NHS on brink of winter crisis after increase in patient numbers

The NHS is on the brink of winter crisis after a larger than expected increase in patient numbers caused a third of hospital trusts in England to warn they needed urgent action to cope last month.

The BBC commissioned the Nuffield Trust health thinktank to look at four weeks of hospital data in the run-up to Christmas and found that 50 of the 152 English trusts were at the highest or second highest level of pressure.

During the time period seven trusts had to declaring the highest level of emergency 15 times, meaning they were unable to give patients comprehensive care.

Nigel Edwards, chief executive of the Nuffield Trust, said the situation could deteriorate further in the next two weeks when the NHS was usually most stretched.

“The real crunch point generally comes in week two or three after the Christmas break … there are early signs that there is a problem,” he told BBC Radio 4’s Today programme.

NHS England insisted hospitals were coping, but Edwards said “there are reasons to be really quite concerned”.

He pointed out that hospitals were having to cope with a 4% increase in A&E attendance, which is more than expected from population growth. At the same time problems in social care was making it “really tricky” for hospitals to free up beds, he said.

“If you can’t get patients out of the back of the hospital, home, then obviously, the whole system begins to seize up,” he told Today.

“Anecdotally, what you are hearing from chief executives of trusts is that they are experiencing very, very high levels of pressure in their A&E departments.”

The Nuffield Trust found that some of worst problems were in Berkshire, the West Country, and parts of the east Midlands. But Edwards pointed out: “This pattern of increase demand is spread right across the country.”

Dr Taj Hassan, president of the Royal College of Emergency Medicine, warned that hospital emergency departments “are in an absolute acute state of distress”. “This is on the background of chronic underfunding, understaffing, both in health and social care and failures in the wider urgent emergency care system.”

Hassan said the issue was the “number one item on the agenda” in a meeting the college had on Thursday with the NHS chief executive, Simon Stevens. “Our four hour performance in A&E departments is the worst in 15 years. We entered this winter in the worst state of affairs possible and we predicted that this situation would arise,” he told Today.

Hassan called for emergency funding to resolve problems in social care to help free up hospital beds.

He said: “There is an absolute and urgent need to address the patients who are fit to be discharged from hospital, which in some systems is running between 10% or 20%.

“We need to move those patients back into the community so that we can create flow in our hospitals and our significantly overcrowded emergency departments which are struggling badly.”

In a statement NHS England said: “The NHS’s tried and tested plan is currently managing the ongoing pressures of winter. The public can play their part avoiding going to A&E and using their local pharmacy and NHS 111.”

NHS on brink of winter crisis after increase in patient numbers

Hospitals in England are on the brink of collapse, warn NHS chiefs

The body that represents hospitals across England has issued a startling warning that the NHS is close to breaking point because of its escalating cash crisis.

Years of underfunding have left the service facing such “impossible” demands that without urgent extra investment in November’s autumn statement it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment – all options that will provoke public disquiet, it says.

In an unprecedentedly bleak assessment of the NHS’s own health, NHS Providers, which speaks for hospital trust chairs and chief executives, tells ministers that widespread breaches of performance targets, chronic understaffing and huge overspends by hospitals mean that it is heading back to the visible decline it last experienced in the 1990s.

“Taken together this means the NHS is increasingly failing to do the job it wants to do and the public needs it to do, through no fault of its own,” Chris Hopson, the chief executive of NHS Providers, writes in the Observer.

His intervention comes days before the influential Commons health select committee decides whether to launch a special inquiry into the state of the NHS in England. After months dominated by the Brexit debate, the state of the NHS is now emerging as the key domestic challenge facing Theresa May’s government.

Recalling the NHS’s deterioration in the 1990s, which caused political problems for John Major’s government, Hopson adds: “NHS performance rarely goes off the edge of a cliff. As the 1990s showed, instead we get a long, slow decline that is only fully visible in retrospect. It’s therefore difficult to isolate a single point in that downward trajectory to sound a warning bell. But NHS trust chairs and chief executives are now ringing that bell. We face a stark choice of investing the resources required to keep up with demand or watching the NHS slowly deteriorate. They are saying it is impossible to provide the right quality of service and meet performance targets on the funding available. Something has to give.”

In a direct appeal to May to increase NHS funding in the autumn statement in November, Hopson warns the government will face “unpalatable choices” if the service is to keep within the existing budget. “The logical areas to examine would be more draconian rationing of access to care, formally relaxing performance targets, shutting services, extending and increasing charges, cutting the priorities the NHS is trying to deliver or, more explicitly, controlling the size of the NHS workforce,” says Hopson.

His warning comes days after the NHS posted its worst set of performance figures for services such as A&E, planned operations and ambulance response times.

Hopson blames the “full-blown crisis in social care” created by cuts to town hall budgets for causing “major problems for the NHS”, such as record numbers of healthy patients who cannot be discharged because social care is not available. This means that “hospitals are now being asked to routinely run at capacity levels that risk patient safety”.

Norman Lamb, the Liberal Democrat MP who was a health minister in the Tory-Lib Dem coalition, said Hopson’s “absolutely accurate reflection” of life on the frontline showed that “the government is in total denial about the reality of the state of the NHS and that they continue to mislead”.

“Ministers refer to ‘£10bn extra’, which to many people will seem a lot of money. But that £10bn is being stretched in a number of directions, including to pay for the seven-day NHS. Everyone who has looked into the finances of both the NHS and care system knows that this is nowhere near enough. We are the world’s fifth or sixth largest economy so it’s really horrendous that, despite our relative wealth, we have a health and social care system that is on its knees,” he added.

Chris Ham, the King’s Fund’s chief executive, said: “The clear message from the NHS leaders, doctors and nurses I’ve spoken to is that they are increasingly unable to cope with rising demand for services, maintain standards of care and stay within their budgets.

“The government must be honest with the public about what the NHS can deliver with the funding it has been given. It is simply not realistic to expect hard-pressed staff to deliver new commitments like seven-day services while also meeting waiting-time targets and reducing financial deficits.”

A government spokesman said: “We know the NHS is under pressure because of our ageing population, but we rightly expect the service to continue to ensure that patients get treated quickly.”

Hospitals in England are on the brink of collapse, warn NHS chiefs

Central African Republic a surgeon"s diary from a nation on the brink

They come in ones and twos, sometimes a lot more. Some of the individuals have fresh bullet holes or machete wounds other people have wounds that have been neglected for days due to the fact of an inability to attain the hospital. Some are innocents caught in the crossfire, some the very ones who shoot.

And as is most typically the situation in civil conflicts, the majority of patients are not the ones immediately wounded but individuals who suffer the consequences of the disruptions of an previously-feeble health technique: intestinal perforations from typhoid fever pregnancies challenging by arrested labour significant skin and muscle infections that have spilled more than into the bloodstream, foremost to septic shock.

The Bangui General Hospital is a single of three primary hospitals working in the Central African Republic’s capital, with its population of some 1 million folks. Built in the 1960s by the Moroccan government, the big complex sits a few miles in one route from the relative peace of the Oubangui river, and in the other course from the chaos of Bangui’s violence-torn PK5 and PK12 neighbourhoods.

It is from the latter two locations that practically all of Bangui’s Muslim citizens have fled or been evacuated in the past few months as sectarian violence amongst Muslims and Christians threatens to tear the nation apart. Most have continued on to the north-west of the nation, or to neighbouring Chad or Cameroon.

I am part of a skeleton staff of expatriate physicians, nurses and support staff from Médecins Sans Frontières that functions with Central African physicians and nurses to give emergency space and surgical care at the hospital, although other teams focus on outreach in refugee camps and mobile clinics across the nation. From the hospital’s rooftop we peer across the city.

A flock of birds floats languidly across the sky, the crimson glow of the sun setting behind the unlit spotlight towers of the main soccer stadium. The peaceful scene belies the spasmodic chaos below. At evening we hear scattered gunfire and grenade explosions in the distance and wonder how a lot of patients will come, and when.

Muslim in the P12 district of Bangui put together to flee the violence. Photograph: Eric Feferberg/AFP/Getty Pictures

A 23 yr-previous lady arrives one particular early morning, her body riddled with bullet holes. Numerous slugs have blasted via her limbs, shattering bones. Despite our ideal efforts, her gaping chest wounds portend a death that can’t be averted by restricted surgical capacity. I wonder – no more here than back house in the US – what prospects people to violence. The human physique is not meant to be torn apart by bullets.

Spasms of violence grip this country, whilst in the background regular societal structures unravel. Thirteen percent of the population is internally displaced, schoolrooms are usually empty and crops go unplanted.

A yr in the past, the overt violence in the capital was possibly worse aid workers who have been here described dead bodies lining the streets on the way to the hospital and extrajudicial killings happening everyday across the city, some even outdoors the paediatric ward down the street.

And what now? Regardless of the presence of some two,000 French troops and 6,000 members of an African Union-led peacekeeping force, the Central African Republic appears to teeter on the brink.

The UN just lately approved the deployment of 12,000 extra troops and police to support maintain buy, but they are not due to arrive right up until September. Meanwhile, the disorder in this former French colony continues.

While the war-wounded might be the most visible victims, the true and lasting tragedy could lay in the consequences of worsening malnutrition, estimated to impact in excess of two million citizens, many of them young children. A society broken at the centre is fraying ever much more at the edges.

A rebel fighter in the Central African Republic smokes during a patrol, near to the border with the DRC. Photograph: Goran Tomasevic/Reuters

From the northern village of Boguila, near to the Chadian border, information of the slaying of 16 civilians, like three Médecins Sans Frontières nationwide staff, chills our hearts and rattles nerves.

Unprovoked, and taking place throughout an armed robbery at a well being outpost clearly marked as a Médecins Sans Frontières facility, the killings have sparked a debate within the organisation, utilized as it is to working in challenging situations. Médecins Sans Frontières made a decision to decrease its pursuits during Central African Republic in protest for a quick time, though the function at the hospital continues unabated.

Final week, a 35-12 months-previous female in her 10th pregnancy arrives in the emergency room in shock, barely coherent. The shape of her swollen abdomen suggests a ruptured uterus and she is rushed to the operating space. The eight-month-old foetus has perished and the mother’s life hangs by a thread as we perform an emergency hysterectomy.

Uterine rupture occurs up to ten occasions more frequently in least-produced nations than it does in the most-developed nations. It can be a last blow right after the domino result of having several pregnancies, limited pre-natal care and obstructed labour with impaired entry to well being care services. Up to 90% of girls with uterine rupture die, as will this patient in a couple of hours.

There is too little that we can do, also late. The patient’s mom waits outside and receives the news, translated from French to Sango and back, with an unmoving face. A short while later on, as daylight breaks and the sounds of roosters and the waking hospital fills the grounds, I observe as she carries away the wrapped physique of her unborn grandson. She disappears behind a cement column painted a rusty red, bare feet padding along the floor. It ought not finish like this…and nevertheless it does.

David Rothstein is a paediatric surgeon at the Lady and Children’s Hospital of Buffalo. He started operating with Médecins Sans Frontières in 2007 in northern Sri Lanka and has made month-extended journeys for MSF each 12 months because, working in Chad, Nigeria, Democratic Republic of Congo and the Central African Republic

This report initial appeared on Warscapes

Central African Republic a surgeon"s diary from a nation on the brink

The NHS is on the brink: can&nbspit survive until May 2015? | Polly Toynbee

The clock is ticking: ‘the mildest winter on record nonetheless noticed 3% much more emergency admissions. So far deft NHS management has contained an explosion’. Photograph: Christopher Thomond for the Guardian

Magical thinking and false accounting constantly hit the crash barriers at some point. That is what happened this week as the Guardian exposed belated panic in excess of the Greater Care Fund (BCF) prepare to slice £2bn out of hospitals to give to nearby government to integrate with social care. Every little thing about this scheme illustrates this government’s phenomenal ineptitude in the essentials of policy delivery.

There was absolutely nothing wrong with the objective: every person agrees that pooling NHS and social care funds is the only way to cope with the soaring numbers of older and disabled men and women. But the policy leapt from very good notion to fantasy and fraud. It was Tony Travers from the London School of Economics who spotted it: George Osborne’s spending evaluation for 2015-sixteen creatively accounted a total including up to more than a hundred%. In devising the BCF, Osborne shifted funds out of overall health into social care, but he double-counted so that it nonetheless appears in the two columns. This meant he could fool the two sides: nearby government cut by 27% and in crisis over social care eyed the “ring-fenced” plenitude of the NHS, even though the NHS was advised it was new income – prior to it found that £2bn was getting stripped from its funding. The fantasy was that merging two bankrupt outfits – the NHS and social care – miraculously creates 1 solvent services.

Following April, the NHS loses £2bn to nearby government Wellness and Wellbeing Boards who, collectively with nearby clinical commissioning groups (CCGs), should style local community providers to lessen hospital admissions. Practically no hospitals have been consulted, regardless of losing £15m every. Developing up the neighborhood indicates beefing up GP providers, extra nurse practitioners, some Darzi polyclinics, reopening misplaced Walk-in centres and day centres, much more property adaptations, and community and mental nurses locating the regular hospital end users prior to they reach a crisis. Professor Azeem Majeed, creating in the BMJ, calls for the NHS to directly employ GPs, which may iron out enormous variations in hospital referrals and prescribing routines. But none of this is low-cost.

To make the sums operate, NHS England tiny print demands 15% fewer emergency hospital admissions in the very first yr: every single CCG has to stop a fixed number, which no one particular thinks is remotely achievable. Beds are beneath this kind of stress that they will go on currently being filled with no saving. No hospitals strategy to cut beds or workers post the Mid Staffs scandal they are rightly employing more. Nuffield Believe in research shows that 15,000 much more beds are necessary more than the following 7 many years just to hold tempo with ageing individuals and a lot more premature babies surviving with disabilities. With virtually half of hospitals already in deficit, the BCF calls for that from next year each and every should minimize yet another 7%, although none succeeded in cutting the four% ordered for each and every of the past four years, since it really is extremely hard.

Does switching to community care ever save money? The very best illustration is the excellent closure of psychological hospitals. It took 10 many years with double-funding to construct the local community services just before shutting the hospital doors the new system never grew to become less expensive. Well being economist Professor Alan Maynard factors to scores of evaluations of integrated care experiments, such as the health department’s personal, which he says identified no evidence of financial savings. On the contrary, “extra neighborhood companies reveal large unmet want, costing a lot more, with more hospital bed use.”

Nigel Edwards of the Nuffield Believe in says it is frequently more affordable to treat individuals in a ward rather than travelling to care for the frail at home. “Our evaluations show you can stop some admissions, but they are replaced by other folks as far more neighborhood require is unveiled. Hospitals have 80% fixed charges, so fewer admissions do not conserve much.” Everyone, except the magical thinkers, says the exact same: switching to the local community is no get-out-of-jail card. The Cabinet Workplace panicked more than a report that stays below lock and key: however the BCF plan is delayed it will appear to proceed to cease hospitals easing up on the squeeze.

All NHS organisations are sending up distress flares. The King’s Fund calls subsequent year’s price range “totally unrealistic” the Nuffield Trust talks of “flawed logic” and “wishful thinking”. Hospitals undergoing more and more savage Care High quality Commission inspections (as the CQC covers its own back) refuse to take the blame for deficits. Waiting lists are swollen to nearly three million, waiting instances are lengthening, and A&ampE targets are starting up to be missed: the mildest winter on record nonetheless noticed 3% a lot more emergency admissions. So far deft NHS management has contained an explosion. Can it hold to up coming May?

ONS figures last week showed that amid G7 countries only Italy spends less per head on wellness than the United kingdom. Tony Blair pledged to raise us to the EU average, which Labour did briefly with an eight% yearly improve. Now the NHS has had 4 years of the lowest funding rises ever.

The British Social Attitudes survey finds fulfillment is still quite higher at 60%, but not recovered from the fantastic drop brought about by Andrew Lansley’s upheaval. The Commonwealth Fund regularly scores the United kingdom substantial on fulfillment and paying efficiency. Unsurprisingly, with this kind of minimal investing we still score reduced on numerous avoidable deaths – often excellent ammunition for NHS opponents. Wiltshire GPs calling a BMA vote on charging for appointments will be resoundingly trounced by the excellent majority, but they are a vanguard for rightwingers permanently claiming that NHS deficiencies can only be cured by privatisations.

The NHS and its thinktanks say that every celebration going into the up coming election pretending that the services will stick to current paying ideas is “wildly optimistic” – or, frankly, lying. A cut of seven% next year and another 5% or a lot more every single of the following three many years is never ever going to happen – so who will get the credit for fiscal honesty by saying so? Simon Stephens, new NHS England supremo, politely told parliament he hoped a growing economic climate would increase NHS revenues let us hope that behind the scenes his message is much more urgent.

Labour rushed to reject any suggestion of a hypothecated 2p on national insurance coverage or income tax, regardless of the Wellness Service Journal reporting that two-thirds of voters are inclined to shell out more for the NHS. Labour can’t keep warning of the crisis without having saying how it will cope. Andy Burnham’s plans for integrated health and social care are evolutionary and neighborhood – but Labour can’t pretend they will conserve ample to rescue the NHS. Which is the exact same homeopathic accounting as the BCF, on which Jeremy Hunt has waxed uncharacteristically silent. Amount 10 has advised him to pipe down and hold the NHS out of the information, just praying it doesn’t explode just before next Might.

• Feedback on this report will be launched later this morning (United kingdom time)

The NHS is on the brink: can&nbspit survive until May 2015? | Polly Toynbee

The NHS is on the brink of extinction – we need to have to shout about it

The health secretary, Jeremy Hunt, has introduced policies that open up the NHS to private organisations. Photograph: Neil Hall/PA

In school, I don’t forget getting component of a perform called The Emperor’s New Clothes.

The plot revolved all around a king who was tricked into believing that he was wearing a particular outfit when, in reality, he wore absolutely nothing at all. His sycophants complimented him for his wonderful decision of clothes, and on the street scared commoners praised the invisible suit right up until an innocent small kid screamed: “Search, the Emperor has no garments!”

The a single loud proclamation sent the whole town into shock. Nonetheless, since it was the truth, no person could deny it any much more. And eventually, the Emperor came back to his senses.

The NHS desperately demands that kid. An individual who could stand up and shout: “Appear! The NHS is at the brink of extinction. And David Cameron and Jeremy Hunt are facilitating its demise on the back of an unmandated NHS Act 2013!”

I have received 35 years encounter of functioning in the NHS, from a junior medical doctor to a GP, and then chair of a Main Care Believe in and now deputy chair of the BMA council. This has taught me that most factors can be created to operate – even across organisational and local authority boundaries – if you have the appropriate working relationships which develop over time by way of honesty, openness and believe in.

The way this NHS is being managed by Hunt and the government is a beautiful example of how not to do things. The roadmap of their policies is foremost to the comprehensive privatisation of the NHS, a approach that has deep roots in Thatcherite ideology.

Aneurin Bevan as soon as mentioned: “No society can legitimately contact itself civilised if a sick individual is denied health-related support due to the fact of a lack of means.” The new NHS Act has not just repealed society’s contract with the health services, but it has made the NHS a repository of privateers with the mindset of venture capitalists.

For the whole length of 2013, the NHS came below relentless assault on grounds of “top quality” by politicians and the correct-wing press, driving the privatisation agenda.

I believe it will be a totally different healthcare program in five many years time – one particular which will be significantly worse in terms of entry, equity, well being outcomes and value.

We are inexorably moving toward a program ruled by bogus selection, competitors, industry forces and diversity of suppliers. By opening each NHS corner to “any qualified provider”, the whole service can be taken above by private companies, with a handful of token charities and mutuals. NHS hospitals, faced with the consequences of cherry-selecting by private consortia, risk bankruptcy when left to deal only with complex circumstances.

In the past two many years, £11bn well worth of our NHS has been put up for sale, whilst 35,000 workers have been axed, which includes five,600 nurses. Half of our 600 ambulance stations are earmarked for closure. 1-third of NHS stroll-in centres have been closed and 10% of A&ampE units have been shut. Waiting lists for operations are at their longest in years as hospitals are consumed by the crisis in A&ampE.

The morale of the NHS loved ones is at rock bottom. Their spend has been frozen for two years beneath the coalition, and they have been forced to accept a major downgrading of their pension positive aspects. Freezing and squeezing pay is heaping economic misery on a lot more than 1 million NHS workers.

The NHS will just be a logo a most cherished institution reduced from being the main provider of overall health providers in England with one of the largest workforces in the globe, to a US-type insurance scheme, divorced from the delivery of care. Fewer treatments will be accessible to folks as cuts start to bite, with wealthier people able to “prime up” remedies. It really is not just a postcode lottery – it truly is also a tax code lottery.

Individuals are getting denied prompt hip or cataract operations – and the record of hard-to-get services will develop and increase, reducing the NHS to a skeleton. Funds that could be invested on patient care is getting spent on needless bureaucracy, debt interest and dividends. Meanwhile, Hunt blames individual funds-strapped trusts for generating “undesirable selections”.

Because 2012′s Well being and Social Care Act scrapped the government’s duty to safe a comprehensive wellness support, Hunt is now legally – if not morally – capable to wash his hands of the whole mess – a scenario that must be reversed urgently, and democratic accountability restored.

We want to battle for universal healthcare as a basic human proper, irrespective of no matter whether we reside in flourishing suburbs or inner-city deprived places. Passionate supporters of the NHS and ordinary folks alike should speak out about their discontent with the government’s reforms, just as the kid did to stay away from further embarrassment to a narcissistic Emperor and a nation that would have suffered the consequences of self-indulgent behaviour.

The time has come to show that the NHS is not for sale.

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The NHS is on the brink of extinction – we need to have to shout about it