In 2009, NHS chief executive David Nicholson was set a challenge by Gordon Brown to find £20 billion in “efficiency savings” by 2015, as the NHS’ contribution to bailing out the banks and paying off the national debt. It was dubbed ‘the Nicholson Challenge’ by Brown, a tag enthusiastically embraced by the Conservatives to signal where the buck would stop if it failed. Nicholson was clear this was a one off, drastic squeeze in NHS funding that he hoped could be achieved by improving quality and productivity without affecting patient care. The fact that it was enforced as the horrors of the Mid Staffordshire scandal were unfolding, and yet were repeatedly ignored and denied by government, showed the dangers of prioritising savage savings over safe staffing of the NHS.
Nicholson’s failure to meet Mid Staffs campaigners and to act earlier on widespread concerns about appalling care contributed to his retirement, but his replacement Simon Stevens fell into exactly the same political trap. In promising to make a further £22 billion of fantasy efficiency savings by 2020 to fund his ‘Five Year Forward View’, the NHS is now facing over a decade of static funding in the face of
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Blamestorming and Bedhunting
Politicians have always been adept at centralising praise and devolving blame, but for Theresa May and Jeremy Hunt to blame GPs for the meltdown in hospitals takes it to a new level of stupidity. True, the waiting times for routine GP appointments are rising (due to increased demand and a lack of GPs), but 86.3% of GP practices in England already provide pre-bookable appointments outside core opening hours. The limit on appointments is down to the number of GPs, and we have fewer of them per head of the population than comparable countries in Western Europe. Hence the alarmingly high levels of staff stress, unlikely to be eased by the government’s crude blamestorming.
We also have far fewer hospital beds per head (2.8 per 1000) than comparable countries, and are about to cut thousands more in an attempt to squeeze a further £22 billion of savings out of an already over-stretched NHS. Patients who go to emergency departments for a minor illness that a GP, chemist or sensible family member could have sorted out are easily treated. The reason hospitals are in crisis is because of the number of sick people turning up who need to
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The NHS in 2017
WHETHER you agree with the Red Cross that the crisis in social care and the NHS is ‘humanitarian’, or merely ‘human’, there is no doubt that millions of people are being denied the care they need or waiting too long for it.
Christmas was particularly bad, with a third of hospitals having to take urgent action to safeguard patients and reports of staff meltdown and deaths in the corridor queues. With so many hospitals overcrowded and on red alert, now does not seem to be the time for the massive cuts in bed numbers predicted by the McKinsey-heavy NHS Sustainability and Transformation Plans.
This crisis has been a long time coming. In September 2016, 32 percent of the most urgent ambulance calls weren’t responded to in eight minutes, the worst ever performance for that month. In quarter two of 2016/17, 9.4 percent of patients (558,000) waited more than four hours from arrival to discharge, admission or transfer in all A&E departments, the highest percentage for this quarter since 2003/4. More than 107,600 patients waited more than four hours for a hospital bed, up 70 percent on last year.
At the end of September
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In 2016, the government made it abundantly clear that it was not going to match demand for health and social care services with income tax. Services will have to somehow survive with a decade of flat-line funding (in the NHS) and huge cuts (in social care) while demand grows 4-6% year on year. The lame hope is that moderately un-progressive council tax rises and selling family homes will save social care, and that the NHS can plug a multi-billion underfund by making eye-watering efficiency savings without killing too many people on the way. Private companies and charities are now being encouraged to fund health and social care services in the form of ‘social investments.’ The NHS is also being ‘incentivised’ to generate income by expanding the private services it offers, ‘partnering’ and ‘innovating’ with the private sector and selling its services abroad. Likewise private companies can take over or partner with existing NHS services in ‘a truly mixed market where patients are blind to the provider.’ Labour started the commercialisation of the NHS, and VirginCare may well finish it.
The Sustainability and Transformation Plans (STPs) that are to be rolled out across England have the smell of untested
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Chronic Fatigue Syndrome 2
The Eye received many supportive letters for stating Chronic Fatigue Syndrome/ME has biological causes but also some criticisms. As one doctor put it: ‘Every illness had a physical, psychological and social component, and limiting diagnosis or treatment to only one aspect of someone’s illness is likely to lead to a much poorer outcome. This ‘triple diagnosis’ applies to any disorder you care to consider, although obviously in varying proportions. The one exception seems to be CFS/ME where any suggestion that there might be a psychological or social component leads to criticism. That Cognitive Behavioural Therapy (CBT) is the only treatment which has repeatedly been shown to have any benefit is conveniently ignored.’
ME campaigners don’t ignore the fact that CBT and Graded Exercise Therapy (GET) have been shown to work in randomised controlled trials and are endorsed by lofty scientific institutions such as the Cochrane Collaboration and NICE, but they do challenge the science. The PACE trial, which compared four non-drug treatments for CFS/ME, has caused particular controversy and activists have had to fight to gain access to some of the data which they are reanalysing to determine if claims about the efficacy of GET and
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