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  • Mitigating public health risk from evictions Over the last few of weeks campaigners have been working hard to gather together health bodies such as the BMA, the Royal College of Physicians, and the Royal College of General Practitioners, Pathways, Faculty of Public Health, the Royal College of Psychiatrists among others, to write to the government calling on them to protect those experiencing housing insecurity during the coronavirus crisis.
    Housing is a key determinant of health and a right to good health means a right to have safe & secure housing.
    They sent a collective letter to the Housing, Communities and Local Government Minister Robert Jenrick, highlighting the serious public health risk posed by the ban on evictions ending on the 23rd August.
    The letter has now been covered in both the Financial Times and The Guardian.

  • Hospital ‘bed blocking’ numbers hit highest level since 2017 Guardian highlights another indicator of a system lacking capacity and very far from being "integrated": but headline uses the old-fashioned and perjorative phrase "bed blocking" when the proper terminology is delayed discharge or delayed transfers of care.
    Whatever we call it the facts are stark: "The number of “delayed days” in the NHS increased from an average of 114,000 a month in 2012 to more than 200,000 in October 2016, before extra funding and higher council taxes brought the numbers back down.
    "But the latest NHS figures show the problem is returning. December 2019 saw 148,000 delayed days across England, 15% higher than the same month a year earlier. The combined figures for the last quarter of 2019 were the highest in two years."

  • Social care is crumbling, and Johnson’s immigration plans will only make it worse Guardian's Polly Toynbee joins the dots to show the impact of the latest efforts to deter migrant workers:
    "The fourth biggest provider of home care for the frail, the Mears Group, … is abandoning its domiciliary care services.
    “…Social care is collapsing because too few people are willing to work gruelling hours in disgraceful conditions for pitiful pay.
    "The new points-based immigration system announced by the home secretary, Priti Patel, on Wednesday will see many more companies fleeing the sector for lack of staff. With 122,000 vacancies, this decade’s 25% increase in people over 65 means another 580,000 staff will be needed to care for them over the next 15 years. In London, 40% of care staff are from overseas. Median average pay as of last March is a meagre £8.10 an hour, with parts of their hours unpaid: a quarter of staff are on zero-hours contracts."

  • NHS 'took 18 months to help after suicide attempt' BBC report on gaping holes in NHS provision for serious mental illness:
    "Simon, who is from Derbyshire, said: "After one of my first hospital admissions, I received a safety plan through the post 18 months after I had been discharged.
    "When I struggle, I look for things that reinforce my negative view of myself - missing out on a safety plan on discharge reinforced that message that I am worthless.
    "There have been times when I've been given a generic plan which has little or no relevance to me. And, truthfully, if it's not personal, for me it's pretty pointless"

  • The Lowdown – the first year's issues Omnibus collection Searchable compilation of 200 pages of first 22 issues of The Lowdown since January 2019. A wealth of information -- with live hyperlinks to sources. Plus an appeal for support to keep it going another year

  • Government is sharpening its scrutiny of the NHS (£)HSJ column by former special advisor to Matt Hancock Richard Sloggett (sic) who argues:
    "The slide in the performance numbers, a larger than expected majority and the centrality of the NHS to the election victory has led to the exploration of what new powers ministers could take in setting direction to NHSE; as reported recently by The Times.
    "The current model of NHS independence clearly does not suit the Number 10 world view of directional oversight of key organisations to drive improvement.
    "Critics will argue that any moves will miss the point. They argue that direct ministerial control is not a solution to performance issues which are driven by a multitude of factors, many beyond the boundaries of the NHS. And as Dave West adeptly argues legislative change will not likely come in until April 2022 making it a medium-term lever for change at best."
    The question remains why should we expect a government that won a majority by wilfully misleading voters with inflated claims of the amount of "extra" money for the NHS after a decade of real terms freeze should suddenly decide now to put in more cash than they promised?

  • Behind the Scenes at Leicester Royal Infirmary: An NHS Worker Speaks Out Campaigners publicise the anonymous account of an NHS worker at Leicester's Royal Infirmary where a new £40m A&E has not solved the problems of lack of capacity:
    “Multiple Patients have been on the backs of ambulance for over 4 hours throughout the year with nurses leaving in droves and junior doctors saying that there is no way they are going to go into the field of emergency medicine.
    "Nurses are bullied by senior staff and managers to make unwell patients, who should be on trollies, sit on chairs in an already overcrowded waiting area. They call it 'fit to sit'.
    "Half the patients should be in Resus and no matter how much you beg the senior team you are told that it is full with red call patients on the way with no space for the red call emergency, let alone a patient in the waiting room."

  • 360 degrees of spin More brilliant spoofs from NHS Blithering that almost seem lifted from a genuine CCG.
    Director of stakeholder nurturement and realtime feedback Martin Plackard is responding to the latest NHS staff survey:
    "Great care for all
    "Overall we saw a four-fold improvement on last year after seasonally adjusting the baseline to the sector average for an organisation of comparable demographics and applying the deflator.
    "More than two-thirds of you (11%) would be happy to recommend the care provided by your organisation to a friend or member of your family. Only a tiny minority (89%) said they would be “deeply worried” or that they “wouldn’t wish it on my worst enemy”."

  • Marketising the Mental Health Crisis: How the CBT Empire-Builders Colonised the NHS Powerful article by Paul Atkinson on Novaramedia ruthlessly exposes the hype and spin surrounding the IAPT talking therapies as a solution to England's growing mental health crisis.
    "Last financial year, the service had 1.6 million GP and self-referrals. IAPT claims a recovery rate of 50% of people who finish a course of treatment. Given roughly a third never start, and up to a third never finish, the average national recovery rate of all referrals is actually closer to 16%.
    "IAPT stats also reveal that people from more deprived communities fare significantly worse. A couple of years ago, in my own borough of Tower Hamlets, the recovery rate for all referrals from the Bangladeshi community (32% of the local population) was around 4%.
    "Waiting times are growing, despite IAPT’s statistical wheeze of offering a speedy initial assessment, months before any sessions begin. And according to Freedom of Information requests, a quarter of people treated by IAPT have returned to the service between two and 10 or more times.
    "Most of us might consider this evidence-based failure rather than success."

  • We need the biggest NHS rebuild since the Beatles NHS providers again banging the drum for the need for substantially higher capital investment in the NHS, but perhaps over-optimistic on what they can expect from B. Johnson and pals:
    "capital budgets, which cover spending on assets such as buildings, land and equipment and sit outside the NHS 'ringfence', haven’t been set out beyond the end of next year. We have just had a decade of under-investment in NHS capital. The system for allocating capital to the frontline is broken. The money hasn’t got through to where it’s needed most. The system often seems arbitrary and haphazard."
    Will Johnson act? We urge NHS Providers not to hold their breath waiting.

  • Private agencies paying workers less than half what they charge NHS to hire The Mirror lifts the lid on the rip-off charges for use of agency staff – and where the money goes:
    "Private nursing agencies are paying workers less than half what they charge the NHS to hire them.
    "We found one raked in £71.53 an hour for busy overnight shifts but the nurse pocketed just £34.
    "Another hospital paid the same agency £864.77 for a 12-hour day shift but the nurse got £387.
    "The agency, Thornbury Nursing, is owned offshore in the Caribbean and is controlled by a private equity fund run by a major Tory donor.
    "It is part of a string of firms specialising in health temping jobs and run by TowerBrook Capital Partners, which raked in nearly £600million in revenue last year."

  • Locked away: the national scandal you may have missed Excellent Guardian report on the shocking mistreatment of people with autism and learning disabilities:
    "In England, there are more than 2,000 people with autism and learning disabilities in what officialspeak calls “inpatient care”. We now know about them, and the awful cruelties and indignities many of them are suffering, because of the much-maligned mainstream media – and in particular, the tireless work of the campaigning journalist Ian Birrell.
    "Birrell and others have highlighted not just the injustice of the way very vulnerable people are treated by local authorities, the NHS and the private contractors now woven into our public services; …"

  • Improving the prognosis of health care in the USA Free access Lancet article by Yale Uni researchers who are the latest to show the evidence for a single payer system as the way forward in the US:
    "Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017).
    "The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households.
    "Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo."

  • I've been an NHS doctor for five years. The Home Office wants to deport me Guardian reports on more brutality and ignorance from the Home Office, now led by the relentlessly reactionary Priti Patel.
    Dr Luke Ong says "My troubles began towards the end of last year when I applied for indefinite leave to remain in the UK. I am from Singapore.
    "I was five months away from qualifying as a GP and had studied medicine at Manchester University, starting as a doctor in the NHS in 2012.
    "I booked an appointment and paid for it before my visa ran out. I thought that was fine. In reality, the application is made when you attend the appointment, by which time my visa had been invalid for 18 days. I was refused residency for that reason, and since then it’s been a battle to reverse the decision. "

  • Fears Sussex patient transport to hit 'crisis point' Brighton Argus reports on the latest of an apparently endless series of contract failures of patient transport companies as local CCGs go from one stupid decision to the next. Time to bring this service back in house!
    "A union has warned vital patient transport services are nearing “crisis point” after a contractor ran into financial trouble.
    "About 30 staff were left unpaid and without work after private ambulance firm Medi 1 went into receivership, a process similar to administration, after financial difficulties.
    "The company was contracted to run non-emergency patient transport services to hospitals across Sussex.
    "Now the GMB trade union has called on health chiefs to bring these services in-house by contracting them to the NHS-run South Central Ambulance Service.
    “Medi 1 has now become the latest in a long line of failed private contractors,” said regional organiser Gary Palmer.
    “As before staff and their families now have to endure the brunt of profit-driven business failures and need to find new work immediately while struggling without the money they are owed."

  • East Kent baby deaths: Scale of deaths at trust 'not clear-cut' BBC report of a Trust Board and chief executive in denial on the scale of the failure of their services: "The boss of an NHS trust at the centre of concerns about preventable baby deaths has claimed the scale of the failings is not clearly defined.
    "Susan Acott, chief executive of East Kent Hospitals Trust, said there had only been "six or seven" avoidable deaths at the trust since 2011.
    "However, the BBC revealed on Monday that the trust previously accepted responsibility for at least 10.
    "Ms Acott said some of the baby deaths were "not as clear-cut".

  • Huge revamp of Peterborough City Council could see services disappear to tackle financial black hole Peterborough Today report. A Tory-led council points to government cuts as the reason for its growing crisis:
    "The council said years of huge cuts to its government funding had left it on its knees and in a desperate need to scale back in order to survive.
    "This could see a reduced standard for services which it is legally required to provide, while other, non-statutory services could be partially or completely scaled back.
    "Further job losses are also expected, despite dozens of redundancies currently being made."

  • New NHS figures show why we must fight the government’s spin on health service funding KONP's Press Officer Samantha Wathen writes in Left Foot Forward:
    "Behind these never-ending statistics are real people. Patients waiting in fear and pain for treatment, and NHS staff desperately trying to help them, but increasingly being set up to fail. As has been famously asserted: “The NHS isn’t failing – it’s being failed.”

  • Harrowing stories of burned out NHS doctors bullied and broken in decade of Tory cuts Shocking Daily Mirror front page story of insensitive and brutal management:
    "Dedicated to caring for the sick and vulnerable, junior ­doctors should expect to be ­supported and valued as they carry out their vital work.
    "But hundreds have revealed they are subjected to bullying and harassment at overstretched hospitals that have been plunged into a staffing crisis by a decade of savage Tory health cuts.
    "A Mirror investigation uncovered harrowing stories of young medics being denied drinking water during gruelling shifts, working for 15 hours on their feet non-stop and of uncaring managers tearing into them for breaking down in tears over the deaths of patients.
    "One was even accused of “stealing” surgical scrubs she took to wear after suffering a miscarriage at work."

  • Combined Performance Summary: December 2019 - January 2020 Nuffield Trust's regular visualisation of the most recent performance stats. Note that there have been fewer Type 1 A&E attendances and fewer emergency admissions since last year, but a sharp increase in trolley waits over 4hours and over 12 hours -- presumably for lack of beds:
    "There were over 1.32 million type 1 A&E attendances in January 2020. This equates to an average of 42,814 type 1 A&E attendances per day – a decrease of 1% compared to January 2019.
    "Emergency admissions via A&E have been increasing year-on-year, but decreased in January 2020 to 416,541. There were on average 13,437 emergency admissions via A&E per day, which is 1% lower than January 2019.
    "100,578 patients spent more than four hours waiting on a trolley from a decision to admit to admission in January 2020; this is the highest since records began. 2,846 patients had a trolley wait of over 12 hours, which is more than four times higher than in January 2019."

  • Cost of hospital building project doubles in 18 months (£) HSJ article on the soaring estimates of the cost of rebuilding Ashford's William Harvey Hospital, or building an alternative new hospital in Canterbury, notes:
    "The east Kent reconfiguration is not one the government has earmarked for money, although, before the election, Boris Johnson suggested there could be a new hospital for Canterbury."
    More on this story and the Kent & Medway plan in The Lowdown https://lowdownnhs.info/hospitals/kent-and-medway-seeking-820m-for-capital-projects/

  • Racism in medicine—migrant doctors aren’t here just to “fill a gap” GP Rammya Mathew in a BMJ blog argues that "Even at its inception, it was clear that the NHS could not be fully staffed by “homegrown” doctors. Because of this, doctors and other healthcare workers historically bypassed immigration laws, and the 1960s and ’70s saw a surge in the number of doctors migrating from the Indian subcontinent to work in the NHS. This included my parents."

  • New targets set to be phased in from April, says NHSE (£) HSJ report on views of NHS Improvement chief operating officer Amanda Pritchard, making clear that existing 4-hour targets are likely to be ditched:
    "The NHS can expect a phased implementation of new operational targets from April — instead of a full switchover on day one — NHS England’s number two has said.
    "In an interview with HSJ, chief operating officer Amanda Pritchard said its testing so far still suggested — as NHSE’s clinical review of standards reported before Christmas — the four-hour emergency target did not work well for the current model of care.
    "However, she said introducing new measures needed to take place alongside — rather than ahead of — further redesign of urgent and emergency services. Ms Pritchard said this included, for example, reducing bed occupancy to around 92 per cent, redesigning emergency departments, developing 111 and urgent treatment centres, and improving the response of community reablement services."

  • Jeremy Hunt sceptical about building 40 hospitals (£) Times report of the new scepticism of the former Health Secretary now he is trying to prove his independence as chair of the Commons Health Committee:
    "The government’s plan to build 40 new hospitals was “highly ambitious” and its funding promises needed “a lot more thinking and ambition”, the former health secretary said."

  • Health inequality greater than previously thought, report finds Guardian reports on latest NHS data on health inequalities:
    "The new analysis means that men on average are being diagnosed with their first significant long-term condition at 56 and women at 55. In the poorest areas, women are getting their first significant long-term illness at just 47 and men at 49 years old."

  • Nurse unfairly dismissed for wanting to commence NHS whistleblowing process Personnel Today reports on tribunal case of district nurse who wanted to raise concerns over North Tees and Hartlepool Foundation Trust:
    "A senior district nurse with 38 years’ experience was unfairly dismissed after she told management of her wish to instigate her employer’s formal whistleblowing procedure, an employment tribunal has judged.
    "It followed numerous safeguarding concerns raised to her bosses about her team’s workload, employee stress and sickness, and a need for the retraining of healthcare assistants. The nurse had also raised concerns on the risk to patient safety, including one death she felt may have been preventable."

  • “Super‐Utilizer” Interventions: What They Reveal About Evaluation Research, Wishful Thinking, and Health Equity A useful Millbank Quarterly critique highlighting US research that undermines faith in the idea that interventions targeted at so called "frequent flier" repeat patients can reduce dependence on hospital care:
    "Many super‐utilizer interventions claim to be addressing patient “social determinants of health” when they are, at best, identifying and struggling to remedy a subset of patient social risks and needs.6 The truth is that hot‐spotting interventions are primarily cost‐containment strategies aimed at individual, very expensive patients. They are not interventions aimed at the macro‐ and community‐level systems and institutions that drive social, political, and economic disadvantage and health inequities."

  • Nurses to retrain as doctors ‘more quickly’ without EU red tape Nursing Notes reports comments on suggestions from Matt Hancock about swifter training.
    "Nursing leaders warn that the move needs to come without compromising patient care.
    "Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC) said: “Having enough health and care professionals with the right knowledge, skills and values is vital to meet the individual needs of people across all four countries of the UK now and in the future.
    “The NMC supports the wish to explore how education and training for registered nurses and midwives may be achieved in more flexible ways while ensuring our high standards are maintained and not compromised. Every nursing and midwifery professional must be safe and competent to provide the best care and support possible."

  • Health insurers can use this loophole to push pricy medical bills onto you, the patient USA Today report points out that "insurers require preapproval – sometimes called “prior authorization” – for a widening array of procedures, drugs and tests. While prior authorization was traditionally required only for expensive, elective or new procedures, such as a hip replacement or bypass surgery, some insurers now require it for even the renewal of some prescription drugs. Those preapprovals are frequently time-limited.
    "While doctors and hospitals chafe at the administrative burden, insurers contend the review is necessary to ferret out waste in a system whose costs are exploding and to ensure physicians are prescribing useful treatments.
    "But patients face an even bigger problem: When insurers revoke their decision to pay after the service is completed, patients are legally on the hook for the bill."

  • Utah sends employees to Mexico for lower prescription prices ABC news on the US state that is taking advantage of lower priced drugs in Mexico.
    "The cost difference is so large that the state's insurance program for public employees can pay for each patient’s flight, give them a $500-per-trip bonus and still save tens of thousands of dollars."

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