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December 22, 2017

Private Eye Medicine Balls 1460 December 15, 2017
Filed under: Private Eye — Dr. Phil @ 7:30 pm

Something has to give (and it’s not the Treasury)


As MD predicted (Eye last), the NHS England board responded bullishly to being given 40% of what every expert authority (apart from the Treasury) deemed necessary to keep the NHS upright for another year. Whilst Philip Hammond and Jeremy Hunt insist the extra money be used to get waiting times back on target, NHS England declared bluntly that ‘NHS Constitution waiting time standards will not be fully funded and met next year’.  NHS England also said that new advisory National Institute for Health and Care Excellence guidelines would only be implemented ‘if in future they are accompanied by a clear and agreed affordability and workforce assessment at the time they are drawn up’. So even if NICE says a new treatment is effective and good value for the NHS, it may only be provided in your area if the funding and staff are available. Pretty much what happens now.


The NHS probably could do more to reduce waste and variations in the quality of care, but it was the Conservative’s lethal Health and Social Care Act 2012 that has squandered billions on unnecessary reform, compulsory tender and transaction costs, substandard outsourcing and a fragmented system that struggles, in Nye Bevan’s vision, to ‘universalize the best.’ NHS England is at least being honest with the public about the harsh consequences of continued austerity, but many staff are worried that their hasty move to ‘accountable care systems’ in England is less about joining up care and more about outsourcing it en masse.


Performance problems in the NHS are not exclusively English. Wales has consistently failed to hit its targets for A&E waits, routine operations and cancer care. In 2012-13 it did not hit any of its monthly targets and in 2016-17 it was the same. The last time a target was achieved nationally was 2010. Northern Ireland cut its target for planned operations and care from 80% to 55% but has still not hit it. Scotland has a more ambitions 18-week target of referral to treatment of 90% but only 81.4% of patients hit that target in September 2017, the worst performance since 2011, and the number of people waiting more than the 12-week target for outpatient appointments, and for inpatient and day case treatment, has also increased.  But it’s the NHS in England that has seen the biggest deterioration. Last year, it missed every monthly waiting target. The problem is that a decade of near flat-line funding has coincided with a sharp rise in demand. A typical hospital will be dealing with 5000 new cases of cancer a year with the same number of oncologists. The number of A&E visits made each year across the UK has risen by 20% in four years to over 30 million, while the number of cancer cases has risen by more than a quarter to over 170,000. Staff increases have been tiny in comparison. Something has to give.


English trusts have already put bids in for a slice of Hammond’s £335 million ‘winter pressures fund’ but hospitals struggle to discharge patients due to the enduring crisis in social care. Despite a huge national drive to cut delayed transfers of care (formerly ‘bed blocking’), less than half the 2,400 beds targeted to be freed up for winter has been achieved, and the number of ‘bed days lost’ increased in the last quarter to 297,019. This does not bode well for winter, and neither does the crisis in care homes. More than half of care home places in some parts of England are in facilities rated as ‘inadequate’ or ‘requiring improvement’, according to a Which? analysis of Care Quality Commission (CQC) data. In Westminster alone, 69% of places aren’t up to standard.


Four Seasons, the UK’s second largest care home provider responsible for 17,000 residents, is £525 million in debt and struggling to cope with state funding cuts, the national living wage and staff shortages since the Brexit vote. A report by the Competition and Markets Authority has found that state funding for care home places is down by 8%. 75% of care home residents are Local Authority funded and on average they are paying 10% less than their actual costs. The average cost for a self-funder in 2016 was £846 per week (nearly £44,000 per year), while LAs on average paid £621 per week. This disparity has caused a deficit of £300 million, which will either be sorted by charging private payers more, refusing to take on state funded places, or closing care homes. Finally, research by Quality Watch calculated that care home residents in England had 40-50% more emergency admissions and A&E attendances than the general population aged 75 and over. So demand for care home places is up but care homes are in debt and closing, the lack of care home places is preventing the transfer patients out of hospital, and those that make it to a care home are far more likely to end up back in hospital. Hammond’s budget short-changed the NHS but made no mention of the crisis in social care. If the system can’t cope now how will it be in 2025, when the number of over 85s will have grown by 35% to 2 million?