Prices paid by NHS chemists for antidepressants and a breast cancer treatment have soared by more than 800 per cent in recent weeks, The Mail on Sunday can reveal.
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The report said trusts had responded well to the A&E challenges this winter
A study of NHS foundation trusts in England has found the number of those in financial trouble has nearly doubled in a year from 21 to 39.
Monitor, which regulates England’s 147 foundation trusts, also found 18 trusts missed a target that 85% of suspected cancer patients start treatment within 62 days.
However, it said most accident and emergency departments were coping well.
A Conservative spokesman said trusts were on the whole in surplus.
Two-thirds of England’s NHS hospitals are now foundation trusts. They are not directed by government so have greater freedom to decide on the way services are run.
The study by Monitor found the combined deficit of those trusts was £180m, higher than the £168m expected, with 60% concentrated in five organisations.
A further 17 trusts have “very small” deficits, Monitor said.
Mid Staffordshire NHS Foundation Trust, which runs the scandal-hit Stafford Hospital, became the first trust to be put into administration in April.
‘Tough climate’
Monitor said the reasons for the breaches of the cancer target varied between the trusts, but that an increase in GP referrals “is a possible common factor”.
Late referrals and consultant cover were also mentioned as other troubling issues.
Trusts did perform well against a target to see the most urgent cases within two weeks, according to the figures for October to December 2013.
The financial trust sector is doing remarkably well in tough circumstances but is looking a little frayed at the edges.”
Jason DorsettMonitor
The foundation trust sector as a whole has a £135m surplus so far this year, however that is lower than the planned £173m and it has “halved since this time last year, reflecting the tough financial climate and foundation trusts’ response”, the study said.
The Midlands is the most “financially challenged” region, with 14 of its 38 trusts in deficit, including Peterborough, Mid Staffordshire, Sherwood Forest and Milton Keynes.
Overall, 44% (33) of acute trusts, 20% (one) of ambulance trusts, 11% (two) of specialist trusts and 7% (three) of mental health trusts are in deficit.
Of the 147 trusts, 26 are currently in breach of their licence, including eight that are in special measures.
Monitor is also investigating a further eight for potential licence breaches for issues including performance failures and financial problems.
Trusts have delivered £867m of “efficiency savings” so far this year, although that is £185m below what had been planned by this stage.
Jason Dorsett, financial reporting director at Monitor, said: “All trusts need to up their game in delivering efficiency savings this year in order to maintain and improve the quality of care for patients, and ensure the sustainability of services.
“The financial trust sector is doing remarkably well in tough circumstances but is looking a little frayed at the edges.”
A Conservative health spokesman said: “As Monitor themselves say, foundation trusts are performing well despite pressure on services, and are on the whole in surplus.
“This government has shone a light on poor care in a way that Labour neglected to do – and which led to tragedies like Mid Staffs – in some cases putting pressure on finances as trusts address historical issues with nursing numbers and the like.
“We are putting recovery plans in place for any trust in financial difficulty, but as the culture within our NHS changes, we do not accept that delivering safe and compassionate care in the longer term costs more money.”
Shadow Health Secretary Andy Burnham said: “After a decade of improvements in cancer waiting times, progress has been derailed by David Cameron’s NHS reorganisation.”
via BBC News – Rise in NHS foundation trusts with deficit, says Monitor.
The NAO has urged NHS England to apply greater scrutiny to waiting-time statistics
Patients in England cannot rely on information on waiting times for non-emergency operations, such as knee and hip replacements, a watchdog says.
The National Audit Office (NAO) found wrong and inconsistent recording after reviewing 650 cases in seven trusts.
The watchdog said it was unable to discern whether this was deliberate, but overall the practices concealed delays rather than over-recorded waits.
The government said the issue would be investigated.
The NAO said that the lack of reliability, whatever the causes, was harmful to patients because it hampered their ability to make informed choices about where to choose to have their treatment.
It also called into question whether the NHS was actually meeting its waiting-time targets.
Greater scrutiny
There are more than 19 million referrals for elective operations each year.
Patients are meant to be treated within 18 weeks of a referral and the NHS is currently meeting its targets on this – but only just and the report noted there was growing pressure on waiting times.
The waits are monitored and recorded by hospitals themselves.
They have the power to pause the clock if a patient is unavailable for appointments for personal or social reasons.
The patient can also be sent back to their GP – which means the clock starts all over again – if they fail to attend appointments.
But the watchdog said this leeway was being applied wrongly or inconsistently.
Of the 650 orthopaedic cases reviewed, the watchdog found that more than half were “not supported by documented evidence or were incorrectly recorded”.
The NAO also highlighted other cases that were brought to its attention during the review.
These included North West London Hospitals Trust failing to record the waiting times of 2,700 of its inpatients, while Barnet and Chase Farm failed to properly monitor more than 2,000 patients. The problems have now been rectified.
There is also the well-publicised case of Colchester Hospital’s misrecording of cancer waiting times.
‘Deliberate manipulation’
The report urged NHS England to apply greater scrutiny to waiting-time statistics to establish what was really happening.
NAO head Amyas Morse said: “Performance information should be reliable.
“However, we have found significant errors and inconsistencies in how trusts record waiting times, masking a good deal of variation between trusts in actual waiting times.”
Katherine Murphy, of the Patients Association, said the findings were “concerning”, accusing the NHS of deliberately manipulating the figures.
“The care and welfare of patients must always come first, and managers’ efforts to try and ‘fudge’ their figures to meet targets will inevitably divert attention from providing high-quality care for the patients.”
Shadow Health Secretary Andy Burnham said: “What this report reveals is real, huge questions now over what we are being told by the government about the NHS and waiting times.
“I’ll be writing to Jeremy Hunt today to say there must be an urgent review into NHS waiting time statistics so that the public can have confidence in them.”
NHS England said action would be taken.
“We firmly believe it is essential to have accurate information provided in a timely way to ensure better care for patients,” said NHS England’s director of policy and strategy, Bill McCarthy.
A spokeswoman for Health Secretary Jeremy Hunt said: “It’s crucial that reporting is always accurate, and we will work with the NHS to make sure hospital staff get the support they need to get this right.”
via BBC News – NHS waiting time data for elective surgery ‘unreliable’.
Spending on locum doctors to plug the gaps in A&E units in England has risen by 60% in three years, figures show.
The data obtained by Labour under the Freedom of Information Act showed £83.3m was spent last year, up from £52m in 2009-10.
Employing locum doctors can cost £1,500 a shift, four times as much as filling a shift with permanent staff.
A government spokeswoman said retaining A&E doctors was a long-standing problem in the NHS.
‘Service getting worse’
Labour received data from 108 trusts – three-quarters of the ones that run A&E units.
It covered all grades of doctors and suggested these temporary staff were now being employed for nearly one in 10 consultant shifts and up to one in six for more junior posts.
Shadow health secretary Andy Burnham said the rise in spending was linked to the “disastrous” reorganisation of the NHS carried out by the Coalition government.
“This government is guilty of gross mismanagement of the NHS.
“They are paying more for an A&E service which is getting worse by the week,” he said.
Dr Cliff Mann, of the College of Emergency Medicine, said: “This sort of spending is very unwise.
“It is not an efficient way of spending NHS money and can be damaging for morale when doctors work alongside other, sometimes less qualified doctors, who are earning much more.
“But this has really been building for the past decade. There has been a lack of job planning and it is now very hard to attract doctors to this speciality.”
Flexible working
Research by the college has suggested half of trainee posts are going unfilled.
It believes the unsocial hours and pressures on A&E departments have made it less attractive than other areas of medicine.
The college has recently worked with Health Education England to draw up plans to tackle the problem, including more flexible working patterns and training opportunities.
Conservative MP Dr Dan Poulter, a health minister who works part-time as a doctor, said: “There has been for many years a problem.
“It was first flagged up in 2004 under the previous government about recruiting doctors into A&E and it takes six years to train A&E doctors, so this well pre-dates the current government.”
He said is it was important that improving the work-life balance of A&E doctors was part of the the government’s plans when re-negotiating its contract with doctors.
Coffee shops may not be a conventional model for NHS care.
But in this week’s Scrubbing Up, Dr Johnny Marshall – a GP and director of policy at the NHS Confederation, says their customer care could be an example worth following.
Alongside the menu of lattes, frappes and plain old filtered brew, a sign in my local coffee shop informs customers that if the drink you receive isn’t perfect, the barista will make it again for you free of charge.
The one time I did politely complain, my lukewarm coffee was replaced with a piping hot one in a flash. I didn’t have to make a fuss and left as a very satisfied customer.
My experience clearly demonstrated to me two things: the shop values customer satisfaction above all else, and that it is so sure it delivers a high quality customer experience, it is happy to put its money where its mouth is.
Complain more
So could GP surgeries do the same?
Now I’m not suggesting that your GP amends his or her clinical opinion until it fits with what you would prefer to hear – that wouldn’t serve anybody well.
But publicly and permanently showing that feedback is welcomed on any and every aspect of the patient’s experience is something I think the NHS should do much more of.
In fact, I think we should be encouraging patients to complain much more.
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In my opinion, GPs offer patients the chance to make far more important decisions about their lives than whether to buy a biscuit to accompany their coffee.”
Patients who raise concerns are a very good thing – they empower themselves, they improve the care they receive, and they drive up standards of clinical care and patient experience across the service.
But how do patients know what to complain about?
Everyone knows if they’ve spent too long trying to get through by phone to their local surgery, or if they are spoken to by a member of practice staff in an impolite or patronising way.
Obviously neither is acceptable, and patients should feel able to say so and to have the problem looked into.
Customer experience
But when it comes to clinical advice and treatment, how do patients know what the optimal standard of care looks, sounds and feels like?
The NHS Constitution sets out what patients can expect from their NHS as a minimum, including maximum waiting times and basic rights. But if we only focus on the standards below which care or services must not fall, we are not aiming high enough.
We should start describing to patients what high quality care looks like, and encouraging them to question us if they get less than this.
It demands the best of us – which is what our patients deserve.
Involving patients in choices about their care is key
We can start by ensuring our patients better understand the full range of clinical options available to them.
When you enter a branch of Starbucks or other high-street chain, you can order a coffee in about two dozen different formats, choosing everything from the type of coffee bean to the amount of foam you want to sip it through.
Customers are likely – subconsciously, maybe – to make a choice based on a host of factors, perhaps taking account of the time of day they are making a purchase, and whether they’ve got time to savour it or are “on the hoof”, as well as personal taste.
For a patient with a condition like stable angina, there are a wide range of possible treatments, from relaxation techniques, through tablets and sprays to stents or a bypass.
During the initial assessment it is possible to determine those people for whom treatment is life prolonging (the minority) and those people for whom it is symptom relieving (the majority).
‘Empower patients’
To make his or her “customer experience” exceptional, each patient needs to understand the full range of possibilities, including their advantages and their risks, and then to receive support to help them decide the best option for their circumstances.
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GPs offer patients the chance to make far more important decisions about their lives than whether to buy a biscuit to accompany their coffee”
This requires GPs and other healthcare professionals to better understand what the patient wants, in the same way that salespeople seek to understand what you are looking for from a new outfit, an electronic device or a present for a loved one.
Then they can best assist you in making an informed decision about the options available to you to achieve what you really want.
Sales-people and retail designers know the importance of creating an environment in which customers feel able to make decisions regarding their purchases.
In my opinion, GPs offer patients the chance to make far more important decisions about their lives than whether to buy a biscuit to accompany their coffee.
It is time for us to empower patients like the retail industry does, put them in control and encourage them to complain if we don’t get it right, so we’ve got a chance to put things straight immediately.
Patients will benefit, the health service will benefit and so will the reputation of GPs.
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