy of withdrawing treatments now evaluated as procedures of limited clinical effectiveness (PoLCE) or procedures of limited clinical value (PoLCV). There is no national list of these, as CCGs are free to choose which ones to fund and which to not. The Royal College of Surgeons states that the growing list is “extremely detrimental to patients across the NHS, removing equality of access to treatment, creating postcode lotteries, lowering the standard of care provided in the NHS and potentially reducing the quality of life for some patients.”

Following the fragmentation described here, the architects of the STPlans want an Accountable Care Organisation (ACO) to put it back together, with the private sector cocooned and shareholding, in the provider structure.

Dr Kelly speaks of the Hospital Avoidance Team, going into hospitals to facilitate early discharge. What we have learned since the public meeting is that there is a postcode lottery with regard to what is on offer following a hospital stay and hospital nurses and other staff have to know where you live, because North Kirklees patients can not have what Wakefield patients get.”

Ottery Community Hospital – a campaigner speaks on council in-fighting

Text of address to Ottery Town Council by Philip Algar, a long-term campaigner for the Ottery hospital, including its in-patient beds:

“OSMTC 29th NOVEMBER 2018

As an interested member of the public, I have attended almost all the town council meetings over the last few years. During that time, I have seen the councillors confront many issues, some trivial and some serious. However, I have not seen a collective, note the word “collective”, and timely public effort by the council as a whole to support those of us who have been campaigning to save the Ottery hospital. I can think of nothing that is more important to the local people than having access to a well-located modern greatly-valued hospital and this, surely, justifies your collective support. Why has such support been missing?

Whenever the subject of the hospital’s future has been included on the town council agenda, the main speaker, often the only speaker, has been one councillor, who, quite correctly, has said that she does not speak for the council but for a group of which she is a leading member.

As recently as last August, I asked the council to adopt an official and supportive role but nothing happened and, as far as I know, my suggestion that the hospital should become a community asset, which was rejected by EDDC, was not challenged by this council, even although such status has, I am told, been granted to other hospitals. I had suggested in advance that it might be wise to devise a response in anticipation of a negative decision.
All this is why I shall no longer be attending your meetings which will be good news for many of you. Furthermore, the well-intentioned and hard-working unofficial groups have failed to make much progress with the official bodies and, apparently, admit this. That said, it would be helpful if they were more communicative with the public.

Given this lamentable situation, it was hardly surprising that three councillors, backed by a county councillor, suggested setting up a semi-official working group to solve the crisis. Three councillors voted in favour and six, according to the draft minutes of the meeting, abstained.
I was astonished to learn that, allegedly, some councillors construed this as a defeat for the trio. That is breathtaking and worthy of Private Eye. If this is true, it also exposes a level of ignorance that calls into question the competence of those involved. If it is not true, I withdraw this comment immediately.

Now, despite an objective explanation from Dr. Margaret Hall, explaining that, effectively, NHS groups, apparently, will only discuss matters with official groups or those under the aegis of the council, you still chose to organise this meeting, at an unusual time when so many residents are at work. I note the comments that this meeting was planned as councillors were attending a finance meeting. The claim by the abstainers, that they did not have sufficient information, has already been undermined by Dr. Hall’s contribution so why have another meeting?

This, presumably, is an effort to overturn the initial decision on the creation of a working group. The agenda also raises the possibility of supporting a decision that has already been agreed after a vote of three to nil, and which has now been explained by Dr. Hall. I find the possibility that organising a meeting to consider reversing the democratically-taken decision to be a truly ludicrous waste of time and totally unnecessary.
Those who were penalised by the decision to remove inpatient beds and now face the prospect that the hospital may not even become a hub, deserve much more from their councillors.”

End: 29.11.18