Anxiety may be the scourge of our times, but it now appears we have “scanxiety”, too. According to a study of 2,000 women, the phenomenon of pregnant women paying for extra private scans is on the rise. Almost a third paid for scans during pregnancy, with 36% citing anxiety as a reason. The NHS offers routine scans at 12 and 20 weeks, although more may be given for medical reasons.
“For the last 20 years, it’s been quite common for women to access private facilities for scans,” says Dr Christoph Lees, a consultant in foetal and maternal medicine and obstetrics and a spokesman for the Royal College of Obstetricians and Gynaecologists. “Sometimes it’s simply for reassurance, or because they don’t feel they’re getting sufficient scans on the NHS. Sometimes they’re accessing a service that isn’t routinely provided, such as 3D and 4D scans. Many are what you might call souvenir scans.”
For Lauren McGlynn, who has two boys aged four and nine months, anxiety was the main reason for paying for private scans. “Before my first son, I had two miscarriages,” she says. “I just couldn’t deal with waiting until 12 weeks. I had a private scan at seven weeks, which is the earliest they will let you do it.” Did she speak to her midwife or doctor about her worries and ask for an early scan on the NHS? “I didn’t say anything,” she says. “I just assumed the NHS wouldn’t be able to give an extra scan to every woman who had a miscarriage.”
Mandy Forrester of the Royal College of Midwives believes the rise may be partly explained by the shortage of 3,500 midwives in England (Lees also points to the national shortage of sonographers). “Midwives are pressurised during antenatal appointments and continuity of care is an issue,” she says. “If a woman is seeing the same midwife, it’s more likely they will build a good relationship. It may be that women are not getting the reassurance they need.”
There is also the issue of the small, unconfirmed risk to the foetus associated with ultrasound, which is why multiple scans without sufficient medical reason are not recommended. “And it’s difficult to know the quality of the service,” Lees adds. “While there are many private providers that are extremely good, there are pop-up services where the person doing the scan doesn’t have any training in ultrasound. You don’t need to have a licence to do an ultrasound scan privately.” Does he often see women who have had private scans that have worried them? “I do see women who come back to me with a private scan report,” he replies. “Quite often we have to repeat the scan and sometimes the advice is not correct. [Private scans] can cause concerns that are not necessarily merited, which rather negates their point.”
• This article replaces an earlier story that was based on an incorrect agency report.
A private healthcare provider has signed a deal with Uber to transport its carers and home patients.
Cera said it had struck a deal with Uber to transport its London-based carers to their patients, while its disabled customers will be able to use UberAssist and UberWav to get out and about.
In a separate deal, Cera is to provide on-the-go care to patients of several NHS hospitals, covering five million people. Specifically, at Barts Health NHS trust, the largest NHS trust in the country, Cera will deliver care for patients, including those with dementia and cancer, in their homes.
A spokeswoman for Barts said, however, that its contract with Cera did not cover patient transport, as had been incorrectly reported by the media [including the agency report on which the earlier Guardian article was based].
“We do not have any contracts with Uber to provide non-emergency patient transport,” she said. “When patients need assistance getting to and from our hospitals we provide ambulances and medi-cars, driven by trained experts.
“We are working with a number of registered organisations, including Cera, to make sure patients get vital support in their own homes. This includes physiotherapy, nursing or domestic support to help people recover after a stay in hospital.”
Cera was launched in November 2016 and is regulated by the Care Quality Commission.
In a statement announcing the deal with Uber, Cera said: “The partnership will enable Cera’s London-based carers to use Uber to get to the people they are caring for as quickly and seamlessly as possible.
“It will also give those who need care the freedom to book cars so they can get out and about when they would otherwise have been housebound, or had to rely on someone else.
“Disabled customers, or those who need a little extra help, will be able to book UberAssist – or a fully wheelchair accessible vehicle through UberWav – driven by one of Uber’s hundreds of fully licensed and top-rated partner drivers, who have been through a specially designed disability equality training course.”
Dr Ben Maruthappu, a former doctor and Cera’s co-founder, said the Uber deal would “radically integrate care and transport through technology”, adding: “Older people and those with disabilities will now have access to the highest-quality drivers, while carers will be able to efficiently travel to ensure they can provide services in the right place at the right time.”
The Unison general secretary, Dave Prentis, said: “Social care and the NHS are in such a state of crisis that any initiative to ease the pressure will be welcomed by patients and staff.
“But the funding chasm between what is needed and the pitiful amount councils currently have to commission care is too deep. Nothing short of an emergency injection of cash in the budget, followed by the sustained and realistic funding of health and care will be enough.
“The government must also ensure that all companies that win care contracts don’t exploit staff and pay at the very least the minimum wage. Sadly there are still many out there breaking the law and getting away with it.”
David Mowat, the minister for community and social care, said: “This is an interesting and innovative proposal which will help raise awareness of the challenges faced by the vulnerable elderly, and those with specific conditions that are becoming increasingly common in our society.”
Ambulance services are increasingly calling in private firms to respond to 999 calls in the latest sign that NHS care providers are struggling to cope with the sharply rising number of patients who need urgent medical attention.
The London ambulance service (LAS) has had the biggest increase among England’s 10 regional ambulance trusts. The amount it spent on private ambulance providers soared from £700,000 in 2011 to £10.1m last year, a thirteen-fold increase.
Cost of private ambulances
Many other NHS ambulance services are also spending more of their budgets on private firms because of their growing reliance on them to meet demand.
For example, the amount paid out by South East Coast ambulance service (Secamb), which covers Kent, Sussex and Surrey, rose from £5.8m in 2012 to £11.6m last year, though it spent even more than that, £14.5m, in 2014.
Similarly, Yorkshire ambulance service paid private services £1.85m in 2014-15 to respond to 10,862 incidents. Last year that jumped to to £7m for attending 38,821 incidents.
The number of calls for assistance in London to which private ambulances have responded rose from 5,024 in 2011 to 59,749 last year. The figure includes both 999 calls and non-urgent journeys to hospital or other medical appointments.
Number of private ambulance responses
The trend has sparked serious concern about the NHS’s chronic shortage of paramedics, which has coincided with big annual rises in emergency calls to all 10 ambulance services in England.
“Ambulance services are not something that should be flung out to the private sector,” said Tim Farron, the Liberal Democrats leader, who obtained the figures for London under a freedom of information request.
“We should not be offering this out to the lowest bidder. It’s not what people want or expect, and the NHS needs more paramedics.”
He said increasing demand was forcing NHS services to draft in private operators to ensure calls were answered on time. “Without the private providers we would currently not have enough resources to get to all the patients who need an ambulance.”
East Midlands ambulance service’s spending on private firms has also risen, up 15% from £4.47m in 2013-14 to £5.15m in 2015-16.
North West ambulance service used to pay only St John Ambulance and the British Red Cross to supplement its own services. But in 2014-15 it began using private providers for the first time, spending £998,741 on seven firms during that year, including QAS Ambulance (£244,365) and Trust Medical (£206,744).
Paul Woodrow, the director of operations at LAS, said: “We have seen a 45% increase in the number of life-threatening incidents in the last five years, responding to 504,685 category A incidents in 2015-16 compared with 347,659 in 2010-11. To continue providing a safe service to Londoners, we use three carefully selected providers in a similar way to hospitals employing agency nurses.”
Crews employed by all three providers “are appropriately trained at either paramedic or emergency medical technician level and carry the same equipment as our crews”, he said.
However, some NHS paramedics claim that private ambulance personnel are not always as well trained as them.
One Secamb paramedic said: “We as crews think they are not as well trained as us and we regularly have to travel with them and the patient to hospital because they cannot cope.
“They are good people but don’t have the same level of training as Secamb staff. This is not good for the patient as their skill set is well below ours. Often they call up asking for para backup, meaning they can’t manage that patient.”
LAS spending on private firms increased almost seven-fold inside one year, from £700,000 in 2011 to £4.8m in 2012, and then more than doubled inside the next 12 months to just under £10m in 2013. It fell slightly in 2014 to £9.2m but then rose to £12.2m in 2015, before falling to £10.1m last year.
Paul Evans, the director of the NHS Support Federation, a research group, said: “Ambulance services sit at the epicentre of the crisis in health and social care services and it’s not surprising they are struggling to cope with demand, but even so this is a shocking escalation in privatisation.
“Resorting to private providers is not the answer if we want to secure safe and effective emergency services. The evidence shows that they use fewer paramedics than NHS crews, which impacts upon patient safety as they will inevitably be sent to treat patients that they are not qualified for and leads to more situations where more experienced staff have to be sent to take over.”
Late last year Coperforma, a private transport firm, had to hand back the £63.5m contract it had held only since April for taking patients in Sussex to non-urgent hospital appointments after a series of blunders. Some of those involved cancer patients, and led MPs and others to describe its service as “a shambles”.
Evans said: “That shows that there are serious flaws in outsourcing theses vital services.”
Christina McAnea, the head of health at the Unison union, said: “Strained NHS finances have led to staffing shortages where shifts aren’t covered and ambulance services have no option but to call on private companies to fill the gaps.
“But the millions of pounds used hiring private ambulances would be better spent filling vacancies and holding on to those highly skilled staff who are leaving in droves.
“Ministers must accept that by continually slashing budgets they are forcing ambulance services into short-term solutions for urgent long-term problems. This helps no one.”
The number of people in Britain taking out private medical insurance has risen significantly for the first time since 2008, amid fears about the ongoing crisis gripping the NHS.
After falling steeply between 2008 and 2011 and then staying flat, demand for private medical insurance cover in Britain rose by 2.1% in 2015 with just over 4 million people insured.
The figures, compiled by healthcare consultancy LaingBuisson, account for the period until the end of 2015. Figures for 2016 are not yet available.
Philip Blackburn, an economist at LaingBuisson, said: “There has been a clear rise in interest in private healthcare recently as more and more people are dissatisfied with higher waiting on the NHS and increased restrictions on NHS treatment. Private medical cover will benefit from this, and there is a wide choice of policy options at different prices to attract customers.”
The rise in sales of private medical insurance (PMI) comes despite increases in insurance premium tax (IPT) during the period from 6% to 9.5%, which has made policies more expensive. But the private medical industry is still far below its peak in 2008, when 4.35 million people – 12.4% of the UK population – had private cover. After the rise in 2015, a total of 4,022,000 people have cover, or 10.6% of the population.
All of the rise in private cover is coming through company schemes, where the number of employees with medical insurance rose by 3.4% to 3,070,000 people, or 76.3% of the total. This suggests that the increased popularity of PMI may be down to a recovery in the economy and companies taking more staff, rather than fears about the state of the NHS.
The number of individual subscribers to private medical insurance continued to decline, dropping by 1.7% to 952,000.
Most are put off by the rising cost of buying cover independently. A typical PMI policy for a healthy 35-year-old costs about £650 a year, but this rises steeply to £2,300 for those aged 70, when claims are far more likely.
But the LaingBuisson data suggests that the companies and private hospitals selling cover are enjoying bumper profit margins. Companies and individuals spent £4.7bn on private medical insurance in 2015, but the total value of claims was £3.6bn, leaving the providers with a gross profit of £1.1bn.
LaingBuisson estimated that the total gross profit margin for PMI providers rose from 25.9% in 2014 to 26.7% in 2015. But it added that further tax rises and Brexit may make 2017 a tough year for the industry.
“A sharp increase in IPT from 6% to 9.5% effective from November 2015, and further rise to 10% from November 2016 has loaded significant additional cost for all medical insurance customers. A further hike to 12% in June 2017 will tighten this ‘taxation straitjacket’, and in an industry where affordability has been identified as the primary reason for a lack of growth in demand, this hefty additional burden is likely to mean demand for PMI is vulnerable going forward,” said Blackburn, adding that “the medical cover sector faces further uncertainty from the UK’s impending exit from the European Union.”
NHS organisations are paying millions of pounds to private firms that stop patients being referred to hospital by their GPs, an investigation has found.
Controversial referral management centres are used by some clinical commissioning groups (CCGs) to scrutinise patient referrals to hospitals by family doctors.
Supporters say they can reduce inappropriate referrals, saving the NHS money, but critics argue that adding an extra layer of scrutiny risks delaying diagnosis. There is also doubt over the effectiveness of such schemes.
In an investigation, the British Medical Journal (BMJ) sent freedom of information requests to all 211 CCGs in England. Of the 184 that responded, 72 (39%) said they commissioned some form of referral management scheme.
Almost a third (32%) of the schemes are provided by private companies, while a further 29% are provided in-house and 11% by local NHS trusts. Some 69% of the CCGs with schemes gave details of operating costs. These CCGs combined have spent at least £57m on schemes since April 2013.
Most CCGs were unable to provide evidence showing the scheme saved money. Only 14% could show that the scheme had saved more cash than it had cost to operate, while 12% showed that their schemes had not saved money overall.
Meanwhile, 74% of CCGs (53 groups) failed to supply figures to show whether any money had been saved, the BMJ reported.
Some CCGs did not collect data on savings, some said their referral scheme was designed not to save money but to improve the quality of referrals, and others declined to disclose details of savings on the grounds of commercial confidentiality.
Overall, there were 93 referral management schemes in operation across 72 CCGs, with some CCGs having more than one.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, told the BMJ: “[CCGs] are leaping at these schemes without any clear evidence of benefit. They are just hopeful that it might reduce their costs.
“It is a very short-term approach to healthcare management. We need to see much more evaluation … and not just keep making the same mistakes year after year. As public bodies, there should be an expectation on every CCG to account for what it is doing.”
Vautrey said some schemes were helpful because they gave GPs rapid access to advice from local specialists.
Graham Jackson, co-chair of NHS Clinical Commissioners, the membership organisation representing CCGs, said referral management was only one way of managing demand for services.
“In many cases they provide a useful and effective role which is more than a redirection service,” he said. “CCGs will balance the cost of commissioning with the benefit they provide to GPs and patients in terms of peer review, education, caseload management and choice.”
In October, Roberta Blackman-Woods, Labour MP for City of Durham, criticised a local scheme to screen referrals for conditions including cardiology, gynaecology and gastroenterology.
The North Durham CCG has awarded a contract to the private firm About Health to manage referrals.
The sad death of journalist AA Gill from lung cancer has led to a barrage of criticism of the NHS. In his last piece for the Sunday Times, Gill described how his cancer had spread, despite conventional treatment, and how he was then unable to get a pioneering treatment called immunotherapy on the NHS.
Gill described asking his oncologist, Dr Conrad Lewanski, why the UK is “such a bad place to get cancer”. Lewanski replied: “It’s the nature of the health service. The key to cancer outcomes is the speed of diagnosis and treatment.” In response to the piece there have been letters and articles supporting the perception that you will be doomed if you rely on the NHS. It cannot be acceptable, writes oncologist Dr Mark Saunders, “that in a 21st-century NHS, patients must have to pay privately for a drug that can extend life”.
Gill paid for the drug Nivolumab privately; unfortunately, it wrought no miracles. Nivolumab, marketed as Opdivo, is a so-called checkpoint inhibitor, helping the body’s immune system to attack cancer cells by boosting the impact of our own T-cells. National Institute for Health and Care Excellence (Nice) has approved the use of this drug in advanced melanoma, but ruled that it’s not cost-effective to offer it to all patients who have the specific kind of lung cancer Gill had. Instead, Nice recommends that these patients are tested for a certain biomarker, which predicts whether they are more likely to respond to Nivolumab. Funding could come from the Cancer Drugs Fund for these patients, who make up a third of those with this type of lung cancer.
Reaction to Gill’s death has included a wave of letters and comment along the lines of: “God help me if I get cancer and have to rely on the NHS.” Many issues and arguments have been thrown into the pot along the way, including lack of funding for advanced cancer drugs, late diagnosis and poor cancer survival rates in the UK compared to some other countries. Gill himself thought delays in getting a GP appointment, rushed consultations, delayed referral and slow investigations might all play a part, although he visited a private doctor until he started treatment, so wasn’t able to present personal evidence for his view.
But he may well have been right and there is no doubt that we could do better. The five-year relative survival rate for breast cancer in England in women diagnosed up to 2007 was 79.1%, compared to 86% in Sweden. And the corresponding figures for bowel cancer were 51.3% in England compared to 62.2% in Germany.
AA Gill, journalist and restaurant critic, dies aged 62
So for those of us who live in the UK and rely on NHS care, just how bad is it to get seriously ill here? The Organisation for Economic Co-operation and Development (OECD) produced a pithy summary of the state of UK healthcare last year. It said access to care is good, while quality of care is “uneven” and “continues to lag behind that in many other OECD countries”. We’re good at keeping people with diabetes out of hospital, but less good when it comes to asthma and respiratory diseases. UK health spending per person is slightly below the OECD average. And the main factor the summary highlights is the fact that we smoke, drink and overeat more than the OECD average. “To reduce premature mortality, more attention to tackling health risk factors – smoking, alcohol consumption and obesity” are needed, according to the report. Public Health bodies are trying, but the alcohol, sugar and tobacco lobbies are powerful brakes on change.
And what about if you get cancer? Should you board a plane as soon as you’re diagnosed? In truth, survival following diagnosis for cancer has improved in the UK over the past 10 years but we are still in the bottom third of OECD countries in five-year relative survival for colorectal, breast and cervical cancer. On the plus side, writes the OECD, “survival rates are improving at least as fast as the OECD average”.
Perhaps the solution lies in taking out private health insurance? But buyer beware: read the small print. Insurance companies pay for some treatments, not others. Say you find you have a genetic mutation that gives you at least a one in two chance of getting breast or ovarian cancer. You may want to opt for risk-reducing surgery as Angelina Jolie and Sharon Osbourne did. But you may be surprised to learn that most health insurance policies won’t cover you for any form of preventive treatment; you have to wait until you get the cancer to be treated. If you want it done, you will be able to get it on the NHS if eligible.
But why have any system at all? Why not just stow away some cash and use it to buy whatever healthcare you need directly? That would work if you have unlimited wealth, never get sick and are determined not to access modern medicine even if one of your kids gets seriously ill.
Most would agree that we do need some sort of system in place for our healthcare. And there is no system on Earth that offers the full range of treatment options as soon as they come to market. Each system in operation has pros and cons; it is tempting but daft to attribute headline figures about cancer survival rates in different countries entirely to the way they deliver healthcare.
The NHS is not the monolithic, static system some would have us believe; there is scope to deliver the evolutionary changes that we certainly need. This means adapting to the new opportunities offered by science and technology; expect to see rapid innovations in coming years in the field of genomics and artificial intelligence. And there will be more emphasis on promoting wellbeing and preventing ill-health rather than just treating disease. This can only happen if the NHS engages better with patients, carers and citizens. That’s the vision, and we’re all a part of it.
Income received by NHS hospital trusts from private patients has risen by 23% in the last four years, as waiting lists for non-paying patients have soared.
Under the government’s reforms, hospitals have been given the right to raise 49% of their funds through non-NHS work, often from patients seeking to avoid waiting for surgery. Prior to this, there had been a 2% cap on income that could be raised from private patients.
Ministers revealed in parliament that in 2015-16, hospitals in England received £558m from patients choosing to pay private – up from £454m four years earlier. The figures come as the number of patients waiting more than 18 weeks for treatment has increased by 54% during the same period. Of those treated in October, more than 360,000 patients had been waiting for 18 weeks or more for treatment, according to the latest data from NHS England, compared to 234,030 in October 2011.
The shadow health minister, Justin Madders, said: “This government is presiding over a two-tier system, where the wealthiest in society can pay to jump the queue. The Tories’ disastrous top-down reorganisation has allowed hospitals to fill up to half of their beds with private patients while leaving NHS patients waiting longer on ever-growing waiting lists.
“The NHS is stretched to breaking point at the moment, so for it to be seeing more and more private patients is an unforgivable position to be in. Access to healthcare should be based on a patient’s needs, not ability to pay for treatment, and this government needs to act in the interests of all patients, not just those who can stump up cash for quick treatment.”
Hospitals have been told to discharge thousands of patients and pass some scheduled surgery to private organisations to reduce pressure ahead of a potential winter crisis, it was reported.
Leaked memos also revealed that managers have been banned from declaring black alerts, the highest level, when hospital services are unable to cope with demand, the Daily Telegraph said.
The newspaper claimed instructions were sent by NHS England and the regulator NHS Improvement last month to reduce the levels of bed occupancy in hospitals, which are the most crowded they have ever been ahead of winter.
In the three months to the end of September, 89.1% of acute and general beds were full, compared with 87% last year, prompting the order for hospital trusts to take the drastic measures.
The goal is to reduce occupancy levels down to the recommended safe limit of 85% from December 19 to January 16, the Telegraph said.
Dr Mark Porter, chairman of the British Medical Association, said: “This is evidence of an over-stretched healthcare system that the government has failed to properly fund, which must outsource patient care to private providers to cope with predictable patient demand.”
Hospitals have been told to turn to the private sector to “maximise elective activity”, with operations such as knee and hip replacements likely to be among the outsourced procedures to help free up beds for urgent patients.
The measures are likely to have a significant cost to the NHS.
NHS England said plans to pace elective programmes and hospital discharges are put in place every year to maximise bed availability and reduce the possibility of cancelled operations.
A spokeswoman said: “Our ambition to reduce bed occupancy in hospitals over the festive period is about timely discharge and getting people to the most appropriate care setting ahead of the holidays, so there is capacity for early January when we know pressure is greatest.
“This is part of our well-rehearsed winter preparedness every year.”
A spokeswoman for both NHS England and NHS Improvement added there was a lack of a historic national protocol for hospitals when declaring alerts, leading to “a hotchpotch of confusing terminology”.
She said: “This has led to confusion between hospitals, ambulances and the public over what is happening, how to respond or how they can help.
“The new NHS guidelines are for hospitals to use when managing local operational pressures in order to deliver a consistent approach across the country.”
I’m afraid Stephen Dalton is wrong about pretty much everything (Private money is the NHS’s saviour, not its bogeyman, 22 November). Where sustainability and transformation plans have been published (most have been shrouded in secrecy, and for good reason) it is clear that cuts and closures are on the way. For instance, 600 GPs are to be reduced to 400 in one part of London alone, and maternity units and A&E departments face the axe. We have the second lowest number of hospital beds per capita in the EU, and that is set to fall further. Dalton says we must move care away from hospitals, but that means investing in primary and community care, both of which have been undermined and cut.
Dalton says that the private sector can help the NHS. Well, up to a point, Lord Copper. The private sector has always been there, but as a peripheral presence and not competing with the NHS. The compulsory competition introduced by Andrew Lansley has been a very costly failure. The private sector is expensive, unaccountable, and will walk away when it can’t make a profit. By cherrypicking profitable services it destabilises the local NHS, which can’t drop the expensive work or turn away patients with complex problems. And its ethos is questionable, leading, for example, to profits being sent offshore with no tax paid.
The answer for the current NHS crisis is to fund the NHS to the EU average (it is currently heading down to less than 7% GDP), to deal with the costly market and PFI schemes which are wasting money hand over fist, to value and support the staff, and to stop re-disorganising it every two years in a futile effort to sort out the last political mess inflicted on it. Dr Jacky Davis Founder member, Keep Our NHS Public
• The article by Stephen Dalton is simplistic in the extreme. Here in Cornwall we have examples of two of the privatisations he extols. Both failures.
Twelve years ago a panel I was a member of voted to give Serco the out-of-hours service for Cornwall. It was a mistake. They were condemned by a parliamentary committee for cooking the books and they have since abandoned the contract. I voted against them.
In 2014 the Royal Cornwall hospitals trust board of which I was vice-chairman voted to allow Mitie to run their hotel services, catering, cleaning etc. I voted against. They have proved to be a disaster. If Stephen Dalton wishes to write these misleading articles he should at least give examples of the successes of privatisation. Does Hinchingbrooke ring a bell with him? Rik Evans Truro, Cornwall
• Stephen Dalton argues that “examples of beneficial of private sector involvement include … more rapid discharge from hospital through well-established ‘recovery at home’ services and access to private sector community diagnostic facilities”. Meanwhile you report that the private company Mitie has said it would withdraw from its healthcare business, which provides home care for the elderly (Mitie profit warning as it bales out of elderly care, 22 November); your article quotes the chief executive as saying that government spending cuts had made the healthcare business unviable: “If we are serious about social care in the UK it needs significantly more than the funding that has been suggested.” Quite.
More generally it is worrying that Dalton, as chief executive of the NHS Confederation, still does not understand that for private companies profits come before patients, and that any system that has to fork out to shareholders has less to spend on care. Supposed benefits from “greater efficiency” usually means cutting corners and paying workers less. Dr David Griffith London
• Despite Stephen Dalton’s assertion of an apparent “political negativity” towards privatisation of the NHS, the non-public-sector involvement within our healthcare system actually continues unabated: the Department of Health’s funding of “independent sector providers” rose from £4.1bn in 2009-10 to £8.7bn in 2015-16. And a study published in the Journal of Public Health in July this year found that: “An increased use of private sector provision by NHS boards was associated with a significant decrease in direct NHS provision and with widening inequalities by age and socio-economic deprivation.” Steven Jouanny Sheffield
• We completely agree with Stephen Dalton’s assertion that we need to shift the focus away from hospitals in order to help create a more sustainable NHS. However, being more open to private providers is not the only answer.
The mixed economy for end-of-life care in the UK is a case in point, and the role of charitable hospices in this should not be overlooked. Last year hospices in the UK spent more than £868m on care and supported 200,000 people with life-limiting conditions – a significant contribution to the UK’s health economy.
Hospice care is provided free and yet hospices receive only a third of their funding from the NHS, having to raise the rest themselves through community fundraising. Hospices have a strong ethos of compassionate care, coupled with a vibrant culture of innovation and enterprise reflected in the new and different ways they raise income and successful partnerships developed with other providers.
In these hugely challenging times for the NHS, improving end-of-life care by working more closely with hospices could help deliver the sustainability that is so desperately needed. Tracey Bleakley CEO, Hospice UK
• On the occasion of American Thanksgiving, as a British citizen who lives in the US but finds myself in the UK with an ailing father, I feel compelled to express my gratitude for one of the things that makes the UK exceptional: the NHS and associated strongly held value that good healthcare for all is a right not a privilege. I am a management consultant and have spent a large chunk of my career working within the American healthcare system. The recent US election troubles me greatly as the incoming administration seems to offer little vision for healthcare other than the aspiration to unwind the recent gains of improved access to all. In recent weeks I have sat holding my sleeping father’s hand as he moves beyond a stroke. As I’ve watched the wonderful staff on the Dunkery stroke unit at Musgrove Park hospital in Taunton, which, somewhat ironically, started as an American army hospital during the second world war, I have felt incredibly grateful for the compassionate care he – and my family – are receiving. Absent is the additional stress of wondering how we as a family will be able to pay for his care, which would already be well into the hundreds of thousands of dollars had he been born on the other side of the pond. Celia Kirwan Boston, Massachusetts
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Recent headlines about the NHS drawing up secret “sustainability and transformation plans” have led to speculation about widespread cuts to local services and allegations of an orchestrated attempt by the NHS to keep the public in the dark. For the record, indiscriminate closures are neither planned nor legal. But the need for a rational, national debate about how we secure a viable health and care system is urgent, and made more difficult by partisan and party-political arguments.
What’s more, and with this week’s autumn statement highly unlikely to offer anything other than jam tomorrow, we must shift the focus away from hospitals. I don’t know any NHS leaders who believe that more hospitals are the answer. Quite a few hospitals and services could do with shifting to where they’re most needed, but the NHS has no appetite for solutions reliant on more institutional settings.
Right now NHS leaders are calling for the priority to be social care. But with the country’s most publicly treasured institution facing unprecedented demand, exponential growth in high-cost complex care and a post-Brexit economic landscape that leaves little room for optimism, what are our political leaders talking about? The threat posed to the service by the private sector.
What was seen a decade or so ago as a sensible way of attracting investment, and what helped get average waiting times down from 18 months to 18 weeks, is now seen as a political no-go area, with the Tories and Labour locked in an arms race over who has used the private sector least while in office. This is a con trick, as in reality the private sector has been used for decades to help sustain a health service that is free at the point of use and available to all based on need and not ability to pay.
Currently, NHS leaders are working through how to bridge the quality, access and finance gaps in their areas, and it’s not unusual for these plans to be predicated on the need for multimillion-pound injections of capital. Across the country, funding requirements run into billions, and there will need to be significant private investment if plans for transforming the NHS care landscape are to be realised. This raises the spectre of the rightly discredited PFI schemes. Acknowledging and learning from their failure, rather than being paralysed by past events, is the way forward.
Independent-sector healthcare providers, which increase the system’s capacity to respond to demand, help meet waiting-time targets and enable investment to bring important benefits for patients – most of whom are relaxed about who provides their care, so long as it’s high-quality and free at the point of use. This is particularly important at a time of lengthening waiting times and unprecedented demand, and in advance of winter, which always adds to existing pressures.Examples of beneficial private sector involvement include quicker access to treatment through the use of private hospitals paid at NHS prices, more rapid discharge from hospital through well-established “recovery at home” services, and access to private sector community diagnostic facilities for scans, tests and examinations, again at NHS prices.
There will need to be significant private investment if plans for transforming the NHS care landscape are to be realised
We need to remember too that the public sector does not have a monopoly on caring. I have more than 40 years of public sector clinical and leadership experience, and in that time we have seen high-profile failures in the private, public and voluntary sectors. I don’t seek to deny the incidence of failure, but providing choice beyond a single, public option, introducing personal budgets and enabling different forms of independent sector provision has more often been a force for good, and improved people’s lives.
And this is still the NHS – free at the point of use, with strong safeguards over quality and safety.
So let’s stop pretending that private sector involvement in the NHS is a uniformly bad thing: it isn’t. Around 10 million NHS patients per year are treated by private sector organisations operating across nearly 2,000 sites. Patient feedback and Care Quality Commission inspection reports demonstrate that these services are generally safe, responsive and high-quality.
The political debate over the future of the NHS urgently needs refreshing, and portraying private sector healthcare organisations as bogeymen that should either be pushed out of the NHS or never spoken about simply serves to bind the hands of NHS leaders who want to bring about change in partnership with others.
As long as this political negativity exists, it will be patients who feel the consequences.
A senior NHS leader has sparked controversy by urging ministers and health service bosses to let private firms treat more patients in a bid to cut hospital waiting lists.
Stephen Dalton, the chief executive of the NHS Confederation, said Theresa May and Jeremy Corbyn should stop denying that private sector health companies are “a force for good” in the NHS. They are not “bogeymen”, look after patients well and should start treating more than the 10 million patients a year they are already paid for out of the NHS’s budget, he said.
The service is under such intense pressure that private firms should urgently be handed a greatly enhanced role, just as Tony Blair’s Labour government did in the early 2000s, in order to help it cope with fast-rising demand, Dalton argues in an article in Tuesday’s Guardian.
“What was seen a decade or so ago as a sensible way of attracting investment, and helped get average waiting times down from 18 months to 18 weeks, is now seen as a political no-go area, with the Tories and Labour locked in an arms race over who has used the private sector the least while in office”, Dalton writes.
“This is a con-trick, when the reality is that the private sector has been used for decades to help sustain a health service which is free at the point of use and available to all based on need and not ability to pay. So let’s stop pretending that private sector involvement in the NHS is a uniformly bad thing; it isn’t.”
Dalton also wants private firms to help provide the “billions” of pounds needed to build a new generation of hospitals and clinics as part of the NHS’s Sustainability and Transformation Plans, though acknowledged that lessons should be learned from Labour’s use of the discredited Private Finance Initiative.
The Confederation represents most of England’s 238 NHS acute, mental health, ambulance and community services trust but also, through its NHS Partners Network, private firms who have been awarded contracts to treat patients.
But Dalton’s views prompted warnings that the private sector’s track record in the NHS made it unfit to expand its role and that handing it more contracts would pose “serious dangers” to patient care. The firm Coperforma recently lost its contract to ferry tens of thousands of patients in Sussex to and from hospital after a string of blunders sparked huge concern.
Two former health ministers said they shared Dalton’s belief that private firms can deliver real benefits for patients and his belief that “the public sector doesn’t have the monopoly on caring.”
“What matters is what works best for patients”, said Conservative MP Dr Daniel Poulter, who was a health minister until May 2015 and is also doctor in the NHS. The fact that GPs and pharmacies work closely with the NHS but operate outside it shows that the NHS has always been a public/private partnership, he added.
Liberal Democrat MP Norman Lamb, who was also part of the health ministerial team during the coalition, said: “We should focus on the quality of care and equal access rather than on who provides it. Around the country there are good collaborations between statutory and independent sector, which I welcome.”
But both MPs said they feared that a greater private sector role could threaten the drive to integrate NHS and social care services, which the government has pledged to deliver by 2020. “While there is undoubtedly considerable benefit to the approach taken by Tony Blair of using the private sector to help the NHS to increase capacity, the history of wider private sector NHS commissioning tells us that private providers tend to ‘cherry pick’ the most profitable services to deliver,” said Poulter.
“So there is undoubtedly a serious danger that widespread commissioning of alternative – private – providers will result in greater fragmentation of the health and care system at the very time when there is need for increasing integration of services.”
Lamb warned against relying on private capital to build new NHS premises. “We must never again allow the outrageous profiteering under the last Labour government’s Private Finance Initiative, which has mortgaged the future of the NHS to the tune of tens of billions of pounds.”
Labour rejected Dalton’s call and said that problems with contracts previously awarded to private firms meant they could not be trusted to expand their role.
“In recent times private providers have utterly failed to offer patients the quality of care they would expect. What’s more when the priority should be public investment in the NHS, privatisation such as the selling off of NHS Professionals announced last week could very well end up costing the taxpayer more”, said Jon Ashworth, the shadow health secretary.
Dalton’s plea was prompted by ministers denying the NHS enough money to do its job properly, he added. “It is indicative of the government’s neglect of our NHS that senior figures are saying we now must resort to the private sector for the investment our NHS so badly needs”.
At last month’s Conservative annual conference Theresa May used her set piece speech to deny Labour claims that her government was privatising the NHS. “Every election, they say we want to privatise the NHS – and every time we have protected it. In fact, the party that expanded the use of the private sector in the NHS the fastest was not this party, but the Labour Party”, she said.
The Department of Health said only that “Any decisions about use of the private sector are taken by local doctors who know their patients best. We are clear that patients should be able to access the best possible treatments based on quality of care not the provider.”
GPs attending the UK’s biggest family doctor conference are being urged to accept thousands of pounds to treat private patients.
Medics can earn £50-£60 per hour on top of their NHS salary – or up to £90,000 a year if they work full-time – by offering consultations to patients on their smartphones.
The cash is being offered by the firm Babylon to GPs who want to work “flexibly”. Doctors are told they can work from home or their usual workplace.
The Royal College of GPs (RCGP) has accepted thousands of pounds from Babylon to put recruitment flyers in about 1,500 delegate bags at the RCGP annual conference in Harrogate. Babylon has also paid for its logo to appear on the conference handbook and website.
On Thursday the chair of RCGP, Prof Maureen Baker, said NHS doctors were under intense pressure. She said GPs were “worried about making errors because they are so overwhelmed with work. This is a serious threat to patient safety.”
Babylon is an app-based service that works by offering patients unlimited private GP consultations for £4.99 per month or one-off appointments for £25. Patients can get access to one of 100 doctors for video-call or text-message consultations seven days a week from 8am to 8pm. The firm also offers appointments with specialists from £49.
Katherine Murphy, chief executive of the Patients Association, said GPs were often trying to tackle long waiting lists, but added: “What is disconcerting about this situation is that private firms are allowed to advertise positions at a conference of the RCGP.
“What this means is that NHS doctors are being targeted to give up their role working for our NHS and instead work for private companies, which I think most patients would consider unethical. When the NHS is so desperately short of GPs, how can this be right?”
The RCGP accepts sponsorship money from a wide range of firms for its conference, including the pharmaceutical companies Pfizer and Novartis. In 2014, the most recent year for which figures that are publicly available, bronze sponsors paid the RCGP £11,500 plus VAT.
Dr Mobasher Butt, global medical director of Babylon, said: “As a GP, I see doctors across the country working in public, private and voluntary organisations. At Babylon we work with NHS and private patients. Our GPs are often juggling family and professional commitments, and value the flexibility that we offer.
“Without this flexibility, many would not work additional sessions to their NHS work, which in effect is actually increasing our total national GP capacity. All of our GPs carry out face-to-face practice, mostly in the NHS, and Babylon provides them with a much-welcomed addition to their portfolio of work.”
He added: “We have an excellent relationship with the RCGP, having met members of the RCGP council to discuss our service in detail, which they found impressive. Many of our GPs, including myself, are RCGP members and Babylon is proud to support the college.”
Despite Babylon flyers telling GPs they have the “freedom to work from home or your workplace”, Butt said: “All of our GPs work from home and we do not recommend working from their NHS practice.”
A spokeswoman for the RCGP said: “The RCGP exhibition is a commercial venture that generates income for the college’s charitable work. It showcases latest developments in general practice and all exhibitors go through a rigorous process before they are allowed to take part.
“The decision to allow Babylon to become a bronze sponsor at this year’s conference was taken on the basis that it is an emerging digital healthcare company.”
She added: “They are also working with the NHS in some areas to reduce pressure on GP surgeries by offering virtual consultations. At the moment, general practice in the UK is struggling, and we need to pull out all the stops to recruit as many GPs to the NHS as possible, and retain existing ones. But that is not to say we are in a position to close the doors to opportunities for our members.
“Babylon’s presence at the annual conference is in line with the college’s sponsorship policies. Due to commercial confidentiality we are unable to disclose further details of the sponsorship.”
Last month it emerged that another Uber-style app-based medical service, Doctaly, was being rolled out nationally.
By 2018 more people will use so-called private exchanges than similar ones created by the Affordable Care Act, according to a recent analysis by Accenture.
Walgreen, Sears and Aon Aon Hewitt, among the earlier pioneers in this new approach, give employees a credit to buy insurance in an online marketplace.
Already an estimated 3 million Americans are getting insurance from their employers this way, which is triple the number of active employees that were buying from private exchanges a year ago, according to Accenture Accenture, which projects 40 million Americans will be buying on private exchanges in 2018. Employees get a credit or subsidy, and are sent to buy a plan on a private market place akin to Amazon.com Amazon.com or Orbitz in their respective industries.
Aon Hewitt, the largest manager of a private insurance exchange, says that the approach reduced growth in health insurance costs for its clients’ active employees to 5 percent, compared to 7 percent for most large employers.
So far, Walgreen has been the largest company to disclose participation by workers in its private exchange. The pharmacy giant says more than 220,000 workers and their dependents are getting coverage through the Walgreen proprietary “Live Well Benefits Store,” a marketplace that is an outsourced solution through Aon Hewitt Corporate Health Exchange.
Aon Hewitt, Mercer and Towers Watson (TW) are the leading consultancies pushing the exchange approach for both active employees and retirees with IBM (IBM), AT &T (T) and Time Warner moving their workers to retiree private exchanges. And the consultants are on the verge of having more competition as health insurance companies get into the act like Cigna (CI), Aetna (AET) and others.
“We continue to work to develop our own proprietary exchange called, the Aetna Marketplace, which we believe will offer an attractive alternative to existing multi-carrier exchanges and the current defined benefit model for health benefits,” Aetna chairman and chief executive officer Mark Bertolini told analysts and investors Tuesday on the company’s second-quarter earnings call.
Wondering how private exchanges or Obamacare exchanges will affect your health care? The Forbes eBook Inside Obamacare: The Fix For America’s Ailing Health Care System answers that question and more. Available now at Amazon and Apple.
A lack of info has restricted the influence of individual budgets amongst folks from black and minory ethnic backgrounds, says Jabeer Butt. Photograph: Alamy
Simon Stevens, NHS England’s new chief executive, has announced a “dramatic extension of patient power”, by delivering money for vulnerable sufferers to get their wellness and social care. While individual budgets are not new, the dimension and scale of the roll-out is unprecedented.
Stevens’ announcement is very likely to be met with widespread service user, carer, public and cross-get together help. For the most portion this is a outcome of personalisation, in concept, providing people much more selection and management above their lives by making it possible for them to decide on well being and social care providers tailored to their certain needs. The argument often articulated, and repeated by Stevens, is that private budgets will allow patients/support end users to pay out for help this kind of as carers, physiotherapists and psychotherapy sessions to bridge present gaps in wellness and social care and in the long run to support them to remain out of hospital.
Nonetheless, whilst the possible of higher numbers attaining personalised care is clear, new study from the Race Equality Foundation suggests that the reality may be less so, especially for people communities who are often regarded as becoming challenging to reach. The difficulties knowledgeable by black and minority ethnic groups when engaging with mainstream health and social care providers are broad-ranging and nicely-acknowledged: whether it is those younger African Caribbean guys who need to have assistance with their mental wellbeing, but are reluctant to engage with mental overall health providers due to past bad experiences or whether or not it is older Asian folks who struggle to locate care residences who are able to meet the practical or dietary needs of their faith. In concept, personalisation supplies the possibility for black and minority ethnic and other folks to physical exercise higher handle in selecting solutions and overcoming the barriers that presently indicate their needs are not constantly met.
Our newly published briefing paper suggests that there are a quantity of motives that this may not come about. Evidence suggests a lack of available info about personalisation has limited uptake of personalized budgets by folks from black and minority ethnic backgrounds. This appears to be combined with a reluctance to undergo assessments. In addition there is a dread that benefits and companies will be minimize or modified. Worryingly, this dread has been compounded by a lack of suitable advocacy and support. This is specifically crucial as appropriate advocacy solutions have helped men and women apply for personalized budgets or recruit personalized assistants in a position to realize and meet their particular cultural wants.
Such problems have been exacerbated by stereotyped concepts among some professionals about the extent of family help available within some communities, with a developing physique of proof showing the issues faced by carers of men and women from black and minority ethnic groups. In specific, black and minority ethnic carers may possibly locate themselves far more isolated from mainstream help providers, whether or not due to diverse cultural expectations about asking for assist, limited possibilities to get a break from caring or merely a lack of awareness of mainstream solutions.
In addition, the original vision for personalisation integrated a concentrate on early intervention and prevention, creating social assets, and bettering entry to solutions this kind of as leisure and transport, access to info and advice on care. Even so, our paper suggests that the funds that are made available are frequently utilized to meet the quick care requirements and are not of the scale that may offer opportunities to lead a more lively and fulfilled lifestyle.
So Stevens’ announcement whilst welcome will need to have to be accompanied by important adjust to ensure that groups such as black and minority ethnic communities are equally in a position to benefit. Funding smaller sized local community-centered organisations to carry out advocacy, outreach, and care will need to be component of the change. But also making certain mainstream companies correctly attain out, engage and help these tough to attain groups will be crucial to ensure well being and social care is actually individual.
Jabeer Butt is deputy chief executive of the Race Equality Basis
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By Jonathan Ingram, Nic Horton and Josh Archambault—Mr. Archambault and Mr. Ingram are Senior Fellows, and Mr. Horton Policy Analysis Analyst, at the Foundation for Government Accountability.
U.S. Property Majority Leader Eric Cantor’s gorgeous loss in the Virginia principal to underfunded insurgent candidate David Brat sent shock waves by means of the nationwide political establishment, but its affect on the American men and women may rival the outcome of a state senate major in Arkansas, as the architect of the “Private Option” Medicaid growth lost his major largely on the expansion issue. Lawmakers in the 24 states that have not expanded are beginning to see the prospective political fallout from supporting an “alternative” Medicaid expansion program.
Voters Driven by ObamaCare’s Medicaid Expansion Situation
In Arkansas, three-term Republican State Representative John Burris misplaced a main runoff for a State Senate seat to first-time candidate and political novice Scott Flippo. Rep. Burris, an architect of the ObamaCare “Private Option” Medicaid expansion, need to have walked away with the GOP nod right into the State Senate right after a November vote for which Democrats failed to area their personal candidate.
Rep. John Burris: Private Choice ObamaCare Growth Architect
Burris had much more identify ID and substantially a lot more funding: the most recently offered campaign reviews display Burris obtaining outraised Flippo almost three-to-one—including tens of thousands of dollars in contributions from hospital lobbyists and other Personal Selection-supportive well being care special interests.
By all accounts, Rep. Burris has been the face of the ObamaCare Private Choice. Not only did he sponsor the ObamaCare growth bill, he came up with numerous of the empty guarantees utilised to squeeze just enough help to enact the plan.
Despite the political frenzy induced by the Personal Choice debate, Rep. Burris was still the favored. Flippo was a political unknown when he announced his candidacy earlier this yr, but as he hit the trail his message was simple and clear: ObamaCare growth is undesirable for Arkansas taxpayers, and John Burris is to blame for it.
Rep. Burris must have been a minor weary heading into the runoff.
An anti-Private Selection message throughout a specific election for a State Senate seat last yr vaulted Republican John Cooper to workplace in a district that hadn’t elected a Republican given that Reconstruction.
As Flippo’s anti-PO message seemed to take root, Rep. Burris’ campaign message seemed to vacillate among help and opposition for the system. While he claimed to have by no means shied away from his assistance for the Private Selection, he explained on at least a single voter’s manual that he “opposed” the Private Option law he crafted. And later on, he claimed in a Television ad to have blocked the ObamaCare exchange, even though he truly voted for it.
Despite his try to muddy the waters, and his supporters’ complaints that Flippo was making the entire race about ObamaCare, Rep. Burris couldn’t escape his direct involvement with expanding Medicaid below ObamaCare in Arkansas.
The Future of ObamaCare’s Medicaid Expansion Personal Alternative is Uncertain At Best
Final 12 months, funding for the Personal Alternative just barely squeaked by in the Arkansas Legislature. This previous legislative session, the plan barely survived a funding-reauthorization vote in March. Soon after 4 failed attempts, weeks of arm-twisting and legislators publicly trading their votes for pet projects, the system just barely survived, without having a single vote to spare in the Senate. Principal elections have previously tipped the stability strongly against the Private Choice.
The Senator whose retirement designed a pitched battle among Burris and Flippo was also a supporter of the ObamaCare Private Choice. And prior to this runoff, another Personal Option supporter, Senator Bruce Holland, was defeated in his own major by a committed anti-Personal Selection candidate.
Randy Reed, deputy assistant director of housekeeping at North Carolina State University, North Carolina’s largest campus, often fretted about the effects of chemicals on the 300 housekeepers as they cleaned. While nobody was ever seriously injured, he fielded several reports of rashes, occasional respiratory problems and headaches, possibly caused by exposure to the harsh smells the cleaners omitted.
The Occupational Safety and Health Administration, a government agency, warns of this in its public safety warnings (pdf). Cleaning chemicals, OSHA states, can cause dangerous gases causing headaches, dizziness, wheezing, even lung damage. With this in mind, two years ago, Reed replaced traditional industrial cleaners such as Diversey Glance and Comet Cleaner with Orbio SC 5000 split stream water technology to clean floors, surfaces, even urinals.
This new system uses a salt-based, chemical-free process, where water passes through the system giving it an electrical charge. The solution cleans and sanitizes surfaces leaving it 99% germ free, Reed explains. “On our first trial our hygiene meter monitored the bacteria count on a urinal and found the technology removed as many germs as a regular sanitizer.”
Orbio SC 5000 uses a salt-based process, where water passes through the system giving it an electrical charge. Photo: Courtesy of Orbio
NC State is part of a larger trend in which universities, retailers, sports facilities and large corporations are not just cleaning with greener chemicals, but without chemicals at all.
Companies including Coca-Cola Enterprises in the Netherlands; ISS, one of the world’s largest commercial facilities services providers; and Chapman University, (pdf) one of California’s oldest private universities, have made the switch. Examples include sanitizing facilities with technologies such as steam vapor systems, spray and vac systems using pressurized water to remove and loosen soils along with ozonated and electrolyzed systems using electricity to turn water into a cleaning agent. The use of microfiber cloths and mops, which require only water to remove germs, grime and bacteria also make up the trend.
While industry numbers don’t yet exist, Stephen Ashkin, executive director of The Green Cleaning Network, a non-profit working with corporations to green the cleaning industry, estimates that, based on his client research and surveys, 30% to 50% of corporations and institutions across the US, now clean their facilities with eco-friendly chemical cleaners or cleaners without chemicals at all.
“The professional cleaning industry has changed,” he says. “The newer trend experts are seeing is cleaning without chemicals.” Ashkin believes cleaning products minimizing chemicals will never replace floor finishes, heavy-duty cleaning chemicals or graffiti removers, but this is a “tool in the toolbox for creating a healthy and clean environment while leaving a minimal footprint.”
Defining Chemical-Free Cleaning
The trend is so new that even the description of these products is controversial; while some call them chemical-free, others say eco-friendly. Ashkin rejects the term “chemical-free” cleaning because no cleaning product or device completely avoids chemicals.
“Chemical-free cleaning is a marketing term versus a technical term,” he says. Case in point is companies offering chemical-free cleaning products, such as Tennant, maker of the Orbio systems, which use their own technologies to define “chemical-free.”
OSHA defines green cleaning as products certified by independent organizations as safe to use and less harmful to your health and environment than conventional alternatives such as bleach and ammonia.
Wherever the definition lies, all this means good business for the big players. In April, Tennant posted quarterly results showing growth year-on-year. Other brands including Tursano, maker of the popular Lotus Pro device (similar to the split stream water technology), and the larger company Ecolab also reported positive first-quarter earnings. Makers of chemical free antibacterial microfiber cloths have good customer following as well. Norway-based Norwex, now in multiple markets including Canada, Australia and the US, sells microfiber towels and cloths, microfiber scarf clips for cleaning tablets, glasses and jewellery (instead of toxic sprays and wipes) and dry polyester floor pads for mopping.
But much of this market is in the commercial sector. Based on his client work, Ashkin estimates that residential cleaning remains only around 1-5% of the core eco-friendly and chemical-free cleaning market, probably because the conversion payback is higher for large corporations. Purchasing a chemical-free cleaning device for a commercial space can cost up to $ 5,000, a worthwhile investment, if used daily. A Lotus Pro split stream water technology cleaning device for your home averages $ 150 retail, too much for a parent worried about putting food on the table, Ashkin adds. Commercial facilities also have employees to compare costs, and review and analyze the cleaning products they buy, which the household consumer often lacks.
Homemade Chemical Free Cleaning
Another growing trend is Americans making their own cleaning products, with limited chemicals. Senior account supervisor at MMI Public Relations in North Carolina, Jennifer Fair ditched Clorox and other harsh cleaners for recipes she found on Pinterest such as pairing vinegar with baking soda. The vinegar dish soap concoction gets her shower super clean, she says. Other recipes suggest using baking soda, sprayed with water, to clean ovens.
This interest is valid given the Environmental Working Group, a non-profit group, has found through their Hall of Shame (pdf) study that 438 of 2,000 assessed cleaning products contain at least one chemical that the non-profit group Association of Occupational and Environmental Clinics identifies as an asthmagen.
The worst offenders, the study claims, were those labelled as “green cleaners” such as the Simple Green Concentrated All-Purpose Cleaner (labelled as non-toxic and biodegradable) when one of its ingredients is 2-butoxyethanol, a solvent which can cause red blood cell damage and eye irritation. EWG also cites several studies showing pregnant women are more at risk for birth defects when exposed frequently to cleaning chemicals, especially window cleaner and air deodorizer sprays.
Effectiveness of greener cleaning products
Ashkin doesn’t believe home cleaning product recipes work well. “We have a romanticized view that because we can eat it, it’s good for you,” he says.
And can we say split stream chemical-free technologies clean as well as eco-friendly chemicals? Tennant doesn’t know the answer to this question, and Ashkin says it’s too early to know. However, companies are evaluating the technologies, comparing the impact to chemicals and other devices along with the wattage. He suspects the environmental benefits of chemical-free cleaning devices and technology will outshine chemical cleaners.
“Conventional cleaning requires extracting the raw materials, turning these into ingredients, shipping to a formulator who mixes everything into an effective cleaning product before putting the chemicals into packaging (with their own environmental impacts) and finally shipping to the end user. Through green cleaning those impacts go away.”
Debbi McCullough is an independent writer, editor and owner of Hanging Rock Media based in North Carolina.
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The organization, which has 8,000 workers, will be the very first hospital chain to go public. Spire was designed in 2007 when Cinven, the private equity house, purchased a chain of private hospitals that had been carved out of Bupa, the private health insurance giant, and rebranded them Spire Healthcare. It is anticipated to be valued at about £1bn upon listing.
More are anticipated after the summertime, in spite of concerns about a loss of investor appetite for new share issues, which not too long ago prompted Excess fat Face and Blue Inc, the retailers, and Wizz Air, the airline, to shelve float strategies.
Market place self confidence was dented by a series of disappointing debuts like AO Globe, the electrical goods retailer, and Saga, the above-50s vacation group. Nevertheless, considering that then the effective listings of B&M Bargains, the low cost retailer, and TSB have aided to restore sentiment.
Spire and SSP, the quick food giant, will be among the last firms to record before the summer, when the City tends to take a break from deal action. The pace of new issues is most likely to reignite in September with British Auto Auctions, the 2nd hand car auctioneer, DFS, the sofa chain, and Aldemore, the new higher street bank, all primed to go.
Earlier this year, Spire was cleared by the Competition watchdog of currently being art of a cabal of big operators that including rivals BMI and HCA that exerted too considerably market dominance. The organization has stated it plans to capture expanding possibilities in the swiftly expanding private healthcare market place where the NHS is expected to spend a greater slice of its spending budget. About 25% of Spire’s patients come from the NHS, up from 18% in 2007, but just £5bn of the £110bn-a-12 months NHS finances go to the private sector.
About half of Spire’s perform comprises orthopaedic procedures this kind of as hip and knee replacements, a developing market. Just lately, the hospital operator has moved into acute care by opening standalone cardiovascular and cancer treatment method centres.
The Spire float is becoming overseen by Bank of America Merrill Lynch, Morgan Stanley, JP Morgan and Numis Securities.
‘Pulling well being and social care personalized budgets into one pot will aid make support about them a lot more integrated and responsive.’ Photograph: Alamy
Integration employed to suggest common assessments, merged teams and management restructures. Occasions have altered, and it’s no longer just about shifting occupation titles and Tupe – Transfer of Undertakings (Safety of Employment). Above the last handful of years the health and social care method has begun to embrace the concept of “man or woman-centred, co-ordinated care” that shifts the target from organisations back to the knowledge of the man or woman needing assistance.
Some of this has turn into necessary simply because men and women obtaining care are no longer willing to accept that specific models of institutionalised provision are proper for them just due to the fact they have a particular diagnosis. Decision and management, even though becoming policy terms that have been repeated so usually that there is a threat of shedding the meaning, do resonate with us all personally in the decisions in lifestyle that are most important: where we reside, who’s in our existence, and how we spend our time.
Much of this shift, although, has come about because the wellness and social care technique is dealing with increasing pressures that conventional remedies cannot address. For a man or woman with a number of extended-phrase situations, better co-ordinating the wellness and care they acquire will be significantly appreciated, and possibly much more powerful – but it only goes so far. One thing more than this is needed if we are to make a step adjust in how we react to the complicated health wants of men and women. With two thirds of emergency hospital admissions currently being associated to people’s lengthy-phrase situations, the health method has as considerably interest in assisting folks to handle their prolonged-term problems better as it does in diagnosing and treating acute illnesses.
Key to supporting individuals to remain as healthier as they can is interest to psychological properly-being, developing social capital, and discovering techniques to look right after their own overall health. These types of solutions and responses cannot be prescribed. They need to have to come from a deeper knowing of the particular person, and what they have and worth in their daily life. This skills is the person’s to deliver into the conversation – a different conversation with a various electrical power stability.
Revolutionary approaches to supporting people to remain out of hospital are combining a variety of health-related and non-health care answers, by means of a wider group of partners. The neighborhood and voluntary sector can play a important part in addressing underlying sensible issues this kind of as housing support, as effectively as loneliness, isolation and boredom. Rotherham’s social prescribing pilot does just this and early evidence about how people most at threat of hospital admissions are kept healthful at property is encouraging.
What if what would actually assist is possessing anything fully “off menu”? Elements to modify a bicycle so that a person with motor neurone disease can even now use it to hold match? Reflexology for an individual residing with MS? Not to deal with the issue, but to help cope much better with its results.
What if obtaining this variety of open strategy to planning their care actually produced an effect on peoples’ good quality of existence and psychological effectively-being? What if it also manufactured a substantial reduction in lengthy-keep hospital use? The massive-scale personal overall health price range pilot evaluation showed these outcomes.
Pulling collectively well being and social care personal budgets into one pot for people will support make assistance all around them more integrated and responsive, and less irritating. The real chance, however, is to co-make new solutions with the particular person from across medication and civic existence, creating on the person’s own skills and strengths. Some thing various is only achievable if we give people the room and control to envisage it, and the right assistance to enable it to happen. Anything various is attainable, and well being and social care personalized budgets are a effective element of the solution.
Zoe Porter is programme manager for the personal health budgets delivery staff at NHS England. She will be speaking about integrated health and care personal budgets – early learnings at Wellness+Care 2014.
Well being+Care 2014 takes spot on 25 and 26 June at ExCel, London. Passes are free of charge for NHS and public sector teams, but you need to have to register in advance.
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Dr Mark Porter, chair of council at the British Medical Association. Photograph: Frank Baron for the Guardian
Doctors will fight the government every day in the run-up to the general election if it does not backtrack on changes to the NHS that have harmed patients, the British Medical Association’s chair of council has said.
In his speech to the BMA’s annual conference on Monday, Dr Mark Porter, said the changes had cut investment, fragmented care and prioritised the tendering of services to private companies.
He also accused the government of “sly briefings” blaming doctors for every failed policy and criticising pay, thereby destroying morale in the NHS.
In a speech that sets the BMA on a collision course with the coalition over its reforms during campaigning for the next election, Porter said it was not too late for things to change but warned that if they do not, the association is “up for” the fight.
“We’ll show the public that money is wasted on untested policies, not hard-working public servants,” he said. “We’ll show the public the care we already deliver out of hours, in hospitals and in general practice – and that we designed it and do it for them. We’ll show the public the chronic lack of investment in emergency medicine, in general practice, in public health, in mental health, across the NHS. Who should the public blame? The people who work in the NHS, or the government that holds the purse strings? And with the general election just 10 months away, we could be fighting like this every day.”
Porter said that under the coalition government, the NHS had become “obsessed” with private companies tendering for services, describing the first full year of the Health and Social Care Act as a bumper year for multinationals and their lawyers and accountants, while making things worse for patients by fragmenting care among companies “eyeing up each other’s business”. He gave the example of Bedfordshire and Milton Keynes, where he said management consultant McKinsey was carrying out review of services at a cost of £3m as an example of “market lunacy”. He said McKinsey had written to 500 providers including a US provider offering ‘faith-based’ healthcare.
Porter said he was angry at claims that NHS spending is protected. “The so-called efficiency savings are cuts,” he said. “The experience of every healthcare worker, every doctor, is of having resources cut every year. We are seeing cuts that are driven by an uninformed and arrogant assumption that the NHS is bloated and inefficient.” He said savings should be made by not wasting money on management consultants or fragmenting care by opening the NHS to private bidder rather than by freezing the pay of medical staff.
The BMA chair of council described the government’s promise not to impose change from the top as needlessly and recklessly broken, and asked: “Do you really want to be forever remembered as the government that spent five years breaking a promise, five years frog-marching the NHS towards fragmentation, five years attacking the morale of its staff and burning the rich fabric of goodwill?” Despite the savage criticism of its reforms, Porter insisted that the BMA was ready to work with the government on improving patient care but warned that the department of health had to prove first that it had the best interests of the NHS at heart. “First, you stop the screaming headlines and the starving of resources,” he said. Those sly briefings that blamed emergency medicine pressures on GPs, when the evidence said the opposite, and when practices are offering 40 million more appointments than they did five years ago. Spreading the myth that consultants are not delivering urgent, emergency and acute care out of hours. When I and my colleagues are in hospital at 2 o’clock on a Sunday morning, what do you think that does for our morale? Finally, I say to the government: work with us, not against us.”
Sir Nick explained the public would merely not tolerate this kind of lax attitudes in the direction of “intensely private” data about them.
The sales were manufactured by the NHS Data Centre, the predecessor body to HSCIC.
The evaluation published on Tuesday calls for a series of adjustments to tighten controls of information, with increased transparency about the use of details.
The Government has presently announced legal alterations to stop the sale of information to the insurance coverage industry, following the disclosures by the Telegraph.
The review mentioned that the 3 insurance coverage bodies which at the moment hold this kind of information have been ordered to delete the data.
Sir Nick said: “The HSCIC must understand lessons from the loosely recorded processes of its predecessor organisation. The public just will not tolerate vagueness about healthcare data that may possibly be intensely personal to them.
“We exist to guard their information and we have to earn their trust by demonstrating scrupulous care with which we manage their private details.”
Even though data did not title patients, in some cases it would have been attainable to “deduce” which patients the information referred to, the assessment identified.
It concluded that “there have been significant administrative lapses in recording the release of data. In some instances the decision making method was unclear and records of choices incomplete when handling medical data this is unacceptable.”
The revelations in February about the handling of hospital information emerged amid developing worries about ideas for a nationwide database which will carry with each other info from GP data.
The programme was due to be launched in May possibly, but has been place on hold until next 12 months as further controls had been drawn up, and will comply with a variety of local pilot schemes.
The HSCIC board explained it had accepted Sir Nick’s suggestions in complete.
Jeremy Hunt: NHS culture wants ‘profound transformation’
