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  • Government says it has no duty to secure food supplies in a no-deal Brexit (nor any other crisis) Frightening analysis from Sustain, the campaign for better food, which reveals:
    "Two official documents this week reveal that our Government feels no legal responsibility for securing our food supplies in an emergency – neither fire, flood, disease epidemic, conflict, supply chain disruption, nor no-deal Brexit.
    "In one of the documents (Defra’s answer to a Parliamentary Question), the Government places the main responsibility for securing our food supply in an emergency squarely with the commercial food industry. Yet the other document (Yellowhammer) clearly acknowledges that “Private sector companies’ behaviour will be governed by commercial considerations, unless influenced otherwise.” In a food crisis, we are caught between a rock and a very hard place."

  • Funding for councils' child addiction services slashed Guardian reports Labour Party findings that
    "Councils across England have made £2.4m of cuts to specialist drug and alcohol misuse services for children and young people this year. Spending is falling from £40.9m to £38.5m as part of steps taken by local authorities to cope with a £72m Whitehall cut to their public health grant.
    "The disclosure prompted warnings that highly vulnerable children with complex addiction problems are being denied the treatment they need at a time when under-18 drug use is rising."

  • Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’ New York Times article highlights the private equity takeover of US health corporations:
    "TeamHealth was acquired in 2016 by the private-equity firm Blackstone Group in a deal valued at $6.1 billion. And last fall, in one of the largest takeovers of the year, the private-equity giant KKR spent $9.9 billion to acquire Envision Healthcare."

  • Hospitals need way out of 'toxic' NHS mortgages BBC picks up on IPPR report which belatedly notes the scale of payments and outstanding debts left over from PFI deals signed off with IPPR support in 2000s!
    "More than 100 schemes were signed off over the past 20 years in England under PFI contracts where private firms paid for new hospitals and centres.
    "In return, NHS trusts have to make annual repayments like a mortgage.
    "The Institute for Public Policy Research (IPPR) said some of the fees were extortionate - and with £55bn still owed, action was needed.
    "Chris Thomas, a health fellow at the think tank, said the worst deals were the equivalent of taking out a mortgage from a "loan shark charging high rates of interest that could not be renegotiated".

  • Why some eastern Idahoans are being served, arrested and sometimes jailed over medical debt East Idaho News offers another grim slice of life under private healthcare in the USA, and highlights the role of the debt collectors:
    "MRS is Medical Recovery Services, an Idaho Falls debt collection company. The company files several thousand lawsuits each year seeking to collect on medical debt in Idaho. In hundreds of these cases, they attach attorney fees, which double or triple the amount of the original debt. Additionally, while the numbers are much smaller, sheriff’s office records show MRS is responsible for requesting a majority of civil arrests in eastern Idaho."

  • What can England learn from the long-term care system in Germany? Nuffield Trust report argues that:
    "The German system has much to be admired: it is an example of fundamental reform, implemented with high levels of public and political support, that has provided the foundations for a system that has been able to adapt and respond to changing circumstances. However, it is not without its challenges and limitations. It is these challenges, as well as the successes, that provide rich learning for England."

  • Chancellor announces return of duty-free HM government appalling public health experts by cynically arguing that the possibility of buying "duty free" crates of beer and cigarettes offers compensation for a no-deal Brexit:
    "Passengers travelling to EU countries will be able to buy beer, spirits, wine and tobacco without duty being applied in the UK, thanks to the lifting of EU rules.
    "The decision on duty-free shopping in UK ports, airports and international train stations will mean:
    "•UK excise duty will no longer be due on alcohol and cigarettes bought when leaving the UK. A bottle of wine purchased in Heathrow duty free on the way to the EU could be up to £2.23 cheaper
    "•At the point of leaving the EU, people can continue to purchase and bring home unlimited alcohol and cigarettes in Europe if they pay duty on it there – as is the case currently
    "People will now also have the alternative option to buy limited amounts of duty-free alcohol and cigarettes at duty free shops in Europe instead. For example, a holidaymaker could save more than £12 on two crates of beer. The travel industry has been calling on the government to re-introduce duty-free, which stopped when the EU Single Market was introduced."

  • End NHS maternity charges for vulnerable migrants, say midwives Guardian highlights report commissioned for Royal College of Midwives emphasising the impact on poor migrants of NHS charges brought in as part of Theresa May's "hostile environment":
    "The safety of vulnerable mothers and newborn babies is being put at risk by NHS fees that deter undocumented migrant women from accessing care, a new report from Maternity Action backed by the Royal College of Midwives (RCM) has warned.

    NHS packages for overseas pregnant women start at £7,000 for antenatal, pregnancy and postnatal care, but can rise to thousands of pounds if the mother or child experience complications. Midwives said some women delay accessing help or fail to have scans over fears that they will be charged or detained."

  • Large provider of 999 support enters administration HSJ reports on yet another private sector contract failure -- this time for a company delivering frontline emergency ambulance services.
    "One of England’s largest providers of 999 support to the NHS has gone into administration, affecting several NHS trusts, HSJ has learned.
    "SSG UK Specialist Ambulance Service Ltd was put in administration last week. The company mainly provides emergency and non-emergency transport services for the NHS.
    "HSJ understands the news has forced South East Coast Ambulance Service Foundation Trust to approach other private ambulance companies to make sure it has capacity to respond to patients if SSG’s services are disrupted."

  • London GPs told to restrict specialist referrals under new NHS 'rationing' plan Guardian reports on the cash-driven plans to ration care being driven through in NW London, where the intention is to merge 8 CCGs into a single bureaucratic monolith unaccountable to local communities:
    "Health chiefs hope the programme, which will affect millions of Londoners, will plug a gaping hole in healthcare budgets by saving more than £60m in the next few months.
    "The sweeping changes, some of which will take effect immediately, will affect essential hospital care rather than treatments sometimes considered more peripheral. They include significantly reducing referrals to consultants, axing some outpatient appointments and replacing them with a phone conversation, and urging GPs to find “alternative ways” of dealing with patients who need hospital referrals.
    "The changes were communicated in a letter from the North West London Collaboration of clinical commissioning groups (NWLCCCG), which funds NHS health services for more than two million Londoners, to key individuals including local MPs"

  • CQC threatens enforcement action for ‘inadequate’ hospital HSJ highlights CQC intervention: but the NHS has been paying out money for a sub-standard private sector hospital where 90% of staff are unqualified.
    "A private hospital for learning disability patients has been rated “inadequate” and placed into special measures, with the Care Quality Commission finding nine in 10 staff were “unqualified”.
    "The CQC inspection of Elysium Healthcare’s The Woodhouse hospital in Cheadle, near Stoke-on-Trent in Staffordshire, uncovered serious staffing concerns within the unit. The hospital is an NHS-commissioned service, which caters for up to 39 male patients with learning disabilities, autism and forensic histories, including sexual offences.
    "Following an inspection in June, the CQC found the majority of the hospital’s staff were “unqualified support workers”.

  • NHS stockpiling body bags to prepare for no-deal Brexit reveals Tory minister Reminder from the Metro back in February of the arrangements designed to put minds at risk in the expectation of leaving the EU on March 29:
    "Health minister Stephen Hammond wrote a letter to a fellow Tory MP revealing that the NHS had taken the measure in a bid to stop shortages, in case the UK crashes out of the EU without a deal. The macabre information was revealed to reassure one of the MP’s constituents that the NHS will continue to run as normal in the event of no-deal."

  • Time to rebuild the NHS and create a 21st century health service Blog from NHS Providers CEO Chris Hopson kicking off a campaign for capital investment that allows more than emergency backlog maintenance.

  • A no-deal Brexit under Boris Johnson remains a threat to public health Guardian letter from 29 public health experts who warn:
    "We, the undersigned, express concern over the increasing likelihood of a no-deal Brexit and the risk this poses to public health. We have sought to mitigate the very real risk of Brexit exacerbating the devastating consequences of health inequalities, and are concerned about the impact that a no-deal Brexit would have on the public health of all four nations of the United Kingdom, including placing at risk the Good Friday agreement and the peace and stability it has brought to Ireland.
    "Brexit is proceeding at a time when the long-term improvement in life expectancy has slowed and, for some age groups, gone into reverse, while the most vulnerable in our population face growing insecurity of income, employment and even food. We believe that all of these would be exacerbated by a no-deal Brexit."

  • Rural hospital closures lead to higher mortality rates North Carolina Health News with findings that may well also apply to Britain:
    "When a hospital closes in an urban area, mortality rates don’t change. But when a rural hospital shuts its doors, according to a new study, mortality rates increase nearly six percent.
    "The new study helps clear up a question about the impact of hospital closures on health. Earlier studies at times have shown that a closed hospital didn’t seem to have much impact on health.
    "In this study researchers at the University of Washington studied 92 hospital closures in California between 1995 and 2011. As a group, the closures, in fact, didn’t show much impact on mortality rates.
    "But when the hospitals were divided between rural and urban, the researchers found a distinct difference. Mortality rates in rural areas increased 5.9 percent. This matched earlier studies, which found mortality rates increasing from 3 to 10 percent after a rural hospital closes."

  • Joint letter to Members of Parliament on no deal Brexit Statement to MPs from Nuffield Trust, the King’s Fund and Health Foundation to lay out the impact for health and social care of leaving the EU without a deal .

  • Doctor dares 'muppet' Rees-Mogg to report him after no-deal clash Guardian reports that "The consultant neurologist who clashed with Jacob Rees-Mogg over contingency plans for a no-deal Brexit has challenged the politician to report him to the General Medical Council.
    "David Nicholl, who drew up a risk register of epilepsy and neurology drugs for the government’s Operation Yellowhammer plans for no deal, said he was not going to take lessons from a “muppet” who had no medical qualifications.
    “If he has got doubts about my probity, I am more than happy to be referred to the GMC,” said Nicholl.
    “I am not bothered about Jacob Rees-Mogg. I’m not going to take a single word of health lessons from a muppet like him. What does he know about epilepsy or neuropathic pain?” he added.
    “What I am worried about is my patients. To suggest I am wrong in what I say is defamatory. When, as I have done, I look people in the eye and say some of the drugs they are on might be in short supply and who are understandably worried, what he says about me is ridiculous.”

  • Social care services in England under extreme duress, says Age UK Guardian highlights Age UK report which reminds us of the scale of the cuts inflicted on social care:
    "The failure of funding to keep pace with rising demand – nearly £8bn has been cut from council adult social care budgets since 2010 – meant 1.4 million people went without help with basic activities such as getting out of bed, washing and going to the toilet.
    “Growing levels of desperation described by those individuals, families and professionals on the sharp end bear testament to a system working at full pelt, stretched to its limit and still failing people left, right and centre,” the report said."

  • Assessing the health effects of a “no deal” Brexit Detailed and evidence based analysis from experts in a major BMJ study:
    Key messages
    "*Leaving the EU without a deal threatens health and the NHS in many ways, but the scale of the threat remains unclear
    "*We propose a framework that could be the basis for the comprehensive health impact assessment to inform politicians and the public
    "*The government’s claims that it is prepared for no deal are implausible and, at best, might mitigate some of the worst consequences"

  • Labour drawing up plans to offer all pensioners state-funded care in their homes Sunday Telegraph shoots itself in the foot by revealing a potential Labour policy that many of its ageing readers will find appealing:
    "Labour is drawing up plans to offer all pensioners state-funded care in their homes, as Jeremy Corbyn attempts to steal a march from Boris Johnson on a key election issue, The Sunday Telegraph can disclose.
    "Mr Corbyn's party is preparing to pledge "free personal care" for over-65s, after a similar policy was endorsed by a panel of influential peers, including two former chancellors."

  • They Got Estimates Before Surgery — And A Bill After That Was 50% More Another reminder from Kaiser Health News of the chaos and cost inflation that would await us if a Johnson government opened up the NHS to US-style health care.

  • No-deal Brexit could 'devastate' NHS by disrupting supply of life-saving medicines, health leaders warn Evening Standard highlights concerns of health professionals:
    "The British Medical Association, Royal College of Nursing and the Royal College of Nursing are among organisations to join forces and issue the strong warning.
    "They said that leaving the EU without a deal could also intensify the staffing "crisis" in the NHS, adding that thousands of EU staff have already left since the 2016 referendum."

  • Doctors will not be the agents enforcing a new “hostile environment” Dr David Wrigley, vice chair of BMA, in uncompromising BMJ blog:
    "It is a doctor’s job to treat the patient in front of them, not determine how the treatment is being paid for—and we have significant concerns that healthcare staff would be expected to be familiar with and to administer these complex arrangements.
    "Since the guidance was published, campaigners for the rights of EU nationals have warned that they risk creating a new “hostile environment”. Let me be clear, doctors will not be the agents enforcing this.
    "The BMA has longstanding concerns about the impact current upfront charging regulations have on both patients and healthcare workers. Earlier this year, the BMA reported on survey results that found many doctors had faced pressure from admin staff when making clinical decisions over an overseas patient’s need for care, while there was serious concern that the regulations were negatively impacting public health. So, to see them extended to 27 more countries come Brexit day could be potentially disastrous."

  • More than 120,000 NHS patients kept on ‘hidden waiting lists’ for mental health appointments Independent reveals research dug out by Labour confirming the continued under-funding of mental health:
    "People seeking help with their mental health are being kept on “hidden waiting lists”, with more than 122,000 patients waiting more than eight weeks to see a doctor again after their first appointment, The Independent can reveal.
    "Patients who received an initial talking therapy session were then told to wait longer for a follow-up appointment in 90 per cent of NHS clinical commissioning groups (CCGs) in 2018-19, according to the Labour Party. CCGs are responsible for the planning of health services in local areas; there are currently 191 across England."

  • IEA: think tank funded by big business rejects public health policies and the NHS Analytical article in The Lowdown on the right wing lobby group run as a "charity" takes a critical look at the countries the IEA's Kate Andrews claims have preferable health systems to the NHS:
    "Andrews always works to the same basic list of countries whose systems she points to as more effective and preferable to the British NHS. The list includes Australia, Belgium, Netherlands, Germany and Switzerland.
    "All of these countries spend much more money per head of population than the UK. According to the latest OECD figures, Australia spends 12% more per head; Belgium (never cited by anyone other than the IEA as a model health care system) spends 15% more; Netherlands 28% more, Germany 32% more and Switzerland – one of the highest spending countries after the USA – 89% more per head than the UK. And of course the UK average is higher than spending in England."

  • Johnson ‘cash-bombs’ the electorate – with fictional NHS funding increases Report in The Lowdown written before the extraordinary events in Parliament notes:
    "Soon after selecting his cabinet Johnson began making announcements about the NHS which have proved to be misleading.
    "In early August news media trumpeted the story that he had “announced a one-off cash boost of £1.8 billion for NHS hospitals in England – about a tenth of the extra £350m a week the Leave campaign and the famous bus promised would flow to the NHS after Brexit.

    "But within hours this story started to unravel: just £850m could be claimed to be extra spending, and this is far less than the billions that have been squeezed out of hospital budgets in so-called savings in recent years."

  • Campaigners challenge NHS shakeup without consultation Lead article in The Lowdown warns of CCG mergers and summarises the legal basis on which campaigners can demand each merger be subject to a full public consultation: It warns that CCG mergers threaten "to marginalise any local voice or accountability for patients and the public in dozens of areas.
    "Many if not most of these mergers are going ahead without any public consultation. This is important because the scrapping of locally based CCGs would remove the already limited level of public democratic accountability. At present each CCG must meet in public, publish board papers, and consult on changes."
    However the current regulations governing CCGs require NHS England, before authorising mergers, to assess: “The extent to which the CCG has sought the views of individuals to whom any relevant health services are being or may be provided, what those views are, and how the CCG has taken them into account”.
    This means a public consultation is required and not the partial “engagement with stakeholders” that is currently taking place.

  • Legal basis for public consultation on CCG mergers Louise Irvine of Save Lewisham Hospital campaign and Secretary of HCT highlights the elements of the existing legislation on CCGs that requires a public consultation on the widespread plans to merge several CCGs at a time into bodies covering vast populations of up to 2.2 million. Behind the antics in the Commons 86 CCGs are planning to apply for merger to take effect from April 2020.
    They have to get their merger applications to NHS England by this month, or October at the latest. This process is being rushed through without public consultation.

  • Infographic on health impact of no-deal Brexit A picture that's worth a thousand words.

  • Rural hospital closures lead to higher mortality rates US study highlights the contrast between urban and rural populations:
    "When a hospital closes in an urban area, mortality rates don’t change. But when a rural hospital shuts its doors, according to a new study, mortality rates increase nearly six percent.
    "The new study helps clear up a question about the impact of hospital closures on health. Earlier studies at times have shown that a closed hospital didn’t seem to have much impact on health.
    "In this study researchers at the University of Washington studied 92 hospital closures in California between 1995 and 2011. As a group, the closures, in fact, didn’t show much impact on mortality rates."

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