Friday, March 26, 2010

Cuts and savings for the NHS

The NHS needs to save more than £4bn within two years yet the budget in England has trebled to more than £100bn. in the last few years , helping to pay for the 80% rise in managers over the period along with the many thousands of extra nurses a doctors and other staff

However, over the period same period productivity has fallen by over 3% a year on average.

But in reality this is just part of a wider efficiency drive. The NHS is aiming to make between £15bn to £20bn of savings by 2014.which equates to about 5% more productivity a year.

The following facts and analysis are from the Guardian

The NHS budget in England will be £105bn for 2010-11
Future years' budgets have yet to be set, but at best the NHS can only hope for a very small rise
The head of the NHS has already told the health service to make up to £20bn of savings by 2011
The £4.35bn announced on Budget Day is just the first part of this efficiency drive
This means services such as diabetes clinics and minor surgery.

But for the push to make real savings requires hospitals - or at the very least wings of hospitals - to close.

This, of course, is extremely unpopular.

Another area which could be tackled is labour costs, which account for about half of the budget.

Reducing headcount significantly is not easy and so - after years of bumper pay rises for some - staff are now facing freezes in their salaries.

This will save about £3.5bn by 2014. But understandably the approach has proved unpopular with staff.

However, ministers are unlikely to stop there. As the Department of Health announced following the Budget, a saving of £555m is being aimed for by tackling staff sickness.


The average NHS employee is absent through illness for more than 10 days a year, which is slightly higher than the public sector average and much higher than the private sector figure of 6.4 days.

The government aims to do this by giving staff quick access to physio and counsellors to tackle back injuries and stress which are both common problems in the health service.

But staff believe it will also lead to more and more pressure being put on front-line workers not to take days off when they are sick.

Kim Sunley, the Royal College of Nursing's senior employment adviser, says: "We have anecdotal evidence that trusts are adopting more draconian measures in tackling sickness. If anything staff already feel they can't take days off. It is a real concern."

While morale in the health service will probably not be of a great concern in the rest of the economy when people are losing their jobs, it will impact on how successful the NHS efficiency drive will be.

The savings are not being handed back to the Treasury. Instead, they will be ploughed back into the health service to ensure it can keep up with demand.

The ageing population means the pressure on the health service is rising steadily each year.

So the challenge is clear. The NHS pound has to go further - and if this does not happen services for everyone will suffer

Thursday, March 25, 2010

Homeless Link -social care

I am posting this press realise from Homeless Link as I feel it highlights an aspect of social care that seams to be in danger of being overshadowed by the debate on how we fund long term elderly care in the UK

While the following deals with the housing and linked issues other vital support services such as Adult Autism could also be overshadowed.

Homeless Link calls for the protection of services for the most vulnerable
25 March 2010
Homeless Link, the national organisation for agencies working to end homelessness, hopes that as the details of the public expenditure cuts become clearer after yesterday's Budget, protection will be given to those services for the most vulnerable.

Our recent Survey of Needs and Provision ( found that almost half of the homelessness organisations who took part indicated that funding pressures and predicted decommissioning of services threaten their services. These findings are reinforced by a survey from the Charity Commission released on 24th March 2010, which highlights the vulnerability of the voluntary sector to spending cuts.

Jenny Edwards, Chief Executive of Homeless Link said, "The homelessness sector is now completely indispensable in ensuring that the most vulnerable people in society are supported and become positive and active contributors within local communities. It is vital that the need to make savings does not result in all the investment of recent years being wasted."

We urge those making the decisions to minimise the impact of public expenditure cuts on the most vulnerable, particularly those for whom there is no statutory entitlement to support.

Homeless Link welcomes the Budget's increase in the tax on high alcohol cider. Our members see every day the negative impact and deterioration in health of homeless people caused by super strength alcoholic drinks. We would like to see this extended to high alcohol lager.

GP's and MH therapy

The following is from the Guardian newspaper , it makes interesting reading -

Britain's GPs are increasingly angry and frustrated at not being able to get the right therapy for people with mental illnesses – especially for children, who face unacceptable delays in receiving help or do not get it at all, according to a new survey.

An "overwhelming" response to a survey sent out to family doctors by the Royal College of General Practitioners (RCGP) has painted a picture of patchy availability of adult psychological services across the country and an even poorer availability for children. Family doctors reported shocking cases of critically mentally ill people having to wait months for help, or not getting it at all, in breach of national guidelines.

The situation of children was worse than for adults, with 78% of doctors saying that they could "rarely" get help for a distressed child within the recommended two months' waiting time. One doctor reported the case of a 16-year-old rape victim who had started self-harming after being refused help, while another said a girl who had seen her sibling burn to death in a car was offered an appointment with the mental health service in six months' time. "Our service is appalling unless the kids are actually slitting their wrists – I see this as an area of huge need," said one GP.

Professor Steve Field, president of the royal college, wrote to members asking whether adult patients suffering from depression or anxiety disorders and requiring specialist psychological therapy were able to get treatment within two months. Some 1,150 doctors replied, with 65% answering "rarely". Only 15% of them answered "usually", with 20% responding "sometimes".

When asked about children suffering from emotional or behaviourial problems who needed such therapies, 78% of the GPs replied that "rarely" could they get the child help within two months with just 5.8% saying they could "usually" access treatment within the Nice (National Institute for Clinical Excellence) guideline of two months. "We were overwhelmed by the responses. It is shocking," said Field. "There is a strong sense of frustration coming through in many parts of the country and patients clearly deserve better. People should have access to approved treatments, and this has to be a wake-up call.

"If patients can't get access to talking therapies, then they will be on medication. Investing in mental health services will save the NHS and the economy a lot of money, and save it very quickly."

The survey was carried out as part of a campaign launched this month by the RCGP, the Royal College of Psychiatrists and the mental health charity Mind calling for all political parties to make a manifesto promise to back a new deal for children and adults with mental health problems. The government began its Improved Access to Psychological Therapies (IAPT) programme in 2007 after repeated clinical trials showed that "talking therapies" – where people are helped to challenge their own negative thoughts – are as effective as drugs in the short term and better in the long term at preventing relapses. That evidence led Nice to issue guidelines stating that people with depression and anxiety disorders should be offered the choice of cognitive behavioural therapy – a talking therapy.

The chief executive of Mind, Paul Farmer, says talking therapies save lives. "When someone is assessed as being in need of counselling or CBT, it is crucial that they can start treatment as soon as possible. Waiting months and months for urgent treatment would not be acceptable for patients with other health problems, and it should not be acceptable for patients with depression."

But while extra money has been given to health trusts around the country, it is now no longer ring-fenced and the campaigners want a political commitment to the IAPT programme from whoever wins May's general election.

"There has been some great work from the government and they deserve credit for being the first British government to take mental health seriously," said Richard Layard, of the London School of Economics.

Layard led a research team who in 2007 published a cost benefit analysis of psychological therapy. It found that the costs of providing psychological therapies would be recouped within two years in savings made on paying out incapacity benefit and lost taxes from more than a million people who are unable to work because of their mental health issues.

Layard said strides forward had been made but the service was spread too thinly. "IAPT has made very good progress, but it is still at a fragile stage if the political will is not behind it. We need to get mental health raised up as a national priority and see significant pressure brought to bear on primary care trusts to invest."

Sunday, March 7, 2010

Respite funding is being spent elsewhere!!

Millions of pounds intended for but not ring-fenced to respite breaks for voluntary carers has been spent on other areas of the NHS, alleges two charities.

The government said in 2008 that it was doubling money set aside to allow long-term carers some time off - £50m this year and £100m next year.

The Crossroads Care and Princess Royal Trust for Carers allege that only 23% of this year's cash is being spent on carers.

PCT/Health officials say that as the money was not ring fenced they should be able to move money to where it is most needed.

After all Councils have been top slicing the carers grant for years .

I'm afraid that this sort of give with one hand take away with another will go on for a long time yet !