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  • Council decides not to ask Government to intervene on A&E overnight closure Weston Mercury reports North Somerset council' scrutiny panel has bottled out of referring the controversial permanent night time closure of Weston's A&E to the secretary of state. This is a body blow for campaigners who now have no local body prepared to stand up for local access to emergency care.

  • Pathologists vote to strike over new shifts row at Barking NHS trust that puts patients’ samples ‘at risk’ Press release from Unite the Union:
    "Pathologists at a north east London NHS trust have voted for strike action in a dispute over new shift patterns which, it is claimed, could compromise the integrity of patients’ samples.
    "The warning has come from Unite, which represents 88 biomedical scientists working at Queen’s Hospital, Romford and King George Hospital, Ilford who face losing about £10,000 a year, if the new shifts go-ahead on 4 November.
    "The pathologists, who are employed by Barking, Havering and Redbridge University Hospitals NHS Trust, voted by 87 per cent for strike action. Strike dates are expected to be announced soon.
    "Unite said that it submitted a Freedom of Information (FoI) request to probe what was happening to patient samples and the trust replied: ‘No sample is discarded prior to analysis’.
    "However, the trust cited ‘commercial confidentiality’ in declining to answer the question: ‘How many blood and other examples within the pathology department at Queen’s Hospital and King George Hospital have been processed after the recommended testing time in each of the last 12 months?’"

  • (US) Patients Eligible For Charity Care Instead Get Big Bills Kaiser Health News reports on a less obvious aspect of the US health care nightmare:
    "Under the Affordable Care Act, nonprofit hospitals like St. Joseph are required to provide free or discounted care to patients of meager incomes — or risk losing their tax-exempt status. These price breaks can help people avoid financial catastrophe.
    "And yet nearly half — 45% — of nonprofit hospital organizations are routinely sending medical bills to patients whose incomes are low enough to qualify for charity care, according to a Kaiser Health News analysis of reports the nonprofits submit annually to the Internal Revenue Service. Those 1,134 organizations operate 1,651 hospitals.
    "Together, they estimated they had given up collecting $2.7 billion in bills sent to patients who probably would have qualified for financial assistance under the hospitals’ own policies if they had filled out the applications."

  • Health chiefs blast Boris Johnson's opposition to 'sin taxes' – calling for the PM to 'follow the evidence' and expand them to cover ALL junk food Daily Heil finds room for a straight report on calls from Simon Stevens and other senior NHS figures for extension of "sugar tax" and similar measures to deter unhealthy diet:
    "Health chiefs have blasted Boris Johnson's opposition to 'sin taxes' and are calling for the Prime Minister to 'follow the evidence' and expand them to cover all junk food.
    "The head of NHS England has urged the Government to be 'led by the evidence' showing the so-called sugar tax has worked, days before the results of a review into whether it should be extended to all unhealthy foods are due."

  • Growing pressures on access and staffing risk creating ‘perfect storm’ for people using mental health and learning disability service The CQC's own press release on their State of Care report:
    "In this year’s State of Care, we have highlighted mental health and learning disability inpatient services because that’s where we are starting to see an impact on quality – and on people. There has been a deterioration in ratings in these services – and our inspection reports highlight staff shortages, or care delivered by staff who aren’t trained or supported to look after people with complex needs, as a reason for this.
    “Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all."

  • More than half of A&Es provide substandard care, says watchdog Guardian reports on the CQC's latest State of Care report, highlighting problems in A&E:
    "More than half of A&E units are providing substandard care because they are understaffed and cannot cope with an ongoing surge in patients, the NHS watchdog has said.
    "The Care Quality Commission (CQC) said 44% of emergency departments in England required improvement and another 8% were inadequate, its lowest rating. Last year 48% of A&Es fell into the two ratings brackets combined.
    "Ian Trenholm, the CQC’s chief executive, said A&E was “the department in a hospital we are most concerned about”. The regulator said units were struggling because of increases of as much as 10% a year in the number of people seeking care.

  • Mental health services: CQC warns of “perfect storm” (£)BMJ report on the latest Annual report from the CQC:
    "A shortage of skilled staff, coupled with rising demand, has created a “perfect storm” for patients using mental health and learning disability services, England’s healthcare regulator has warned. …
    "The CQC said that since October 2018 it had rated 14 independent mental health hospitals that admit people with a learning disability or autism as inadequate and put them into special measures. Two of these services have since improved, three are now closed, and one is still registered but with no patients resident."

  • Kidney patients face waving goodbye to EU travel after Brexit More joy from the looming Brexit, according to the (£) Times:
    "[26,000] kidney patients who need life-sustaining treatment when travelling in the EU will have to pay up to £1,200 a week under a no-deal Brexit.
    "The four hours of dialysis they need several times a week is free with a European Health Insurance Card (EHIC). However, the NHS website says: “The [card] may not be valid if there’s a no-deal Brexit. This . . . might mean you need to pay for treatment in full.”
    "Dialysis, which costs about £300 a session, is not covered by travel insurance because it is “a planned treatment for a pre-existing condition”.

  • Troubled care home operator fails to pay landlords (£)FT report on yet another financial nightmare in care home sector:
    "Four Seasons, Britain’s second biggest care home operator, failed to pay millions of pounds of rent this month with no warning to landlords, raising concerns over the care of thousands of elderly residents.
    "… Four Seasons, which runs 320 homes housing 16,000 residents, has been fighting for survival since 2017 after its owner — Guy Hands’ private equity firm Terra Firma — defaulted on an interest payment.
    "… Four Seasons said in a stock market announcement on Monday that it was seeking to renegotiate rents on the remaining 135 leasehold homes. It then failed to pay rent owed to landlords the same day, according to three sources who say they received no advance warning."

  • Adult care staff turnover rises for sixth consecutive year, report finds Community Care article based on new research shows massive rise in staff turnover in adult social care:
    "The adult social care staff turnover rate has risen for the sixth year running, with lack of training and qualifications and zero-hours contracts among factors driving workers to leave, a new report has found.
    "Skills for Care’s annual report on the state of the workforce found turnover among directly-employed staff (excluding personal assistants) had risen from 23.1% in 2012-13 to 32.2% in 2018-19. Turnover was highest among care workers, at 39.5%, and this group had also experienced the highest increase since 2012-13, at 11.1 percentage points.
    "According to the report, staff were more likely to leave their role if they were younger, relatively inexperienced, lower paid, had higher rates of sickness and were on a zero-hours contract."

  • It’s hysteria, not a heart attack, GP app Babylon tells women Times report revealing that so-called AI chatbot Babylon has been programmed with all of the sexist prejudices of the medical profession and may miss symptoms of heart attack in women.
    "Entering identical heart attack symptoms for men and women resulted in different suggested diagnoses.
    "The Babylon app, which bears the NHS logo, uses artificial intelligence (AI) to identify health problems. But doctors found that the algorithm tells a 60-year-old female smoker who reports sudden onset chest pain and nausea that she is probably having a panic attack or pain caused by inflammation.
    "A 60-year-old male smoker with the same symptoms is told that he may be having a heart attack. The man is advised to go to A&E, while the woman is told to contact her GP within six hours if the symptoms persist."

  • England sees 'worst summer on record' for A&E waits Analysis by BBC Newsnight and the Nuffield Trust found an average of 86% of patients were admitted, transferred or discharged from A&E within four hours in the six months to September.
    This is the worst performance in that period since the 95% target was brought in in 2004. Doctors are warning that the system is "running out of resilience" and that winter in A&Es was going to be "really difficult".
    In September there were 64,921 patients waiting more than four hours from decision to their actual admission to further care, of whom 455 waited more than 12 hours. This is a 195.5% increase from the previous year.

  • Boris Johnson accused of 'pork barrel electioneering' with NHS hospitals Mirror highlights story broken in HSJ: “Boris Johnson has been accused of using the NHS for ‘pork barrel electioneering’, snubbing Liverpool and funnelling hospital funding into Tory target seats.”
    Liverpool, Mersey and Cheshire areas have 4.5% of England’s population but just 1% of the new money announced by the Johnson government for hospital building and refurbishment.
    Kathryn Thomson of Liverpool Women’s Foundation Trust told the Health Service Journal she had been left “hugely frustrated” when her organisation was excluded from the list of NHS buildings to benefit from a cash boost.
    She said: “We were the top priority for Cheshire and Mersey, and we understand from NHS Improvement that we were one of the priorities for the north west of England, so we don’t understand why we haven’t got anything. We’ve asked a number of times for feedback on what prevented us getting something, so we could rationalise it, but we’ve never had anything back.”
    Of the 21 trusts receiving seed funding, more than half are in Tory seats, and nine are in seats with majorities of less than 5,000 votes in the 2017 election.

  • PM aide's advisory role with Babylon 'raises conflict of interest questions' Pulse version of the story on Dominic Cummings' links with Babylon quotes Sam Smith, coordinator of patient confidentiality campaign group MedConfidential:
    "This Government and NHSX is committed to using private companies to deliver NHS technology innovation, as was clear from the recent awards to Digital Innovation Hubs.
    "Any innovations they create will only be available to their paying customers – £250m of the NHS budget will be used to fund AI innovation, and then other NHS budgets will be charged to use it, per patient, forever. This double charging makes the worst of PFI look like a good deal."

  • Dominic Cummings accused of conflict of interest over NHS fund Guardian report that may surprise some people:
    "Boris Johnson’s most senior aide, Dominic Cummings, is facing conflict of interest accusations over a consultancy role he undertook for a government-endorsed healthcare startup that is in position to receive a share of a new £250m flagship public fund.
    "Cummings advised Babylon Health, a controversial artificial intelligence (AI) firm working within the NHS, on its communications strategy and its senior recruitment, an investigation by the Guardian and the Bureau of Investigative Journalism can reveal.
    "A GP app developed by the company was later backed publicly on multiple occasions by the health secretary, Matt Hancock."

  • 'It destroys lives' - Teen's dismay at 18-month mental health delay As CQC inspectors return to the troubled Norfolk & Suffolk Foundation Trust, the Eastern Daily Press highlights delays and problems. Waiting times for non-emergency referrals have worsened:
    "The number of people waiting longer than the target of 28 days to be assessed shot up to 1,466 in August from 912 in March."
    More than 30pc of medical jobs are vacant at the NSFT and the Campaign to Save Mental Health Services in Norfolk and Suffolk said the decline in waiting times was down to staffing problems.
    They pointed to massive issues within the NSFT's "crisis teams" who look after those most in need in the community."

  • NHS could lose thousands of staff under Brexit migration shake-up (£) HSJ brings a grim warning that will no doubt be brushed aside by Brextremists as "project fear":
    "More than 60,000 international NHS workers could be at risk of deportation if the government was to tighten immigration rules and increase the salary threshold for visas for skilled workers, analysis by HSJ has revealed.
    "Home secretary Priti Patel has committed to introducing an Australian points based immigration system for the UK after Brexit, while the government has asked the Migration Advisory Committee to consider the evidence for salary thresholds and at what level they could be set.
    "According to NHS Digital data, examined by HSJ, there are 60,611 NHS staff, by headcount, from the EU and the rest of the world who are not currently on the shortage occupation list and earn less than £36,700."

  • Waste in the US Health Care System: Estimated Costs and Potential for Savings An important new free access study in Journal of American Medical Association updates previous estimates and reveals the staggering scale of waste in the US health care system:
    "In this review based on 6 previously identified domains of health care waste, the estimated cost of waste in the US health care system ranged from $760 billion to $935 billion, accounting for approximately 25% of total health care spending, and the projected potential savings from interventions that reduce waste, excluding savings from administrative complexity, ranged from $191 billion to $282 billion, representing a potential 25% reduction in the total cost of waste.
    "Implementation of effective measures to eliminate waste represents an opportunity reduce the continued increases in US health care expenditures."

  • NHS chiefs fear hospitals will not cope amid growing social care crisis Daily Telegraph reports:
    "Eight in ten hospital chief executives fear their wards will be unable to cope within a year, amid a growing social care crisis.
    "A damning report today says most of those running NHS trusts are worried about short staffing and a lack of investment in services to keep the elderly out of hospital.
    "Six in ten trust chief executives and chairmen said a lack of doctors and nurses is endangering decent patient care, with almost 100,000 staff vacancies across the NHS.
    "And eight in ten of those running hospitals said they feared they would not be able to cope with demand within the next 12 months."

  • Digital-first overhaul could strip Babylon GP at Hand of primary care network GPonline follows up on its previous report that GP at Hand's list of more than 60,000 patients - all currently registered with a single west London host practice - would be broken up into more than a dozen separate contracts, potentially from April 2020.
    NHS England also plans to force them to set up physical premises in any CCG area from which they have recruited more than 1,000 patients. See also The Lowdown report: https://lowdownnhs.info/news/private-gp-service-sets-sights-on-further-nhs-expansion/

  • Psychiatrist vacancies 'threaten' NHS transformation BBC report based on Royal College of Psychiatrists survey on the uneven spread and general shortage of consultant staff for mental health:
    "The number of vacancies has doubled in six years - and is particularly marked in children's services, says the Royal College of Psychiatrists.
    "One in 10 consultant posts - 568 out of 5,730 - is vacant, up from one in 20 in 2013, a census by the college suggests.
    Being the BBC it has to include the usual inadequate response from ministers: "The government pledged an extra £2.3bn a year by 2023-4 to improve care."

  • 'It's like a death sentence': retired Britons in EU face loss of healthcare Guardian report flags up the hidden danger of a no-deal Brexit:
    "The UK government announced last month that if Britain crashes out of the EU without a deal the estimated 180,000 retired British nationals in the bloc whose healthcare costs it funds would continue to be covered for six months.
    "Most of the 1 million Britons in the EU are earners, so pay into the health systems of the EU member states they live in. Their healthcare arrangements should be unaffected by a no-deal Brexit.
    "But pensioners, who paid social security when they lived in the UK, are part of a reciprocal healthcare scheme, S1, under which the NHS reimburses the cost of their treatment – and which will cease to exist after a no-deal Brexit."

  • One of UK’s biggest care home operators investigated over finances Guardian warning that:
    "One of the UK’s biggest care home operators, which looks after about 3,000 elderly residents, is being investigated by regulators, heightening concerns over the state of Britain’s social care provider market.
    "More than 150 local authorities in England and Scotland were alerted at the end of August that Advinia Group was failing to co-operate with a regulatory inquiry into its finances.
    "Advinia has 3,250 beds and employs 4,500 staff in its 38 residential homes in England and Scotland. It became England’s 10th biggest care home operator overnight in 2018 after borrowing £59m to buy 22 homes from private healthcare firm Bupa."

  • 'Unprecedented' rise in infant mortality in England linked to poverty Irish publication flags up British statistics:
    "An additional 570 infant deaths, compared to what would have been expected based on historical trends, were recorded in [the UK] from 2014-2017.
    "About one-third of those deaths, which related to children under the age of one, were linked to rising poverty.
    "Rising infant mortality is unusual in high income countries, and international statistics show that infant mortality has continued to decline in most rich countries in recent years."

  • Sunday Mirror demands Government coughs up to end GP crisis caused by Tory cuts The Mirror article warns that:
    "Appointment waiting times have hit a record high as more and more GPs quit, broken by heavy workloads.
    We want to save our surgeries by:
    * BOOSTING the number of trainee GPs by at least 5,000 a year to replace the 1,600 already axed by the Tories – and to cover a looming shortfall of 7,000 in the next four years.
    * CREATING nearly 30 million extra appointments to shrink growing surgery waiting times for everyone which can be as long as TWO MONTHS – especially for patients suffering serious conditions, and
    * ENDING the flood of experienced GPs who are leaving the NHS in droves by improving working conditions wrecked by Tory cuts."

  • NHS delays to surgery risk patients becoming addicted to strong painkillers Times report warns:
    "The NHS is putting patients at risk of opioid dependency by rationing routine surgery, experts have warned. …
    "Some local NHS trusts are delaying operations by up to 12 months.
    "GPs, surgeons and patient groups said the “totally unacceptable” delays raise the risk of opioid dependence among patients awaiting pain-relieving surgery. They say people in need of medical help will be left in pain as they are forced to wait for treatment, and may end up addicted to the enormously powerful drugs."

  • Decrepit NHS mental health wards put lives at risk Guardian article highlighting the continued consequences of chronic neglect of investment in mental health services, which remains an obvious flaw in the latest government announcements of "new" hospitals, none of them for mental health:
    "Crumbling old buildings are unsafe as they offer opportunities for mentally vulnerable people with conditions such as depression and schizophrenia to try to hang themselves or fall from a height, according to mental health trusts in England.
    "New figures show that patient safety incidents in mental health units caused by problems with staffing, facilities or the environment in which people are treated have risen by 8%. In all, 19,088 such incidents occurred in 2018-19 compared with 17,693 the year before."

  • Trump Bars Immigrants Who Cannot Pay For Health Care US National Public Radio report should be shocking, but shows how much our own government's imposition of racist charges to access NHS treatment are all of a piece with the actions of a racist US President:
    "President Trump signed a proclamation late Friday barring legal immigrants who cannot prove they will have health care coverage or the means to pay for it within 30 days of their arrival to the United States.
    "Trump said uninsured individuals are a burden on the health care industry and U.S. taxpayers.
    "Immigrants who enter this country should not further saddle our health care system, and subsequently American taxpayers, with higher costs," Trump declared."

  • Virgin Care hires former NHS regulator boss (£)HSJ reports on a new nice little earner for an ex-McKinsey director who was a health advisor to Tony Blair and led the foundation trust regulator Monitor for five years until it joined up with the Trust Development Authority to form NHS Improvement in 2015.

  • Before travelling abroad it is important to take out comprehensive travel insurance More joy from the looming Brexit: another government warning.
    "The European Health Insurance Card (EHIC) may not be valid after Brexit. You should make sure your travel insurance covers your healthcare needs," whether there’s a deal or not
    "There may also be changes to your vehicle insurance when driving in the EU after Brexit."

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