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Archive for the ‘postcode lottery’

Big variations in NHS surgery due to postcode lottery rationing

March 20, 2013 By: Dr Search- Principal Consultant at the Search Clinic Category: Doctors, Health Direct, health insurance, Healthcare, National Health Service, NHS, NHS Cash Shortages, postcode lottery, Private Healthcare, Uncategorized

The number of patients undergoing common NHS surgical procedures varies widely across England because of postcode lottery funding restrictions.Big variations in NHS surgery due to postcode lottery rationingLocal NHS rationing of hernia repair, hip and knee replacements, cataracts and varicose vein surgeries has led to a “postcode lottery”, say researchers.

Writing in the Lancet, they warned such policies could be “storing up problems for the future”.

The Department of Health said access to services should not be decided on cost as suitability for surgery should be judged by clinical experts on the basis of individual need, a spokesman added.

There has been much anecdotal evidence about rationing of some surgical procedures on the NHS, but this has tended to focus on the number of policies in place rather than details on how this has affected patients being operated on.

And while there had been much debate about the “clinical value” of some elective surgical procedures, there was poor consensus on which treatments should be restricted to save costs, the Imperial College London team said.

A comparison of hospital data with primary care trust (PCT) policies on rationing of surgery showed a significant difference in the number of operations being done depending on local rules.

For cataract surgery, PCTs with rationing in place were admitting about 48% fewer patients than those with no such policy in the first year restrictions were introduced, the figures showed.

And for knee replacements there was at least a 20% difference in the number of patients having the operation, depending on whether there were restrictions in place, they found.

When rationing for hernia surgery was introduced in some areas in 2006-07, there were 59% fewer patients being operated on in some PCTs, compared with those with no policy.

The researchers said this gap had since narrowed but in 2010-11 there had still been a 15% deficit, which equated to 64 fewer operations per 100,000 people per year in areas with restricted access.

Significant variations had been seen in access for almost every year looked at since rationing policies had been in place, they said.

The type and number of procedures rationed by PCTs varied considerably and only 17 of 119 respondents had no policy for all five of the procedures looked at.

Postcode dementia care is disgraceful according to the Alzheimer Society

January 15, 2013 By: Dr Search- Principal Consultant at the Search Clinic Category: Doctors, Health Direct, health insurance, Health Websites, Mental Health, postcode lottery, Preventable Crisis, Private Healthcare, Uncategorized

There is a “disgraceful” variation in the number of proportion with dementia being diagnosed across the UK, according to the Alzheimer’s Society. Postcode dementia care is disgraceful according to the Alzheimer SocietyAbout 800,000 people in the UK have some form of dementia, but most have not been diagnosed.

Estimates by the charity suggest only 32% were diagnosed in the East Riding of Yorkshire compared with 76% in Belfast.

The government said the variation was “unacceptable” and caused “unnecessary suffering”.

Predicted levels of dementia across the UK were compared with data from GPs on the actual number of patients being diagnosed.

The map suggests a north-south divide, with the highest rates of diagnosis in Scotland (average 64%) and Northern Ireland (average 63%).

Rates dropped to 50% in the north-east of England, 41% in the south-west of England and 39% in Wales.

Across the whole of the UK, the percentage of people with dementia who have been diagnosed has gone from 43% in 2011 to 46% in 2012.

Jeremy Hughes, the chief executive of the Alzheimer’s Society, said: “It’s disgraceful that more than half of all people with dementia are not receiving a diagnosis, and disappointing to see such a disparity in diagnosis rates in different regions of the UK.

“This goes against best clinical practice and is preventing people with dementia from accessing the support, benefits and the medical treatments that can help them live well with the condition.”

The charity said one explanation was variation in “stigma”, which resulted in people not visiting their GP. The higher figures in Scotland were put down to a better relationship between social services and the healthcare system.

Health Secretary Jeremy Hunt said: “The small improvement in dementia diagnosis is good news, but the extreme variation across the country is unacceptable.

“It’s time for the worst performing areas to wake up to the dementia time bomb.”

He said failing to diagnose dementia was delaying treatment and “causing unnecessary suffering”.

Diabetes care depressingly poor warn MPs

November 14, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Conservatives, diabetes, Health, Health Direct, NHS Deaths, postcode lottery, Preventable Crisis, Uncategorized

The standard of care for diabetes in England is “depressingly poor”, causing unnecessary deaths and disabilities- a parliamentary committee warns.Diabetes care depressingly poor warn MPsThe Public Accounts Committee came to the conclusion after looking at how well the NHS was doing at helping patients manage their condition.

Previous reports have criticised the lack of checks being carried out, such as blood pressure, eye and foot exams.

But the government said services were better than they were being portrayed.

The report by the cross-party group comes after the National Audit Office and Diabetes UK both published critical studies on diabetes care this year.

They both flagged up statistics showing less than half of people with diabetes get all the nine basic tests they should.

Without effective care, patients can develop a range of complications, including blindness and kidney disease.

If everyone got the right care, it is estimated 24,000 lives could be saved each year.

The report said despite the clear consensus over what diabetes patients needed, performance had been “depressingly poor”.

Committee chairwoman, Margaret Hodge, said: “There is no strong leadership and no effective accountability.  Variation in the level of progress across the NHS also means that there is an unacceptable ‘postcode lottery’ of care.”

Barbara Young, chief executive of Diabetes UK, said: “Given all the increasingly strong evidence of inadequate care, we simply cannot understand why the NHS has sleep walked into this situation.”

A million dementia friends to be taught how to diagnose and improve care

November 08, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Care Professionals, Dementia, Doctors, Health Professionals, Healthcare, NHS Cash Shortages, NHS Deaths, postcode lottery, Preventable Crisis, Uncategorized

One million people are to be taught how to spot the early signs of dementia as part of a drive to spread knowledge about the illness and improve the care of sufferers.A million dementia friends to be taught how to diagnose and improve careDavid Cameron will also announce today that the Government will trial new medical technology that could potentially reduce the time it takes the NHS to diagnose dementia from about 18 months to only three months.

GPs will use iPad-compatible software to test people’s memory, and should be able to tell whether they have normal or abnormal memory in 10 minutes.

Those needing further investigation will be referred to a specialist brain centre.  Two pilot schemes will cover about 200 patients next year.

An estimated 400,000 dementia sufferers in the UK are not diagnosed and experts believe the tests, if introduced nationally, could double the diagnosis rate to 80 per cent.

The number of sufferers is expected to double in the next  30 years.

Mr Cameron, who launched his Dementia Challenge in March, will give a progress report today as he outlines plans to recruit “Dementia Friends.”  People will be educated in free sessions in church halls and workplaces on how to detect  tell-tale signs of the condition and provide support to family, friends and colleagues.  The hope is that the initiative will also help the public understand the illness.

The Prime Minister admitted that general awareness was “shockingly low”.  He said: “We cannot underestimate the challenge we face in dealing with dementia in our country.  There is still a long way to go in fighting the disease but together we can improve the lives of millions.”

From today people wishing to become “Dementia Friends” can text “Friend” to 88080 or visit  The Government hopes that one million will volunteer by 2015.  People will get a badge with a “forget-me-not” symbol after completing their training, so they can be identified as being able to help sufferers.

Other measures include requiring health care professionals to ask all patients aged between 65 and 74 about their memory as part of every standard health check. A £1m prize fund will reward any NHS organisation  finds ground-breaking ways to  reduce the number of undiagnosed people with dementia.

Jeremy Hughes, Chief Executive of Alzheimer’s Society said: “Dementia is everyone’s problem and we all need to be part of the solution. Day- to-day tasks such as going to the shop or catching a bus can become increasingly difficult for people with dementia. Without a helping hand, this can mean people are left feeling isolated, unable to be part of their community and in some cases even unable to continue living at home.”

The priority given to early diagnosis and increasing public awareness of dementia will be highlighted next week when the Government publishes its “mandate for the NHS” over the next year.

Dr Eric Karran, Director of Research at Alzheimer’s Research UK said: “At a cost of £23 billion  a year to the UK economy, we all agree that dementia is not a problem we can ignore.”


Sexual healthcare at risk from NHS changes

October 31, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Health Professionals, NHS Cash Shortages, Patients, postcode lottery, Private Healthcare, Sexual Health, Uncategorized

In April 2013 many health services are being put out to private tender – and will be overseen by amongst others the GP-led Clinical Commissioning Groups (CCGs).Sexual healthcare at risk from NHS changesBut CCGs will not commission sexual health or public health services such as obesity and smoking prevention.

This function will fall to local councils, and elected officials. The directors of public health who will advise on these decisions will need to be strong advocates for the disadvantaged and stigmatised.

HIV services, meanwhile, will be commissioned centrally by the NHS Commissioning Board.

This separation is fraught with difficulties: especially when both sexual health and HIV care are currently provided by the same healthcare professionals on the same premises.

It is similarly unclear who will pay for HIV prevention campaigns.

Over 85% of all people attending NHS sexual health clinics take up HIV testing, with referral and retention rates both excellent – resulting in world-class patient outcomes.

Currently, we are able to treat patients, map epidemiological trends (disease patterns in the population) and target our prevention campaigns in a manner which is the envy of the world.

Any private company tempted to bid for a contract from a local council, may have subtly different priorities.

There will certainly be a handsome profit to be made from delivering straight-forward tests for sexually transmitted infections and HIV.

But diagnosis, management and treatment of the more complicated cases or assiduous epidemiological data collection might not be such money-spinners.

Is the private sector willing to provide such expertise, to perform ‘contact-tracing’, the unique NHS service which helps us track the spread of pathogens and identify outbreaks?

The worried well are an easy market.

But will private companies really target the hard-to-reach populations who need the services most, such as prisoners, commercial sex workers and intravenous drug users?

The difficulty with splitting HIV service provision apart from sexual health provision will also begin to tell.

Relatively expensive HIV services may become untenable without the staff and stability offered by providing the two services together.

Instead, there is a very real risk that currently joined-up services will become fragmented, with huge variation in service.


Diabetes UK warns of health calamity

October 17, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Accident & Emergencies, diabetes, Diets, Doctors, Health Direct, Health Websites, NHS Cash Shortages, NHS Deaths, NHS Waste, Obesity, postcode lottery, Uncategorized, weight loss, Wellbeing

The Diabetes UK charity calls for government intervention after fears that another 700,000 Britons will be diagnosed with the disease by 2020.Diabetes UK warns of health calamityThe rise will put severe strain on the NHS, which currently spends 10% of its budget treating the consequences of the condition, according to Diabetes UK.

The charity’s estimate of 700,000 extra cases in England, Scotland and Wales by the end of the decade is based on projections compiled by the NHS-funded Yorkshire and Humber Public Health Observatory, which monitors the number of peopled affected.

About 3.7 million people in Britain currently have diabetes, including 850,000 who are believed to have it without knowing.

“I have grave fears about the potential impact of an extra 700,000 people with diabetes, which is almost the combined population of Liverpool and Newcastle. If this projected increase becomes reality it would be a calamity for the healthcare system and a disaster for public health,” said Barbara Young, chief executive of Diabetes UK. “But the government and the NHS do not seem to have grasped the scale of the impending crisis and at the moment we seem to be sleepwalking towards it.”

The charity is urging ministers to put more resources into preventing type 2 diabetes, which is closely associated with obesity and accounts for 90% of cases of the disease. It also believes they should fund a major public health campaign to raise awareness of how serious type 2 diabetes can be and what the risk factors are – such as being overweight, having a large waist or a close relative with the condition.

The Department of Health said it wanted to prevent people developing diabetes and was overhauling the NHS to try to improve treatment of the condition.

“We are taking wide-ranging action to tackle diabetes. First through prevention – by encouraging healthier lifestyles and identifying those at risk and supporting them to take the necessary action to prevent diabetes. Secondly, by better management of the condition, both in hospital and in the community,” it said.


NHS hospital patients facing severe cutbacks if elderly care crisis not solved

October 12, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Care Professionals, Health Professionals, National Health Service, NHS, NHS Cash Shortages, postcode lottery, Private Healthcare, Uncategorized

NHS patients will see “severe” reductions in their care in the next few years if the Government does not close an estimated £2 billion shortfall in funding for care for the elderly, hospital chiefs are warning.NHS hospital patients facing severe cutbacks if elderly care crisis not solvedThe current system of care is in danger of becoming “unsustainable” if more money is not made available, they say.

A Government scheme transferring hundreds of millions of pounds a year from NHS budgets to care is no more than a “sticking plaster” and could cause serious problems for hospitals if it became permanent, they add.

The warning comes in a report by the NHS Confederation, which represents managers in health trusts, amid debate about the future of the social care system.

Around 1.2?million frail or vulnerable people in England rely on care services provided by their local council.

But it is thought that almost one million more are in need but do not receive help because they do not qualify for state support and cannot fund it themselves.

The report offers strong support for the recommendations of the landmark Dilnot report to cap the amount anyone would pay for care in their lifetime at around £35,000, to enable people to plan for old age and take out insurance.

But it warns that even if the Dilnot recommendations are implemented in full, the estimated £2 billion needed to fund the system would still have to be found by the taxpayer.

And it argues that any attempt simply to take that money from the NHS would amount to “robbing Peter to pay Paul”.

More immediately, it warns the Government that a temporary system involving transferring money to social care from the NHS cannot be sustained in the long term.

The Department of Health is giving councils up to £2 billion a year by 2014 to spend on care for the elderly and disabled amid swingeing cuts to local authority budgets.

That will include up to £1 billion a year being diverted directly from the NHS into the crisis-hit social care system.

“We recognised this as a necessary ‘sticking plaster’ in the short term, however, the transfer did not represent a long-term solution,” the report says.

“In many areas this money has had to be used to paper over the cracks in the system and local authorities have had to plan on the basis that this money will continue to be available.

“Without further action on funding, even the basic social care that we currently expect for the very old will not be available in the future from local authority-funded social care.”

The report outlines how, although NHS funding is being protected amid the cuts, it is coming under greater pressure than ever, with the ageing population fuelling demand.

It estimates that so-called “bed blocking” alone costs the NHS £200 million a year – a cost expected to rise as social care becomes more scarce making it harder for hospitals to discharge elderly patients from wards.


Surgery death rate twice as high as previously thought

October 05, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Accident & Emergencies, Doctors, Health Professionals, National Health Service, NHS, NHS Deaths, Patients, postcode lottery, Uncategorized

Twice as many people die after surgery in NHS hospitals as previously thought according to a new report that finds serious shortcomings in the way many patients are treated.Surgery death rate twice as high as previously thoughtThe overall chance of dying within two months of surgery is one in 28 (3.6 per cent), found the study published in The Lancet.

Dr Rupert Pearse, who led the research, described its findings as “very worrying” and said many patients were simply not getting the care they should. “We need to act,” he said.

People at a high risk of dying from surgery were routinely not being told of the dangers, said doctors, often because hospital staff were not identifying them properly.

Patients were also being sent back to general wards after surgery rather than critical care beds because of a “one-size fits all” approach that was “ingrained” in the NHS.

Dr Pearse, a reader in intensive care medicine at Barts and the London School of Medicine and Dentistry, said lessons needed to be learnt from cardiac surgery, where information on death rates was freely available and hospitals vied to be the best

A previous report, published last December by the National Confidential Enquiry for Patient Outcome and Death (NCEPOD), found the chance of dying within 30 days of surgery was just one in 63 (1.6 per cent).

But Dr Pearse said the difference between the two figures could not simply be explained by more patients dying in the second month.

“The great majority of deaths happen in the first seven to 10 days after surgery.”

Patients undergoing specialist surgery are treated differently, for example by dedicated teams on dedicated wards. Dr Pearse argued that meant they essentially received better care.

He said the mortality rate among adult cardiac patients was now less than two per cent – even though they tended to be older, have worse health, and require more dangerous surgery than average.

“If we did the types of things that we did in cardiac surgery, in all types of surgery, outcomes would improve.

Cardiac patients are treated by specialist teams of surgeons and anaesthetists and cared for by specialist nurses on dedicated wards.

Dr Pearse also said outcomes for cardiac surgery had improved markedly since the mid 90s, partly due to changes triggered by the Bristol Royal Infirmary scandal. Between 1990 and 1995, 35 babies died in its cardiac unit and dozens more were brain damaged due to lack of staff, leadership, and scrutiny.

This led to cardiac units being constantly audited, with results now published online.

“I think the reason we see such amazing care and excellent outcomes with cardiac surgery, is that hospitals compete with each other,” he said.  “If they find that their hospital is below par, they want to improve it.”

Doctors concede that there is simply not the money to provide such a level of care for all patients.


NHS has cash reserves of almost £4 billion

October 02, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Health Direct, National Health Service, NHS, NHS Cash Shortages, postcode lottery, Preventable Crisis, Uncategorized

The NHS has stockpiled cash reserves of almost £4 billion- emphasising the disparity in the National Health Service which we posted about yesterday NHS under pressure with more trusts in the redNHS has cash reserves of almost £4 billionFour per cent of the entire NHS budget – half of which was not spent in 2011-12 alone – is sitting in the bank, even as cuts have increased and the number of nurses has reduced.

Dr Peter Carter, general secretary of the Royal College of Nursing (RCN), said: “Patients will question why as many as 61,000 posts are at risk in the NHS when there is an overall surplus of £1.6 billion.”

Dr Jennifer Dixon, director of the Nuffield Trust health think tank, said that £4 billion was a large amount for a service with a £100 billion budget to hold and the money should be spent to help patients and relieve the strain on hospitals.

NHS bodies in England achieved an underspend of £2 billion in 2011-12 alone, which contributed to the service saving just under £4 billion in “uncommitted finances”, the Audit Commission told the Guardian.

Primary care trusts (PCTs), strategic health authorities and hospital trusts between them accumulated a surplus of £1.6bn from their budgets in 2011-12, while semi-independent foundation trust hospitals underspent by a further £400m, according to the Commission’s annual report into NHS finances.

Yet despite the surplus, more than twice as many hospital trusts and PCTs were in deficit at the end of the 2011-12 financial year than the previous year – 34 compared to 15. The number of foundation trusts in the red more than tripled from six to 21, their collective deficit ballooning from £27m to £130m.

The number of NHS hospital trusts in financial trouble has risen from seven to 10, and their collective deficit increased from £102m to £177m.

The bottom line, however, shows that the NHS has succeeded in making £5.8bn of efficiency savings on the way to its target of £20bn by 2015.

Andy McKeon, the Commission’s managing director of health, said: “Overall, a combination of underspend, surpluses and non-recurrent spending in 2011/12 have given the NHS approaching £4bn in uncommitted finances, providing financial room for manoeuvre in the future.

“These savings did not materially affect the total number of frontline staff and do not appear to have resulted in any major transformation to the way care was delivered.”


NHS under pressure with more trusts in the red

October 01, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Health, Health Professionals, National Health Service, NHS, NHS Targets, Patients, PFI, postcode lottery, Uncategorized

The number of NHS trusts in financial difficulty has more than doubled in a year an Audit Commission report warns.NHS under pressure with more trusts in the redThe NHS ended 2011-12 with a £1.6 billion surplus- but the differences between solvent trusts and struggling ones is growing, warns the Audit Commission.

Hospitals on the outskirts of London and across the south east are struggling to balance their books, according to the report, while those in the centre of the capital, the Midlands and northern England are tending to fare much better.

Across England, the Audit Commission found 31 ended the 2011-12 financial year with a deficit. That compares with just 13 at the end of the previous year.

The NHS Financial Year 2011-12 report, published today, notes that most trusts reported “an improved financial position”, with the NHS overall recording an unspent “surplus” of £1.6 billion, up on £1.5 billion the previous year.

“However, there is a growing difference between those organisations that are struggling financially and those that are not,” it goes on.

It warns of “stark geographical differences” such as those “between the relatively financially comfortable inner London NHS bodies and financially harder pressed outer London bodies”.

That fact was baldly revealed this summer when South London Healthcare NHS Trust, responsible for three hospitals in south east London and metropolitan Kent, effectively went bust.

It was placed under the authority of a special administrator because it was losing £1 million a week.

The Audit Commission report said the trust had the largest deficit of any NHS body, at £65 million for the year. Its cumulative deficit is £148 million.

Part of the problem stems from two public finance initiatives (PFIs) costing it £61 million a year in interest.

But the report highlights serious financial problems at other hospital trusts on the edge of the capital, notably in north west London.

Senior NHS figures believe long term problems are now coming to the fore. Inner London hospitals have been able to pull in talent, patients and funding due to their reputations, but elsewhere in London and the south east, some hospitals without star attractions have withered.

There are seriously troubled trusts outside the south east too. The report mentioned Peterborough and Stamford Hospitals NHS Foundation Trust, which has a £46 million deficit.

Andy McKeon, managing director of health at the Audit Commission, said: “While nationally the NHS appears to be managing well financially, and preparing itself for the changes and challenges ahead, a number of primary care trusts and trusts are facing severe financial problems.

“The Department of Health and other relevant national authorities need to focus their attention on the minority of organisations whose financial position is deteriorating, and on their geographical distribution and service standards.”

The 31 trusts in deficit include 21 foundation trusts, which are financially independent of the Department of Health, up from six in 2010-11.

The report also found the health service was on track to make £20 billion of efficiency savings by April 2015, and was “in a good position to meet the challenges of spending within its limits”. However, it warned there was “no room for complacency”.

A Department of Health spokesman said: “We know the NHS is facing even greater pressures, not least from rising demand and costs.

“That’s why we are investing an extra £12.5 billion in the NHS, modernising it and improving efficiency while at the same time improving choice for patients to drive up the quality of patient care.”