Schools cutting mental health services to plug funding gaps, warn MPs

Cash-strapped schools are cutting mental health services such as counsellors and pastoral provision as they try to cover funding gaps, two influential groups of MPs have said.

The health and education select committees joined forces for the inquiry, which called on the government to look at the impact of budget cuts on mental health services for children.

Services to support wellbeing are “the first thing to go” when budgets are under pressure, the inquiry heard. The government announced £1.25bn in additional funding for young people’s mental health in 2015, but almost 80% of primary school headteachers responding to a survey said a lack of money prevented them from providing mental health support in schools such as counsellors.

The MPs wrote: “We know that more than half of all mental ill health starts before the age of 15 and it is therefore a false economy to cut services for children and young people.”

There are “unacceptable” variations in the level of access children have to mental health services because some parts of the country lack strong links between schools and mental health providers, the inquiry found.

The education minister, Edward Timpson, told the inquiry a pilot scheme increasing collaboration between schools and mental health services was being expanded to 1,200 more schools. The MPs called on the government to “commit resources to establish partnerships with mental health services across all schools and colleges”.

The issue of social media was of particular concern for the inquiry, which found that it could help and harm young people’s mental wellbeing. Witnesses told the inquiry that young people tended to contact support services such as Childline on the internet rather than by phone, and social media could help connect young people, especially those with rare conditions, to supportive communities. But cyberbullying and sleep deprivation due to late-night screen use concerned witnesses to the inquiry.

Schools should teach pupils how to make sensible decisions around social media, the inquiry determined, as part of equipping them for the modern world. But they should also teach parents about social media, especially about its impact and that of screen time more generally on children’s sleep.

“Parents have a key role to play in limiting screen time, reducing sleep deprivation and preventing exposure to harmful online activity,” the MPs wrote.

Ofsted inspections could play a key role in raising the importance of mental health and wellbeing in schools, the MPs said, but witnesses said thewatchdog was too focused on academic achievement, with only one-third of Ofsted reports specifically referring to the mental health and wellbeing of pupils. The report called on Ofsted’s chief inspector, Amanda Spielman, who took over in January, to look at ways of making mental wellbeing more prominent “as a matter of priority”.

An Ofsted spokeswoman said: “Personal development, behaviour and welfare of pupils is one of our key judgments in school inspections and is graded in every section five inspection. As part of this, inspectors already evaluate the experience and wellbeing of particular individuals and groups of pupils, including those with mental health needs.

“Ofsted has also started discussions with the CQC [Care Quality Commission] about some future joint survey work in relation to the government’s proposals to transform mental health support for children and young people.”

Sarah Brennan, the chief executive of mental health charity YoungMinds, said: “We are facing a mental health crisis in our classrooms and it is vital that the next government rebalances the education system to ensure that the wellbeing of children is as important as academic achievement in schools.

“Many schools are doing excellent work to promote good mental health. But funding constraints, coupled with a lack of prominence given to wellbeing in the Ofsted inspection framework, mean that when schools face tough decisions about which services to cut, they are under pressure to prioritise other areas.

“At a time when rates of self-harm are rising sharply, and when specialist mental health services are overwhelmed, this cannot be right.”

Norman Lamb, the Liberal Democrat MP and mental health campaigner, said children and young people were being “shortchanged”.

“It is scandalous that much of the additional funding for children’s mental health secured by the Liberal Democrats in 2015 is not getting through,” he said.

“Until the government commits to providing more long-term funding for health and social care, this mental health crisis will not be tackled.”

Schools cutting mental health services to plug funding gaps, warn MPs

Immigration skills charge could hit health funding for years

A new immigration skills charge which comes into force on Thursday could take “desperately needed money” from the health service for years to come due to the service’s continuing reliance on foreign staff.

Employers will have to pay a £1,000 annual charge for skilled workers from outside the European Economic Area newly applying for the two main categories of Tier 2 visas. There were more than 6,000 such applications for non-EEA doctors and nurses in 2015 alone.

Smaller businesses and charities will pay a reduced charge of £364 per employee per year. The charge is on top of the fees already in place.

The employers of Tier 2 skilled visa holders who are already in the UK and those currently outside the UK who were assigned a certificate of sponsorship before today will not have to pay the charge.

The British Medical Association and Royal College of Nursing have raised concerns that the £1,000 annual charge could have a “damaging impact” on health and social care funding.

They jointly wrote to the home secretary in March expressing concern that the charges would take millions out of the NHS budget each year. However, their call that the NHS and the wider health and social care system be exempted from the charge has not led to a reversal in the government’s position.

BMA council chair Dr Mark Porter said it was “unthinkable” that trusts should be penalised for trying to fill staff shortages from overseas who it requires to maintain safe staffing levels and safe patient care.

“The government’s poor workforce planning has left it struggling to cope with huge and predictable staff shortages,” he said. “The introduction of this charge could take desperately needed money from an already under-funded health service, worsen the current staffing issues, and impact the level of care that hospitals are able to provide to patients.”

The chief executive of NHS Employers, Danny Mortimer said the immigration skills charge meant recruiting new non-EEA staff in future will become more expensive.

“Because of the workforce shortfalls faced by the NHS, and the time it takes to train new clinical staff, we anticipate employers will still need to recruit more non-EEA staff in the short to medium term,” he said.

Current exemptions only apply to PhD-level occupations and specific categories of trainee graduates and those switching from student visas to skilled work visas.

Detailed figures provided by the Home Office under the Freedom of Information Act show there were 87,280 applications for Tier 2 visas for non-EEA workers in the UK in 2015, an increase of 52% compared to 2011.

Among that figure there were 3,702 applications made on behalf of doctors, including consultants, specialists, GPs and surgeons. The highest number of these were Indian (820) and Pakistani (795) nationals.

3,702 doctors, including consultants, specialists, GPs and surgeons, applied for skilled visas in 2015

There were 2,535 applications for skilled visas for nurses in the same year, the majority of them from either the Philippines or India. A further 130 Croatian nationals also appear on the list of nationalities recruited as nurses due to restrictions on Croatian nationals’ access to the UK labour market.

There were 2,535 applications for skilled visas for nurses in the same year, the majority of them from either the Philippines or India.

Health is not the only industry that will be affected by the charge. The IT industry uses skilled visas more than any other: almost 35,000 tech professionals applied for Tier 2 visas in 2015, 40% of applications.

The vast majority of those who applied for positions in IT in 2015 were Indian citizens, almost 30,000 in total, followed by US citizens.

34,835 IT workers applied for skilled visas in the UK in 2015, up 71% on 2011

Programmers and developers are in highest demand with more than 12,300 applications for skilled visas while business analysts, architects and systems designers accounted for almost 10,500 applications within the sector.

Charlotte Holloway, policy director with techUK says that, while larger companies will be able to absorb the cost and additional bureaucracy the charge will bring, that the new charge was an extra burden on business which would disproportionately affect SMEs.

The business, research and administration sector also relies heavily on the visa scheme, making up 11% of skilled visa applications in 2015, most commonly for management consultants and business analysts and accountants.

In the same year almost 5,000 engineers applied for the skilled visa programme making it the third most reliant industry on non-EEA labour.

Other smaller industries such as speciality restaurants may also see an impact. There have been repeated warnings in recent years of a curry house crisis with the industry warning that a third of curry houses are at risk due to rising costs many of them connected to changes to immigration rules.

This is borne out in the figures provided by the Home Office. The number of non-EEA chefs and cooks applying for visas fell from 1,860 in 2013 to 745 in 2015.

Chart showing that the number of applications for non-EEA chefs and cooks fell from 1,860 in 2013 to 745 in 2015

A government spokesperson said income raised from the new immigration skills charge will be used to address skills gaps in the UK workforce.

“For too long there has been an under-investment in training for UK workers but this government is committed to building homegrown skills and wants to encourage employers to do the same.

“The introduction of the immigration skills charge will help encourage employers to invest in training so that UK workers have the right skills to fill jobs.”

Immigration skills charge could hit health funding for years

Funding the NHS in a retail world | Letters

Your editorial (31 March) calling for repeal of the 2012 Health and Social Care Act is a transformative shift of position and potentially very significant. Repeal will save huge sums of money for the NHS with immediate effect. If sustainability and transformation plans are used to return to geographical areas, ending stand-alone hospitals, substantive returns in terms of integrated care will be easier to achieve. I hope Labour will soon commit to repeal the Act. 

David Cameron admitted that this act was the coalition government’s biggest mistake. Theresa May should remove it from the statute book as an economy measure.
David Owen
House of Lords

• The NHS was designed to serve a more or less cohesive, class-based society where there was a political will to provide jobs and homes for all. Illness was due to bad luck and everyone deserved treatment.

We now know that bad luck is not random: unjustifiable inequalities set relatively disadvantaged people on an unhealthy path. The fact that resilient individuals will buck the trend merely fuels public scorn for people who cannot help themselves.

Without public investment in egalitarian family and social provision from the start of life, the NHS will seem increasingly irrelevant to citizens who have swallowed the idea that you can’t rely on the state to look after you, and expect to pay for everything they get. 

The “flexible, efficient organisation” that you call for will never be able to care for a demoralised population with diminishing opportunities for good health. The NHS is cornered in a retail world that has no concept of socialism.
Dr Sebastian Kraemer
London

• Replacing routine operations with non-surgical treatments implies that 60 years of NHS funding, staffing and competence crises arose from a system clogging itself up with unnecessary operations (Deborah Orr, 1 April). If avoiding them can significantly reduce the workload, removing targets should not be necessary. The danger of removing waiting time targets is that it will allow the stream of unnecessary work to continue unmonitored, to the great reward of the medical profession, relieved of the risk of being challenged about what they are doing at taxpayers’ expense.
John Hall
Bristol

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Funding the NHS in a retail world | Letters

Lib Dems call for 1p income tax rise to provide NHS funding boost

Income tax should be increased by 1p to deliver a £4.6bn boost to the struggling NHS while a long-term funding solution is found, the former Liberal Democrat health minister Norman Lamb has said.

As the Lib Dems seek to woo traditional Labour voters and win back public trust, after being reduced to just nine MPs, Lamb will urge his party’s spring forum this weekend to back higher taxes to pay for health and social care.

“You have to be straight with the public about what you say you will raise and then do it,” he told the Guardian, in the wake of a government U-turn over the national insurance contributions rise that was proposed by Philip Hammond in last week’s budget.

He would like to see income tax increased by 1p immediately while a new system is phased in. Lamb has asked a committee of health experts to make recommendations, but he suggests rebranding national insurance and earmarking it for health and social care is likely to be his preferred solution.

“You can have a mature discussion about why this is necessary,” Lamb said. “The bottom line is: it comes down to our loved ones. That hour of need when there is that real anxiety that there may be a cancer and you are not sure if you will get treated on time – that is something most people will find intolerable. That stake we all have in a system that works properly is very powerful.”

Lamb leads a cross-party group of Lib Dem, Labour and Conservative MPs, including the chair of the health select committee, Sarah Wollaston, who recently met the prime minister and pressed her to put the funding of the NHS and social care on a more sustainable footing.

Theresa May has agreed the group can consult her health adviser, Dr James Kent – a former medical doctor turned management consultant. Lamb said he will make the case for a cross-party investigation, lasting roughly a year, into long-term reforms.

Though Lamb said he ultimately believed the solution to the health crisis would be found in cross-party collaboration, he said his party had to be “audacious” with their own policy proposals, “because if we don’t, we’re nothing, there’s no point to us”.

He said Labour had failed to say where it would find the money to fund the NHS more generously, despite its leader, Jeremy Corbyn, regularly making the issue a key theme at prime minister’s questions.

“They are crushed by caution because this is difficult and they are worried about saying people will pay more tax under Labour,” Lamb said. “That is everybody’s fear about Labour, that they will expect everyone to pay loads more tax. So they, the leadership, resort to shouting.”

Norman Lamb MP, a former health minister. Photograph: Linda Nylind for the Guardian

Though he stressed his support for the NHS as a tax-funded health system, Lamb said it was an “uncomfortable truth” that European social insurance models had kept better pace with demand.

“In Germany they just put the premium up and it doesn’t feel the same as increasing tax,” he said. “I think a dedicated health and social care tax, independently assessed, would work as a hybrid, a tax-funded health system which you see going into the care system.”

Lamb, who has devised the new proposals with a panel of health advisers including David Nicholson, the former chief executive of NHS England, will also propose an “OBR for mental health” to make independent assessments either once a year or the start of a parliament, of the funding the health service needs.

That approach would echo George Osborne’s creation of the Office for Budget Responsibility, which checks the Treasury’s economic forecasts and tax and spending plans.

The MP admitted that any new system would take several years to implement and that tax rises would be necessary in the interim. “My view is that we as a party should make the case for a 1p increase in income tax, raising about £4.6bn,” he said. “That would make a massive difference.”

Lamb said the extra funds raised should be ringfenced for health and social care, with an emphasis on investment on prevention, particularly in digitisation of systems. “It’s unbelievable we still have faxes flying around the NHS,” he said.

Other priorities should be improving general practice and investing in social care – giving people better treatment at home rather than deterioration, which results in hospital admissions, he said.

The Treasury has traditionally been sceptical about hypothecation – the practice of earmarking the revenue from particular taxes for one purpose. But former permanent secretary Nick Macpherson recently advocated five-year budgets for healthcare, paid for by a dedicated tax.

The Lib Dem vote collapsed in the 2015 general election, after the party joined the Conservatives in coalition and broke a manifesto pledge not to increase tuition fees.

The leader, Tim Farron, hopes his party can make a comeback as the champion of pro-remain voters, but believes it must be upfront about the need to raise taxes.

Lamb, who has been a vigorous campaigner for mental health during his time in politics and as a health minister during the coalition, has spoken out about his family’s struggles to get swift treatment for his son’s mental illness.

Archie Lamb, who subsequently founded a music label that launched the careers of stars including rapper Tinchy Stryder, had obsessive compulsive disorder and the family paid for private treatment after being told the waiting list for the NHS would be too long.

“If you can pay, you’re not going to watch your child deteriorate, but there are families who can’t pay and I can’t tolerate that,” he said. “That’s what makes me very driven. I came across so many cases as a minister where families are desperate and being completely let down by the system, with teenage girls with eating disorders told their BMI wasn’t low enough, so basically go away and get sicker.

“It is morally wrong and economically stupid but this is happening in our country and we have to confront it.”

Lib Dems call for 1p income tax rise to provide NHS funding boost

Dying patients waiting hours for pain relief in NHS funding shortfall

Dying patients are waiting up to eight hours to receive pain relief because of cuts to district nursing services during the NHS’s unprecedented budget squeeze, a new report has revealed.

Severe financial pressures on the NHS are leading to longer waits for treatment and a short-sighted and growing rationing of care that is storing up problems for the future, according to a study by the King’s Fund health thinktank.

The report quotes one unnamed manager of a hospice saying: “The district nurses working at night are not able to give effective response times; you can wait up to eight hours … for patients experiencing pain and discomfort in the last two to three days of their life, it has a massive impact. It’s a frightening time for patients.”

The King’s Fund research has found that district nursing and sexual health services are among the areas of care most affected by six years of the NHS in England receiving annual budget increases of 1.2%, far less than its historic average of 3.7% rises.

It highlights how the diminishing number of district nurses are struggling to give patients prompt high-quality care because they are increasingly overworked.

The need to balance budgets and the smaller numbers of district nurses are prompting some NHS bodies to restrict their eligibility criteria for patients seeking help, refusing it for those with serious mobility problems unless they are completely housebound.

“We heard some examples of providers attempting to limit access. This was mainly through tightening referral criteria, particularly in relation to patients being ‘housebound’. Increasingly, if patients are able to visit their general practice (even if doing so is challenging), they will not be eligible to receive care from district nurses,” the report states.

The past two years have seen a loss of one in seven (14.8%) district nursing posts. “There is a significant gap between demand for district nursing and the available resources in terms of funding and staff numbers,” researchers found. Heavier workloads are contributing to 20% vacancy rates in some places.

The report also warns: “Pressures in district nursing are affecting the quality of patient care. Staff are increasingly rushed. Visits have become more task-focused, and there is less opportunity for thorough assessments. This dilution of quality may damage patient experience and outcomes.”

Many services provided by acute hospitals have been “relatively protected” despite the lack of investment in the NHS in recent years, the authors say.

However, genito-urinary medicine services have been hard hit, with cuts of up to 20% in 2014/15-2015/16 in some places in the budgets for testing for and treatment of sexually transmitted infections. “This has resulted in fewer clinics and reductions in staff in some areas, while there have also been cuts to prevention and outreach services. This could put patients and the general population at greater risk of infection,” the report adds.

The number of hip replacements has also started to fall, despite growing demand for them caused by the ageing population. Slightly fewer were carried out in 2015-16 than the year before as NHS clinical commissioning groups (CCGs) sought to save money by making surgery conditional on losing weight or giving up smoking. Waiting times for the procedure have also lengthened and more patients are waiting longer than the supposed maximum 18 weeks.

“It’s a disgrace that as a result of the Tory funding squeeze many elderly people are forced to live in prolonged agony and without independence because they are denied a hip replacement in reasonable time,” said Jonathan Ashworth, the shadow health secretary.

“Patients are unfairly suffering the consequences of a deliberately underfunded NHS at breaking point,” said Dr Mark Porter, chair of council at the British Medical Association.

The King’s Fund warns that rationing of care will become ever more common. “Although NHS funding growth began to slow in 2010/11, it appears to have taken some time for financial constraints to impact on patient care, and our data suggests that these impacts will spread and intensify,” the report adds.

The Department of Health has told CCGs not to ration care, despite the tight financial constraints it has imposed. NHS England said only: “Ultimately these are legally decisions for CCGs, but informed by best evidence and national guidance where appropriate.”

Dying patients waiting hours for pain relief in NHS funding shortfall

The solution to the NHS funding crisis? Its property | Dag Detter

The NHS was offered little relief in Wednesday’s budget. The proposed spending increase of £250m in social care the first year and then £130m the following two years will hardly cover inflation, let alone other cost pressures that the shortfall places on the health service. With such austerity the NHS faces years of underfunding, according to a King’s Fund report.

Yet the most promising avenue towards financial salvation is not even contemplated. The NHS is one of the country’s largest property owners; but also one of the least efficient property managers. Decades of debate have raged between those who want to keep it that way, and those who want to privatise or outsource property management to the private sector. The glaring third alternative has been left by the wayside – professional management of NHS property while maintaining public ownership but isolated from short-term political meddling.

The British Medical Association asks for a short-term £10bn funding increase, which would bring the NHS up to about 10.3% of GDP, still below spending in many other European countries such as Germany or Sweden. The government simply stalls, requesting NHS efficiency savings of £22bn by 2020. It refuses to clear the path towards professional NHS property management beyond the marginal initiative of the NHS Property Services, which manages only a fraction of the total portfolio.

The NHS in general, or each individual trust, has no detailed list of assets or even a basic understanding of the portfolio value and yield. Without a professional understanding of the extent of its real-estate portfolio, or recognising the market value, it lacks incentives to maximise value. Many of the buildings owned by the NHS are not even managed to maximise healthcare quality. For example, because of political pressures, opening new hospitals and health facilities is much easier than closing old, underused and inefficient NHS buildings, despite the fact that transferring services to more modern facilities will usually deliver better health outcomes.

International examples point to the benefit of specialisation by separating the property operations from the service providers, while retaining public ownership. In Sweden, local healthcare providers are serviced by a separate property company, both owned by the local government. A similar example in the UK can be demonstrated by London & Continental Railways, which has successfully helped to develop the commercial assets around King’s Cross, Waterloo and Stratford stations in London, and around the former Manchester Mayfield station.

A separate professional holding company at a national or local level would improve visibility of asset and portfolio data (floor areas, running costs, metrics such as building costs per medical procedure/patient) and would help make the case for closures, proving that a closure can be about good estate management and health outcomes, rather than being incorrectly attributed to “NHS cuts”, as usually seems to be the case. Over the coming years, many new ways of delivering digital healthcare can be realised, which makes it even more important to adapt facilities quickly and efficiently.

If the entire NHS portfolio were transparent and professionally managed, the value it would create would help to fund healthcare. One can draw a parallel to retail chains such as Tesco that earn more on their property management than on sales in their shops. Most NHS properties are in residential areas and so can easily be redeveloped in ways that yield more housing as well as better health provision.

If such a holding company for the property could generate a return of a modest 3% yield, it would mean almost £2bn in additional funding for the NHS. This may seem marginal for a budget of £116bn last year, but could prove decisive and, together with the operational efficiency gains, it could end up being a much larger sum since healthcare specialisation and new healthcare technology require functional, yet flexible facilities. With the two management organisations at arm’s length, it would help to raise quality, as well as release land for much-needed housing and offices, while earning a higher return on some of its property.

In recent years, investing in NHS facilities in cooperation with the private sector through private finance initiatives has gained a poor reputation, perhaps rightly so. This makes it even more important for an independent and professional property holding company to develop its own competence. That may also be a prerequisite for any future cooperation with private sector partners. Frustratingly, the political impasse creates a need for simplistic solutions – spend more or prioritise public fiscal balances. This solution may not suit those looking for a quick fix. But it may turn out to be the only realistic long-term funding plan for the NHS.

The solution to the NHS funding crisis? Its property | Dag Detter

Funding to two Indigenous sexual health programs cut without consultation

The federal government decided to stop funding two long-running Indigenous sexual health programs without consultation or analysis, and despite a growing sexual health crisis in the Top End, Senate estimates has heard.

Both organisations have accused the government of shortsightedness, and said without their services or any feasible replacement Indigenous LGBTQI people will be less likely to seek medical care.

The Northern Territory Aids and Hepatitis Council’s Aboriginal Sexual Health program, and the Queensland Aids Council’s 2 Spirits program have run for more than 20 years addressing the disproportionately high rate of sexually transmitted infections among Aboriginal and Torres Strait Islander populations.

Both organisations were told last year they should seek alternative funding to continue operating beyond June 2017.

In Senate estimates last week, Department of Health officials said they had done a “desktop review” of programs, which found “really limited evidence that these programs, which we’ve been funding for decades now, have really had any impact”, according to Bobbi Campbell, the first assistant secretary at the department.

Asked if the department had asked the NT and Queensland programs to partner with the department for an evaluation, Campbell said no. “We need to look at this from national perspective.”

The Queensland Aids Council’s executive director, Michael Scott, said his organisation had more than two decades of experience and community rapport, and their annual funding of $ 451,000 was a “drop in the ocean” for the work they did.

“We employ four Indigenous staff and they work from a whole-of-community approach, which means even though we’re funded to work with Indigenous gay men and sistagirls, we do remote outreach to Indigenous remote populations, to the entire community,” he said.

“It is a really important service because we also do training for other organisations, such as Aboriginal medical services, on how to appropriately work with Indigenous gay men and sistagirls.”

During the estimates hearing department officials also pointed to the rising rates of STIs and HIV in Indigenous populations, particularly the remote communities where the two organisations work. While the rate of new cases of HIV among non-Indigenous men and women stabilised in the four years to 2015, the rate among Indigenous men doubled.

Aboriginal and Torres Strait Islander men were twice as likely to have HIV than non-Indigenous men, according to the University of New South Wales Kirby institute for infection and immunity in society, which also reported rates of chlamydia, gonorrhoea and syphilis were, respectively, three, 10, and six times greater than among the non-Indigenous population in 2015. Remote and very remote areas saw even more substantial differences.

Last year the number of syphilis cases in the NT increased to 229 from just 14 in 2012. The high rate is set to continue in 2017, with more cases reported in January than for the whole of 2012.

Scott said his employees had been told people in the community would probably not seek care elsewhere once 2 Spirits closed.

“They forgo health care because they’re not comfortable walking through the door,” he said. “They’ll be living with STIs because they aren’t getting tested. That’s not just a health issue for them but for their communities as well.”

Daniel Alderman, a care and support coordinator for the Northern Territory Aids and Hepatitis Council, said his organisation had heard similar reports.

“This directly affects the most marginalised population we work with, Indigenous clients, [who] as you know suffer significant trauma,” he told Guardian Australia.

“Then we have seen more marginalised communities – sistagirls, brotherboys … they’re shunned from their communities that they live in and suffer significant stigma and discrimination.

“It’s cutting funding to Indigenous employment and one of the common things we hear from our Indigenous clients is they don’t want to access general or Aboriginal medical services because they fear they’ll be discriminated against.”

The Labor MP Warren Snowdon said the government didn’t just fail to perform an evaluation but “ignored the fact that these organisations had been operating for 21 years and providing an important service”.

“It beggars belief they can be canning these programs without any transition to other programs and leaving exposed these people who are involved [to] sexually transmitted infections and Aids,” he told Guardian Australia.

He said the cost of prevention far outweighed the cost of treating someone with HIV, and accused the government of “wiping its hands” of the responsibility.

“You’re prepared to pay for the treatment of HIV … but you’re not prepared to pay upfront for the prevention programs,” he said. “It doesn’t make sense.”

The office of Indigenous health minister, Ken Wyatt, was contacted for comment.

Funding to two Indigenous sexual health programs cut without consultation

Tories wary about plugging Trump gap in family planning funding

The hastily convened global gathering of governments in Brussels to pledge tens of millions of euros to family planning charities who had their US funding pulled by Donald Trump’s so-called “global gag” has been a tightrope to walk for the British government.

Trump reinstated the rule by executive order in his first few days in the White House, meaning US government funding cannot be provided to charities whose work includes offering abortion services.

Perhaps more than any other country, the UK has been keen to demonstrate that, whatever the concerns about the Trump administration, the answer is engagement rather than isolation. In January, Theresa May became the first foreign leader to meet the US president on a trip criticised by some as overly hasty. Given the UK’s need for new and fast free trade partners after the exit from the EU, such a position is perhaps unavoidable.

Viewed through this prism, its decision to send Rory Stewart, a junior minister, rather than Priti Patel, the secretary of state for international development, could be interpreted as a mild snub to the She Decides conference, an event intended by its organisers to be a symbol of solidarity against Trump. Ditto the UK decision not to pledge any additional money, when countries from Norway to the Netherlands are stumping up millions.

But that is not how ministers at the Department for International Development see it. They say they have been planning to host their own major global summit on family planning over the summer with the UN and that – far from ignoring the issue – the department has intensified UK aid efforts on family planning.

Observers might detect a sense of irritation that the UK will now be put in a position where it is a follower, rather than a leader, given that this week’s conference has been convened by the Dutch, Belgian and other northern European nations.

However, critics have warned that the determination of the department to forge its own path, rather than be perceived as embarrassing Trump, could leave charities in limbo, without specific pledges that their loss of support from the US will be matched elsewhere.

That uncertainty could have long-term consequences for reproductive health in developing countries. About half of all abortion procedures worldwide – more than 20m – are unsafe, with the vast majority in developing countries. About 68,000 women die annually after backstreet abortions, making it one of the leading causes of maternal mortality, according to the World Health Organization.

Five Labour MPs wrote in January to Patel to urge her to commit emergency funding to the She Decides effort, arguing that policymaking needed to be reactive to a volatile political climate. “We would implore you to take urgent steps on funding and policy as the Dutch government has, and as the UK government has done so previously, to mitigate the impact of this decision,” they wrote.

At least one of the MPs is speaking from experience. Gareth Thomas was a minister at DfID in 2006 when the Labour government publicly defied George W Bush’s own reinstatement of the global gag rule to pledge money for safe abortion services where US funding had been cut off.

At the time, the International Planned Parenthood Federation praised the bravery of the UK, saying they were “deeply grateful for the gesture not only financially but politically”.

Any kind of similar statement of thanks from charities in 2017 would be deeply unhelpful to the Conservative government in the post-Brexit era, connecting international aid spending to diplomacy.

Sources at the department see the decision by European and other governments to make immediate pledges to match the support as too hasty and say the scale of the funding gap from Trump’s order has not yet been fully calibrated. The UK’s 2006 funding pledge came five years after Bush’s order, and in a very different political climate.

Tories wary about plugging Trump gap in family planning funding

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

The algebra is simple. The NHS is having another terrible winter. It does not collapse, but “spills demand” on to the next line of defence, local government welfare. But while the NHS gets more money annually from the Treasury, local government gets less, some 30% less since 2011. It cannot cope with the new pressure.

The equation resolves itself into rationing, by quantity and quality: fewer care places, fewer home visits and fewer district nurses leads to more bed-blocking, fewer operations, longer trolley waits.

Tory Surrey is a responsible supplier of post-hospital care. Like all councils, it is allowed by the Treasury to increase its council tax by 5%, specifically to boost its care budget and thus ease pressure on the NHS – which the Treasury is responsible for funding. Surrey county council regarded this as nothing like enough. It therefore activated its statutory right to hold a referendum on a 15% increase.

Far from showing delight at a wealthy council accepting this burden, the Tory government was appalled. Tories do not increase taxes. The chancellor (and Surrey MP) Philip Hammond duly did what Jeremy Corbyn called a secret deal. If Surrey abandoned its referendum and the 15% hike, it could retain revenue from a different tax – the local business rate, which normally went to the Treasury. That is, the Treasury would in effect spend more on health and care in Surrey, but secretly and, so far, just for Surrey.

This is the stuff of a banana republic. If Britain wants to spend more on health and elderly care, it should raise it and spend it honestly. Instead, the Treasury is running around its fiscal A&E department, staunching the flow of political blood by slamming on plasters wherever a patient screams or twists an arm.

Leaked Surrey council tax texts allow Corbyn to ambush May at PMQs

Some might argue that an NHS free at the point of delivery has had its day. New disciplines and incentives, through fees or insurance or more prevention, must constrain marginal demand. But for the time being, it makes no sense to squeeze the NHS at the top – where politicians are exposed – and dump its problems on to local government and different funding streams at the bottom. It wastes money and distorts priorities. It is illiterate public finance.

If Surrey is harbinger of a new health and care service, and business taxes are to relieve an ever-burgeoning NHS, so be it. But few places are as rich as Surrey. Revenue will have to be redistributed from rich to poor areas. In other words, it is not just the NHS that needs rethinking, but the whole murky world of local government finance.

The banana republic of Surrey has shown local council funding is broken | Simon Jenkins

London FGM clinic to close after funding cut

A London clinic for women who have undergone FGM is being forced to close after the local council withdrew funding from March 2017.

The Acton African Well Woman Centre was awarded the Guardian sponsored Diversity and equality award in 2011 and houses experts in the field of female genital mutilation (FGM) who are able to help women who have have been through the trauma of the procedure.

The facts you should know about female genital mutilation

It also offers women de-infibulation – a reversal of of the most extreme form of FGM. Type III is the removal of the entire genitalia, leaving a hole small enough for urine and menstrual blood to pass through.

“Ealing council’s priority is to raise awareness of FGM and the support available to a wider audience,” a spokesman told the Guardian.

“We will continue to commission FGM awareness work in the borough to reach more people such as schools and community groups and signpost women to clinical support,” he added.

The clinic was notified of the council’s decision late last year, but the closure was confirmed following the rejection of a last-ditch appeal to Ealing Clinical Commissioning Group for alternative funding.

Staff have told the Guardian closing the clinic will destroy a strong community of women who bring, “sisters, cousins and friends” to the service.

“I don’t think anyone is questioning the value and expertise of the service,” a worker said, but I wonder if it was white middle class women who were vocal and out there would they close down the service?

“These are vulnerable women and they don’t have many places to go. It’s devastating that this clinic can’t survive after 10 years demonstrating that it is a goal standard.”

Since opening in 2007, the Acton clinic has seen more than 1,000 women in its fortnightly open hours and staff have performed upwards of 500 de-infibulations.

A number of healthcare professionals have been trained by the clinic, including GPs at a community-based service in Bristol, which is modelled on the Acton service.

The clinic does not refuse women from outside Ealing borough, which means any woman from across the UK can walk in. Women have come from as far as Northern Ireland seeking help.

Psychotherapist, survivor, and campaigner Leyla Hussein has referred women to the clinic. “What commissioners need to understand is that there’s a taboo,” she said. “[Women] aren’t going to go to the clinic in their area and we shouldn’t put barriers around them when they need to have access. I’m shocked and disappointed that the commissioners didn’t take that into account.

“A majority of women are cut by women. The idea of these of women trusting other women is a big deal. That they trust them is brave of these women to do that. Now that they have become confident and trusting, it’s going to be taken away from them.”

A petition to save the service has gathered over 11,000 signatures.

London FGM clinic to close after funding cut

Tory health committee chair defends NHS chief in funding row with PM

The Conservative chair of the health select committee has defended the NHS England chief executive, Simon Stevens, in his dispute with Theresa May over health service funding.

Dr Sarah Wollaston said she agreed with Stevens’ contradiction of May’s claim last Sunday that the NHS had been given more funding than it required up to 2020.

Stevens repeatedly dismissed May’s comments to Sky News when he appeared before the public accounts committee on Wednesday, showing the extent of the divisions between himself and the prime minister.

Asked on Sky News’ Sophy Ridge on Sunday programme if the NHS had been allocated more cash than it needed, Wollaston replied: “I don’t think that is strictly true.”

She said the government’s £10bn figure included transfers from other healthcare budgets. “So, you can see how the government has reached that figure. But the committee felt that a fairer figure, if we’re using the usual measure, was £4.5bn, which is a very different number,” she said.

Health had to be considered with social care “and what Simon Stevens was very clear when he spoke to the committee about, was if you have cuts to social care, that has an enormous impact on the NHS. So that is why he doesn’t agree,” she said.

“And I would agree with him that the NHS hasn’t been given everything it asked for, because it doesn’t actually consider social care, and it doesn’t consider the cuts to public health budgets, the kind of prevention work that we know is essential if we’re going to reduce demand on the NHS.”

Responding to claims that Stevens was not doing enough to alleviate the NHS crisis, Wollaston said “Personally, I think that is unreasonable. I think as a public servant and somebody who heads the NHS, the government needs to give him their unequivocal support in the very hard job he is undertaking to try to get this whole system to work.”

Wollaston, a former GP, also criticised the scapegoating of family doctors and the threat to withdraw funding unless they agreed to work longer hours.

She said it was entirely wrong to blame one section of the workforce, when administrative work, home visits and chasing test results had to be done when surgeries were closed.

GPs were “extraordinarily stretched and working under relentless pressure as bed numbers [in hospitals] are being cut,” she said.

“We now have the lowest number of beds per head in Europe. What we are finding is more and more complex conditions are coming back to primary care, so the work of the GP is changing and the pressures on them are relentless.

“The workforce simply isn’t there in many parts of the country, So I think to then be suggesting that all of this problem is due to GPs not seeing people is really stretching it,” Wollaston said.

“It’s just not the case and wrong to scapegoat them, in my view.”

Tory health committee chair defends NHS chief in funding row with PM

Care home closures set to rise as funding crisis bites

Care home operators, trade unions and charities have been telling Theresa May for months that the care home industry is in crisis and needs help.

Last week, May got her sternest warning yet – the chairs of three influential Commons committees urged the prime minister to deal with the “immense challenge” of paying for health and social care in the future.

“We are calling for a new political consensus to take this forward,” Conservative MP Sarah Wollaston of the health committee, Labour’s Meg Hillier of the public accounts committee and Clive Betts, another Labour MP, of the communities and local government committee wrote.

Since the collapse in 2011 of Southern Cross, then Britain’s biggest care home operator, no other major nationwide company has failed. However, smaller firms are failing across the country.

The Guardian revealed late last year that 100 more care home businesses have collapsed since 2010 than previously thought. A staggering 380 have been declared insolvent since 2010, according to the Insolvency Service. The number of failures each year has risen sharply since 2010, when 32 businesses failed. In 2015, 74 were declared insolvent, while another 34 failed in the first six months of 2016, the most recent figures available. The squeeze is being particularly felt by so-called “mom and pop” operators, who may run one or two care homes but account for about 55% of the industry.

Care homes are struggling because of a fall in the amount that councils pay towards fees for residents at the same time as costs are rising, driven by the government’s “national living wage”, which meant that workers aged 25 or over must be paid at least £7.20 an hour from April 2016. This led to an increase in payroll costs of about 5% for most businesses last year. This rise would have been problematic anyway, but local authorities are also reducing how much they pay towards social care after seeing their budgets cut by up to 50% as a result of government austerity measures.

“Some local authorities are paying less than £2 an hour towards the cost of caring for a resident,” says one senior executive at a leading care home operator.

Large companies are also ailing. Four Seasons, the biggest care home operator in the country with more than 400 properties, is the most at risk. It recorded a pre-tax loss of £28m in the three months to the end of September 2016, the most recent financial accounts available.

Guy Hands, founder of Terra Firma, which now owns the care home operator Four Seasons. Photograph: Bloomberg/Getty Images

The company, which is owned by Guy Hands’ private equity firm Terra Firma, is also sitting on more than £500m of debt, a legacy left by the previous owners. This debt means it pays about £30m in interest to its lenders every three months.

Four Seasons insists it can easily manage its debt burden, but Robbie Barr, the chairman of Four Seasons, warns the industry is “struggling at tipping point”. As well as care home operators collapsing, other companies could simply pull out of the industry. Bupa, one of the largest operators behind Four Seasons, was reported to be looking to sell 200 homes, although it has said it remains committed to the industry.

Stung by accusations that the autumn statement ignored social care, last month, Sajid Javid, the communities and local government secretary, announced that councils could increase council tax by an extra 3% to fund social care. He also said there would be a £240m “adult social care support grant” to help councils with care of older residents.

But Barr is cautious. He says: “It is essential that councils use the powers they have been given to raise the social care precept and pass it on to frontline elderly social care services to help offset the additional costs of the national living wage increase and avoid further pressures on a sector that is struggling at tipping point.”

Secret figures collected by Four Seasons show that although more than 90% of councils increased council tax last year – thanks to a similar 2% precept announced by David Cameron’s government – less than half of these passed it on to care homes through an increase in their fees.

Even if councils pass on the new precept, Javid’s package of measures, worth £900m, will not even cover further increases in wage costs this year. The national living wage is scheduled to rise by 4.2% in April to £7.50, which is larger than the proposed 3% increase in council tax.

The Local Government Association estimates there will be a £2.6bn funding gap in providing adult social care in England by 2020. A report by the Health Foundation, the King’s Fund and the Nuffield Trust calculates the gap would be £1.9bn in 2017 alone.

Izzi Seccombe, chair of the community wellbeing board for the LGA, says: “The care provider market cannot carry on as it is and there is a real danger of more widespread market failure.”

This squeeze is not just leading to the closure of care homes but compromises to the quality of care and an increase in costs for private residents. In a report last October the Care Quality Commission, the industry watchdog, warned that adult social care is “approaching a tipping point”. This conclusion was based on its inspections, tipoffs and external data. Its damaging findings included that half of the 1,850 social care services rated as needing improvement had not changed when reinspected and that 153 were downgraded to inadequate. Furthermore, it said the total number of nursing homes has dropped for the first time in five years and 81% of local authorities have reduced their real-terms spending on social care.

Another consequence of the crisis is that residents paying privately are suffering increases in their fees or top-up payments to make up for the shortfall in state funding. Well over half of care home residents are still either entirely or partly paid for by the state, with council funding available when a person’s savings and assets are worth less than £23,500. However, Age UK found that the number of residents paying their own costs has risen by 28.5% in the last decade and that the gap between private payers and council-funded residents is stark. While self-funders pay between £603 and £827 a week on average depending on the area, councils pay between £421 and £624 a week.

This is one of the reasons why the Competition and Markets Authority announced an investigation into the care home industry last month, a move that could have serious ramifications for the government and the major operators. The CMA said it will probe the “effectiveness of competition between care homes in driving quality and value for money for residents and taxpayers” and also “consider how local authorities and other public bodies purchase and assign care home places”. The government regulator has the legal power to force companies to make changes, as well as make recommendations to the prime minister.

Given the structural issues in the industry, the investigation has been welcomed by the biggest care home groups. Joan Elliott, managing director of UK care services at Bupa, says: “A strong, functioning care home sector is vital if the UK is to meet the growing needs of our ageing population. The new CMA market study is a real opportunity to address the barriers and blockages in the system, in particular how some local authorities set up their contracts, price quality care and pass through government funding.”

With 430,000 people in care homes and more than 11 million people aged 65 or over in the UK, the problems need to be addressed urgently. The country cannot afford to lose another 70-odd care home businesses in 2017, but that looks likely unless the government steps in.

Care home closures set to rise as funding crisis bites

John McDonnell calls for NHS funding audit as winter crisis deepens

NHS funding levels should be checked by the government’s budget watchdog amid public distrust of the figures and a worsening winter crisis in hospitals, John McDonnell has said.

The shadow chancellor wrote to Robert Chote, head of the Office for Budget Responsibility (OBR), asking him to look at NHS funding levels, as doctors warned that the shortage of resources in health and social care has created a crisis.

There have been a number of calls from Labour and the Liberal Democrats for an
independent auditor for the NHS. But McDonnell called on the existing OBR to see if it could establish the truth about public spending on the NHS.

The level of NHS funding has become hotly contested amid claims that cuts to social care have been causing unprecedented pressure on hospitals and further controversy over the government’s claims to be putting in another £10bn a year into the health service by the end of this parliament.

“It has become clear that Labour’s warnings of a looming winter crisis in the NHS were not heeded,” McDonnell wrote to Chote. “And we have seen in recent days that the British Red Cross has now had to describe the ongoing situation as a humanitarian crisis. The response from the prime minister at the weekend was to play down this situation despite the volume of continued complaints from frontline NHS staff.

“I strongly believe that this is leading to widespread public distrust in the government’s presentation of the level of funding and support for the NHS and social care. Therefore, it seems that now is the time to assess further enhancing the role of the OBR, and add additional responsibilities to your organisation.”

John McDonnell Photograph: Danny Lawson/PA

He suggested there should be an “annual standalone report that assesses short-medium term policy decisions made on health spending by the government, that takes into account the analysis you already do on the long-term trends and drivers of health spending.”

On Monday night, frontline doctors issued an unprecedented warning that patient safety was at risk at many A&E units across the NHS because hospitals are overwhelmed.

The health secretary, Jeremy Hunt, ­told the Commons in an emergency statement that hospitals may have to cancel operations and outpatient appointments so that staff can concentrate on the sickest patients.

GPs may also be drafted in to help hospitals cope with record demand for medical care. He also provoked controversy by suggesting the four-hour treatment target should exclude people who waste time by presenting with minor ailments.

The Royal College of Emergency Medicine said a substantial number of A&E departments were falling significantly short of the four-hour standard – but Hunt said that as many as 30% of those turning up were neither an urgent case nor a genuine emergency.

The college, which represents doctors in emergency care, warned: “In our expert opinion, when an emergency department falls below 75% against the four-hour standard, it shows a significant level of overcrowding and begins to put safety at risk. Present figures suggest a substantial number of departments are falling below this level.”

The college believes that one in four A&E units are at risk of offering poor care, citing delays in assessing patients and administering pain relief.

In an emergency statement prompted by reports of intense pressure at A&E units around the NHS in England, Hunt said that the four-hour waiting time had to be revised to remove non-urgent cases.

“This government is committed to maintaining and delivering that vital four-hour commitment to patients,” Hunt said. “But since it was announced in 2000 there are nearly 9m more visits to our A&Es, up to 30% of whom NHS England estimate do not need to be there. And the tide is continuing to rise.

“So, if we are to protect our four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”

NHS Providers, which represents hospital bosses, welcomed the change as “potentially helpful” in relieving the strain on A&Es.

But Jonathan Ashworth, the shadow health secretary, said: “Is he now really telling patients that rather than trying to hit the four-hour target, the government is now rewriting and downgrading it?”

John McDonnell calls for NHS funding audit as winter crisis deepens

NHS buckling under mismatch of demand and funding, says report

The NHS in England is buckling under a mismatch between soaring demand for care and levels of funding, a thinktank has warned. The King’s Fund said the number of admissions to hospital were rising steeply and were outstripping increases in the health service budget.

Hospital admissions have increased 3.6% a year since 2003-4. A&E attendances, referrals to outpatient services and diagnostic tests have also increased, it added. But since 2010, this increased activity has coincided with a prolonged funding squeeze, a the King’s Fund report states.

Between 2010-11 and 2014-15, funding increases “slowed significantly”, averaging 1.2% each year, compared with average increases of 4.8% a year between 2003-04 and 2010-11, the authors said. As a result of this mismatch between funding and activity, plans for the health service in the coming years could be in jeopardy, the report warns.

The NHS Five Year Forward View sets out a plan for meeting the projected gap between funding and demand – but the authors said: “Failure to moderate the rise in demand for hospital care … highlights the challenges in delivering the Forward View.”

It also warned that the “squeeze on spending” is set to tighten further over the coming years, with 1.1% growth in 2017-18, no growth in real terms funding in 2018-19 and only 0.4% in 2019-20.

Chris Ham, chief executive of the King’s Fund, said: “The NHS is treating more patients than ever before, which is a tribute to the hard work and commitment of its staff.

“However, our analysis provides more evidence that the health system is buckling under the strain of trying to meet rising demand and maintain standards of care within constrained resources.

“With the gap between funding and hospital activity set to grow over the next few years, the NHS needs to do everything it can to moderate demand for hospital care.

“We know that some of this demand can be avoided if alternative services are available – the challenge is to provide the right care in the right place at the right time, and to ensure hospitals are only used when necessary and appropriate.

“This means increasing investment in community services to provide more care closer to people’s homes and focusing on prevention to reduce the need for treatment in the first place.”

NHS buckling under mismatch of demand and funding, says report

Progress on malaria deaths at risk without big boost in funding, UN warns

Real progress in driving down infections and deaths from malaria will be at risk if substantially more funding is not forthcoming, according to the latest annual report on the epidemic.

Last year, more than 400,000 people (pdf) – mostly small children and pregnant women – died from malaria. Insecticide-impregnated bed nets to sleep under and effective drug treatments have brought the number of deaths down by nearly 30% worldwide in the five years from 2010 to 2015; the number of new cases over the same period is down by more than 20%. But the report, published by the World Health Organisation, shows there are substantial gaps in the coverage.

Some countries such as Sri Lanka and Kyrgyzstan have eliminated malaria and the WHO says the target of elimination in ten countries by 2020 will be met. Last year at least ten countries had 150 cases or fewer and nine more had between 150 and 1,000.

But the task of reducing the toll of malaria in the heavily endemic countries of sub-Saharan Africa, which have 90% of cases and 92% of deaths, is hard and needs more resources, says the report.

“We are definitely seeing progress,” said Dr Pedro Alonso, director of the WHO Global Malaria Programme. “But the world is still struggling to achieve the high levels of programme coverage that are needed to beat this disease.”

On the positive side, more children are being tested to determine whether they have malaria, so that the treatment is effective, and more pregnant women are being given drugs to prevent them getting malaria.

But an estimated 43% of the population of sub-Saharan Africa was not protected by nets or indoor spraying to kill the mosquitoes that transmit the disease last year. A third of the children with fever in 23 African countries were not taken to a health facility where they could be tested and appropriately treated.

While funding went up steeply between 2000 and 2010, it has flatlined for the last five years. It is estimated that $ 6.4bn (£5bn) per year is needed to keep the global malaria elimination efforts on target in 2020, but in 2015 it was only $ 2.9bn, or 45%. A third of that is provided by the governments of countries where malaria is endemic. Last year the US contributed 35% of the total and the UK put in 16%. The report says that substantially more money is needed both from international donors and from the affected countries.

“If this flatlining remains, we will not be able to achieve the ambitious goals and targets the world agreed on a year ago,” said Alonso. In 2015, the World Health Assembly adopted a global technical strategy for malaria, with milestones every five years until 2030. It calls for a 40% reduction in malaria cases between 2015 and 2020. Only 40 of the 91 countries with endemic malaria are on track to achieve that.

Progress on malaria deaths at risk without big boost in funding, UN warns

Care for elderly ‘close to collapse’ across UK as council funding runs out

Theresa May is under intense pressure from senior doctors and a powerful cross-party alliance of politicians to avert a collapse in care for the elderly, as shocking new figures show the system close to meltdown.

The medical profession, together with Tory, Labour and Liberal Democrat leaders in local government, have demanded a funding U-turn, warning that the safety of millions of elderly people is at risk because of an acute financial crisis completely overlooked in chancellor Philip Hammond’s autumn statement.

New figures obtained by the Observer show that 77 of the 152 local authorities responsible for providing care for the elderly have seen at least one residential and nursing care provider close in the last six months, because cuts to council budgets meant there were insufficient funds to run adequate services.

In 48 councils, at least one company that provides care for the elderly in their own homes has ceased trading over the same period, placing councils under sudden and huge pressure to find alternative provision.

In addition, 59 councils have had to find new care arrangements after contracts were handed back by a provider who decided that they were unable to make ends meet on the money that councils were able to pay them.

The medical profession, council leaders and even the former Tory health secretary, Andrew Lansley, are appalled that the social care crisis – exacerbated by growing numbers of elderly people and the rising costs of paying staff – was not addressed in the autumn statement.

In a letter to the Observer, the leaders of the four main political groups in local government expressed their disquiet at the chancellor’s dismissing talk of a crisis despite calls from politicians, NHS leaders, doctors and others.

Former Tory health secretary Andrew Lansley is among the critics. Photograph: David Jones/PA

“The fact the government appears to have chosen not to act will lower the quality of life for our elderly and vulnerable residents,” they said.

The cross-party group adds that, without an urgent injection of extra money to fund a £2.6bn funding gap, “the quality and safety of care of our elderly is at risk and the vulnerable will increasingly struggle to receive the help they need to meet basic needs such as washing, dressing or getting out of bed”.

They added that May cannot claim to be governing for everyone if she fails to act to help the elderly and most vulnerable: “The social care crisis is real and it is happening right now. The government cannot ignore it any longer if we are to truly have a society that works for everyone.”

Providers of social care say they have been squeezed by a combination of cuts to local authority funds provided by central government and their own rising costs, particularly as a result of the introduction of the national living wage.

Separately, the president of the Royal College of Surgeons, Clare Marx, told the Observer that the failure to provide adequate care in the home means elderly people are ending up stuck in hospitals, putting huge strain on their finances at a time when government is also demanding large efficiency savings. The logjam means operations for other patients have to be cancelled, causing further added bills to the NHS.

John McDonnell says autumn statement ‘offers no hope’

Marx said surgeons and other medical staff increasingly feel they are failing the elderly: “Cuts to local authorities’ social care budgets result in older people staying in hospital much longer than is necessary. Elderly patients, many of whom are living at home alone with little support, are regularly being admitted to A&E after falls or for acute infections. They then get stuck in hospitals because there is nowhere for them to go to continue their recovery.

“It is incredibly sad to see this happen, and we feel that we are failing our older people towards the end of their lives – when they deserve more dignity and greater support to stay in their own homes.

“Regrettably this has a knock-on effect for planned operations. I am hearing more and more regularly from colleagues who have had to cancel planned procedures because there aren’t enough beds free on wards to admit patients for their surgery. As a result the NHS is becoming increasingly inefficient. It is a vicious circle that won’t end until we properly resource social and community care.”

In the autumn statement debate, Hammond responded to Labour MPs who demanded action on social care by saying: “I know that it is tempting for opposition members to paint everything as a crisis or to talk of looming chaos, but that is not the case.”

He added: “We have created a better care fund that will be delivering £1.5bn a year into social care by the end of this parliament. We have allowed local authorities to raise a social care precept, which will be delivering another £2bn a year by the end of this parliament. That is £3.5bn a year of additional funding into the social care system.”

Council leaders say that Hammond’s claims are completely untrue and that the extra money councils can raise will not come close even to what is needed to meet the cost of introducing the national living wage (estimated to be at least £600m this year).

They also argue that wealthier areas, where more people can afford private care, will be better-placed because they collect more of their budgets through council tax and are less reliant on government funding. More deprived areas will be hit doubly hard because they will have to cope with the deep government funding cuts while being unable to raise as much to meet rising costs.

Care for elderly ‘close to collapse’ across UK as council funding runs out

Andrew Lansley chides chancellor lack of NHS and social care funding

The former health secretary Andrew Lansley has joined MPs from across the political spectrum in criticising the autumn statement for its lack of extra funding for the NHS and social care.

Lansley, who is now a peer, said he was disappointed there was not extra cash for the health service, which is under increasing pressure because adult social care budgets have been cut.

“I think the time is now to put some measure in place to try and help health and social care through the next two years,” he told the BBC’s World at One.

Asked whether he had been surprised at the lack of a funding announcement, he said: “Not being surprised doesn’t mean I’m not disappointed.”

He said the NHS and social care were facing an “incredibly difficult” period in the coming years.

“In the last parliament a challenging target was set and it was achieved,” he said. “The trouble is in this parliament, what has been asked of the National Health Service is not just more of the same but even more, and I’m afraid what was evident in the last financial year was when you take the level of support for the NHS below a 2% increase – to hospitals, that is – and the demand is rising at 4% there comes a point where they start to go in to significant deficit.

“The front-end loading of the money for the NHS in this parliament in to this financial year will probably mean those deficits come down this year, but without action next year and the year after those deficits will rise again and the accumulated deficit will make it very difficult for hospitals in particular to cope.”

He said the Better Care Fund, which brought together money from the NHS and social care, amounted to “robbing Peter to pay Paul”.

“That is not going to be remedied simply by taking money out of the NHS budget and passing it to local authorities,” he said.

Labour politicians led criticism of the chancellor, Philip Hammond, after his autumn statement for his failure to mention the NHS or social care in his fiscal document or to allocate any more money, instead prioritising infrastructure and projects such as more grammar schools.

Some Conservatives also voiced concern, including Sarah Wollaston, the chair of the health committee, who has said NHS and social care are at a tipping point. She and four other members of the health committee have also criticised the government’s claim to be putting an extra £10bn into the NHS by 2020.

“The continued use of the figure of £10bn for the additional health spending up to 2020-21 is not only incorrect, but risks giving a false impression that the NHS is awash with cash,” Wollaston and her four fellow committee members told the chancellor in a letter earlier this month.

Andrew Lansley chides chancellor lack of NHS and social care funding

Government scolded by watchdog over NHS funding claims

The watchdog overseeing how ministers use official statistics has told the government to be clearer and more exact in its claims about NHS funding after it investigated Theresa May’s contentious claim that she was giving the health service a £10bn boost.

The UK Statistics Authority looked into the prime minister’s repeated use of the £10bn claim after Labour and the British Medical Association complained that the figure was misleading and wrong. It has asked the Treasury to overhaul how government spending on both the NHS and health more widely is presented in order to minimise the risk of further “confusion” about the size of budget rises.

The UKSA’s intervention followed an increasingly public disagreement between May and Simon Stevens, the chief executive of NHS England, over how much extra funding the government had pledged to give the health service over the course of this parliament. May has put the figure at £10bn in the House Commons, a newspaper interview and at the Conservative party conference. She said that sum meant her administration was giving the NHS more money than the £8bn it had asked for in 2014 in order to transform how it works and close a £30bn budget gap by 2020.

Jon Ashworth, the shadow health secretary, accused the prime minister of exaggerating the true sum and using “spin” to try to present the government in a better light over the NHS. Dr Mark Porter, chair of the BMA’s ruling council, had also asked the UKSA to look into May’s claim.

In 2015, then chancellor George Osborne said the NHS in England would receive £8bn more between 2016-17 and 2020-21. But the Conservatives began saying they were giving it £10bn soon after they won last year’s general election. The larger figure comes from adding in the £2bn boost the NHS received in 2015-16 and was already announced by the time Osborne made his pledge.

Ed Humpherson, the UKSA’s director general for regulation, replied to Ashworth on Monday, saying that the watchdog “has considered the statements made and reflected that for any statement drawing on official statistics or other public data the following principles should be followed: the source of the statement should be clear and accessible; aspects pertaining to the data such as time period represented should be clear and; it should be very clear about what is being measured and in what context.”

He also said confusion had arisen because “while NHS England spending is rising, some other elements of the Department of Health budget are decreasing”. Health thinktanks, NHS groups and Labour and the Liberal Democrats have all criticised Jeremy Hunt, the health secretary, for slashing the non-NHS parts of his department’s budget – such as money for public health and for Health Education England to educate and train health professionals – by several billions of pounds in order to free up cash to help ministers give NHS England the promised £8bn rise.

Humpherson said: “While the Department of Health has been when asked about the nature of the estimated real terms increase in health spending and its split between NHS England and the department’s overall budget, the total health spending figures are much less frequently referred to by government and may be less readily accessible.”

The UKSA intends to ask the Treasury to “investigate whether in future they can present estimates for NHS England and total health sending separately. I will also explore with officials producing these figures other ways in which they might ensure clarity around sources, time periods and what is being measured, and in what context, when reporting on the level of increase in real budget allocations to NHS England.”

While Hunt has acknowledged that the £10bn was the budget increases over a six-year period, May has yet to do the same.

Ashworth said the UKSA’s response showed it had endorsed his concerns about the £10bn figure. “This response makes clear that the government’s claims about an extra £10bn for the NHS are very misleading and I’m glad that the UKSA have asked for the government to present the figures more clearly in future.”

Meanwhile, Dr Sarah Wollaston, the Conservative MP and ex-GP who chairs the health select committee, has thrown her weight behind Stevens after a story in the Mail on Sunday claimed that Downing Street was keen to oust the NHS boss because he had publicly disagreed with May’s account of the NHS’s budget.

“I asked him a question at Commons health [committee] and Simon Stevens was right to answer truthfully. It’s called duty of candour”, she tweeted. “If No 10 aides really are ‘gunning for’ Stevens for upholding his duty of candour, that would set a disgusting example to the NHS.”

Wollaston added that “there cannot be one rule for government and another for NHS staff. I’m sick of post-truth politics and the double standards on duty of candour”.

Government scolded by watchdog over NHS funding claims