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  • Virtual GP service allowed to expand out of London despite criticism from doctors NHS England continues with its crusade against evidence or evaluation of pilot schemes, giving the nod to Birmingham adopting the controversial privately-led service that has caused financial havoc in general practice across London and which has yet to be properly evaluated.

  • Combined Performance Summary December 2018 - January 2019 The Nuffield Trust's Quality Watch data with very clear graphs, based on NHS England's Combined Performance Summary, which provides data on key performance measures for December 2018 and January 2019.
    SitRep data for Week 6 of 2019 was also released, giving a more up-to-date analysis of how the NHS is coping this winter.

  • Queen's Medical Centre needs £77m of urgent improvements Nottingham post report reveals that: "Examples of maintenance needed can be upgrading software on medical equipment, maintaining generators and boilers, and ensuring the structural integrity of buildings."
    The bigger bill for urgent repairs in the whole of Nottingham University Hospitals trust is £104m.

  • Priory to close 'inadequate' High Wycombe hospital Guardian report highlights more evidence of poor quality private care propped up by subsidies from NHS budgets. Time to cut the support and invest the money in expanded NHS services.
    The Priory Group is privately owned – in 2016 it was bought by US firm Arcadia Healthcare for £1.3bn – but 85% of its income comes from the public sector.

  • Private providers could grab unlimited share of GP consultations online GP Online report flags up the implications of the minimalist answer from health Minister Stephen Brine to a question from Shadow Minister Justin Madders on the estimates of the share of online consultations to be delivered by private companies.
    The report also makes clear the extent to which the government is forging ahead with the roll-out of "digital first" consultations without any consideration of the level of exclusion this will bring for older, poorer and less literate patients for whom it is less appropriate. Coupled with Health Secretary Matt Hancock's insistence that letters to patients should increasingly be restricted to emails rather than conventional posted hard copy, it is clear that the government remains insensitive to the needs of anyone other than young middle class patients and the private app industry.

  • A&E waits at worst level for 15 years in England The downward curve of A&E performance continues, driven I n part by continued increases in numbers needing emergency admission. During January, only 84.4% of patients were treated or admitted in four hours - well below the 95% threshold. Eleven trusts had a performance below 70 per cent.
    Nearly 330,000 patients waited longer than they should with hospitals reporting significant problems finding beds for those needing to be kept in.
    The performance is even more worrying for the more serious "type 1" cases: nine trusts recorded 60 per cent or below. Croydon Health Services Trust was the worst at 49.2 per cent.

  • Greece, 10 Years Into Economic Crisis, Counts the Cost to Mental Health A sobering reminder in the New York Times of the brutal austerity imposed on Greece by the EU and IMF concludes: "Even if the Greek government manages to address weaknesses in the health care system, health experts note that the main reasons behind the mental health crisis are very much alive.
    “As long as there is unemployment, insecurity and debt, the products of the financial crisis, this problem will not go away,” said Dr. Sioras, the union leader. “I fear it will get worse.”

  • Newly-obtained cabinet orders show health overhaul well underway Shocking story from CTV news in Toronto on the latest moves by the neoliberal Ontario Provincial Government, led by Doug Ford, driving to abolish all of the local and accountable bodies controlling health care across the province and rolling them into one "super health agency" with powers to close, cut and privatise at will. The campaign of resistance is getting under way -- but the government is moving fast.

  • NHS staffing crisis as thousands of midwives quit over the stress of the job Daily Mirror report highlights NHS Digital figures showing record numbers of midwives "quitting the NHS because the pressure of the job is ruining their lives. … almost one a day resigns because they are unable to find a decent work-life balance.
    "Understaffed wards have left many having to work longer and do more after years of NHS underfunding."

  • What matters to you? - Urgent Treatment A quick as a flash survey by Shropshire CCG, announced on Feb 1, closing on Feb 12. The main factor being smuggled through with barely any public scrutiny here is reducing the proposed hours of UTCs from 24/7 to 12 hours 9am-9pm. Surely that calls for a serious explanation, discussion and decision making process?

  • Interserve is caught in the fault lines exposed by the Carillion collapse Prem Sikka in Left Foot Forward examines a now grimly-familiar sounding story of the efforts to keep contractors Interserve afloat:
    "To finance its bad investment and dividends, Interserve built a debt mountain. Its long-term debt increased from £406m in 2015 to £647m in 2017, and in 2018 reached £807 million.
    "It owes £799m to suppliers and has a pension scheme deficit of £48m. In 2017 Interserve paid £28.4m in interest charges compared to £23.3m in 2016. For the first half of 2018, the interest payments rose to £31.1m.
    "A loss-making company, with low margins on contracts and turnover of £3.2bn cannot sustain a debt of £807m. So the deal has been cut with banks to convert £480m of debt into shares. This may provide some breathing space."

  • Concerns over birthing options as NHS shuts midwife-led centres Guardian's Denis Campbell brings together the stories on plans in England to close 8 midwife-led units, for a variety of reasons:

    "NHS chiefs have sparked controversy by shutting eight birth centres in England, prompting criticism that pregnant women are being denied the choice of place of birth that all have been promised.
    "The wave of closures has resulted partly from more women choosing to give birth in obstetric units in hospital, where doctors are in charge, rather than in birth centres, where midwives are the only staff. It is also linked to the shift toward older motherhood, the rise in maternal obesity, the drive to reduce stillbirths and a shortage of midwives."

  • Nursing degree applications down 30% since bursary axed RCN press release commenting on latest UCAS figures that show that despite a small increase on last year, the latest figures from UCAS show nursing degree applications in England have fallen by 13,000 since 2016.

  • Just Another Day The full UNISON report, which sums up: "Staffing shortages across the health service clearly have a direct effect on patients. Almost half of the respondents (45%) said there were not enough staff on their shift to deliver safe, dignified and compassionate care. This was most pronounced in acute inpatients with 59% saying there were too few personnel to deliver the required standard of care. It was also a serious issue for those in mental health (45%), primary care (41%) and community health (36%)."

  • Health service staffing is compromising patient health, says UNISON Press release highlighting latest UNISON survey.

  • Diabetics in Britain worry a no-deal Brexit could put their lives at risk Interesting Washington Post article which is clearly not targeting either side of the British Brexit debate. It points out "Diabetes has become one of the most high-profile conditions to be highlighted by Brexit jitters, in part because 99 percent of Britain’s insulin is imported, largely from the E.U. It also needs to be refrigerated, so it cannot sit indefinitely in traffic jams."

  • ‘Crumbling’ NHS hospitals face £3bn repair bill (£) Sunday Times article shows 6 of the 10 largest backlog maintenance bills are London hospitals. The backlog has grown because "ministers repeatedly raided the health infrastructure budget". The consequences are serious:
    "Patients and staff are being put at growing risk of harm, with more than 5,500 serious safety incidents last year, including deaths. Surgery often has to be delayed or cancelled because of infrastructure problems such as burst pipes and failing heating systems."

  • Leeds NHS campaigners stage ‘protest and celebration’ Yorkshire Post gives welcome advance publicity to Yorkshire Health Campaigns Together is organising march through Leeds on Saturday March 30. People taking part are being asked to assemble outside Leeds Art Gallery on The Headrow at 11.30am on the day.

  • DHSC slaps down quangos over Brexit messages HSJ (£) report shows Department of Health busily proving that "arm's length bodies" are supposed to shut up when told and toe the government line even when it's obvious ministers are making a complete pig's breakfast of the so-called negotiations, with potentially disastrous consequences for NHS services and patients.

  • International recruitment scheme adds 34 GPs to workforce in three years Telling story from GP Online: government incompetence and the dire impact of Brexit and Theresa May's "hostile environment" for overseas visitors of all kinds are now severely impacting potential recruitment to run GP services and making a nonsense of promises to recruit thousands more. How much has been wasted on these recruitment projects?

  • Why are there More Than Double the Number of Non-Elective Admissions to Hospitals of Ealing Patients than Westminster Patients? Ealing campaigners flag up the inequalities issue again:
    "In 2015/16 there were more than twice the number of Ealing patient NELs compared to Westminster patients. Of the 426,086 patients registered with Ealing’s 79 GP surgeries, 31,726 of them were NEL admissions to hospitals. Of the 177,950 patients registered with 25 Westminster GP surgeries, there were 6,286 NEL admissions.
    "Calculated as NELs per 1,000 weighted registered patients, Ealing scored 74.46 whilst Westminster scored 35.32. Admittedly there are only 25 GP surgeries (out of a total of 35) in Westminster included, because there were fewer than 50 NELs or less than 500 registered patients at 10 surgeries."

  • Chief Inspector publishes report on Home Office collaborative working with other government departments and agencies Chief Inspector Borders and Immigration report reveals Operation DINTEL– secret Home Office operation using NHS data on patient debt to track down asylum seekers and migrants at their home address and arrest them. Doctors of the World, highlighting this aspect of the report, also flags up evidence thatsharing NHS patient data with the Home Office makes many of our patients too afraid to see a doctor when they are unwell.

  • ​1 million new patients unable to access NHS dentistry, as recruitment and retention crisis mounts Hard hitting report from British Dental Association with some atark figures:
    "•BDA analysis of the government's own GP Survey – based on feedback from over 350,000 adults – reveals nearly 1 in 4 new patients (estimated at over 1 million in total) not currently on the books with an NHS dentist have tried and failed to secure an NHS appointment.
    •This data points to access problems across every English region – with over 40% of these irregular attenders missing out in parts of Norfolk, Derbyshire, West Yorkshire and Cornwall, reaching over 60% in parts of Lincolnshire.
    •The BDA's new national survey of dentists suggests nearly 3 in 5 practitioners (59%) based in England are now planning to scale down or leave NHS work entirely in the next 5 years
    •Those with higher NHS commitments are the most likely to leave - 67% of dentists seeing more than 75% NHS patients expressed their intentions to move on – falling to 51% among those doing less NHS work."

  • Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial While NHS England and trusts are obsessed with cutting so-called 'back office' staff, this BMJ free access report on an Australian study shows the effectiveness of medical scribes to speed implementation of decisions:
    "A medical scribe helps the physician by doing clerical tasks. The scribe stands with the physician at patients’ bedsides, documenting consultations, arranging tests and appointments, completing electronic medical record tasks, finding information and people, booking beds, printing discharge paperwork, and doing clerical tasks.
    "They do this via a computer-on-wheels connected to the hospital’s electronic medical record system. The aim of the role is for scribes to do clerical tasks otherwise done by the physician, enabling the physician to manage more patients in the same amount of time."

  • £8 billion funding black hole by 2025 will swallow up popular council services The Locla Government Association points out that:
    "Between 2010 and 2020, councils will have lost almost 60p out of every £1 the Government had provided for services.
    "Some councils are being pushed to the brink by this unprecedented loss of funding and an ongoing surge in demand for children’s services, adult social care services and homelessness support. This is on top of having to absorb other cost pressures, such as higher national insurance contributions, the apprenticeship levy and the National Living Wage.
    "More and more councils are struggling to balance their books, facing overspends and having to make in-year budget cuts."

  • Waiting times now even longer at QMC's revamped emergency department The Nottingham Post reports that "The hospital’s four-hour target performance – a key measure the Government sets – has been dragged down. The target is to see 95 percent of patients within four hours.
    "In January this year, the actual performance was 72.6 percent – down from 80.2 percent compared to this time last year."
    The reorganisation to separate minor cases from more serious ones has backfired:
    "Despite there being a seven percent total increase in the number of people attending in January compared to the year before, there was an 18.1 percent rise in patients with ‘minors’.
    "This caused delays for redesigned A&E department, which were compounded in part by staff shortages in the UTU."

  • Neighbourhood Midwives closure: Mothers-to-be left 'high and dry' Yet another private contract failure as company walks away at shortgg notice leaving pregnant mums stranded. Question keeps coming up: why do gullible CCGs keep bringing in these private companies to disintegrate care and undermine NHS services, when NHS trusts could be funded to do the job better as part of their existing work?

  • Surgeons do make mistakes – it’s time to reboot the surgery checklist Lord Darzi in the Guardian points out that
    "In January 2009, the surgical checklist was mandated for every operation across the NHS in England. It was promoted across the globe by the World Health Organization, and checklists have since been introduced in thousands of hospitals and more than a dozen areas of medicine to prevent medication errors, pressure sores, blood clots and injuries in childbirth."
    "But when applied to medicine, they have met resistance. Some surgeons scoffed at the idea that such basic checks could make a difference. Some objected that it was a box-ticking exercise. Staff complained it was poorly worded, time-consuming, inappropriate or redundant – and bridled at what was felt to be another top-down initiative."

  • All the headlines from the 2019/20 GP contract at a glance As usual Pulse magazine is the first with this detailed coverage.

  • The GP substitute will see you now BBC headline on the new 5-year GP contract wrongly dismisses valuable skills of therapists and professionals who can play a valuable role in enhancing primary care, but must not become a way of preventing patients seeing a GP when they need to.
    According to the report:
    "An army of more than 20,000 physios, pharmacists and paramedics are to be recruited in England to work alongside under-pressure GPs, NHS bosses say."
    It's not clear whether any let along all of these promised staff can be delivered, especially those already in short supply elsewhere in the NHS -- physios, paramedics etc.
    BMA GP leaders have "warmly welcomed the move but warned extra doctors were also needed."

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