NHS chiefs order hospitals to begin urgent overhaul of A&E care

NHS chiefs have ordered hospitals to push through an urgent overhaul of A&E care, with GPs assessing every patient when they turn up to help the health service avoid another winter crisis.

The move comes as the NHS in England disclosed that it recorded its worst performance to date in January, missing vital treatment targets covering A&E, cancer and planned hospital care. The number of patients stuck in hospitals due to inadequate social care, such as a shortage of care home places, also hit an all-time high.

In a speech on Thursday, Jeremy Hunt, the health secretary, added to the pressure on hospitals by telling them to get back to meeting the target of treating 95% of A&E patients within four hours. That fell to 77.6% in January as hospitals buckled under unprecedented demand for emergency care.

However, hospital chiefs immediately criticised Hunt’s edict as “unrealistic” and demanded much more money to improve A&E care than the £100m in Wednesday’s budget.

NHS groups have voiced serious doubts as to whether there are enough GPs in England to work at every A&E unit. Dr Helen Stokes-Lampard, the chair of the Royal College of GPs, said: “We feel that the best place for GPs is working with patients in their communities and the money just announced for new triage systems in emergency departments would achieve more if most was spent shoring up general practice.”

The NHS England chief executive, Simon Stevens, and his counterpart at NHS Improvement, Jim Mackey, have written to all parts of the health service outlining “concrete changes” they must make to prevent next winter from overwhelming hospitals.

Over the previous winter, pictures of patients lying on trolleys in hospital corridors and countless stories about waiting many hours for ambulances caused major embarrassment to ministers and NHS chiefs.

Under the changes set out on Thursday:

• Ambulance crews will treat many more sick people where they find them, rather than bringing patients to hospital. In future, paramedics should be “conveying patients to hospital only when this is clinically necessary”, the letter says.
  


• Every hospital will have put in place “comprehensive front door streaming” by October, under which family doctors and nurses will assess how unwell patients are to reduce the risk of A&E units becoming overloaded by the 1.5 million to 3 million people who turn up unnecessarily every year.
  


• GP surgeries will have to offer many more appointments at weekends and in evenings, ultimately providing these to everyone in England by 2020.
  


• Doctors and nurses will have to provide better medical care to the 400,000 older people living in care homes, to stop them becoming so unwell that they need to be admitted to hospital.
  


• NHS bodies will work much more closely with local councils to reduce so-called bedblocking in hospitals. Councils will use the £1bn extra for social care in 2017-18 announced in Wednesday’s budget to provide more at-home care services and places in care homes.
  


• The NHS 111 telephone advice service will be overhauled to enable many more callers to speak to a doctor, nurse, mental health specialist or other type of health professional, as the Guardian reported on Wednesday.

Stevens and Mackey made it clear in their letter, published on Thursday, that NHS hospital trusts that do not implement every element of the plan will in effect be fined, by being denied money from the service’s £1.8bn-a-year sustainability and transformation hospital bailout fund.

Prof John Appleby, the chief economist at the Nuffield Trust health thinktank, said the latest performance figures “make dismal reading for the NHS and patients”.

“The number of patients stuck on a trolley waiting for a hospital bed has gone through the roof, with more than 80,000 patients waiting for four hours or more in January, and a staggering 988 of them waiting longer than 12 hours,” he said. “These are vulnerable people with acute medical needs. Corridors, it seems, have become the new emergency wards.”

Cancer charities criticised ministers over the NHS again missing the target for treating cancer patients referred for urgent treatment within 62 days.

Emma Greenwood, the director of policy at Cancer Research UK, said: “Today’s figures for January are the worst ever performance against this crucial cancer target, which has now been missed annually for three years. This is completely unacceptable.

“Cancer targets exist to ensure quick diagnosis and access to treatment, and provide a snapshot of how the NHS is performing for patients. The government and NHS England have committed to improving early diagnosis of cancer, including increasing investment, but it’s clear that this is yet to have an impact.

“Specifically, we have yet to see any significant progress to address huge staff shortages in the diagnostic workforce, especially for radiologists, pathologists, endoscopists and radiographers.”

NHS chiefs order hospitals to begin urgent overhaul of A&E care

Test all pregnant women for smoking, say NHS chiefs

England’s public health chief is urging hospitals to give every pregnant woman a carbon monoxide test to see if they smoke, as part of an NHS-wide drive to persuade patients to kick the habit.

Duncan Selbie wants midwives and nurses to routinely screen mothers-to-be when their pregnancy is first “booked”, monitor them at all their antenatal appointments and support those who want to quit.

Hospitals would also ban smoking shelters used by staff and patients, hand out nicotine gum and patches and include helping smokers to quit in patients’ treatment plans under Public Health England (PHE)’s plans. It also wants doctors and nurses to use their conversations with patients to advise them how to give up tobacco or encourage them to switch to e-cigarettes instead.

“One in four hospital inpatients smokes, but too many hospitals do too little to try to help them to give up. I want people who are in a hospital bed or in a consulting room to have a conversation about their smoking with a member of staff and, if they want to quit, refer them on to stop smoking services”, Selbie, PHE’s chief executive, told the Observer.

“This isn’t about scaring or hectoring people. It’s about making people aware that if they want to give up, NHS staff can help them. The evidence shows that if someone is helped to quit, they are four times more likely to succeed than if they do it on their own.

“We talk a lot about sugar and diet as health risks, but smoking remains the UK’s biggest killer and is responsible for near half a million admissions to hospital each year. One in four beds is occupied by a smoker and seven in 10 of them want to quit. It is time to consign tobacco to history and for the NHS to help people to give up.

“There’s something anachronistic about the NHS being associated with smoking,” he added.

The Royal College of Midwives (RCM) backed carbon monoxide testing for expectant mothers as long as they had the right to refuse to undergo it if they chose not to.

“The RCM is supportive of pregnant women being offered carbon monoxide testing at a time when it is appropriate to do so. Depending on the circumstances, it could be at the initial antenatal booking or during subsequent antenatal visits. Women should have the ability to decline testing as with any other area of antenatal screening,” said Janet Fyle, the RCM’s professional policy adviser.

But the NHS needed to understand that some women, especially those from poorer backgrounds, smoke as a way of helping relieve the stress of preparing to have a baby, Fyle added. “Having a baby and caring for a newborn along with other family members is one of the most stressful life events for some women, as some new mothers struggle to adapt to their new roles with little or no social support,” she said.

“We know that the incidence of smoking is higher in lower socioeconomic groups. We cannot ignore the psychological, social or economic circumstances of new mothers when developing strategies for how we communicate the risks of smoking and health care.”

PHE officials are frustrated that hospitals are doing too little to tackle smoking. In a strongly worded blog for the British Medical Journal, Dr Mary Black, its head of digital strategy, accused them of displaying “a kind of misguided sympathy [that] keeps the last vestiges of tobacco acceptability alive in the NHS.

“We falter before ill patients in pyjamas dragging their IV fluid stands out into the winter street in front of a hospital to have a fag, we pass with no comment past colleagues clustered around the emergency department exit having a communal smoke – some staff even smoke with patients at the exits of mental health units or in the last few remaining smoking shelters. Tolerating smoking on NHS premises is a form of collusion,” she said.

Black was especially critical of NHS personnel who light up outside their hospital. “Staff who smoke in NHS uniforms are sending a very clear pro-tobacco signal. Health staff who smoke with patients are empathising in a harmful way,” she said.

The National Institute of Health and Care Excellence (Nice) already advises hospitals to screen pregnant women to see if they smoke. However, many do not do so, even though recent evidence shows that it helps double the number of women who quit smoking during pregnancy and that those who do go on to have heavier and healthier babies. Smoking in pregnancy increases the risk of stillbirth, babies being small for gestational age, having trouble breathing and other problems.

Selbie praised Taunton and Somerset NHS Trust for playing messages recorded by children over the loudspeaker system in its grounds to ask those who are smoking to stop. The South London and Maudsley NHS Foundation Trust tells patients in all the letters it sends them that they should not bring tobacco, cigarettes, lighters or matches on to its premises or smoke anywhere in its grounds.

Selbie also highlighted Medway NHS Foundation Trust in Kent’s raft of anti-smoking measures, including its use of wardens to patrol the grounds telling people to stop smoking and a policy of frontline staff checking a patient’s smoking status and referring them for specialist help to quit if wanted.

Test all pregnant women for smoking, say NHS chiefs

Tories join NHS chiefs in call for increased social care funding

Philip Hammond is being urged by senior Tories to give the crumbling care system a double boost in his autumn statement, amid growing alarm that social care and the NHS will be unable to cope with demand this winter.

The chancellor is under intense pressure from health secretary Jeremy Hunt, local council leaders and NHS bosses to find some extra money to prop up the social care system in England. Well-placed sources say that, although Hammond has ruled out any unexpected increase in the NHS budget, he is examining a plan to plough between £700m and £1.5bn extra into social care services from April to help reduce numbers of older people being admitted to hospital. He is also looking into letting councils raise the amount they can add to council tax bills to fund social care through a precept introduced in April; it is currently capped at 2%. The autumn statement, on 23 November, may see the cash-strapped NHS get access to fresh capital funding to build new hospitals and health centres. to help deliver its promised revolution in how patients are cared for.

The Care Quality Commission warned last month that social care is “approaching a tipping point” and that greater numbers of frail elderly people will suffer falls or illness and add to the strain on hospitals and GPs unless urgent action is taken. Hunt and NHS England chief executive Simon Stevens have been lobbying the Treasury to bring forward to 2017-18 some or all of the £1.5bn it intends to put into the Better Care Fund, a scheme to bolster social care. Ministers have pledged to put £105m into the fund next year, and increase that to £825m in 2018-19 and to £1.5bn in 2019-20.

NHS organisations, the Local Government Association (LGA) and the Association of Directors of Adult Social Care have been making the same case. Sajid Javid’s Department for Communities and Local Government is understood to also be supporting it behind the scenes.

James Davies, a GP as well as a Tory MP and member of the health select committee, said growing numbers of Conservatives wanted Hammond to prioritise social care. The LGA said years of cuts to town-hall budgets have left the sector in crisis, with fewer people getting help with basics such as washing and eating at a time when need is rising. Also, care homes are closing, partly because councils cannot afford high enough fees to allow operators – whose costs have risen because of the national living wage – to make a profit.

“It is my view that, if further funding can be located, it should go into social care, with the expectation that this will indirectly relieve some of the difficulties being encountered by the NHS. I believe many of my colleagues are reaching the same conclusion,” Davies told the Observer. “The current pressures on social care are such that the prompt, safe discharge of patients from our hospitals is increasingly dysfunctional. So-called exit block is now a major challenge needing urgent attention. There is also evidence that hospital admissions could be reduced in number if community social care provision were to be increased in its extent.”

Such coordinated lobbying on behalf of social care by both the NHS and local government bodies is unprecedented. Health service bosses, ahead of a Whitehall spending decision, agree that social care should be the priority for extra resources. They are telling the Treasury that this would bring the double benefit of also reducing demand on the NHS. New figures last week showed “bed blocking” – patients being unable to go home because of inadequate social care provision – at a new record high.

Stephen Dalton, chief executive of the NHS Confederation, said: “The critical and negative tipping point for the health and care system has been triggered by cuts to social care. It’s imperative the chancellor takes the opportunity, in the autumn statement, to prioritise investment in social care before the winter.”

Chris Ham, chief executive of the King’s Fund, agreed: “Six consecutive years of funding cuts have left thousands of older people, their families and carers without the support they need, and are exacerbating pressures on the NHS. With council services facing a funding gap of £1.9bn next year, social care must be a priority for the autumn statement. This is a key test of the prime minister’s promise of a more equal country that works for everyone. There is no more burning injustice today than older and disabled people being denied the care they need to live with independence and dignity.”

Tories join NHS chiefs in call for increased social care funding

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

British Olympic chiefs criticised for Strongbow sponsorship of Team GB

British Olympic chiefs have been accused of encouraging underage drinking following their decision to allow the cider brand Strongbow to sponsor Team GB at the Rio Games.

Doctors, public health experts and alcohol groups are warning that Strongbow’s high-profile association with the exploits of British athletes in Brazil could lead to teenagers starting to drink and increase the amount of alcohol-related harm.

In a letter to the Guardian, members of the Alcohol Health Alliance (AHA)say that the sponsorship of Team GB by a cider brand will “promote the idea of drinking to our young people”.

The signatories include Dr Clifford Mann, the president of the Royal College of Emergency Medicine, which represents A&E doctors, Sarah Toule of the World Cancer Research Fund and experts in liver health. They say: “We are concerned that children will be encouraged to drink as a result. There is strong evidence that exposure to alcohol marketing leads young people to drink at an earlier age.

“We know from the research that exposure to alcohol messages increases the likelihood that non-drinking young people will start to drink, and increases the likelihood that existing young drinkers will drink more alcohol, and in a more risky fashion. This exposure also leads to more positive beliefs among young people about alcohol.”

Under the deal, Strongbow is featuring official Team GB branding on its products and spending several million pounds promoting its “supporting the supporters” campaign aimed at sports fans in Britain.

Heineken, the drinks multinational which makes Strongbow, has not disclosed how much it is paying the British Olympic Association (BOA), which did not have an alcohol sponsor when the Games was held in London four years ago.

But Strongbow rejected the AHA’s concerns and said its tie-up with Team GB and promotional campaign was aimed entirely at adults and would not involve any individual British competitor endorsing the drink.

“Our partnership is exclusively focussed on the adult fans who will be cheering on Team GB over the next two weeks. Strongbow will not be sold or promoted at Games venues, feature in TV coverage, or be linked to any individual member of Team GB,” said a spokesman.

The AHA letter adds: “A study of school children aged 13-14 from four EU countries found exposure to alcohol sports sponsorship through viewing a major football tournament was linked to a 70% increased chance of underage drinking.

“The later we can delay the uptake of drinking among young people, the better. We know that the younger people start to drink, the more chance there is that they will become dependent drinkers, with all the harm that causes to individuals, their families and society.”

When the sponsorship deal was agreed in April, Bill Sweeney, the BOA’s chief executive, said:“The fans made the difference in 2012 and with the team competing some 6,000 miles away in Rio we want to make sure they know they have the whole nation behind them all over again. Strongbow’s commitment to supporting the supporters and celebrating success is a great way of embracing that passion for our Olympians.”

The Portman Group, the alcohol industry trade body, defended the deal. “Alcohol sponsorship makes a significant contribution to the economy, supports major sporting events and provides essential investment for grassroots programmes. In the UK marketing alcohol to children is prohibited and alcohol sponsorship is strictly controlled. The strict rules are supported by all major sports organisations, alcohol producers and have been welcomed by the UK governments,” said a spokesman.

British Olympic chiefs criticised for Strongbow sponsorship of Team GB

NHS income issues will get worse subsequent yr, finance chiefs feel

Pressure on A&E units and the need to hire more nurses are driving up costs for NHS care providers, the Healthcare Financial Management Association found. Photograph: Bethany Clarke/Getty Images

The NHS’s financial problems are set to worsen next year, with more hospitals ending up in the red, the health services’s finance managers have warned.

Growing demand for care, pressure on A&E units and the need to hire more nurses to ensure high standards of treatment are driving up costs for NHS care providers, the Healthcare Financial Management Association found.

Its survey of 188 finance directors of NHS organisations found that just 12% of 129 hospital finance directors believe their trust will achieve its financial targets in 2015-16, while 44% do not.

Similarly, just one in four finance directors in GP-led clinical commissisoning groups, who commission and pay for care, said they would meet their targets.

Professor John Appleby, chief economist at the King’s Fund thinktank, said: “This report echoes our own surveys and highlights a truth now widely acknowledged within the NHS – that it is heading towards a financial crisis in 2015-16, if not before.” The HFMA’s report is published amid speculation that ministers are being lobbied by senior Liberal Democrats to give the service a £2bn bailout this autumn in order to keep it running smoothly.

A mere 2% of hospital finance chiefs and 11% of their clinical commissioning group counterparts think the Better Care Fund – the government’s flagship policy to reduce demand for NHS care by looking after more people at home by taking £2bn away from hospitals – will help improve the services they provide when it starts next April, the HFMA found.

Julia Manning, chief executive of 20/20 Health, another thinktank, said the NHS could save billions by reducing fraud and waste and urged politicians to have an honest debate about what the NHS can be expected to deliver.

More positively, 92% of NHS finance bosses expect the quality of care to improve or stay the same over the next few years, despite the expectation of increasingly widespread financial distress.

The Department of Health said it expected the NHS to live within its means. “We’ve taken tough decisions to protect the NHS budget and the system is on track to make £20bn savings this parliament to reinvest into frontline care. We are confident that the NHS will continue to make the savings necessary to meet rising demand”, said a spokesman.

“Trust chief executives need to have a tight financial grip to keep delivering high quality services whilst making the savings necessary to meet rising demand.”

Dr Mark Porter, leader of the British Medical Association, accused the coalition of cutting investment in the NHS, fragmenting care and prioritising the tendering of services to private firms. As an example of the “bizarre market culture” that has emerged, he said that in Bedfordshire and Milton Keynes, the management consultant firm McKinsey, carrying out a £3m review of services, has written to 500 providers, including dissolved UK trusts and one in the US offering “faith-based” healthcare, for expressions of interest in running local services.

NHS income issues will get worse subsequent yr, finance chiefs feel

NHS chiefs" spend rises condemned as "double standards" by nurses

The Royal University of Nursing, which carried out the analysis, stated the figures highlighted the increasing disparities on pay for NHS personnel. Photograph: Christopher Furlong/Getty Photos

Hospital bosses’ pay has been growing far faster than that of frontline NHS workers for the duration of the service’s unprecedented monetary squeeze, prompting angry claims by nurses’ leaders of double requirements.

Senior NHS managers’ salaries have risen by an average of six.one% in excess of the last two years – virtually four occasions the regular charge of 1.6% for nurses, midwives and wellness site visitors, in accordance to new figures.

Some hospital trust chief executives and other senior figures have obtained bonuses of at least £40,000 – much more than a ward sister’s yearly salary – pay rises of up to £30,000 and benefits in type, this kind of as a leased vehicle, worth £10,000, freedom of details requests show.

The disclosures have led the Royal University of Nursing (RCN), which conducted the research, to condemn what it says are unfair and increasing disparities on shell out in England at a time when most NHS workers who seem after sufferers have had pay freezes or small pay out rises.

They come as anger is expanding amongst unions representing the NHS’s one.35 million-sturdy workforce at the selection by the health secretary, Jeremy Hunt, to reject the NHS pay out-overview body’s recommendation that all NHS staff need to get a 1% pay out rise this year. Several of the unions are contemplating undertaking a coordinated programme of industrial action in the autumn, ranging from an overtime ban to likely strike action, in protest.

The RCN mentioned: “People currently on the highest salaries in the overall health service are seeing their rewards accelerating ahead of the earnings of the staff they lead.” Its general secretary, Dr Peter Carter, described the findings as “yet another kick in the teeth for hardworking and loyal nursing staff”.

NHS hospital trusts are in a position to determine with out ministerial interference how much their senior employees must be paid but are anticipated to do so “with obligation and sensitivity to the place of personnel who are subject to national contracts and restraint over their pay out”.

Dan Poulter, the wellness minister, not too long ago insisted that most were carrying out that. But he said that the specifics supplied by hospitals, contained in a new RCN report, “fly in the face of this assertion”.

For instance, the chief executive of Oxford University Hospital NHS Believe in, which runs the city’s John Radcliffe hospital, acquired a bonus of among £40,000 and £45,000, even though one executive received one of £5,000-£10,000 and six other individuals of amongst £10,000 and £15,000.

Similarly, the chief executive of West Hertfordshire Hospitals NHS Trust, which runs Watford standard hospital and other hospitals, also got a £40,000-£45,000 bonus, while 3 executives acquired bonuses of £15,000-£20,000 and a single of £20,000-£25,000.

The chief executive at 10 other hospital trusts and deputy chief executive at a single other each enjoyed pay out hikes of among £15,000 and at least £30,000 throughout 2011-twelve and 2012-13. For instance, the salary of the chief executive of York Teaching Hospitals NHS Foundation Believe in rose from £160,000-£165,000 to £190,000-£195,000.

“It is incredibly worrying that the government believes that trusts are acting responsibly when it truly is clear several are failing to display the leadership they ought to on senior management pay out,” said Carter.

“The government has maintained an iron grip on the pay out and advantages of frontline staff whilst the senior managers’ shell out bill has gone seemingly unchecked. This is the worst kind of double regular and can make a mockery of their insistence that fairness has been at the heart of their selection-making on public-sector pay out.”

Jamie Reed, the shadow health minister, stated: “Difficult-operating nurses and midwives will locate this galling. David Cameron need to have honoured his promise to give frontline workers a spend rise.”

Bosses have been awarded enhanced packages at a time when the support has been acquiring the smallest spending budget increases in its historical past and struggling to provide £20bn in efficiency financial savings in between 2011 and 2015 – the so-referred to as Nicholson Challenge.

The NHS Confederation, which represents senior managers, declined to comment.

The Division of Wellness (DH) said the RCN’s findings were not dependable simply because they had integrated exit packages awarded to some of the 7,250 NHS managers who had misplaced their jobs because 2010 but not carried out the identical with nurses. There are now 16,300 much more clinical employees and 7,250 fewer managers in the NHS than when the coalition took energy in Might 2010, a DH spokesman explained. He claimed that the government’s radical overhaul of the NHS was conserving £5bn, which was far a lot more than the fees of the 7,250 redundancies.

In a separate matter, Carter stated that the NHS would be forced to rely on rising numbers of company and foreign nurses to bridge the gap brought on by cuts to the quantity of pupil-nurse instruction locations.

Speaking from the RCN yearly congress in Liverpool, Carter said: “The NHS, possessing cut the number of places for pupil nurses, is now not receiving the by way of-put, they’re now having to go off to all points of the compass.

“As an illustration, three many years ago, the NHS in London minimize instruction locations by 24%. Now the result of that is beginning to come through.”

NHS chiefs" spend rises condemned as "double standards" by nurses

Parents of baby blood poisoning victim to meet hospital chiefs

Youself Al-Kharboush died after contracting a deadly bacterial infection at the St Thomas’ hospital neonatal intensive care unit. Photograph: Ian Nicholson/PA

The parents of a nine-day old baby who died after contracting an infection from a suspected contaminated drip are to meet hospital chiefs at a review into the tragedy.

Yousef Al-Kharboush died on Sunday after contracting a deadly bacterial infection at the neonatal intensive care unit at St Thomas’ hospital in London.

Eighteen babies across nine hospitals have been struck down with blood poisoning brought on by an infection “strongly linked” to an intravenous fluid supplied by London-based pharmaceutical firm ITH Pharma.

They had all been given a fluid called parenteral nutrition – which is supposed to deliver a variety of nutrients intravenously when a baby is unable to feed on its own.

Southwark coroner Dr Andrew Harris is treating the death of Yousef, from London Bridge, central London, as “unnatural”.

The baby’s parents have been invited to a meeting with the coroner along with Guy’s and St Thomas’ NHS Trust and ITH Pharma to decide whether a postmortem examination is needed and what further steps should be taken.

A statement on behalf of the Southwark coroner said: “The death of Yousef Al-Kharboush, aged nine days, of London Bridge area, Southwark, on 1 June at St Thomas hospital, has been reported to the coroner.

“An investigation was opened on 5 June by the senior coroner, as he has reason to suspect that the deceased died an unnatural death.

“Dr Andrew Harris, senior coroner, is holding a review meeting in public, to which interested persons are invited to make submissions.

“The parents, the NHS Trust and an intravenous feed manufacturer are interested persons.

“The coroner will decide at this meeting whether an autopsy is required and the initial steps to be taken in the investigation.”

Parents of baby blood poisoning victim to meet hospital chiefs

Hospital chiefs get in touch with for urgent reforms to make sure NHS survives

Simon Stevens, the new chief executive of the NHS. These days he will detail how he programs to fix the service’s budgetary crisis. Photograph: Owen Humphreys/PA

The NHS will turn out to be “unsustainable” in its recent type except if politicians urgently function out how to modernise and fund the services so that it can cope with sharply increasing pressures, hospital bosses warn right now.

In a letter to the Guardian, 71 NHS leaders urge the 3 main parties to commence creating solutions to assist the NHS survive or threat it ceasing to be a universal support that is free at the level of need.

“The NHS is at the most challenged time of its existence,” they warn in a plea directed at David Cameron, Ed Miliband and Nick Clegg, none of whom has nevertheless set out how they would ease the strains on the NHS right after following year’s election.

The intervention comes as NHS England chief executive Simon Stevens, in his very first important speech these days, is preparing to set out how the support can conquer the £30bn gap among its funding and demand for care anticipated by 2020.

The signatories to the letter, who consist of the heads of a lot of of England’s greatest hospital trusts, plead with the Conservatives, Labour and Liberal Democrats not to duck the NHS’s income troubles in the course of subsequent year’s standard election campaign, as they did throughout the 2010 poll.

“At the 2010 general election not one particular of the political events mentioned the monetary issues facing the NHS in its manifesto,” they write. “In 2015, the parties need to address the full range of problems facing the NHS or take duty for it becoming unsustainable in the form folks want it.”

Signatories consist of Rob Webster, chief executive of the NHS Confederation, which represents hospitals, and the chairs or chief executives of acute hospital trusts in London, Nottingham, Teeside, Kent, Sheffield, Oxford and elsewhere.

They want Cameron, Miliband and Clegg to each and every publicly recognise the scale of the difficulties the NHS is under, which is struggling to square fast-growing demand for care caused by ageing, an explosion in lifestyle-related illness and demands for far better care, with its most prolonged fiscal squeeze ever.

That rise in the want for care indicates the NHS’s costs are growing by about four% a year over standard inflation, the signatories say, who contain the heads of companies of acute care, psychological well being remedy and neighborhood solutions.

They also warn that also significantly of the NHS’s infrastructure and practices are woefully unprepared for the developing numbers of frail elderly men and women and individuals with at least a single prolonged-term issue. “The services we commission and run are not designed to cope with the care needs of the 21st century,” they write.

Their warning chimes with Stevens’s remark final week that “the NHS is at a defining second”. He will on Wednes day start to sketch out his views on what a radical NHS overhaul would seem like – including an improvement of solutions delivered outside of hospitals and a target on retaining older folks in much better health – when he addresses about two,000 NHS leaders gathered for the NHS Confederation’s yearly conference in Liverpool.

Dr Mark Porter, the leader of the British Medical Association, mentioned the pressures facing the NHS had been set to enhance and that politicians ought to see it demands much more money to support it remain viable.

“Our NHS is under huge strain from intense pressures, which includes rising patient demand and frozen funding,” he explained. “These difficulties are probably to become far more extreme in the potential, specially as an ageing society spots a more burden on declining resources. The NHS must be constructed on continual improvement, with regional services based on what we know to be best practice. This is unlikely to come from squeezing resources.”

Jeremy Taylor, chief executive of National Voices, a coalition of overall health charities and patient groups, mentioned politicians necessary to spell out how they would deliver “a individuals-powered model of well being and care that promotes wellbeing and independence, and is responsive, compassionate and accountable. They need to say how they will foster a different culture. And they need to have to say how they will correctly fund solutions. Major structural reorganisation and endless tinkering initiatives will not aid.”

Jamie Reed, the shadow health minister, mentioned Labour’s programs to integrate well being and social care showed it appreciated the need to have to rethink how care is organised.

“When the NHS is facing such a large monetary challenge, we must be bringing down the barriers to integration, not constructing a lot more. But the government’s challenging-line technique to competitors is blocking the modify the NHS requirements to make.

“Labour’s program to integrate health and social care is essential to tackling the financial pressures on the NHS at the very same time as driving up care requirements for sufferers.”

The Division of Health insisted that the NHS was “doing properly regardless of rising demand for companies. We know that there are difficulties, which is why we’ve taken difficult selections to defend the NHS price range,” explained a spokesman.

“That is making it possible for us to strengthen household doctoring, reform out of hospital care, and boost GP access for 7.five million individuals across the country. We are also taking radical action now to integrate health and social care providers via the £3.8bn Much better Care Fund.”

Hospital chiefs get in touch with for urgent reforms to make sure NHS survives

Hospital chiefs "ignoring midwives shortage rather than paying out to fill gaps"

The figures, compiled by BBC Radio 4’s Woman’s Hour, showed that 80 per cent nonetheless had vacancies in funded midwife positions. Even so, the rate was now at its lowest for three years.

Births in England have increased by a quarter in the previous decade, according to current statistics.

In the 99 trusts, there had been 561 vacancies at the flip of the 12 months, ranging from a 17.eight per cent vacancy price at West Hertfordshire Hospitals NHS Believe in to the entirely-staffed Hull and East Yorkshire Hospitals NHS Trust.

Cathy Warwick, the college chief executive, mentioned the figures on the delays in assessments have been “worrying”.

“Four in every single five NHS trusts say they have midwife vacancies, a scenario that we truly feel is obtaining worse, not better,” she explained. “This has to change.

“The stress on maternity units becomes worse when there is a combine of insufficient midwives to commence with. On top of this, midwifery vacancies are not getting filled.

“This is a recipe for disaster and can have a disastrous affect on staff morale, burnout and sickness prices, which only make a maternity services even much more short staffed.

“We hear from some heads of midwifery that trusts are not conducting suitable assessments of staffing specifications simply because they know they will not be in a position to afford to put into action the findings.

“So they bury their heads in the sand and stick with their out-of-date assessments that no longer bear relation to their requirements and the requirements of mothers and babies.

“Our evaluation is that we want close to four,800 a lot more midwives in England. The Government is escalating the amount of midwives, and that is welcome, but more wants to be carried out.”

Dr Dan Poulter, the health minister, explained: “The NHS is a secure spot to give birth, with ladies reporting high ranges of believe in and self confidence in staff.”

Hospital chiefs "ignoring midwives shortage rather than paying out to fill gaps"

NHS below fire in excess of redundancy payment to wellness chiefs

An NHS manager acquired a £370,000 redundancy payoff even however he went on to work in the wellness services for a diverse wellness believe in, it emerged last evening.

Rob Cooper, a former deputy chief executive at Yorkshire and the Humber Strategic Wellness Authority, was paid redundancy of among £370,000 and £375,000, The Occasions reported.

By the time the body was abolished he was working as director of finance for South London Healthcare NHS Trust and now works as interim finance director at Barking, Havering and Redbridge University NHS Trust, 1 of the worst-doing in the nation.

He was one of 3 managers paid a complete of nearly £1 million even even though they never ever stopped doing work in the NHS in accordance to a response given to Steve Barclay, a Tory member of the Public Accounts Committee in solution to a Parliamentary query.

Mr Barclay explained: “This is normal of the revolving-door culture that follows publicly funded redundancy payouts and displays a culture inside the NHS which stays cavalier with public money.”

Mr Cooper advised The Occasions: “While I have continued to perform in full-time employment in the NHS because March 2013, I have only charged 75 per cent of my time, which I think reflects the spirit of the letter from Sir David.”

There is no suggestion that any of the managers have broken any principles, but MPs condemned the way the NHS dealt with the redundancies.

Margaret Hodge, chairwoman of the committee stated: “It also seems as if the NHS has misled the two the National Audit Office and the taxpayer to the tune of above a single million lbs. It is not acceptable.”

A Department of Well being spokesperson stated: “We are looking at introducing hard new ideas to cap redundancy payouts for senior managers and claw back all or portion of the payment if they return to work for the NHS inside of a year of becoming manufactured redundant.”

NHS below fire in excess of redundancy payment to wellness chiefs

NHS chiefs might request personal wellness firms to assist if there is a patient surge

Any of the NHS clinical commissioning groups in England could outsource cataract removals, or hip or knee replacements to a personal company. Photograph: Sean Smith for the Guardian

Private firms will be asked to get on some of the NHS’s workload if the support can’t cope with demand this winter, it has emerged, as hospital bosses warned that emergency providers have been on a knife edge.

Professor Sir Bruce Keogh, NHS healthcare director, stated personal organizations would be asked to carry out planned operations in buy to relieve stress on hospitals “when the going gets rough in winter”.

Dame Barbara Hakin, NHS England’s deputy chief executive, has talked to personal companies about the likelihood of them providing “spare capability” to support the services deal with a potential surge in the variety of sufferers ending up in hospital if very cold weather happens.

Keogh told the Commons well being pick committee: “We have started out to seem at how the personal sector might be engaged in the event of a surge by way of hospitals, coming through A&ampE. One particular of the troubles under consideration is when the going will get rough in winter, typically a single of the impacts is on elective care, so waiting lists start off to drift out, so could much more elective care be shifted into the private sector?”

Although the NHS has used private firms just before – to clear backlogs of sufferers waiting for operations – it would be very unusual to bring them in to manage schedule operations, even temporarily. Keogh stated that Hakin “has had meetings not only with the personal sector but with the voluntary sector to see what they could do to support” if the NHS identified itself struggling.

An NHS spokesman explained that could imply any of the 211 GP-led clinical commissioning groups in England outsourcing cataract removals or hip or knee replacements to a private company, but that none have been considered to have signed any contracts so far.

The prospective use of personal firms emerged as the NHS Confederation voiced critical concern that hospitals, specifically A&ampE services, may not be in a position to handle a sudden spike in demand induced by a bout of cold weather.

In a briefing sent to MPs on the select committee, the Confederation, which represents hospitals, warned: “It is clear from our members that urgent and emergency care is on a knife-edge. There are considerable issues about a lack of capacity in the technique to react to a sudden boost in demand for care.

“For instance, although this winter has so far been comparatively mild, our members are concerned about the consequences of any sustained drop in temperatures.”

Also a lot of hospitals continue to be understaffed, it stated. “Our members continue to express significant issues about lack of capacity, notably in terms of staffing. Numerous expressed the see that urgent and emergency care is on a knife-edge.

“While the scenario feels under manage at the moment, there is nervousness about the consequences of a sudden modify in the weather, offered how mild winter has been so far. A cold spell could lead to greatly enhanced stress on our members when there is small slack in the method.”

Whilst hospitals have welcomed the £400m of extra funding for this winter that the well being secretary, Jeremy Hunt, has announced, they think it has come as well late to permit them to retain the services of additional personnel this winter, it explained.

“Our members are even now concerned about the comparatively late release of winter stress funding. This makes arranging and recruitment really hard.”

The Confederation also warned that injections of further funds for emergency care – what it referred to as “sticking-plaster answers” – were not adequate to tackle “the extended-phrase issues the system faces”.

Despite the generally mild winter so far and low levels of flu and norovirus, some hospitals have even now located themselves underneath extreme pressure considering that Christmas, with the two the social-care companies and community-primarily based health providers required to assist keep sufferers out of hospital inadequate, the briefing warned.

An NHS spokesman explained that deals with personal companies could consist of beds in care homes for elderly folks who have been medically well but not yet fit to go house, to assist ease stress on hospital beds.

The influential King’s Fund wellness thinktank additional warned that a lot more overall health organisations had been running into fiscal issues, with 22% of hospitals and 13% of clinical commissioning groups set to end the monetary year in deficit in late March.

Professor John Appleby, the King’s Fund’s chief economist, explained: “The developing quantity of hospitals set to overspend their budgets shows that for some it is no longer attainable the two to sustain the good quality of solutions and balance the books.”

Andy Burnham, the shadow health secretary, explained: “David Cameron promised not to reduce the NHS but that is exactly what is occurring across the nation as NHS organisations struggle to stability the books. As fiscal panic spreads, providers are going downhill.” The coalition’s unpopular £3bn reorganisation of the NHS in England had led to a lot of of the difficulties now currently being noticed, he mentioned.

The Department of Overall health said the NHS had to give better care despite also obtaining to conserve £20bn by 2015. “We have increased the NHS price range in genuine terms, but the NHS need to also turn into far more productive if it is to meet the rapid rise in demand, whilst guaranteeing compassionate care for all in the wake of the Francis inquiry.

“Getting 3,300 more nurses on our wards now than in 2010 is a good issue for individuals,” the spokeswoman stated.

Most hospital trusts had been in a healthier economic place, though some have been being assisted to “get back on track and continue to supply very first-class solutions”, she explained.

NHS chiefs might request personal wellness firms to assist if there is a patient surge

Health chiefs express "deep regret" more than death of man soon after ambulance delay

The Welsh ambulance service chief mentioned a amount of improvements had been because March 2013, when Pring died. Photograph: Christopher Thomond

Overall health chiefs have expressed “deep regret” that an elderly guy died much more than forty minutes right after his wife first dialled 999 and asked for an ambulance to come to his aid.

Fred Pring’s wife, Joyce, rang for support 3 far more times as her husband cried out in ache but in the course of her fourth contact informed the operator: “It is as well late now, he is gone, he was 74. There is nothing at all you can do for him now. You are as well late, I am sorry.”

At the end of his inquest in Ruthin, north-east Wales coroner John Gittins stated modifications must be created to aid reduce the chance of potential deaths.

He said even though it could not be established with certainty that Pring, who had heart and pulmonary disease, would have lived if the ambulance had reached him sooner, it was “probable” that he would have at least got to hospital alive if the ambulance had met its target response time of eight minutes.

In a joint statement, Elwyn Price-Morris, chief executive at the Welsh ambulance service, and Professor Matt Makin, healthcare director of Betsi Cadwaladr University health board, mentioned: “It is with deep regret that on this occasion there was no ambulance offered to send to Mr Pring in a timely manner.

“It is our responsibility to guarantee we have a safe, powerful and higher-good quality urgent care program, and with each other we are operating tough to minimize any delays in transferring patients to hospital. We have presently produced a quantity of enhancements considering that March 2013 [when Pring died].

“We are strengthening the coaching for on-call managers and making sure that handover and choice-generating procedures are clear for all employees across our organisations. We are also revising operating practices to make sure that we have proper staffing amounts for the duration of intervals of large demand.

“The urgent healthcare method across Wales is facing unparalleled strain, with high demands on the two the ambulance services and on hospital emergency departments. We are taking a variety of actions to guarantee that our active ambulances and emergency departments are offered for people who want them most urgently.”

The efficiency of the ambulance services has lengthy been higher on the political agenda in Wales. In November it emerged that a patient had waited in an ambulance for much more than 6 hrs before currently being admitted to a Welsh accident and emergency department.

After the inquest Joyce Pring, who is from Flintshire in north-east Wales, explained: “I sincerely hope that my husband’s death will lead to enhancements in the way the Welsh ambulance trust and the hospitals manage their providers.”

Health chiefs express "deep regret" more than death of man soon after ambulance delay