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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My teenage cousin is having a crisis, but her mother won’t get her the help she needs

My cousin is 16, and apparently going through a crisis. She hates college, skips classes and has spoken to my grandmother often of hating her life and not enjoying anything any more. My grandmother is in bits about this and has tried to talk to my cousin’s mother, her daughter, about getting her some help. However, my aunt’s response has been, “She’s not going to turn out mental like the rest of you people.” (Other members of the family, including me and my grandmother, have had mental health problems.)

My cousin enjoys watching videos and playing video games, but her parents have banned them and see them as an example of her laziness. She is not sleeping either, so her constant exhaustion is taken as yet more evidence of laziness.

What terrifies me is that this is what my mother did to me, and I can only see it getting worse. When I began self-harming in my teens, my mum also banned me from my one hobby, screamed at me when I had a panic attack and slapped me when she found out I had self-harmed.

I had problems with substance abuse and dropped out of school. I moved away from home as soon as I could.

I am now in my mid-20s, and not close to anyone in my family apart from my grandmother. I have now moved somewhere else and, although I don’t see my parents, I am in contact with them. I haven’t seen my cousin for a few years and have no contact details for her. Anyway, I am not sure how, “Hi, I know we haven’t spoken in years but you remind me of me” would go down. I am trying to help my grandmother find a way to talk to my aunt in a manner that won’t enrage her, but my grandmother is a very non-confrontational person and, as much as she is trying to help my cousin, having to confront my aunt has only resulted in my grandmother being screamed at and threatened with losing contact with her grandchild.

I don’t know how to help my grandmother or my cousin, but I feel as if I have to do something, or history may repeat itself.

That you have come so far from a very toxic and unsupportive environment is incredible and a real credit to your strength of character.

It is great that you are so caring about your cousin and grandmother, but I think there is a lot of over-identifying going on. Your cousin doesn’t sound as if she is in a great place, but the facts pertaining to her were thin. The rest of your letter was about your experiences within the family and your fears of what might happen. I am not trying to minimise how you feel, or what is happening in the slightest – but the key is to separate the different strands so you can work on the right bits at the right time.

I consulted Stuart Hannah, a child and adolescent psychotherapist (childpsychotherapy.org.uk), who said: “The news about your cousin is filtered through your grandmother, via her daughter [your aunt].”

News filtered through people who have their own agenda or narratives can get distorted and then there is less likelihood of anyone getting the help and support that is right for them.

I disagree that it is not worth contacting your cousin: I think you should get in touch. Sure, if you go in there with “you remind me of me” that may not be conducive to further communication. But if you make a different sort of contact, more of a general “hi”, and see what happens, that may be really helpful to her in time (don’t expect miracles straight away). After all, you are not that much older than her, a mere decade, and you share a grandmother. There should be lots of other things to talk about so she feels she has someone to talk to if she feels like it – so it’s about her agenda, not anyone else’s.

It sounds as if you have a lot of issues you haven’t dealt with yourself and I wonder if you have some support (apart from your grandmother). If you do, you could come at this situation with less of your own baggage and would be better able to support your grandmother.

I don’t know what the conversations with your grandmother are like, but Hannah counsels: “How can you offer [your grandmother] something different? Something that isn’t judgmental or blaming [that she seems to get from her daughter]. You can listen from a neutral place. Don’t go down the slagging-off route [if you do], and suspend judgment of family members. If you can hear your grandmother’s experience, that may in turn help her listen to her daughter.”

Being empathic is great – however, if we over-identify with a situation (and both you and your grandmother might be), then the danger is, when we hear about something similar we can start to overlay our own experiences on to this new situation. This stops us seeing what is really going, and it imbues everything with extra emotion.

I think, given everything you have said, there is an element of trying to save your younger self, and that’s laudable, but there is a limit to how much you can do. You may also find this website helpful:

Youngminds.org.uk

Your problems solved

Contact Annalisa Barbieri, The Guardian, Kings Place, 90 York Way, London N1 9GU, or email annalisa.barbieri@mac.com. Annalisa regrets she cannot enter into personal correspondence.

Follow Annalisa on Twitter @AnnalisaB

My teenage cousin is having a crisis, but her mother won’t get her the help she needs

NHS needs £9.5bn upfront to secure its future, says BMA

Modernising and securing the future of the health service in England would cost at least £9.5bn in upfront spending, money that the NHS does not have, the British Medical Association has said.

Health managers in 44 areas have been charged with creating sustainability and transformation plans (STPs) to help the NHS repair its crumbling finances and meet clinical and organisation challenges.

But such an overhaul would need significant capital investment, according to the BMA. The doctors’ union sent freedom of information requests to all the areas asking for their estimates to implement the STPs and 37 replied, with the figures quoted in responses totalling £9.53bn.

Dr Mark Porter, the BMA’s chief, said: “These figures are especially concerning given that everyone can see a huge crisis unfolding within our NHS, with record numbers of trusts and GP practices raising the alarm to say they already can’t cope.

“The NHS is at breaking point and the STP process could have offered a chance to deal with some of the problems that the NHS is facing, like unnecessary competition, expensive fragmentation and buildings and equipment often unfit for purpose. But there is clearly nowhere near the funding required to carry out these plans.”

More than half of the STP areas have told NHS England they would each need more than £100m of upfront funding to make changes. Six – Cambridgeshire and Peterborough, Cheshire and Merseyside, Greater Manchester, North Central London, North East London and West Yorkshire – have quoted capital needs of £500m or more.

The BMA says that NHS leaders are unlikely to have anything near the cash required to deliver the projects, with budgets already under severe pressure. The annual capital allocation of £4.8bn granted to the Department of Health from 2016/17 to 2020/21 is being used in part to cover large hospital deficits, it says.

At a hearing last month of the public accounts committee – which scrutinises government expenditure, the NHS Providers chief executive, Chris Hopson, said a quarter of the capital budget (£1.2bn) had been taken “to prop up revenue”, and the health department’s finance director, David Williams, said raids on the capital budget were likely to continue.

The BMA says there will be other demands on the budget, pointing to an NHS Digital report published last year which said that more than £2bn was needed to pay for significant or high-risk outstanding maintenance needs.

Although the NHS says the STPs are vital to the future of the service, they have proved highly controversial as they are likely to lead to the axing of thousands of hospital beds, A&E units being downgraded or closed and women facing long trips to give birth.

Porter said: “These plans are fast becoming completely unworkable and have instead revealed a health service that is unsustainable without urgent further investment, and with little capacity to ‘transform’ in any meaningful way other than by reducing the provision of services on a drastic scale.”

Tom Sandford, the Royal College of Nursing director of England, said: “We have always supported the aims of the plans – preventing ill health, joining up services, delivering care closer to home.

“But proper funding – and consultation – is key to making sure STPs solve instead of exacerbate the problems of England’s health and care system.”

An NHS England spokeswoman said: “Rather than just commenting from the sidelines, local health and care leaders and clinicians are coming together to actually try and solve some deep-seated problems by identifying practical ways to improve services.

“Yes, there are well known pressures and constraints facing the NHS, but for patients’ sake we should obviously all try and make the best of the situation, rather than just stand to one side and say ‘well I wouldn’t start from here’.”

The £9.5bn cost was revealed as an analysis by the i newspaper of the 44 STPs suggested that they will lead to the closure of 19 hospitals, including five acute ones.

Areas where acute hospitals are under threat include Leicestershire and south-west London. The STPs have previously been criticised by the BMA as a stealthy way of cutting NHS services, dressed up as modernisation.

The i investigation also found that nearly 3,000 jobs could be lost under proposals to create a “smaller, more agile” workforce.

Other mooted changes under the plans include cutting prescription costs, rationing care and operations and slashing costs through use of technology, for example, doctors using video links to assess and discharge patients and even “virtual doctors” in an attempt to boost out-of-hospital care.

NHS needs £9.5bn upfront to secure its future, says BMA

Mental health needs good deeds more than good speeches

In less than 12 months, two prime ministers have chosen to start their year with major speeches about mental health, committing themselves and their governments to a transformation of the mental health landscape. But as so many of the statistics and personal stories bear witness; the landscape is not changing fast enough.

In her speech earlier this month, Theresa May talked about the critical importance of relationships and the role of government to “encourage and nurture” them.

This relational approach was reflected in May’s focus on the mental health of children and young people and the welcome recognition that left untreated mental distress can “blight lives, and become entrenched”. Half of lifelong mental illness has its first signs in the teen years, yet just 70p out of every £100 the NHS spends goes towards children’s mental health services. It’s time the resources followed the rhetoric. Otherwise we will keep on missing the opportunity to reduce the burden of life long mental illness.

May said she would hold NHS leaders to account for the £1bn David Cameron promised for mental health in January 2016. But it still remains unclear what has become of the commitment made in March 2015 to invest £1.25bn to transform children and young people’s mental health services. Reports from the frontline suggest the money isn’t getting through everywhere. Getting a grip on the money is essential; it ought to be part of the Care Quality Commission/Ofsted thematic review of children and young people’s mental health services mentioned by May.

In her speech, May suggests that tackling stigma is more important than resources. I think this misses the point: underinvestment in mental health is itself a symptom of stigma at an institutional level. Of course, less stigma is a good in itself, especially if it enables more people to seek help. But if the help isn’t there because of a lack of parity, then the results are the same.

Taking a life course approach, looking beyond conventional mental illness services, emphasising the importance of addressing mental distress early: these are all to be applauded. A whole-system response is needed to make real May’s ambition. Her recognition of the role of schools is very welcome.

May also acknowledged the need to look at what “can be done to prevent mental health conditions” and “build resilience”. I believe a new paradigm is required that looks to address the causes of mental distress and illness. For example, the growing evidence of the critical importance of the first 1,001 days of a person’s life and the role of couple relationships in laying down the foundations on which so many of their life chances rest.

Plans for green paper on children and young people’s mental health to services in education and for families offer opportunities and pose threats too. But my worry is it delays or derails the implementation of Future in Mind, the review by the coalition government committed to by the Conservative government just two years ago.

May’s speech is important if only because it is the prime minister talking about mental health. She recommitted government to the goal I set in 2011 of parity of esteem between mental and physical health. While the road to parity is paved with good speeches, it needs good deeds even more.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Mental health needs good deeds more than good speeches

How do we fix air pollution? It"s simple but it needs political will

Cutting toxic levels of city air pollution to safer levels is simple, but not easy – it requires resolve. Yet, despite the key culprit in the UK being well known – diesel vehicles – the government has been asleep at the wheel for years.

Levels of nitrogen dioxide have been illegally high across much of the UK since 2010. In 2015 86% of major urban areas broke annual limits. Cutting this pollution means choking off diesel emissions and there is a wide range of effective measures available.

Creating zones in city centres where polluting cars are either banned or charged is important, while making cities safe for cycling and walking cuts traffic too.

Cleaner buses and taxis have an important role to play and change to the perverse taxes that encourage people to buy diesel over cleaner cars is needed. There is also some support for a revival of a scrappage scheme which saw dirty old bangers taken off the road.

The environment and transport departments were well aware of all this and proposed many of these measures internally, only for the Treasury to reject most of them, arguing they “would be politically very difficult, especially given the impacts on motorists”.

Motorists happen to be particularly badly exposed to air pollution, but the real political difficulty for the government is two humiliating legal defeats in two years where judges ruled its air pollution plans were so bad they were illegal.

Ministers have now been forced to come up with a third plan, but clean air zones and car tax changes take time to clean up the air. Yet the UK government is also in the slow lane when it comes to emergency measures.

When foul air descended on Paris in December, officials there swung into action. Public transport was made free and the number of cars allowed on roads was restricted, alternately barring those with odd and even licence plates. In the UK, during the same December smog, the government sent a few tweets.

At the root of the problem are diesel cars, which successive governments across Europe have utterly failed to ensure meet legal emissions limits when driving in real-world conditions on the road. The gaming of regulatory tests by carmakers was blown open by the Volkswagen scandal. The scandal of governments prioritising supposed driver freedom over the lungs and health of their citizens is only now playing out.

How do we fix air pollution? It"s simple but it needs political will

The doctor on your Xbox? The NHS needs more digital ambition

Imagine a world where doctors and nurses glance at their watch to see patient updates, where virtual reality headsets are used to consult on medical procedures, or where patients could interact with their doctor through their television or media console.

All of this, and a great deal more, is achievable with the technology we have today, but both the NHS and its technology suppliers are yet to embrace what’s possible and make these scenarios happen.

The health secretary, Jeremy Hunt, has called for an “NHS for the smartphone age”, but mobile and digital means and offers healthcare so much more; something technology consumers are very aware of.

Large touchscreen devices, smart watches, other wearables, smart TVs, virtual reality displays and even games consoles are just a few of the digital devices available to consumers. But mobile health (mHealth), both in the UK and many other parts of the world, still largely falls far short of embracing the potential range of devices.

Meanwhile, clinical staff qualifying today in their 20s and 30s have grown up with mobile technology. They have smartphones, consoles, tablets and wearables. They use FitBits, health apps and messaging platforms.

A lot of frustration can be found among those professionals who want to use this technology in their working environments to improve care.

But chat platforms like WhatsApp have been known to cause challenges to IT teams. Information governance rules do not allow the use of many consumer apps in the NHS, in an attempt to avoid the potential for sensitive patient data to move to servers beyond the UK, and the subsequent loss of an audit trail.

But, while trusts cannot permit the use of WhatsApp by staff, the convenience of these messaging platforms still presents the risk of the technology being used under the radar, with people finding ways round traditional IT management policies. NHS technology leads are searching for ways to overcome the challenge – of addressing the demands of professionals while also safeguarding patient data.

Chat apps could be used to book an appointment at the doctors’ surgery or the hospital

A demand has emerged from staff to be able communicate instantaneously and share real-time information with colleagues through secure chat. But do mobile chat apps have the potential to transform NHS interaction for patients too?

In customer-service settings across other industries, bots, which pull information from applications and services, allow questions to be answered through natural language in a similar manner to the voice interaction on iPhone and Android devices. The same chat style interfaces, with which people are increasingly comfortable, could make a major difference to how patients interact with the NHS.

Chat apps could be used to book an appointment at the doctor’s surgery or the hospital. A patient can simply ask for an appointment next week and, in turn, the app speaks to tell them: “I have an appointment next Wednesday.”

When even augmented reality technologies like Pokemon Go have been recognised for their potential health and wellbeing benefits, consumer expectations about technology and the NHS is growing bolder. There are some promising signs that healthcare is starting to think differently, and it is reassuring to see an increasing number of media reports on new mobile innovations.

A greater focus on using technology for patient monitoring has been seen in the last 12–18 months. More local authorities are looking at patient information apps to prevent hospital admissions. And new mobile innovation tenders suggest a recognition that investment in mobile solutions is now needed. But all this barely scratches the surface of what can be done.

NHS providers, and the wider care community, now have a huge opportunity to really push the boundaries of what mobile technology can deliver and take advantage of both emerging and widely used technologies. If they take this opportunity, they could dramatically enhance their offering to patients and to the staff responsible for their care.

You could create fully interactive NHS apps for Apple TV. Console devices such as the Microsoft Xbox One Kinect could be used to assess a person’s posture and fitness, and provide suggestions for improvement. Wearable devices such as smartwatches could contribute to the government’s preventative medicine agenda.

It isn’t easy. Healthcare organisations can become bogged down in the day to day, and need to focus their finite IT resource on delivering large clinical systems or a new electronic patient record. To make this brave, new mHealth vision a reality the NHS cannot carry the responsibility alone. Tech suppliers need to think about their users, and think beyond mobile.

How long will it be before a doctor or nurse can use an app on their watch to access patient information? How long before a patient can book their clinical appointments via their Xbox, or record their own vital signs through tablet applications? It’s clear we need to do this now.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

The doctor on your Xbox? The NHS needs more digital ambition

Your Body Needs These Minerals if You Crave These Kinds of Junk Food

Your Body Needs These Minerals if You Crave These Kinds of Junk Food

4 Antioxidants Your Skin Desperately Needs

We know that antioxidants are good for our overall health, but do we know actually
know how important and necessary they are for our skin?

What is An Antioxidant?

An antioxidant is a substance that helps prevent against oxidation which forms free
radicals that damage cells in our body including our skin.

Think of it this way; do you know how an avocado turns brown if you let it sit out for too
long? The reason why it turns brown is because it becomes oxidized. Same when an
apple turns brown. We do not want our cells to become oxidized as that may trigger
early signs of aging, inflammation, and other skin issues.

Below are some of the best natural antioxidants for skin which can be found in many
clear skin supplements.

Vitamin E

Vitamin E is a fat-soluble vitamin meaning it is not necessary to obtain high amounts of
it as it remains stored in the body for a long period. We need small
amounts of Vitamin E for optimal health, but at high doses, it can become toxic.

Vitamin E can be used in oil form which is great for reducing the appearance of scars,
acne, and early signs of aging. This oil also has a moisturizing effect which keeps the
skin from becoming too dry. Many moisturizers on the market contain Vitamin E for this
reason.

Vitamin C

Vitamin C works extremely well for smoothing out fine lines, boosting our immune
system, and evening out skin tone. Vitamin C is also one of the best antioxidants for
skin whitening as it is very common that people use lemon juice for dark spots.

It is a water-soluble vitamin which means that any excess that is in your body will be
excreted out from bodily functions. Because it dissolves in water, it is imperative that we
receive enough of this vitamin for optimal results on our overall health.

Resveratrol

Resveratrol is a fairly new antioxidant that people have been talking about lately
especially because it is found in red wine (and who doesn’t want to drink wine and
receive health benefits at the same time?). This antioxidant is also found in cranberries,
blueberries, and nuts. There have been studies recently showing its powerful effects on
the skin including having an effect on anti-aging. It has also been shown to help
stimulate cell growth and protect against UV ray damage to the skin.

Although you can receive some health benefits through ingesting resveratrol whether
through red wine or berries, the most beneficial way to enhance your health is by
applying it directly to our skin which is why it is found in many anti-aging and
moisturizing products.

Green Tea

Green Tea is a powerful antioxidant in that it contains a compound called
epigallocatechin-3 gallate or better known as “EGCG”. Studies have linked green tea to
the creation of new skin cells which may help protect against free radicals, early signs of
aging, and overall inflammation. Acne is an inflammatory condition which is why you
hear all the time to drink green tea to help get rid of pimples and cystic acne.

Another way that green tea helps acne is that it slows the production of sebum from our
skin. Sebum is our body’s natural oil that it produces to lubricate our skin and prevent
dryness, however over-production of sebum is a factor in the development of pimples.
Green tea also contains antibacterial properties which help kill bacteria that cause acne.

Which is the Most Powerful Antioxidant for Skin?

All of the antioxidants for skin care mentioned above contribute to overall skin health so
one isn’t necessarily better than the other. If you can include all of these antioxidants
into your diet and supplement regimen then it is extremely possible you will see a
positive effect on your skin and overall health. When all of these antioxidants are taken
together they form a synergy which makes them even more powerful.

References:

https://www.ncbi.nlm.nih.gov/pubmed/27847126

http://www.naturalnews.com/046391_blueberries_antioxidants_health_benefits.html

http://www.naturalnews.com/033710_vitamin_C_cancer_prevention.html

4 Antioxidants Your Skin Desperately Needs

The social care system needs a rescue package – to help the NHS survive

It speaks volumes about government priorities that the Treasury briefed journalists ahead of Wednesday’s autumn statement that an extra £1.3bn would be spent on roads. Yet we have been kept in the dark over any rescue package for the tottering social care system, on which the chances of the NHS getting through the winter so critically depend.

As it happens, £1.3bn is also the price of a basic rescue for social care. It is the calculation by the Local Government Association (LGA) of the gap between what care providers in England say they need now to sustain threadbare state-funded services for older and disabled people and what councils say they can afford. To meet rising demand, inflation and the costs of the “national living wage” next year would require the same sum again.

Pretty much everyone outside the government understands the perilous position of the social care system, highlighted again this week by withdrawal from the market of another leading homecare provider, Mitie, and by a survey of councils suggesting that four in five local authorities do not have enough provision in their areas – especially for care at home, “extra care” housing with support and specialist nursing homes for dementia.

Relations between social care and the NHS have frequently been awkward and testy. Yet health leaders have been queueing up to say that if there is any spare cash going, give it to the poor folks next door (provided they spend it on keeping people away from hospitals already bursting at the seams two months before winter pressures traditionally bite). Even the health and social care regulator, the Care Quality Commission, has bravely stood up and warned of a system almost at tipping point.

Expectations are modest. While sector leaders say there must be a far bigger long-term settlement, for now they are looking realistically for renewal of the power English councils were given this year to add up to 2% to council tax bills for adult social care, ideally increasing that amount. They also want the extra funding, under the so-called Better Care Fund, already earmarked for the end of the decade brought forward to next year.

That there has been no word on this from the Treasury, even obliquely from the usual sources, is worrying. In a reply last week to Sarah Wollaston, chair of the Commons health select committee – who had warned that NHS reforms would be undeliverable without urgent action to improve social care – the chancellor, Philip Hammond, said he recognised that conditions were challenging and would “continue to closely monitor the position”.

Most observers still think he will find something for social care. But their faith in that extends little beyond rationalising that “he must, mustn’t he?”. Treasury officials are notoriously deaf to special pleading and, let us be frank, social care has done rather a lot of that over the years, not always very well.

One problem is the sector’s apparent inability to make a unified case. Even now, various figures are put on the scale of the funding gap it faces, from the LGA’s £1.3bn (or is it £2.6bn?) to £1.6bn advanced by social services directors and £1.9bn put forward by three leading health thinktanks.

While the size of a water bottle may be immaterial to a man dying of thirst, The Treasury expects precision and rigour in the cases it considers. Another problem is that the evidence of crisis isn’t entirely consistent. Even as care-home chains are privately warning ministers that up to a quarter of beds are at risk of closure, a leading property consultancy is reporting that profitability of homes is rising. Our Treasury friends will not have missed that. A key reason, paradoxically, is that closure of some homes – and overall capacity is falling – is increasing occupancy rates in the others.

But if there should be nothing for social care in Hammond’s statement, or if there is too little to make much difference, the consequences can only be bad: bad for councils, which are braced for an onslaught of legal challenges as it becomes clear that they cannot fulfil their duties under the Care Act; bad for the NHS, as hospital beds fill this winter with older people who could and should be receiving care and support at home; and, above all, bad for anyone who cannot afford to pay for their own care and support.

The distressing scenes of ill-treatment seen in BBC Panorama’s secret filming inside two Cornish care homes this week will only be repeated again and again as long as the care system remains underfunded, underskilled and undervalued by the rest of society.

Even the Care Quality Commission has stood up and bravely warned of a system almost at tipping point

The social care system needs a rescue package – to help the NHS survive

NHS leadership needs to give staff a powerful voice in any system change

Inevitably the NHS reform drive got caught up in the party conference crossfire. Diane Abbott, in her last few days as shadow health secretary, attempted to rebrand sustainability and transformation plans (STPs) as “secret Tory plans”, while prime minister Theresa May made the ludicrous assertion that the government had given the NHS “more than its leaders asked for”, conjuring up an image of NHS England trying to work out what to do with all the extra cash.

But clinicians as well as politicians are becoming increasingly vocal on the current round of reform. The Royal College of GPs is getting angry over the obsessive focus on sorting out hospital deficits rather than transforming care. At their annual conference this week, college chair Maureen Baker accurately pointed out that if there is insufficient investment in general practice, system transformation simply won’t happen, and the whole process will have been in vain.

NHS England has expressed concern about the lack of clinical involvement in drawing up local plans. At the recent NHS Expo, chief nursing officer Professor Jane Cummings revealed that she had had “mixed responses” when pushing for nurses to have a greater role in STPs, and urged healthcare professionals to make their voices heard.

The RCN backs the drive for patients to increasingly manage their own care, but has warned that the only way to do that effectively is to listen to patients and clinicians. In many areas this did not happen before the plans were submitted to NHS England.

The extraordinary speed with which the plans are being put together is causing concern. Last week Julia Simon, who has just finished as the head of commissioning policy at NHS England, went so far as to claim there were “a lot of lies in the system about the … benefits that will be delivered; it’s just a construct, not a reality”. She described the speed as “mad” and “shameful”.

NHS England is rushing the process for a reason. As NHS Improvement chief executive Jim Mackey made clear from his first days in the job, it would be a calamitous failure for the NHS to push the Department of Health over its parliamentary spending limit. The possible consequences are far greater than simply NHS England chief executive Simon Stevens losing his job; it could lead to a fundamental change in the relationship between frontline health services and government.

Despite Health Secretary Jeremy Hunt’s determination to keep a personal grip on the health service, and despite the numerous weaknesses in the current structure, the NHS does at least have a meaningful degree of autonomy from direct Whitehall control. Busting the spending limit runs the serious risk that this would be reversed, to the detriment of the whole system.

But NHS England and NHS improvement need to balance the need for quick action to stabilise the finances with acceptance that the only way to deliver the transformation they seek is for it to be led by clinicians as much as managers.

STPs are focused on structures and process, but as thousands of pages of visions and plans that have come to little over the years demonstrate, documents like these are ultimately worthless without clinical buy-in and leadership, because they all depend on clinicians taking different decisions with their patients on the best way forward.

The frenetic pace of the STP process gives the erroneous impression that, at least for the most advanced areas, it will all be over by Christmas. In reality, this is just the beginning of many years of work to change the culture of the entire health and care system.

Once the immediate panic over getting financial plans in place has subsided, the NHS leadership needs to focus relentlessly on giving staff a powerful voice in system change. Clinicians need to be empowered and supported in making the improvements that they know are needed, while also being challenged to develop their thinking around crucial areas such as building services around the needs of the patients rather than the institution.

Either clinicians start to lead this, or it will fail.

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NHS leadership needs to give staff a powerful voice in any system change

Hurricane Matthew: Haiti needs vaccines to stop deadly cholera spreading | Dr Anita Zaidi and Helen Matzger

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9,000 people died in Haiti’s last cholera outbreak. We must act fast in disaster-affected hotspots to help prevent history repeating itself

Six years ago, as the country attempted to rebuild following a massive earthquake, cholera began spreading in Haiti. And it didn’t stop.

Adults and children – many of whom contracted cholera by drinking untreated water from familiar rivers and streams – lay listless in hospitals packed to capacity with emergency cases. The death toll mounted. The months passed. The cases continued. Stories of pregnant women and tough little girls and boys struggling to survive became the norm and were well recorded by partners on the ground, who were bearing witness to what is now considered the worst cholera outbreak in recent history.

Related: Hurricane Matthew: preparations and aftermath – in pictures

Related: UN makes first public admission of blame for Haiti cholera outbreak

Continue reading…

Hurricane Matthew: Haiti needs vaccines to stop deadly cholera spreading | Dr Anita Zaidi and Helen Matzger

NHS needs EU employees to avoid collapse, says thinktank

The NHS would collapse without its 57,000 workers who are EU nationals and they must be offered free British citizenship so they don’t leave the country after Brexit, according to a leading thinktank.

The Institute of Public Policy Research (IPPR) says in a report released on Thursday the concessions to EU nationals living in Britain are needed to prevent a post-Brexit brain-drain of talent harming the economy.

Chris Murray, who compiled the report, said: “It is critical to public health that these workers do not seek jobs elsewhere. All EU nationals who work for the NHS, or as locums in the NHS system, should be eligible to apply for British citizenship. This offer should be organised by the regional NHS and mental health trusts, who would be responsible for writing to all NHS staff who are EU nationals to inform them of their eligibility.”

In particular, according to Murray, the position of EU citizens working in the NHS needs to be safeguarded by making them a “generous citizenship offer”. He added: “There are currently around 57,000 EU nationals working in the English NHS, accounting for 5% of its workforce; one in 10 of the UK’s registered doctors is an EU national. Without them the NHS would collapse.”

One of its proposals is to reform UK citizenship laws, including waiving the £1,200 citizenship fee for NHS workers.

The report is published as the latest official quarterly migration statistics are released on Thursday, showing whether there was a spike in EU nationals coming to Britain or applying for citizenship in the three months before the 23 June referendum.

The Brexit result has left the future status of 3 million EU citizens living in Britain uncertain. While the IPPR says their deportation is ultimately unlikely, the lack of official reassurance is already having a chilling effect on those seeking jobs, housing, bank loans or making other long-term commitments.

The NHS has become increasingly reliant on EU nationals to keep it on its feet, with the numbers employed rising from 33,420 in 2012 to 41,566 in 2014. As of February this year, 57,063 of the NHS’s 1.2 million staff are citizens of other EU countries. The latest figure includes more than 7,000 EU nationals working as consultants or specialist registrars and more than 21,000 as nurses and health visitors.

The IPPR also suggests that any EU nationals who have lived in Britain for more than six years should be automatically entitled to British citizenship, as well as all children of EU nationals who have been educated in the UK. Automatic indefinite leave to remain should be offered to all other EU migrants currently in Britain.

The thinktank says wider reform of the current system of British citizenship is so overly complicated and bureaucratic that it is deterring the high earners that the British economy needs, and is so expensive that it also deters the lower skilled workers that the sectors of the economy that depend on manual labour also need.

To deal with these problems, the IPPR says those with globally competitive skills should be able to pay extra to get a fast-track to citizenship while those in low wage jobs should be offered a government-backed loan – like a student loan – to enable them to pay back the costs of becoming a UK citizen over years.

Meanwhile, a British Future/ICM poll showed that the public does not believe the government will meet its target to reduce net migration to below 100,000 a year by 2020 even after Brexit takes place. In the poll, which was conducted just after the referendum in June, only 37% agreed the net migration target was likely to be reached in the next five years.

The government’s outgoing chief advisor on migration, Prof David Metcalf, also called for a much stronger enforcement of minimum labour standards in the UK to ensure the country’s flexible labour market prevents undercutting by foreign workers and boosts the welfare of British residents.

After nine years as chairman of the home secretary’s migration advisory committee, Metcalf said in a valedictory report that half the current level of immigration – 308,000 out of 630,000 – was work-related. He said skilled migration was much more likely than migration by people with low skills to be complementary to British labour and capital, adding: “They contribute, net, to productivity, the public finances and the employment prospects of local labour.”

Metcalf said the number of labour migrants was heavily influenced by other public and private employer policies, saying that private sector employers had invested too little in the science, technology and IT skills of UK residents, which has led to the constant pleas for such jobs to be given priority in immigration. He hoped that higher migrant pay thresholds and the new £1,000 immigration skills charge would encourage greater training.

He also warned that public spending constraints often led to greater immigration, particularly for nurses, paramedics, care sector and science and maths teachers.

But he said that while low-skilled migration benefited labour-intensive British employers and most such migrants, they also exerted a downward pressure on the pay of low-skilled workers and – in the worst examples – serious exploitation of migrant, and possibly UK, labour.

“Therefore it is crucial that minimum labour standards are enforced,” Metcalf concluded. “Alas, evidence suggests that in pursuing our flexible labour market – which has mostly served us well – such enforcement is inadequate. Incomplete supervision holds for the national minimum wage, labour gangs (particularly in horticulture) and employment agencies for migrants.”

NHS needs EU employees to avoid collapse, says thinktank

Cancer drug appraisal needs to be reviewed | Letters

Sarah Boseley’s article (Cancer drug companies cut prices to win NHS approval, 18 August) is a welcome demonstration of how serious the UK pharmaceutical industry is about doing everything possible to ensure cancer patients get access to much needed medicines, yet it fails to offer a rounded perspective on affordability and drugs availability in the NHS. Our industry is acutely aware that our health service has limited money to treat millions of patients with wide-ranging medical conditions, but continuing to cut prices may not be sustainable into the future and is no silver bullet.

Our industry is playing its part. A long established deal has already seen drugs companies pay back more than £1.3bn to the government in the last 18 months to help keep NHS spending on medicines affordable. Medicines and vaccines offer some of the best – and most cost-effective – measures we have of preventing, managing and eliminating the world’s most debilitating diseases, but whether or not these successfully reach NHS patients requires fundamental changes to the way medicines are appraised, and how they eventually become adopted and used.

By over-relying on the Quality-adjusted Life Year as National Institute for Health and Care Excellence’s main measure of value, many cancer medicines are disadvantaged. More flexibility, as is seen in other countries, is needed. Nice’s basic cost-effectiveness threshold for assessing value for money is also more than 15 years old and has not kept pace with either the cost of R&D or the NHS budget. With cancer medicines now more effective than ever, we are seeing scenarios where some new medicines used in combination with established treatments would, perversely, be rejected by Nice even if they were given away free due to the fact that patients are living longer.

With 7,000 new medicines in the pipeline in Europe today our industry delivers real innovation for patients. To make sure that the most effective of these are adopted and made available, companies need to offer value for money and the health system needs to ensure that assessment methods are fit for purpose. This is crucial if we are serious about delivering a world-class health service now – and into the future.
Dr Richard Torbett
Executive director, commercial, Association of the British Pharmaceutical Industry

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

Cancer drug appraisal needs to be reviewed | Letters

7 Obvious Signs Your Body Needs to Detox

Even though our organs do a good job detoxifying the body, we need to detox once in a while. But most of us don’t know when we should detox. Gladly, there are some symptoms the body experiences when we need a detox.

It’s normal to experience these symptoms from time to time but if they happen frequently that’s a definite sign that you need to detox.

Here are 7 warning signs that you need a detox.

1. Fatigue

If you’re one of those people who is tired when you wake up, during the day, after work, and at bedtime, you need to detox. Most people drink coffee and other caffeinated beverages to make up for low energy but this doesn’t work long term. The fatigue will kick in again after the caffeine levels go down. Doing a detox is more effective pills or beverages.

2. Lack of sleep

If you have trouble sleeping that could be a sign that your body has excess toxins. Research shows that toxins like mercury disrupt the quality of sleep. Instead of taking drugs if you lack sleep, first detox and see if it’ll improve the quality of your sleep. Other things like keeping the bedroom dark and cold can help you sleep better.

3. Frequent headaches

It’s normal to experience headaches if you have a hectic day or you’ve overworked. But if you can’t identify the cause of your headaches, they could be triggered by toxins. Like I mentioned above, detox should always be the first option before exploring other options. But if your headaches are severe make sure you see a doctor immediately.

4. Inability to focus

Do you have mental fogs frequently? Or easily lose concentration when focusing on important things? Detoxing can help clear your mind and improve concentration. Exercise can also help you stay focused.

5. Constipation

Toxins can also affect your digestive system. So you need a cleansing if you experience frequent constipation. Eating vegetables, chia seeds, and so on can help cleanse your digestive system. And make sure you drink enough water.

6. Weight loss resistance

Toxins hinder digestion, slow metabolism, and ultimately make it harder to lose weight. If you are already maintaining a calorie deficit, exercising, but not losing weight, do a detox. It’ll be easier for the body to absorb nutrients and digest food once you get rid of toxins.

7. Allergies

If you frequently have unexplained skin rashes and allergies it could be due to toxins. But you need to be really keen because your allergies may be caused by daily habits without realizing. And note that some detoxes cause rashes and skin problems but they’re only temporary.

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7 Obvious Signs Your Body Needs to Detox

Family planning is a key development goal that needs greater investment | Letter

Family planning is much more than a vital health and human rights intervention (Critical moment for family planning as funds come under pressure, 28 July). Investments in voluntary family planning are also investments in sustainable development, and therefore should be of as much of concern to ministers of finance as to ministers of health.

In the developing world, about 190 million pregnancies occur each year, of which 73 million (39%) are unintended. These unintended pregnancies often end in abortions (49% of the time, and many unsafe), unintended births (38%) or miscarriages (13%), with detrimental health and economic effects for many women and their families. Behind these statistics are untold stories of human suffering and lives taken off track, underscoring the urgent need for greater investments in family planning.

Related: Critical moment for family planning as funds come under pressure

However, only 1% of all overseas development assistance is allocated to family planning. Funding from local governments is typically even lower. In too many countries, programmes remain weak and political commitment is lacking. Family planning is assigned a low national priority, relegated to the health budgets of donors and the portfolios of health ministers, who are often battling a range of other health issues.

From a broader perspective, this low priority is a mistake, because family planning programmes have a wide array of development benefits that often are under-appreciated. In addition to the improved health and empowerment of women and girls, fewer births lead to a boost in the growth of GDP per capita; reduced pressure on the need to build schools, clinics and infrastructure; reduced environmental degradation; and greater political and social stability, as youth unemployment declines. A dollar invested in family planning returns multiple dollars in savings in other development sectors.

Family planning must therefore be reclassified as a development intervention. If we’re truly serious about meeting the sustainable development goals, we must embrace the rare investment opportunities that drive progress on many different development fronts – family planning chief among them.
John Bongaarts
Vice-president and distinguished scholar, Population Council

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

Family planning is a key development goal that needs greater investment | Letter

There needs to be more clarity in transgender healthcare

Imagine this: you’re the parent of a transgender 14-year-old. When they were born you thought your child was a girl, but it has been very clear for many years that they identify completely as a boy. He’s been known by a male name in your house for years and would be revolted if anyone used a female pronoun for him or referred to him as a girl.

You have been to see your GP, who has referred your son to the Tavistock clinic in London, the gender identity service for under-18s in England and Wales. But because of an unprecedented increase in the number of referrals over the past year, Tavistock has said it will be eight months before your child can be seen. He has just begun female puberty and is starting to panic about growing breasts, changing shape and getting a period. He is desperate not just to be put on hormone-blockers, which will prevent his female puberty, but also to be put on male hormones, so he can start male puberty, which the Tavistock clinic will not prescribe until he is 16 and has spent a year on hormone-blockers.

You’ve heard there are GPs who operate privately and prescribe hormones to children. But you’re not sure if this is legal: if there are age restrictions in NHS clinics, surely, you think, there are guidelines to restrict private practitioners as well. You read up and call around. But no one can give you a clear answer. Worse, no one even knows who you should talk to in order to get one.

Related: UK doctor prescribing cross-sex hormones to children as young as 12

Two weeks ago, the Guardian launched a series looking at some of the issues facing trans people. I spent weeks talking to trans people, their families, trans support charities, as well as doctors and psychiatrists. One issue that came up again and again was that there was an utter lack of clarity when it comes to some issues relating to transgender healthcare.

The issue of private prescriptions of hormones to teenagers is a good example. The NHS guidance says cross-sex hormones can’t be given to patients under 16 at its gender identity clinics, but after talking to a GP who prescribed cross-sex hormones to patients as young as 12, I tried to find out if there are similar guidelines or laws in place that applied to private gender specialists. It seems there aren’t, but the process of getting an answer to that question was beyond farcical.

I first put the question to NHS England, which told me it was a matter for the General Medical Council, which in turn referred me to the National Institute for Health and Care Excellence (Nice) and back to NHS England. Nice said it hadn’t been asked to write guidance on the subject and that this was a matter for the Department of Health. The department said that since private GPs were regulated by the Care Quality Commission (CQC) I should talk to them; the CQC said its job was to enforce guidance, not write it, but suggested speaking to the Royal College of General Practitioners and the Royal College of Physicians, both of whom couldn’t help.

I finally got a statement from the Royal Pharmaceutical Society, which said: “Doctors have to carefully consider each prescribing decision they take based on their own clinical judgment. Medicines can be prescribed off-licence as long there are sound clinical reasons for doing so.”

Trans people shouldn’t have to have some sort of NHS Rosetta Stone to work out what treatment they are entitled to

This is just one example of the muddy, bureaucratic waters that trans people have to swim in order to understand what healthcare is available to them, never mind trying to access it.

In Scotland, for instance, the current guidance says that people under the age of 16 can be prescribed cross-sex hormones if they are thought to “have enough intelligence, competence and understanding to fully appreciate what is involved in their treatment”.

But this is not the understanding of the only gender identity clinic that treats children and adolescents in Scotland, Sandyford in Glasgow, which has said that Scottish services don’t prescribe cross-sex hormones to under-16s and the reason the 2012 protocol says something to the contrary is that it “contains some inaccurate information and requires updating”.

And then there is the raging debate surrounding “bridging prescriptions”. Doctors at gender identity clinics (GICs) say “bridging” prescriptions are meant for patients who have been through an assessment at a GIC and have been prescribed hormones but who have, for example, moved away and need a prescription for hormones to tide them over while awaiting an appointment at a new clinic.

Talk to some trans charities and you hear a different story. They say bridging hormones can be issued to someone who has never been to a gender clinic, but who is on the waiting list to get in. They argue that since waiting times for treatment are so long, GPs are not only allowed to but are bound to issue hormone prescriptions to patients who ask for them in the name of harm reduction.

Related: Gender identity clinic for under-18s sees number of referrals double

I have read everything I can find on bridging prescriptions and I am still not confident as to what they are. The guidelines from the NHS (pdf) are unbelievably vague on the subject.

Trans people shouldn’t have to have some sort of NHS Rosetta Stone to be able to work out what treatment they are entitled to. They shouldn’t have to call nine separate health bodies to get a vague answer about whether a private GP can prescribe hormones to their child. And doctors – both within the NHS and operating privately – should have clear guidance about what treatments they can and can’t offer.

These questions aren’t for the sake of pedantry. If doctors aren’t confident of what’s legal or recommended when treating trans patients, then they will either err on the side of caution and not offer medical intervention when they should; or offer interventions when they shouldn’t, out of a desire to help.

It is only when there is clarity on trans healthcare that doctors who want to do the right thing will be confident of what that is, and that trans people will be able to get the treatment they need and to which they are entitled.

There needs to be more clarity in transgender healthcare

The NHS needs more women leaders

‘We are failing to tap into the vast talent pool obtainable to us,’ writes Karen Castille. Photograph: Johannes Eisele/AFP/Getty Photographs

Have you ever felt like the odd 1 out? I have. I was meeting some of the most potent leaders in the NHS, and as soon as I walked in I felt distinct. I was noticeably shorter and slimmer, and I was not sporting a dark suit. I was the only female in the room. As I sat down the tea trolley was wheeled in and the chairman asked if I would like to pour the coffee for everybody.

The NHS has not nevertheless taken the concept of achieving gender stability on boards significantly. But the enterprise world, in contrast, has decided that it does matter. They believe there are tangible benefits to achieving greater balance at the top. Accordingly they are gradually, but successfully, addressing it. Girls now account for 20.seven% of board positions in FTSE one hundred businesses, up from 12.5% in 2011. In March this year, Cranfield University and Lord Davies of Abersoch both published specifics of the progress produced by FTSE companies.

In contrast the NHS has 37% of board positions filled by girls. Sound excellent? Not truly. The bulk, 77%, of the total NHS workforce are women, compared with 46% ladies in the complete of England’s doing work population. Set in this context, my analysis of how the NHS is doing on gender balance is that we are failing.

So why does it matter for the NHS? There is proof that higher gender stability at the leading improves economic and operational performance. I could also add that, in the wake of vacant difficult-to-fill NHS chief executive and director posts, we are failing to tap into the vast talent pool obtainable to us. But, for me, it issues for an even a lot more critical explanation. I am referring to that notoriously challenging to measure and alter situation – culture. In 2013 three seminal reviews (Francis, Keogh, Berwick) described failings in (some) NHS organisations and every single emphasised the need for NHS culture change. There is no simple or single way to modify culture, but improving the gender balance of leaders is a single of the levers however to be exploited (a stage also emphasised by Lord Davies in his report).

This is not about females currently being greater than males or without a doubt the reverse. Rather, evidence has proven that ladies have different skills than men. Whilst males are frequently discovered to be more powerful at approach, women are regularly powerful on taking initiative, integrity, honesty, creating relationships, collaboration and teamwork. The concern is greater balance, not simply much more women. I would be equally compelled to make the case for much more men if there were any all ladies boards. My level is that when men and women work together in NHS teams and on boards, there is a far more various variety of suggestions and perspectives, richer dialogue, much less group consider and much better challenge. In addition, balanced leadership teams better reflect the diversity of patients, employees and the wider public that the NHS serves.

The NHS has a lot to do to obtain an boost in women leaders. Important studying from FTSE businesses consists of encouraging and supporting the pipeline of girls in the method as our likely leaders of tomorrow. They have shown that this can be attained by supporting talented ladies to fulfill their prospective on merit, rather than by means of the enforcement of quotas.

More than the past twelve months the NHS Confederation has been operating in partnership with Dame Sally Davis, the chief health-related officer, the Royal Schools and other people to increase the situation of gender balance and supporting girls leaders across the NHS.

My hope for the future is that I can walk into a room of senior NHS leaders and for it not be uncommon that I am a female. I want the NHS to find a way of tapping into the deep pools of potential that exist inside of the ladies in its workforce, possible which goes way past the realms of producing very good coffee. The opportunity is waiting to be exploited. With each other with individuals, males and females leaders can collectively work to co-develop a new culture in the NHS.

Karen Castille, OBE, associate director at the NHS Confederation, will be speaking at the yearly NHS Confederation conference on Thursday 5 June.

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The NHS needs more women leaders

The NHS needs a leadership revolution | Michael West

Horizon scanning … NHS boards should prepare very carefully for the amount and design of leaders they will require for the potential. Photograph: WestEnd61/Rex

There are a growing number of warnings about the issues NHS leaders face. An ageing population with a lot more complex overall health demands, a difficult financial climate with no expectation of substantial new money, expanding worries about employees pressure amounts, public expectations that care must be delivered with compassion and respect – there are just some of the concerns NHS senior staff are getting to grapple with. They call for revolutionary alter to the way care is designed and provided they also call for a revolution in leadership.

The difficult, complex and modifying surroundings of the NHS requires our leaders to collaborate and co-operate across boundaries, among – not just within – their organisations. We want more emphasis on team and inter-staff doing work and considerably higher involvement of frontline employees.

The correct cultures of care will not emerge overnight. You are not able to mandate compassion in an e-mail from the chief executive. For employees to have a clear thought of the specifications they should meet requires time, dedication to the growth of men and women and teams – and a plan.

These new leadership capabilities will not emerge by chance. We should program for the leaders with the capabilities necessary in area ahead of time. This will call for method rather than piecemeal options to leadership and organisation improvement. And core to these abilities and to the technique for developing them is a recognition that we want collective leadership. We need to have leaders who make the accomplishment of their neighborhood overall health and social care program their priority, not just the achievement of their individual region. So we should attract leaders who will take the correct method to delivering care for the future.

In result, we need to have all leaders to move overall health and social care organisations from fragmentation to integration from tribes to interdisciplinary and inter-organisational teams from inner focus to external concentrate from domination and manage to enabling collaboration from secrecy to transparency and from conflict and conflict avoidance to doing work by way of.

Leadership is the most important influence on culture – every interaction by each and every leader in healthcare shapes the culture of their organisations. The ideal leaders advertise participation and involvement as their core technique market suitable employees autonomy and accountability for improvement guarantee employees “voices” are encouraged encourage personnel to be proactive and revolutionary steer clear of command and management except in crisis consider action to handle systems problems and needless tasks that avoid staff from delivering high good quality care deal efficiently and swiftly with quarrelsome, rude and disruptive behaviour and poor overall performance, particularly (but not solely) amid senior staff and, above all, they model compassion in dealing with individuals and employees.

The most efficient NHS boards are now preparing for the variety of leaders they will require in every single spot the attributes they will need of these leaders  preparing to make sure that varied groups are appropriately attracted and appointed to leadership positions at every single degree and attracting strong fields of candidates from clinical backgrounds.

The urgent problems require sensible and extended-term answers. The King’s Fund is therefore doing work with the not-for-revenue Center for Imaginative Leadership in North Carolina to aid NHS organisations develop the leadership techniques and abilities they need to have. Hopefully, that need to ensure continually enhancing, large top quality, compassionate care to all in our communities.

Michael West is a senior fellow at the King’s Fund. The King’s Fund, in partnership with the Center for Creative Leadership, published two reviews on collective leadership to coincide with its NHS leadership summit.

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The NHS needs a leadership revolution | Michael West

Why Labour needs a bolder vision | Alison Benjamin

A five-yr-old girl and her mom wait for a food parcel at a food financial institution in Birmingham. Photograph: Sean Smith for the Guardian

A good friend not too long ago expressed surprise and disquiet that each time she had encountered the NHS in excess of the past 12 months or so, she had not really observed or spoken to any person immediately employed by the National Overall health Services. Her out-of-hrs GP service is run by Harmoni, now part of personal healthcare company, Care Uk, she discovered when she essential an inhaler for her asthma in excess of a bank vacation weekend. And when she visited her regional well being clinic to see a podiatrist, the branding at reception informed her that it was now run by Virgin.

Virgin Care won the contract from NHS Surrey to supply neighborhood companies across significantly of the county from 2012 to 2017. This seemed to have passed my pal by until she essential to see someone about her feet. She didn’t contemplate the services she obtained to be any greater or worse than if the podiatrist had been an NHS worker (she was told her issue was untreatable), however she can not shake off a niggling feeling that it’s wrong for a private firm to be delivering her healthcare, in spite of the reality it is still cost-free at the stage of delivery. She couldn’t quite place her finger on why she felt this way. She is not a member of the Labour party (I am fairly confident she voted Lib Dem at the final election, if she voted at all) and she would argue that our healthcare method ought to be about receiving the greatest service for sufferers at the ideal price for the taxpayer. I suspect what she is objecting to is the dismantling of the NHS by stealth without her or any person else obtaining agreed to it at the ballot box.

Shadow well being minister Andy Burnham has accused the prime minister of putting the NHS up for sale without having permission. In a speech in February, he manufactured it clear that the electorate in England faces a stark option amongst a “public, integrated NHS below Labour” or a “well being industry beneath David Cameron”. And he has vowed to fight the 2015 election on these grounds.

With the general election now just a year away, we will hopefully begin to hear more about what we can count on from a potential Labour government. We already know that it programs to freeze power payments and cap rent increases for private landlords and offer longer, more safe tenancies. Both suggestions are pooh-poohed by the Tories and enterprise leaders the identical ones who warned of the grave dangers of a minimal wage.

Lisa Nandy, the shadow charities minister, is set to announce that a Labour government would repeal the Lobbying Act and eliminate barriers that make it challenging for voluntary organisations to compete with personal companies to win public sector contracts in well being and an array of other public companies.

Yet what we require is a daring vision to transform the Uk from a nation where inequality reigns, social mobility is dead and poverty, deprivation and cuts in welfare all conspire to make kids here a lot more likely to die here prior to they reach their fifth birthday than in any other western European nation (except Malta). The authors of the surprising report into youngster mortality last week, described as “the most authoritative amount-crunchers on health in the globe”, said the substantial costs in the United kingdom have been surprising for a nation with free of charge universal healthcare.

But as public well being guru professor Michael Marmot has pointed out, health isn’t just about companies, but also the type of society in which we choose to reside. Nothing illustrates the failure of this government to create the society I wish to live in far more visibly than the rise of food banking institutions.

Nandy says in her speech nowadays to charities that “the problems we face are not about the dimension of the state, they are about the construction of our economic climate”. She is correct, of program, but unless Labour vows to tear up the coalition’s investing programs, its welfare reforms, and to restructure the economic system, more youngsters will be reliant on handouts of baked beans. So what difference will it make who delivers the NHS public, private or the voluntary sector?

Why Labour needs a bolder vision | Alison Benjamin

The NHS needs a lifestyle-conserving idea how about a well being tax?| Peter Wilby

The NHS: time is operating out for ‘a credible idea for preserving Labour’s most enduring achievement’. Photograph: Ian Waldie/Getty Pictures

The NHS is a monster. Its capacity to eat public resources is with no restrict. That is not just due to the fact of an ageing population or developments in expensive healthcare engineering. It is also simply because of growing expectations. Nobody ever considers themselves to be in ideal overall health: there is constantly a wart to be removed, an irritable bowel to be explored, a cough to be relieved, a intercourse drive to be restored.

Proposals to charge for visits to GPs or for hospital stays are in no way met with something less than public outrage. Failure to supply high-priced medication that give, at very best, an further few months of existence to the terminally sick are denounced by newspapers that otherwise rail towards high taxes. Any proof that a hospital fails to strain each and every sinew to keep alive an ailing 95-year-previous is branded as unacceptable “age discrimination”.

The insatiable growth of the NHS’s demands for money have in no way been far more graphically illustrated than beneath the existing government. Though “ringfenced” from the coalition’s spending cuts, the NHS is extensively believed to be deteriorating to the level of collapse because it needs an yearly budget boost of at least 4% (in genuine terms) to meet rising expectations. It almost certainly requirements more, as cuts in care providers put additional burdens on GPs and hospitals.

Though Tory leaders insist they can be trusted with the NHS, the right’s reply is clear: accept the support is unsustainable and replace it with an insurance-based mostly technique in which, even though fundamental remedy remains free of charge, individuals otherwise get what they pay for in premiums. What is Labour’s response? Other than hoping for some type of financial alchemy from the shadow chancellor Ed Balls, it seems to have none. Proposals for a 1% national insurance coverage surcharge devoted to the NHS – emanating from former minister Frank Area and Nick Pearce, director of the IPPR thinktank and ex-head of the Downing Street policy unit – were floated, only to be disowned instantly by Labour leaders. Final month, calls from Lord Warner, a former wellness minister, for a £10 NHS “membership” charge were dismissed as the ravings of a discredited Blairite.

But a credible notion for preserving Labour’s most enduring achievement in government is desperately required. An earmarked wellness tax may be a single whose time has come, and probably a model for financing other strained public companies and modifying voters’ resistance to taxation.

Gordon Brown introduced a one% national insurance health surcharge in his 2002 spending budget. The trickier question is how far the notion can be extended. Should all health spending come from distinct revenue sources – the total proceeds of NI, say, or a general revenue tax? Need to some thing comparable be completed for schooling? Ought to older people’s care bills be financed from an enhanced inheritance tax? Need to corporation tax go to in-work rewards – which, in impact, subsidise inadequate wages?

Hypothecated taxes, as economists get in touch with them (deriving from the Greek hypotithenai, which means “to give as pledge”), are typically opposed by finance ministries due to the fact they minimize central manage. But they are not new. The Television licence charge to support the BBC is a hypothecated tax so was the “ship cash” raised to finance the Navy, which received Charles I into difficulties. Originally, the proceeds of automobile duty went to a fund for the creating and upkeep of roads (people even now refer to the “road fund licence”). Several American states use petrol tax for a comparable function.

Labour took office in 1997 with a manifesto pledge to finance welfare-to-work from a “windfall levy” on privatised utilities. NI itself started out as a hypothecated tax or “contribution” to fund social safety including pensions (however not the NHS). Numerous countries dedicate “sin taxes” on tobacco and alcohol to well being promotion.

This kind of earmarking can reconnect voters to the functions of taxation. Even Labour politicians now refer routinely to the “tax burden”. Tax is portrayed as a disincentive to enterprise, investment and tough operate. In the public thoughts, tax is one thing “they” invest, almost certainly on ministerial limousines and other “wasteful” luxuries. Nearly no person connects the amount of tax they shell out with the quality of their children’s education or how extended they wait to see a GP.

Nor is taxation connected to, say, transport infrastructure or the abilities of the workforce, which might make Britain a greater place to do company. We require a a lot more adult conversation which tends to make voters inquire if what they achieve in reduced taxes will be outweighed by what they drop in inferior companies – although also comprehending that if they demand, say, costly medicines or shorter hospital waiting lists, they need to shell out higher taxes.

British curiosity in hypothecated taxation peaked in the early 1990s soon after the Thatcher government’s well-known tax cuts the Demos thinktank and the Fabian Society have been amongst the supporters.

Many objections emerged. First, governments tend to raid earmarked money and use them for other purposes, as they did with NI and the road fund. They are also apt, if the earmarked tax is meant to meet only component of a service’s charges, to reduce basic expenditure on that service leaving it no much better off.

2nd, tying investing on vital companies to the yields of certain taxes may make individuals providers dependent on the company cycle. Third, sections of the public – the childless or individuals who use personal training or overall health insurance coverage, for instance – would clamour to opt out of certain taxes. Fourth, the opposition to general taxation may turn into even much more intense, and the strain to minimize unpopular spending items this kind of as advantages or overseas help irresistible. The temptation in an election campaign would be to guarantee 1% greater wellness tax and a two% lower in common taxes.

These objections are not insuperable – the very first and second, for illustration, could be conquer if revenues for overall health or training had been paid into a separately managed fund with its personal borrowing powers. And if hypothecated taxes have disadvantages, basic taxes – which are opaque to a lot of voters – have more.

Like each other centre-left get together in Europe and America, Labour battles towards its opponents’ propaganda good results in casting taxation in a wholly unfavorable light. New Labour experimented with to apply its guarantees without the taxes to shell out for them. It failed. It is time for anything new, and the bolder the better.

The NHS needs a lifestyle-conserving idea how about a well being tax?| Peter Wilby