NHS needs £25bn in emergency cash, Theresa May told

NHS leaders are urging Theresa May to give the health service an emergency cash injection of £25bn before 2020 or risk a decline in the quality of care for patients and lengthening delays for treatment.

An influential group representing NHS Trusts says that the care provided by hospitals and GP surgeries will suffer over the next few years unless the prime minister provides an £5bn a year for the next three years – and a further £10bn of capital for modernising equipment and buildings.

NHS Providers is preparing to release its own manifesto next week, calling on the Conservatives and Labour to end what it calls the austerity funding of the health service. Saffron Cordery, the director of policy and strategy , said its analysis showed that there was a “revenue gap” of £4.5bn-£5bn a year in 2017-18 and “each of the subsequent two years as well.”

Hospitals needed that sum, said Cordery, to get rid of their deficits, which are running at £800m-£900m a year, deliver new NHS commitments on cancer and mental health and improve their performance against key waiting time targets.

The NHS also needed a further £10bn for capital spending on building and repairing premises, buying new equipment and moderning how care is provided, she added. That is the sum which a recent report commissioned by the Department of Health said the service needed for those purposes.

May inherited a pledge from David Cameron and George Osborne to provide a £10bn real-terms increase between April 2014 and April 2021. So far in the election campaign, the prime minister has refused to be drawn on how she might fund the health service, telling journalists that they would have to wait for the publication of the party’s manifesto.

A second group, the NHS Confederation, which represents hospitals and ambulance and mental health services, urged May to commit to giving the NHS £8bn-a-year annual budget increases after 2020-21, when the current funding settlement expires. The Department of Health’s budget is due to reach £133.1bn by March 2021.

Niall Dickson, its chief executive, said NHS services were so stretched that it would have to go back to getting at least the 4%-a-year budget increases it enjoyed historically between its creation in 1948 and 2010. After that, the coalition government limited rises to only 1% annually.

“It’s quite unsustainable for the shackles to remain on the health and care system and for society to expect the levels of need that will arrive over the next 10-15 years to be met unless it is willing to fund them,” Dickson said. “If we aren’t ready to put significant extra resources into the NHS then difficult choices will need to be made about things that we are going to do.”

Prof John Appleby, chief economist at the Nuffield Trust thinktank, said that returning to 4% a year rises, which the NHS used to receive regardless of which party was in power, “would require a cash increase of around £8bn in 2021-22.”

While Tory backing for such large sums was unlikely, “this could change if the NHS continues to miss its headline performance targets and the concern the public are starting to express about the NHS continues to rise”, he added.

The two interventions put pressure on May on an issue that some polls show is top of voters’ list of priorities in the general election, even ahead of Brexit.

Jeremy Hunt, the health secretary, has said several times that the NHS budget will need to rise by a significant amount after the current funding schedule ends in March 2021. For example, last October he told the Commons health select committee: “It is a given that over coming decades we will need to put more into the health and social care system … if we want a high quality healthcare service, yes, we need to continue investing more.”

Simon Stevens, the chief executive of NHS, England, has voiced concern that per capita health funding will decline in 2018-19 and 2019-20. It is due to fall from its current level of £2,223 per head this year by £16 next year and £7 in 2019.

Anita Charlesworth, the director of research at the Health Foundation thinktank, said the NHS could no longer make ends meet by holding down pay and reducing investment in equipment and facilities. “Cracks are evident – access to new drugs is being restricted, waiting times have increased and recruitment and retention are growing problems across the NHS. The health service can always be more efficient but it cannot bridge the gap between pressures rising at 4% and funding at 1% for much longer without quality and access suffering”, she said.

A Conservative spokesman said: “A strong NHS needs a strong economy. Only Theresa May and the Conservatives offer the strong and stable leadership we need to secure our growing economy in future and with it funding for the NHS and its dedicated staff.

“We’ve protected and increased the NHS budget and got thousands more staff in hospitals – but we know that progress is on the ballot paper at this election.”

NHS needs £25bn in emergency cash, Theresa May told

Hammond"s budget bows to demands for social care cash injection

Philip Hammond responded to the growing crisis in social care in England by pledging to put £2bn extra into it over the next three years and also produced an unexpected £425m to help the NHS cope better with winter and transform how it works.

Additional money for social care was necessary both to improve the help older people receive as the number of over-75s grows quickly in the coming years and also to ease the huge pressures the NHS is under, the chancellor said in his statement.

He also promised that a green paper, due late this year, would set out options for resolving the financially and politically pressing question of how to fund social care in the long term, given the population is set to continue ageing.

The cash boost, £1bn of which councils will receive to use in 2017-18, follows dramatic warnings from charities, health organisations and the care regulator that England’s social care system is reaching “a tipping point” after years of budget cuts.

“Today, our social care system cares for over a million people and I pay tribute to the hundreds of thousands of carers who work in it. But the system is clearly under pressure. And this in turn puts pressure on our NHS,” Hammond told MPs.

“Today there are half a million more people aged over 75 than there were in 2010 and there will be 2 million more in 10 years’ time. Today I am committing additional grant funding of £2bn to social care in England over the next three years, with £1bn available in 17/18.”

Hammond made clear that he expected “local authorities to act now to commission new care packages” for the coming financial year. Those would enable mainly frail, elderly people to be better supported in order to keep living safely at home and also, in particular, help reduce the number of older patients trapped in hospital – sometimes for many months – despite being medically fit to leave, because social care in their area is inadequate.

The £2bn was significant because Hammond had rejected widespread cross-party appeals for a cash injection for social care ahead of both his autumn statement last November and the local government finance settlement a few weeks later.

But health, social care and older people’s organisations gave the £2bn a lukewarm response. It was much less than was needed to ensure all older people got the care they needed, they said.

“Although we warmly support the chancellor’s announcement of a social care green paper in the autumn, this is tempered by some anxiety that today’s emergency funding package, welcome though it is, may not be enough to keep the system going until a new, sustainable approach is put in place,” said Caroline Abrahams, Age UK’s charity director.

Experts’ recent estimates of the amount needed between now and 2020, after six years of Whitehall cuts to town hall budgets, “were all higher than the amount announced today”, she said. “We also need to know more about where the additional £2bn is coming from and whether it is genuinely new money or not,” she added.

“Our concern is that there could be big trouble ahead in some places for older people needing care and their families if providers continue to shut up shop and councils find it impossible to spread the jam any thinner to meet rising demand.”

Nigel Edwards, chief executive of the Nuffield Trust health thinktank, said the £1bn would plug only half of the £2bn funding gap it expected in 2017-18. “More and more vulnerable people are therefore going to be denied the help they need in the next year,” he said.

Doctors welcomed Hammond’s announcement of £100m to pay for more GPs to work at hospitals in order to help take the pressure off A&E units by triaging and treating less seriously ill patients. Expanding such schemes, which already operate at some hospitals, would help the NHS cope better with next winter, the chancellor said.

“Having primary care on site will undoubtedly benefit patients,” said Dr Chris Moulton, vice-president of the Royal College of Emergency Medicine, which represents A&E doctors. But the British Medical Association and NHS Providers said they doubted there were enough GPs to staff such services, given the chronic lack of family doctors.

Hammond also found £325m of extra money for the NHS’s capital budget to help turn the first batch of NHS England’s controversial sustainability and transformation plans (STPs) into reality. It will enable six to 10 “pioneer” STPs, which the NHS chief executive, Simon Stevens, will identify later this month, to go ahead, shaking up how care is delivered in their area, particularly by providing many more services outside of hospitals.

However, the £325m comes after Jeremy Hunt moved £1.2bn of the NHS’s capital budget into its revenue budget this year, in order to help struggling hospitals. He plans an identical £1bn switch in 2017-18 and, the Health Service Journal disclosed on Wednesday, further raids of £500m and £250m in the two years after that.

Hammond"s budget bows to demands for social care cash injection

Hammond"s budget bows to demands for social care cash injection

Philip Hammond responded to the growing crisis in social care in England by pledging to put £2bn extra into it over the next three years and also produced an unexpected £425m to help the NHS cope better with winter and transform how it works.

Additional money for social care was necessary both to improve the help older people receive as the number of over-75s grows quickly in the coming years and also to ease the huge pressures the NHS is under, the chancellor said in his statement.

He also promised that a green paper, due late this year, would set out options for resolving the financially and politically pressing question of how to fund social care in the long term, given the population is set to continue ageing.

The cash boost, £1bn of which councils will receive to use in 2017-18, follows dramatic warnings from charities, health organisations and the care regulator that England’s social care system is reaching “a tipping point” after years of budget cuts.

“Today, our social care system cares for over a million people and I pay tribute to the hundreds of thousands of carers who work in it. But the system is clearly under pressure. And this in turn puts pressure on our NHS,” Hammond told MPs.

“Today there are half a million more people aged over 75 than there were in 2010 and there will be 2 million more in 10 years’ time. Today I am committing additional grant funding of £2bn to social care in England over the next three years, with £1bn available in 17/18.”

Hammond made clear that he expected “local authorities to act now to commission new care packages” for the coming financial year. Those would enable mainly frail, elderly people to be better supported in order to keep living safely at home and also, in particular, help reduce the number of older patients trapped in hospital – sometimes for many months – despite being medically fit to leave, because social care in their area is inadequate.

The £2bn was significant because Hammond had rejected widespread cross-party appeals for a cash injection for social care ahead of both his autumn statement last November and the local government finance settlement a few weeks later.

But health, social care and older people’s organisations gave the £2bn a lukewarm response. It was much less than was needed to ensure all older people got the care they needed, they said.

“Although we warmly support the chancellor’s announcement of a social care green paper in the autumn, this is tempered by some anxiety that today’s emergency funding package, welcome though it is, may not be enough to keep the system going until a new, sustainable approach is put in place,” said Caroline Abrahams, Age UK’s charity director.

Experts’ recent estimates of the amount needed between now and 2020, after six years of Whitehall cuts to town hall budgets, “were all higher than the amount announced today”, she said. “We also need to know more about where the additional £2bn is coming from and whether it is genuinely new money or not,” she added.

“Our concern is that there could be big trouble ahead in some places for older people needing care and their families if providers continue to shut up shop and councils find it impossible to spread the jam any thinner to meet rising demand.”

Nigel Edwards, chief executive of the Nuffield Trust health thinktank, said the £1bn would plug only half of the £2bn funding gap it expected in 2017-18. “More and more vulnerable people are therefore going to be denied the help they need in the next year,” he said.

Doctors welcomed Hammond’s announcement of £100m to pay for more GPs to work at hospitals in order to help take the pressure off A&E units by triaging and treating less seriously ill patients. Expanding such schemes, which already operate at some hospitals, would help the NHS cope better with next winter, the chancellor said.

“Having primary care on site will undoubtedly benefit patients,” said Dr Chris Moulton, vice-president of the Royal College of Emergency Medicine, which represents A&E doctors. But the British Medical Association and NHS Providers said they doubted there were enough GPs to staff such services, given the chronic lack of family doctors.

Hammond also found £325m of extra money for the NHS’s capital budget to help turn the first batch of NHS England’s controversial sustainability and transformation plans (STPs) into reality. It will enable six to 10 “pioneer” STPs, which the NHS chief executive, Simon Stevens, will identify later this month, to go ahead, shaking up how care is delivered in their area, particularly by providing many more services outside of hospitals.

However, the £325m comes after Jeremy Hunt moved £1.2bn of the NHS’s capital budget into its revenue budget this year, in order to help struggling hospitals. He plans an identical £1bn switch in 2017-18 and, the Health Service Journal disclosed on Wednesday, further raids of £500m and £250m in the two years after that.

Hammond"s budget bows to demands for social care cash injection

Tim Farron: We need a £4bn cash injection now to save the health and care services

The NHS and social care system are suffering a virulent illness and the cause is obvious: a chronic lack of funding. Yet the government is refusing to provide the treatment needed. Four in five hospitals are now not safe enough, we are seeing longer waits for operations, slower ambulance response times and patients delayed in hospital for days and weeks on end because the social care they need isn’t available. The sick note is a long one.

This shouldn’t really come as a shock – this ailment has been obvious to anyone who uses the system. We spend a lower proportion of our GDP on health than almost any of our European neighbours and the government propose to further slash spending, while demand continues to rise. How exactly do the chancellor, Philip Hammond, and the health secretary, Jeremy Hunt, expect services to cope? The chief inspector of the Care Quality Commission said just last week that the NHS “stands on a burning platform”. When he speaks this vividly, we should listen.

So there should be one essential priority for the chancellor when he delivers his budget on Wednesday. Save our most treasured national institution. Give the NHS and care systems the money they need.

The Liberal Democrats are calling for an emergency injection for 2017-18 of £4bn – to be split between health and social care – to bring these services back from the brink of real crisis. I don’t claim this will solve every frailty in our system, but it would be an urgent, short-term boost.

When the government faces a £100bn shortfall in public finances due to a Brexit squeeze, I realise the chancellor’s room for manoeuvre is limited; the economic situation is as grim as it is self-inflicted. But that doesn’t mean it is acceptable to leave the huge, gaping holes in our most essential social safety nets remain unrepaired. These are services we will all need, services that will be there for us when we are at our most desperate and vulnerable. We must do whatever is needed to safeguard them for generations to come.

Ultimately, we must find a long-term solution to the crisis in funding for the NHS and social care. Short-term injections of cash alone will not make services more sustainable indefinitely. That is why my colleague Norman Lamb, the former health minister, has assembled a commission of some of the country’s leading experts (don’t tell Michael Gove) to assess in more detail the scale of the financial need, and options for raising this revenue in the longer term – including through tax increases.

‘We cannot ignore a situation where NHS trusts are declaring services to be in a state of emergency.’ Photograph: Christopher Furlong/Getty Images

We need a funding settlement that will stretch beyond one parliament or one economic cycle, and I am proud that my party is prepared to be honest with the public about the challenges we’re facing and to be bold in proposing realistic solutions, which the Conservative Brexit government might not think sound quick or easy, but that I am convinced are essential.

He has also reached out to politicians of other parties, asking them to join him in working to secure a long-term, sustainable funding solution for the NHS and our care services. Protecting our NHS is a slogan Labour and the Conservatives have fought countless elections under. Well, now is the time to put those words into action. And while this battle is made a lot tougher by the economic challenges posed by that painful Brexit squeeze, I am in no doubt that it is still one worth fighting.

We cannot ignore a situation where more than a million older people are not getting the care they need and NHS trusts are declaring services to be in a state of emergency. The £4bn injection might seem a relatively modest one, considering this deeply concerning diagnosis. But it might just be enough to get it out of intensive care. I hope all progressives will join me in backing my campaign to give the NHS and care the funding it deserves, and so desperately needs.

Tim Farron: We need a £4bn cash injection now to save the health and care services

The Guardian view on the NHS: more cash, less dog-whistling needed | Editorial

Another week, another dreadful story about patients suffering at the hands of our increasingly cash-strapped NHS and care system. This time it was Iris Sibley, an 89-year-old woman kept isolated on a hospital ward for six months, despite being well enough to be discharged, because of a failure to find a suitable nursing home place. The result: not just huge financial expense for the NHS, but great human cost in distress and anxiety for Iris and her family.

The NHS’s alarm bells have been trilling furiously for months. Nine out of 10 hospital trusts have experienced overcrowding this winter, and the number of people facing long waits of more than 18 weeks for routine – often pain-relieving – care, has doubled in the last four years. Cynics are deploying the NHS’s current woes to argue the cherished principle at its heart – free care at the point of delivery based not on ability to pay, but on clinical need – makes for inefficient and unsustainable healthcare. Nothing could be further from the truth: one study rated it the top-performing healthcare system out of a group of countries that included Germany, France and Canada, despite costing less per head than all but one in that group.

What we are seeing is the direct result of our health service being starved of the financial resources it needs to maintain existing levels of care to an ageing population. The government has imposed the tightest funding squeeze the NHS has faced in its 70-year history. Little surprise, then, that hospital trusts in England ended the year with a record deficit triple the size of the previous year’s. The NHS’s problems have been compounded by cuts to social care: council spending on social care has fallen by 11% on average since 2010. Less state spending on social care means older people languishing on hospital wards when they are fit to be discharged, at great damage to their physical and mental health, and to NHS finances. More cash is not the only ingredient needed for the delivery of world-class care.

The NHS needs reform and modernisation to respond to changing needs, with more care delivered in the community for people living with long-term conditions, and more specialist acute care delivered in bigger centres. But deliberately depriving the NHS of the resources it needs makes this even more difficult. Local NHS leaders in England have been charged with transforming the delivery of care in their areas over the next five years to make it fit for the future. There are examples of real innovation, such as Manchester’s ambitious efforts to bring together health and social care in one budget. Yet, forced to find immediate savings, the process has inevitably become more about cutting back than about modernisation.

The government’s response has been shameful. Health secretary Jeremy Hunt continues to insist the English NHS has been given the resources it asked for, despite the health select committee pointing out the dodgy financial engineering involved in this claim. Even worse, he has sought to deflect from the funding crisis by launching an offensive against overseas patients, despite the fact that pre-charging them for elective care would raise only a tiny sliver of the NHS’s annual budget. This dog-whistle politics is all the more revolting given the NHS’s reliance on its migrant workforce.

There is a growing consensus our health and care systems urgently need more cash to see them through the next few years. Those calls are not being heard by a prime minister who warily regards the NHS as a bottomless drain on resources, and has prioritised tax cuts for businesses and more affluent families over spending on public services. Yet public affection for the NHS leaves ample room for leeway: back in 2002, Gordon Brown achieved the unthinkable – a popular tax rise – to boost health spending. Recent polling shows more than half of the public would be prepared to pay more tax if it were earmarked for the NHS. Mrs May should take a leaf out of her predecessor’s book.

The Guardian view on the NHS: more cash, less dog-whistling needed | Editorial

NHS cash crisis in Kent halts non-urgent surgery until April

An NHS body has run so short of money that it has banned patients in its area from having non-urgent surgery for up to 102 days in an unprecedented move that doctors have condemned as unfair and damaging.

Around 1,700 patients will be affected by West Kent clinical commissioning group’s (CCG) attempt to save £3.2m by delaying non-urgent operations from 20 December last year until the new financial year starts in April.

The CCG has introduced what the Royal College of Surgeons says is the longest ban in health service history on patients undergoing surgery to relieve pain, immobility, disability and other problems. The 1,700 patients include those waiting to have a new hip or knee fitted.

It is the latest example of cash-strapped CCGs implementing controversial restrictions on patients’ access to treatment which doctors have agreed they need. It follows a series of rows over the growing number of England’s 209 CCGs rationing care, including to smokers and those who are obese.

West Kent CCG has decided to suspend non-urgent surgery to help ensure that it does not bust its £472m annual budget. It pays for and supervises the care received by 463,000 people in Maidstone, Tunbridge Wells and surrounding areas.

Clare Marx, the president of the Royal College of Surgeons, warned that the move would prolong patients’ suffering. “West Kent CCG’s suspension of non-urgent surgery until April is unprecedented and unfair. Patients, some of whom may be in severe discomfort or pain, should not be made to wait longer for treatment because the CCG has run out of money and surgical patients are perceived as easily postponed,” said Marx.

The policy could mean that patients’ health worsens further while they wait for a date for their procedure, and would waste valuable NHS resources and cost the CCG more in the long run, she added.

“The CCG is trying to make short-term savings, which may have major consequences for patients. While patients wait for treatment, their conditions could deteriorate, sometimes making treatment more complex and costly in the long term. In addition, standing down surgeons and their teams is inefficient and a waste of scarce resource. Clinical decisions must not be made purely on a financial basis,” Marx said.

Recent CCG board papers show that it agreed and began the policy in December because so many more patients than expected were seeking care that it was at risk of overshooting its budget.

Hospitals are being “asked to reduce non-urgent elective care until the end of the financial year. This will inevitably mean delays in treatment for some patients,” it said. It hopes to save £2.1m by not sending patients for surgery at Maidstone and Tunbridge Wells NHS trust and another £1.1m by limiting the number of patients sent to private health firms.

The CCG is also limiting patients’ access to cataract removals and in-vitro fertilisation as part of a raft of measures designed to shore up its rocky financial position. In addition, it is following a lead set by other CCGs and making smokers and obese patients wait for a wide range of surgery until they have quit smoking or lost weight.

“For a hip or a knee replacement, some individuals, although suffering continued discomfort, would be able to wait longer for their operation without there being an adverse outcome for their health,” said Dr Ian Ayres, the CCG’s accountable officer.

“We are working with our providers to identify exactly which patients will be affected, but estimate the number of patients affected to be in the order of 1,700. We have not prescribed in advance a list of procedures or patients to be delayed. Anyone who has had a procedure booked will be treated. No one will have their operation or procedure cancelled as a result of this policy.

“Patients will continue to be referred by their GP outpatient appointment and be seen by a consultant. A judgment will then be made as to whether the required procedure is urgent, or non-urgent and could wait. Therefore, no one with an urgent healthcare need will be made to wait.”

The move comes against a backdrop of fast-deteriorating CCG finances. The 209 CCGs were meant to end 2016-17 with an £800m surplus, which was then going to be used to prop up the ailing finances of NHS hospital trusts. But NHS England recently disclosed that CCGs had overspent by £300m in the first six months of the year, casting serious doubt over their ability to meet that target.

Sally Gainsbury, an NHS finances expert at the Nuffield Trust health thinktank, said the NHS’s overall finances for this year would be put at risk if CCGs did not deliver the requested £800m surplus. “If they don’t underspend by £800m then the NHS system is bust,” she said, because that sum has been earmarked to help ensure hospitals’ collective deficit in 2016-17 is much less than last year’s record £2.45bn.”

NHS cash crisis in Kent halts non-urgent surgery until April

Young people’s mental health services need cash not empty promises | Clare Allan

It’s good to talk, and at the moment there’s a lot of talk about mental health and, in particular, about the mental health of young people.

I’m thinking, of course, of Theresa May’s recent speech, in which she announced a government green paper on children and young people’s mental health services, mental health first aid training for schools and a few other measures – to be funded apparently out of thin air – because mental health has been “a hidden injustice in this country” for far too long. From whom this injustice has been hidden was not specified.

BBC Radio 1, 1Xtra and Asian Network on Wednesday launched a year-long campaign “to encourage young people to explore issues surrounding their mental health”. My Mind and Me aims “to get young people talking about mental health, to reduce stigma around mental illness, and to raise awareness and understanding of mental health issues that affect young people”.

To assist them in this, they have partnered with the National Citizen Service (NCS) to create a group of “social action champions”, a group of young people from across the UK, who will work with the stations to help shape the campaign, sharing their own experience and leading discussions on “the key issues around mental health”.

Giving young people a platform to discuss these issues is certainly important. There is nothing more powerful than hearing directly from people about their experience, especially from people who are far too often stereotyped or simply ignored altogether. To hear an individual talk on their own terms and in their own words allows for a human-to-human connection that cuts through cliches and stereotypes. The result can be transforming. And as Ben Cooper, controller at Radio 1, 1Xtra and Asian Network, put it:“From prime ministers to our young listeners, we all recognise the need to change attitudes to mental health.”

It’s good to talk, but I cannot help feeling there is something of an elephant in the room. I confess that I listened to Theresa May’s speech, and much of the discussion that followed it, with my jaw hanging apishly open.

This government and the previous one have presided over the decimation of mental health services – “a car crash”, according to Prof Dame Sue Bailey, former president of the Royal College of Psychiatrists, speaking in 2014. She was just one of a chorus of voices, from patient groups to professional bodies, carers and mental health charities, all shouting the loudest, most urgent of warnings – it certainly wasn’t hidden from the government.

And between 2010 and 2015 funding for Child and Adolescent Mental Health Services (Camhs) was slashed by £50m, despite massively increasing demand.

Even setting aside both of those things, consider how, as a society, we are failing our young people.

However inconvenient the fact may be, mental health is not some discrete entity. The mental wellbeing of young people cannot be considered in isolation from the issues that affect their lives: the education system, benefits, housing, employment practices. In all these areas, the needs of young people have been trampled on over and over again by the boots of political expediency. And now they are supposed to believe we care about their mental wellbeing.

It may be that My Mind and Me is going to address these issues and I very much hope it does.

In 2016, winners of Radio 1’s Teen Awards, which included a mental health category, were invited to meet the Duke and Duchess of Cambridge, who praised their “inspirational work”. All fine, except that mental health problems have repeatedly been shown to be most prevalent in those countries with the highest levels of financial and social inequality.

And I know it seems churlish to point that out, but it would really be the bitterest of ironies if raising awareness of mental health issues became a means of avoiding confronting the factors that contribute to them.

Young people’s mental health services need cash not empty promises | Clare Allan

NHS "will fail" this winter without cash injection, doctors tell Theresa May

Hospital doctors have warned Theresa May that the NHS “will fail” this winter and patient care will suffer unless she provides an emergency cash injection.

The leaders of 33,000 doctors from 30 medical specialties urged the prime minister to recognise that hospitals are “paralysed by spiralling demand” and warned of an exodus of personnel quitting the already understaffed NHS.

In a letter to May, the Royal College of Physicians (RCP) and a host of senior doctors told her that the NHS is trying to tackle so many problems with such limited resources that it is in danger of not being able to do its job of caring for patients.

“The NHS is the embodiment of your view that ‘We have a responsibility to one another’. Without urgent investment, the NHS will fail to live up to this responsibility this winter,” they say. The signatories include Prof Jane Dacre, the college’s president, as well as experts in cardiology, geriatric medicine and acute medicine.

In a direct challenge to May’s repeated view that the government has given the NHS enough money, they claim that only an urgent bailout will stop the service – which experts say is under pressure like never before in its 69-year history – running into even more serious difficulties.

They welcome the pledges to train more doctors and increase the NHS’s budget by 2020. But they say: “Frontline staff and managers across health and social care are clear: investment levels are not sufficient to meet current or future patient needs. As a result, in spite of rapid advances in clinical care, services are often too paralysed by spiralling demand to transform and modernise. Promises of future investment will not address the very real challenges we face going into 2017: the time to invest is now.”

Money is so tight that “the quality of patient care is threatened by demands which the health service does not have the capacity or resource to meet”, they add.

Downing Street declined to respond to the letter, but May has told Simon Stevens, the chief executive of NHS England, that the service will not get any extra money and that he should concentrate on making major efficiency savings.

The Department of Health replied on May’s behalf, but did not respond to the RCP’s plea for an immediate cash boost or warning that the NHS could fall.

It said : “We know the NHS is facing increasing demand from an ageing population, but this makes building a safer healthcare system more urgent, not less.

“Since just last year, we have 3,100 more nurses and 1,600 more doctors. We’re also joining up health and social care for the first time and investing £10bn to fund the NHS’s own plan to transform services and relieve pressure on hospitals.”

The doctors’ letter comes as more than 20 MPs from all three main parties and two former health secretaries call on May to set up an NHS and care convention to work out how to fund the soaring costs of medical and social care in the long term, given the ageing population.

The initiative has come from the Liberal Democrat MP Norman Lamb, who was a health minister in the coalition government. Backers include Dr Sarah Wollaston, the highly respected Conservative who chairs the Commons health select committee; three other select committee chairs; the ex-Tory health minister Dr Dan Poulter; Alan Milburn, the health secretary under Tony Blair in 1999-2003; and Stephen Dorrell, his Tory predecessor in 1995-97.

In a further sign of the government’s difficulties over its handling of the NHS, A&E doctors made clear that they believe Jeremy Hunt’s plan to downgrade the duty on hospitals to treat 95% of A&E patients within four hours is misguided. They were responding to the health secretary telling MPs on Monday that the four-hour target should not apply to the 30% of people who seek help at an A&E unit despite being neither an urgent or emergency case.

Dr Taj Hassan, president of the Royal College of Emergency medicine, which represents A&E medics, said Hunt was right to say that emergency departments should be for genuine medical emergencies only.

“However, it is exactly those patients who present as emergencies that pose the greatest challenges as a substantial proportion of these spend long periods of time in the emergency department, waiting for a bed. Seeking to target patients with minor illness should not be the priority,” Hassan said.

In new evidence of the chaos engulfing many hospitals, nurses report that some patients are waiting up to 23 hours in hospital corridors across the UK because beds are in such short supply. Hospitals are under such pressure that nurses are being told to discharge even patients who are not fit to leave in order to free up beds, the Royal College of Nursing claimed.

“Nurses from Scotland to London report serious concerns over the quality of the care they can provide in what for many are the worst conditions they have ever experienced,” said Janet Davies, the RCN’s chief executive.

NHS "will fail" this winter without cash injection, doctors tell Theresa May

The Guardian view on the NHS cash crisis: social care comes first | Editorial

As a matter of good administrative practice, it makes sense to charge non-UK residents for non-urgent health treatment (there is no suggestion that anyone in urgent need would be turned away). Reclaiming patients’ costs from other European countries, under the existing reciprocal arrangement, is also sensible. But doing it in a system like the NHS that is predicated on the principle of providing treatment free at the point of use is complex, expensive and, as a Department of Health briefing paper released last winter shows, scarcely cost-effective. The trouble is that the target of a seven-fold increase in what is reclaimed, which is estimated to raise the total from £73m to £500m, has been factored in to NHS England budgets.

It is the question of how to achieve it that led the senior official at the Department of Health, Chris Wormald, to tell MPs on Monday that it might involve requiring all patients to produce their passports. As Mr Wormald readily admitted, that is a course of action fraught with difficulty. It might do more harm, by putting off people in need of treatment for the public good as well as their own, than it saves money; and although for individual budget-holding trusts it may be important – which is why trials are under way in the Stamford and Peterborough area – in the context of NHS England’s annual budget of £120bn, it is a very small drop. That point was underlined by the coincidence that, as Mr Wormald was talking to MPs, the National Audit Office was releasing its latest bleak assessment of the financial sustainability of NHS England. It showed that at the end of the last financial year, more than two-thirds of trusts were in deficit, and it concluded that its financial problems are endemic and not sustainable.

This is not a piece of gratuitous shroud-waving on the eve of Wednesday’s autumn statement. The NAO is the nation’s accountant, and its audits are based on scrupulous analysis. But nor is it necessarily the right answer for the chancellor, Philip Hammond, to reach immediately for extra cash for hospitals. His predecessor, George Osborne, might have seen tackling the headline as the priority, but ever since Theresa May became prime minister the message of no more money (often framed in the context of the deep cuts that have been survived by Home Office dependents such as the police) has been unmistakable. The Department of Health’s defence is that it has given the NHS England boss, Simon Stevens, just what he asked for in the Five Year Forward view – which committed the NHS to heroic and probably unachievable savings in return for front-loaded extra money.

Ministers’ arguments have been vitiated by a Nuffield Trust analysis which suggested the billions promised were worth just £800m in real money. More important is that it also ignores the role of council-provided social care that Mr Stevens said was integral to the success of his plan. Social care budgets have been brutally shrunk. A million people are not getting support to stay at home, with the predictable consequence that many stay in hospital when they no longer need to. It is hinted that councils may be allowed to raise the ringfenced precept that they put on council tax for social care: but that would, on King’s Fund numbers, raise at most £388m. The estimated shortfall next year is £1.9bn. Paradoxically, that means the best help for hospitals may be extra cash not for them, but for councils.

The Guardian view on the NHS cash crisis: social care comes first | Editorial

Jakarta"s Rat Eradication Movement: public offered cash reward for live rats

Samin climbed down into the darkness of the sewer, homemade catapult in hand. He wasn’t using stones this time, concerned they might kill his prey. Instead he formed small balls from damp mud, just enough to stun the rats and get them into a rusty wire cage. The plan was to smoke them out. He threw a fistful of lit rags down the tunnel and waited.

That night, despite an evening thunder storm, the square outside Cakung district administrative office in East Jakarta was packed with street cleaners carrying an assortment of old birdcages and traps made from wire or discarded water dispenser bottles. A good haul for one afternoon – 650 live rats – many of them more than two feet long.

Civil servants in khaki uniforms gathered round to record the scene on smartphones as workers in protective suits and masks vigorously shook the squealing contents of each cage into a pair of steel drums to be gassed with sulphur. Shouts and screams went up whenever a rat escaped, zigzagging through the crowd of legs to get back to the sewer. A few made it. Most were stamped to death.

Samin with the homemade catapult he used to stun and catch six rats

Welcome to the Rat Eradication Movement, a fledgling city programme to rid the Indonesian capital of its rodent problem. It’s the idea of deputy governor Djarot Saiful Hidayat, who has offered the public a bounty of 20,000 rupiahs (£1.20) for each live rat – a generous incentive in a country where 40% of the population live on less than $ 2 a day. Collecting the rats alive stops people claiming rewards for dead rodents found in the street, and allows officials to ensure none have been poisoned or shot, which they fear could be dangerous to the public.

Cats used to catch them but now the rats are bigger than them

Murad Husein

Jakarta recorded 40 cases last year of Leptospirosis – a bacterial infection from rat urine which can be deadly to humans – with the situation made worse by the city’s frequent floods. While rodent populations are highest near markets and their ready supply of waste food, they can be seen almost anywhere in the city. Rats have been spotted in courthouses and government offices, exclusive apartment blocks and expensive restaurants. Wander the streets at 3am and rats can be seen scurrying in and out of drains. They don’t seem too scared of people.

The rats gnaw through plastic drainage pipes and electrical wires. It is both a fire hazard and an expensive problem to fix as a broken pipe or chewed through wire could be anywhere – outside, inside or under – that a rat can get.

A resident shows off the 200,000 rupiahs he earned for catching 10 live rats during a pilot programme in Kemayoran, Jakarta, last month. Photograph: Alez Kurniawan

Funding for the programme currently comes from Djarot’s own budget, and full operation will not start until after city elections in February. He is standing on a ticket with Jakarta governor Basuki ‘Ahok’ Tjahaja Purnama, who was last week named as a suspect in a blasphemy investigation.

A similar pilot evening two weeks ago in the sub-district of Kemayoran yielded 200 live rats. Djarot, who was there to supervise the operation and distribute money to the moonlighting cleaners and ojek motorcycle-taxi drivers who caught the rats, said the city’s rodent population had until now been “uncontrollable”. Ojek driver Sutikno earned 100,000 rupiah after catching five rats with fishing nets and traps. “It’s good money. I’ll do it again,” he said.

Some, though, worry the programme could backfire in a phenomenon economists call the Cobra Effect, where cash rewards lead to unintended consequences.

Workers in protective clothing gassed the rats with sulphur. Photograph: Alez Kurniawan

The term was coined by German economist Horst Siebert, whose book of the same name contained an anecdote about attempts by colonial authorities in India to rid Delhi of cobras. When the British official in charge placed a bounty on the snakes, some enterprising locals started farming them. The scheme proved ineffective and was eventually cancelled. At that point the cobra farmers, faced with an unwanted stock of snakes, released them into the countryside around the city. The supposed solution had made the problem worse.

A similar situation has been documented by historian Michael Vann. His account of “the Great Hanoi Rat Massacre” tells of attempts by French colonial rulers to control rat populations in the Vietnamese city. New sewers in the wealthy European section unwittingly created a secret underground transportation network for the rats, where they were protected from predators, and the dark tubes provided an ideal breeding ground. They could make their way across the city, with flushable toilets in the poshest homes acting as a convenient entry point.

Authorities offered a cash reward to the public, paying out on production of a rat tail to make administration of the scheme easier. Soon residents were turning in tails in huge numbers – tens of thousands a day – but it wasn’t long before tail-less rats became an increasingly common sight.

“[Officials realised residents] were catching rats, but merely cutting off the tails and letting the still-living pests go free – perhaps to breed and produce more valuable tails,” Vann said. “Later, things became even more serious as health inspectors discovered a disturbing development in the suburbs of Hanoi. These officials found … individuals were actually raising rats to collect the bounty.” The scheme was declared a failure and scrapped.

Could Jakarta’s Rat Eradication Movement end up creating similar unintended consequences? Currently the scheme is nowhere near the scale of Hanoi’s Great Rat Massacre and there seems no shortage of genuine sewer rats, but Benvika, head of wildlife at the Jakarta Animal Aid Network, is not convinced by the project.

He advocates a return to a more natural balance, with predators such as snakes and owls used to control rodent populations. “The sulphur gas is not immediately lethal and causes unnecessary suffering,” he added. “The people of Jakarta must return to living healthily, and maintain their environment.”

Overseeing the Cakung operation was the vice-mayor of East Jakarta, Murad Husein. “Cats used to catch them but now the rats are bigger than them,” he said. “Without any predators the rat population has got bigger, and so have the rats themselves. We’ve no idea how many there are but you can see them almost anywhere, night or day.”

Additional reporting by Linda Hairani

Jakarta"s Rat Eradication Movement: public offered cash reward for live rats

Where precious cash is wasted in the NHS | Letters

I used to be involved in decision-making for funding high-cost drugs in the NHS, a process I strived to undertake systematically, transparently and justly. I was passionate about minimising waste. I recall once being forced to give up a perfectly good chair to make way for new ones bought to ensure our budget was spent, at the same time as turning down funding requests for cost reasons. This was galling. Fortunately, I left the NHS before the reorganisation – the abhorrent waste of resources in redundancy and rebranding would have broken me. The fiasco around PrEP (NHS can fund ‘game-changing’ HIV prevention drug, court rules, 3 August) has brought it all back. How much precious money will be spent on court cases, legal advice and appeals? Why does the NHS make everything so complicated, expensive and conflict ridden? And why are healthcare interventions subject to rigorous economic evaluations when other sources of expenditure are not?
Lesley Graham
Toronto, Canada

• Join the debate – email guardian.letters@theguardian.com

Where precious cash is wasted in the NHS | Letters

NHS to give patients cash to purchase their own healthcare

Mr Stevens mentioned that “north of five million patients” could each and every have a personalized combined wellness and social care budget by 2018, paid for by “billions” of lbs offered by the NHS and neighborhood councils.

Mr Stevens stated the dramatic extension of patient electrical power is necessary to assist make certain sufferers get a better deal from companies many find frustrating to deal with, decrease needless stays in hospital by trying to keep them healthier even though even now living at home, and also to conquer the shortages of cash which are more and more visible in the NHS and social care.

“We are going to set out the biggest offer to carry wellness and social care with each other that there is been since 1948 – a new option for combining them at the level of the individual,” Stevens informed the Guardian as he prepared to outline his ambitious plan in a speech to council leaders at the Neighborhood Government Association’s yearly conference in Bournemouth. It is his initial significant policy modify because taking above in April.

The initiative comes from “a widespread sense that our Balkanised wellness and social care providers are no longer match for goal”, Mr Stevens mentioned, particularly when the ageing population has created growing demands for care just when Whitehall austerity programmes have produced what he has called “two leaky buckets”.

Reduced funding for councils has led to a reduction in the availability of services which historically have aided the elderly avoid ending up in hospital, as evidenced by a 124 per cent rise in the last 14 many years in the amount of largely older men and women needing to be admitted for a day or two as an emergency, he mentioned.

The move is meant to improve the top quality of care the four patient groups get simply because at present as well several of them receive inadequate and “fragmented” care. That occurs since overall health and social care services often do not function effectively together and also because the NHS is not as good as it need to be in giving individuals with complicated health care wants the joined-up care they require, he mentioned.

The Nearby Government Association and Age Uk last night welcomed Mr Stevens’s prepare in principle.

Katie Hall, chair of the LGA’s community wellbeing board, explained the 648,000 folks who have individual budgets to help spend for their social care demands had received greater decision and witnessed their lives improved as a result. Today’s announcement extends that to well being wants as well.But even though council leaders will check out with NHS England methods to make care a lot more personalised, the new budgets “will not resolve the structural troubles in the wellness and care method or solve the funding crisis in social care”, she warned.

Caroline Abrahams, Age UK’s charity director, mentioned: “At the minute negotiating the separate health and social care programs is for older people confusing, aggravating and slow, since they have to deal with also a lot of men and women and hold telling their story to distinct individuals. For older people these personalized budgets could imply acquiring the support they need, tailored to their wants, cease duplication and boost their high quality of life.”

Nevertheless, the integrated individual budgets will need to have to be designed so that they do not “existing perplexing options for some vulnerable older folks struggling with sickness or dementia” or make men and women come to feel pressurised into taking one particular up, she additional.

Jeremy Hunt, the overall health secretary, welcomed the strategy.

“Greater out of hospital care is crucial for the two individuals and the prolonged-phrase sustainability of NHS,” stated a spokesman for Mr Hunt

NHS to give patients cash to purchase their own healthcare

Can Cash Actually Buy Happiness? Well, Maybe

Happiness study in excess of the last decade has a lot more or significantly less concluded that we can in reality get happiness, as prolonged as it comes in the type of experience. The conclusion can be described thusly: investing funds on items, no matter how elaborate, leaves us wanting more, even though investing on experiences, specifically with other individuals, yields long-phrase fulfillment. Very good? Very good.

Except maybe that conclusion is not quite very good enough.

New research from researchers at San Francisco State University takes a wrecking ball to that neat dichotomy by suggesting that for many of us, paying cash on experiences also leaves us wanting.

“Everyone has been informed if you devote your money on life experiences, it will make you happier, but we found that isn’t often the situation,” explained Ryan Howell, an associate professor of psychology at SF State and co-author of the research. “Extremely materials customers, who signify about a third of the all round population, are sort of caught. They are not actually happy with either purchase.”

The “extremely material buyers” Howell describes suffer a kind of fulfillment blindness about what purchases mesh properly with their personalities and values.  For these folks—and in accordance to Howell they’re a single in every 3 of us—buying experiences is actually no more successful than buying things, since the experiences will not accurately reflect who they are. In other words, no matter how they devote their funds, they miss the mark of authentic “identify expression.”

Howell supplies an instance: “I’m a baseball fan. If you inform me, ‘Go devote cash on a life knowledge,’ and I buy tickets to a baseball game, that would be authentic to who I am, and it will possibly make me satisfied,” Howell mentioned. “On the other hand, I’m not a massive museum guy. If I bought tickets to an artwork museum, I would be paying funds on a lifestyle expertise that looks like it would be the correct selection, but due to the fact it’s not real to my character, I’m not going to be any happier as a outcome.”

Howell and his staff surveyed consumers with questions designed to find out what factors limit the happiness they should come to feel (in accordance to prior scientific studies) from spending income on experiences. They located that the heaviest consumers of material factors felt the least happiness from experiential purchases.

“The benefits display it is not correct to say to every person, ‘If you commit money on lifestyle experiences you will be happier,’ because you want to consider into account the values of the purchaser,” mentioned Jia Wei Zhang, the lead writer of the study and a graduate student at the University of California, Berkeley who conducted the research with Howell even though an undergraduate at SF State.

So what’s the remedy? According to the researchers, it’s all about directing our getting power toward experiences that jibe with who we think we are. Spending on experiences that others say are universally edifying (i.e. museums and art galleries)–but that really do not genuinely mesh with our identities–is likely to leave us feeling just as empty as investing cash on possessions that lose their novelty minutes after we get them.

“There are a good deal of factors a person may buy something,” Howell stated, “but if the explanation is to maximize happiness, the best thing for that individual to do is obtain a existence experience that is in line with their personality.”

Although I believe this research adds a valuable dimension to happiness studies, I’d like to know a lot more about the impact of investing income on that which pushes the boundaries of our expertise. Would seem to me that someone who hasn’t traveled outside the U.S. could simply say, “I’m not a Europe kind of man or woman,” but really have no thought what that statement indicates. With out taking a possibility on new experiences, our “identity expression” may by no means increase past the relaxed, and limiting, life niches we carve out for ourselves.

The study will be published in the June edition of the Journal of Study in Persona.

You can find David DiSalvo on Twitter @neuronarrative and at his website, The Day-to-day Brain. His newest guide is Brain Changer: How Harnessing Your Brain’s Power To Adapt Can Adjust Your Daily life.

Relevant on Forbes…

Can Cash Actually Buy Happiness? Well, Maybe

How to Finish Cooking Burn Out and Save Cash: An Everlasting Meal

How do you come to feel about cooking?  Are you an individual that absolutely thrives in the kitchen and loves every single minute you get to devote there or is it a chore just to drag by yourself in and “slave” away at the stove to place some thing edible on the table.  Most folks probably locate themselves somewhere in between the two extremes.  After possessing cooked for a loved ones of 7 for almost 20 many years now, I’ll admit I’m not always a cooking enthusiast.  I have been rediscovering the joy of cooking and have discovered meal time is a really sacred time without a doubt.

My own mom was a lousy cook (God rest her beautiful soul) and consequently I didn’t know what a gourmet meal was till I left house. After I received married I grew to become a self-taught cook, understanding by trial and error. Time flies by and almost 20 years later, with shifting dynamics and 2 kids heading off to university, significantly less time to grocery store, and huge meals bills, I necessary a fresh method. I accidentally stumbled on a poetic, philosophical cookbook that modified my encounter in the kitchen. 

An Everlasting Meal: Cooking with Economic system and Grace

Tonight I had a handful of natural chicken breasts in the fridge that were getting perilously shut to the date. I haven’t shopped in days and I really do not have the elements to make anything from a true recipe. There was some stuff in the fridge, but I would have considered “nothing to make”. Thanks to the philosophical shift from studying Tamar Adlar’s guide An Everlasting Meal, I pulled out my pot, boiled some really salty water and starting up by boiling the chicken with a handful of a good spice blend. Then I sauteed a diced onion with some leftover mushrooms that would have been thrown out in the subsequent day or so, chopped celery ends I had remembered to conserve, then created a little roux. I created a sauce with the broth from the chicken breasts and a cup of milk and some cheese pieces. I extra some  leftover cooked veggies and the diced chicken breasts in my yummy mushroom sauce. I also located some also-stale-for-salad croutons in the pantry, so I threw them in the rest of my seasoned broth, creating a makeshift stuffing, and put it on prime of my mushroom saucey chicken concoction and baked for a few minutes. My household declared this makeshift casserole the best factor ever. And there was adequate to place an additional a single in the freezer, so I have solved “what’s for dinner” twice, never possessing touched a single recipe. Almost everything except the chicken, onion, and cup of milk was what Tamar calls “ends”, most of which would most likely have been in the garbage.

Tell us how you feel about cooking in the feedback below.

Add this guide to your library and you’ll be glad you did!

An Everlasting Meal: Cooking with Economic system and Grace

Wholesome Blessings,

Sandy

Go to our Healthy Living Blog for all organic recipes and option treatments.

How to Finish Cooking Burn Out and Save Cash: An Everlasting Meal

A lot more NHS cash – yes, but no restructuring | @guardianletters

The government need to listen to David Nicholson’s stark warnings that the NHS are not able to survive if it is denied “extra money”, but one more best-down reorganisation is not the answer (NHS informed to commit billions on reform or face oblivion, 13 March). It are not able to sustain services offered the combined pressure of increasing patient demand and falling assets. Modify that puts medical professionals and sufferers at the heart of decision generating is required, but centralising hospital services would be an needless restructure that would harm the versatility to react to the wants of local communities.

The government need to guarantee that clinical needs come initial, NHS providers reflect the neighborhood needs of sufferers and, as Nicholson says, our health service have to have the sources to deliver these solutions. Patients have to get the greatest achievable care – which centralisation and budget cuts will not offer.
Dr Mark Porter
Chair, British Health-related Association

• David Nicholson and others who keep banging the drum for a substantial reduction in the quantity of hospitals to offer money for care closer to patients’ properties are currently being disingenuous. It really is not just a question of bricks and mortar, as Nicholson asserts hospital closures usually indicate enormous bed reductions, yet even now we have far fewer hospital beds in proportion to population than the OECD average – half as many as France, for example. How can cutting them more be a secure and sustainable approach with a expanding and ageing population?

It can not be a query of 1 or the other. As Dr Saleyha Ahsan mentioned in her riveting piece primarily based on direct encounter (On the NHS front line there is no swift cure for the crisis, five March), enhanced care in the community is crucial “but if a lot more acute beds shut, the A&ampE waits will get longer for sick individuals requiring admission”.
Professor Ron Glatter
Hemel Hempstead, Hertfordshire

• It really is a small late for the outgoing chief executive to say the NHS demands a multi-billion pound change fund to rationalise hospital solutions. But his fundamental stage, that we need to invest in local community companies and assets prior to dismantling hospitals, is sound. Otherwise the public will never ever feel it is something other than expense cutting. And it is why there isn’t much to demonstrate yet for shifting care out of hospitals it just is not achievable to close providers at the same time as opening new ones.

It is interesting that he is utilizing the identical language of the mental hospital closures 30 many years ago. Thirty many years on we will be hunting back in astonishment at the way we employed to care for the frail and elderly in the final months of their lives, in institutions that are created for healthcare therapy rather than the care and compassion we largely require. This is essential. We have completed it prior to in even less promising situations – with the added stigma of psychological sickness – by creating a huge programme of alter and institutional closures. Nicholson’s message aligns fully with our manifesto for primary care, which launched exactly a single yr in the past. Our message to the incoming NHS chief executive is easy. Please just do it: launch the adjust fund.
Rick Stern
Chief executive, NHS Alliance

• The interview illustrates Nicholson’s isolation from actuality. To instance the provision of care in the neighborhood following the closure of extended remain psychiatric hospitals in the 1980s as a accomplishment is exceptional. He should read Care in the Community Myth or Actuality, a review that paperwork the experiences of 750 former sufferers of Friern Barnet hospital. Briefly, many showed some progress in their initial year, followed by a continuing decline in subsequent many years, since of the lack of proper investment in local community mental health services. This predicament continues and accelerates right now, with the closure of psychiatric beds, closure of rehabilitation solutions and below-provision of appropriate supported housing. Support is often presented by low-paid, unqualified employees.

The puzzling announcements by government of equality of provision for mental wellness with physical well being at the very same time as announcing cuts to an currently inadequate mental health budget is deeply troubling. We require to be profoundly concerned.
John Holmes
London

• The Nationwide Overall health Action Party has place forward plans to increase value for cash in the NHS based mostly on disregarded operate completed in the course of the final parliament:

Guarantee that all remedy is based on proof of effectiveness and ideal worth. Abolish the pricey industry in healthcare and the purchaser/supplier split. GPs and hospitals could then operate closely with each other to make certain that only people who are not able to be cared for by enhanced local community providers want admission to hospital. Patients with minor and lengthy-phrase illnesses need to be taught to care for themselves much more independently. Tackle weight problems, smoking and extreme alcohol intake far more efficiently.

Of course Sir David Nicholson is appropriate: money would have to be invested on strengthening local community care prior to these cost savings could be made. The outcome could conserve the NHS as a publicly provided and funded services for future generations.
Richard Taylor
Co-leader, Nationwide Health Action Celebration

• Yes, we want to be confident that acute companies are obtainable in sensible locations. Even so, the sole criterion need to not be based purely on population. It is also simple for a Londoncentric NHS to style companies this way utilizing minimum population as 1 of the major criteria is taking a sledge hammer to crack a nut. Get vascular surgical treatment. Rurality, transport and street entry, age demographics and deprivation must all be calculated when we determine where we supply our acute centres. With out this we will merely be condemning these who are elderly and residing in rural areas to a even more dimunution of services.
Rik Evans
Truro, Cornwall

A lot more NHS cash – yes, but no restructuring | @guardianletters