ESA benefit payments- retests axed for chronically ill claimants

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Claimants of long term sickness benefits will no longer face repeated medical assessments to keep their payments.

Work and Pensions Secretary Damian Green said it was pointless to re-test recipients of Employment and Support Allowance (ESA) with severe conditions and no prospect of getting better.

More than two million people receive ESA, which is worth up to £109 a week. The move has been welcomed by charities supporting those with severe illness.

Shadow work and pensions secretary Debbie Abrahams said it was “a welcome U-turn” by the government, but “the devil was in the detail”. What about mental health conditions, conditions that are fluctuating, conditions that may not necessarily have a physical manifestation?” she said.

Applicants for ESA have to undergo a work capability assessment to find out if they are eligible and they are re-tested to ensure their condition has not changed. Some are re-tested every three months and others up to two years later.

Under the government’s change, those who are deemed unfit for work and with conditions that will not improve will no longer face re-testing.

Illnesses such as severe Huntington’s, autism or a congenital heart condition are among those that are likely to qualify for continuous payments without reassessment. The criteria will be drawn up with health professionals.

Mr Green said a “key part” of making sure those who were unable to work received “full and proper support” included “sweeping away any unnecessary stress and bureaucracy”.

Currently, those in the “work-related activity group” – deemed unable to work at the moment but capable of making some effort to find employment – receive up to £102.15 a week in ESA payments.

Those in the “support group” – deemed unable to work and not obliged to do anything to improve their chances of finding work – receive up to £109.30 a week.

From April 2017, payments will fall to £73 for new claimants in the “work-related activity” category as ministers argue that too few people in the category are moving into work.

Former Work and Pensions Secretary Iain Duncan Smith, welcomed the “progressive” reform to the re-testing regime, which he had set up when in office.

“I hope that the government will… move on to the fuller reform… where we lock together with the health department much more to be able to get a better health assessment of people, rather than a just strictly work assessment.”

Tim Nicholls, policy manager at the National Autistic Society, said ESA was a vital benefit for those unable to work, covering basic daily living costs such as food, heating and clothes.

“The flawed assessment process can be highly stressful for autistic people who can experience high levels of anxiety meeting new people or when their routine is broken, particularly when the stakes are so high,” he said. “We will be looking out for more details from the government.”

Overseas nurses denied NHS jobs

Thousands of overseas nurses were denied permission to work in England last year, despite hospitals facing staff shortages.

The Royal College of Nursing (RCN) has found that the refusals have hit high profile hospitals in Cambridge, Newcastle and Manchester.

A Freedom of Information request to the Migration Advisory Committee (MAC) found more than 2,341 refusals.

The RCN asked for the number of applications to allow overseas (non-European Union) nurses to work in England between April and November 2015 and the number refused.

It found that East Lancashire Hospitals NHS had the highest number of refusals with 300 out of 300 applications.

The research found that Brighton and Sussex University Hospitals and North Cumbria University Hospitals both had about 240 refusals.

Nursing was temporarily placed on the MAC shortage occupation list (allowing more overseas nurses) in December.

Janet Davies, chief executive of the RCN, said: “These figures show that when nursing is not on the list, many trusts are unable to recruit enough nurses, which could have an impact on patient care.”

Catherine Morgan, director of nursing at The Queen Elizabeth Hospital in King’s Lynn, said that she had been prevented from recruiting a number of overseas nurses.

“It is frustrating because we are running a hospital and do want it to be safe, and we had the opportunity to recruit from India and the Philippines and we had nurses keen to come over but haven’t been able to bring them over,” she said.

A Department of Health spokesman said: “The MAC is currently reviewing the shortage occupation list. Staffing is a priority and there are already more than 8,500 more nurses on our wards since 2010 and 50,000 more nurses in training.

“We want more home-grown staff in the NHS and our recent changes to student funding will create up to 10,000 more nursing, midwifery and allied health professional training places by 2020.”

NHS health staff crisis is worse than cash woes

The growing crisis in healthcare professionals’ morale is a greater risk to the NHS than the financial problems it is grappling with.

The growing crisis in healthcare professionals' morale is a greater risk to the NHS than the financial problems it is grappling with
Nigel Edwards, chief executive of the Nuffield Trust think tank, warned staff shortages, disputes with government and bullying were creating a “toxic mix”.

He said if the problems persisted, the affinity staff felt for the NHS could be irreparably broken.

The warning comes amid growing tensions between the healthcare workforce and government ministers.

This year has seen a series of strikes by junior doctors in England, while nurses and midwives have been protesting about plans to scrap the bursaries they receive while they are studying.

Mr Edwards said this industrial unrest was happening at a time when there were looming shortages – last month, a report by the Public Accounts Committee warned the NHS was short of about 50,000 staff out of a front line workforce of just over 800,000.

The most recent staff survey – published earlier this year – also highlighted the problem, with only 31% of respondents saying there was enough staff for them to do their jobs properly.

The Nuffield Trust also pointed to feedback it had received from health managers warning about deteriorating morale and uncontrollable growth in workload.

One manager said there was a “creeping sense of inevitability and acceptance that failure will happen at some point”.

Mr Edwards said the care and compassion of health workers was underpinned by a “psychological” contract.

He said while financial problems – last month it was revealed NHS trusts had overspent by a record £2.45 billion in 2015-16 – could be rectified in time, deteriorating morale was harder to fix.

“Once the psychological contract with staff is broken, it may be impossible to reverse,” he added.

Siva Anandaciva, of NHS Providers, which represents NHS trusts, said he shared the concerns. “This is a pivotal time for the NHS, with extreme financial and capacity challenges putting extra pressure on staff,” he said. “Perhaps inevitably, staff morale can take a battering.”

A Department of Health spokeswoman said there were signs in the staff survey that some measures were improving.

She added: “Good leadership is the single most critical ingredient to raising morale in any team. We also see that the best hospitals combine tight financial grip, an unrelenting focus on improving patient care and high levels of staff engagement.”

Health Direct notes frequent HR research which finds that levels of staff morale inversely correlates with managements’ staff appreciation in many organisations- the NHS is no expection Mr Hunt.

Agreement in sight for Junior doctors’ contract deal

A potential deal in the long running dispute over a new junior doctors’ contract has been agreed.

AgreementGovernment negotiators and the British Medical Association leadership have reached an agreement after eight days of talks at conciliation service Acas.

Health Secretary Jeremy Hunt said the deal was a “significant step forward”, while the BMA said it represented the “best and final way” to end the row.

The offer will now be put to a vote of over 40,000 BMA members.

That means it could still end up being rejected, but the fact the union and government have agreed a deal to end the stalemate is a major breakthrough.

These talks were seen as the last chance to get an agreement and were set up after a series of strikes, including the first ever full walk out by doctors.

It comes after the government announced in February it would be imposing the contract from this summer after previous talks failed.

The details released this week include several major changes:

  • the basic pay rise is to be reduced from 13.5% to between 10% and 11%
  • weekends will no longer be divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
  • extra pay for night shifts is to be reduced from 50% to 37%
  • extra support will be made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch up on their training and thus qualify for pay rises – after claims women were being unfairly penalised
  • junior doctors will get an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work
  • the deal remains cost neutral, which means the government is not putting in extra money

The fact that something has been agreed is a major breakthrough. But this dispute is still a long way from being over. The BMA has promised its 40,000 members a vote on the agreement. That will be carried out in June and there are no guarantees the membership will give it the green light.

Junior doctors have been incredibly united throughout. Some 98% voted in favour of taking strike action last autumn and whenever union leaders have taken soundings since, the overwhelming sense has been that they have wanted to fight on.

If this hadn’t been the case the leadership would probably have agreed a deal long before now. What will be interesting, and perhaps crucial, is just how strongly the BMA leadership tries to sell the agreement to members in the coming weeks.

BMA junior doctor leader Dr Johann Malawana said he was pleased to have reached a deal after “intense but constructive talks”, adding it was the “best and final way” of resolving the dispute.

“Junior doctors have always wanted to agree a safe and fair contract, one that recognises and values the contribution junior doctors make to the NHS, addresses the recruitment and retention crisis in parts of the NHS and provides the basis for delivering a world-class health service.”

“What has been agreed today delivers on these principles, is a good deal for junior doctors and will ensure that they can continue to deliver high-quality care for patients.”

He said he would be recommending the deal to junior doctors ahead of the vote of BMA members, which will be run in June.

NHS understaffed by 50,000 due to bad health planning

Bad planning and cost cutting have left the NHS in England short of 50,000 vital front line staff MPs are warning.

Bad planning and cost cutting have left the NHS in England short of vital front line staff, MPs are warning.
The Public Accounts Committee said the shortfall in doctors, nurses and midwives could even get worse if ministers did not get a “better grip”.

The group also warned there had been “no coherent attempt” to work out the staffing needed for a seven day NHS.

The cross party group of MPs acknowledged the NHS budget is expected to have risen by just over £8 billion in its report, but cast doubt on how far that would stretch given that ministers are trying to increase the availability of staff and services at weekends.

The report looks at clinical staff – those who provide care, including doctors, nurses, midwives and ambulance crews. These account for more than 800,000 jobs – two thirds of the entire NHS workforce.

It said working out the exact shortfall was difficult, but said estimates made two years ago suggested the NHS was short by about 50,000 professional health staff.

The report was published as it emerged that emergency surgery at a Nottinghamshire hospital has been suspended because of a shortage of junior doctors. Surgical patients at Bassetlaw Hospital are now being transferred to Doncaster Royal Infirmary – almost 20 miles away.

The MPs were scathing of the health leadership provided by the government and national bodies, such as Health Education England, in recent years.

It said NHS trusts had been given conflicting messages – being urged to cut overheads to save money, while investing in staff in the wake of the Stafford Hospital scandal.

This has created a situation whereby the NHS had reduced the number of training posts available for core groups such as nursing, while struggling to retain staff, despite increases in demand for services.

The report said the high level of spending on agency staff seen in recent years was “largely the consequence” of this bad planning.

While NHS leaders have been quick to blame “rip-off” fees, prompting them to introduce a cap on how much can be charged, the report pointed out that most of the rise was a result of the NHS needing locum staff to fill gaps.

Committee chairman Labour’s Meg Hillier said there were “serious flaws” in the approach of government.

“Front line staff are the lifeblood of the service yet the supply of these staff in England is not keeping pace with demand. This poor workforce planning means patients face the possibility of longer waiting times and a greater cost to the public purse.”

British Medical Association leader Dr Mark Porter said this is a “disastrous” situation.

And Royal College of Nursing general secretary Janet Davies added: “What we have seen so far is how short term decisions and budget cuts lead to nothing but lowered standards of care which could so easily have been avoided.”

Fourth Junior Doctor strike hits Health Service

Junior doctors in the NHS are taking part in a fourth strike in their long running contract dispute.

Junior doctors in the NHS are taking part in a fourth strike in their long running contract disputeThe 48 hour strike started at 08:00 this morning as the doctors prepare legal challenges to the government’s decision to impose changes to their pay and conditions from this summer.

Doctors are again providing emergency cover- but 5,000 operations and procedures have been postponed.

The latest action means the total number of treatments that have been delayed has now hit 24,500 during the dispute.

The Patients Association has come out in support of junior doctors despite the disruption, saying the government should not be imposing the contract.

But despite pleas from them and other organisations for both sides to get back round the negotiating table, the government and British Medical Association (BMA) have remained adamant they will not budge from their positions.

The BMA said it had been left with “no choice” in its fight against the government’s plan to impose a new contract in which, it said, the profession had “no confidence”.

Ministers have said the changes, which will see doctors paid less for working weekends while basic pay is increased, are needed to improve care at weekends. This is disputed by the BMA.

How the Junior Doctors dispute reached stalemate

  • Talks at conciliation service ACAS broke down in January
  • A final take-it-or-leave it offer was made by the government in February but was rejected by the BMA
  • Ministers subsequently announced the contract would be imposed in the summer
  • It will reduce the amount paid for weekend work, but basic pay is being increased
  • The BMA wants a more generous weekend pay allowance and more investment for more seven-day services –
  • the government is not increasing the overall budget for junior doctors’ pay
  • Two legal challenges are being pursued by doctors against the imposition
  • Hospitals are pushing ahead with the new contract – offers are expected to go out in May
  • The government is refusing to reopen talks, arguing it made compromises earlier in the year but the BMA did not

Over the past few weeks, a host of organisations, including patient group National Voices and the Academy of Medical Royal Colleges, have come forward to call on the government to drop the imposition and the BMA to stop the strikes and reopen talks.

As the latest strike got under way, Patients Association chief executive Katherine Murphy said the imposition was “not at all helpful”.

“Junior doctors are the backbone of the NHS and it is vital that they are able to provide the safe and effective care that patients need. Such a highly trained and valuable part of the NHS should not be disregarded so lightly.

“At a time when financing the NHS is already at breaking point, we should not further risk losing more doctors whose training is funded by the public purse.”

BMA junior doctors’ leader Johann Malawana said: “By pursuing its current course, the government risks alienating a generation of doctors.

“If it continues to ignore junior doctors’ concerns, at a time when their morale is already at rock bottom, doctors may vote with their feet which will clearly affect the long-term future of the NHS and the care it provides.

“Responsibility for industrial action now lies entirely with the government. They must start listening and resume negotiations on a properly funded junior doctors’ contract to protect the future of patient care and the NHS.”

Health Direct notes that when the Patients still back the Doctors, the politicians should reflect on their own dogmatic intransigence and get back to the negotiating table.

Doctors’ strike may over-crowd hospitals

Hospitals may end be over crowded tonight as they fail to discharge patients because of the junior doctor strike.

Hospitals may end be over crowded tonight as they fail to discharge patients because of the junior doctor strike.
The NHS seemed to cope well on Wednesday following the walkout from 08:00 GMT over the contract dispute. But NHS England said the second day of the 48 hour walkout in England was always going to be more difficult.

Officials said hospitals may struggle to discharge patients without junior medics on wards.

Dr Anne Rainsberry, who is in charge of planning during the strike, suggested hospitals might find it difficult to discharge patients, which could then create a backlog in hospital wards.

She said this was because they had a “valuable role” in chasing up test results and ensuring patients were ready for discharge.

“So far the NHS is holding up, but we always expected the second half of the strike will be more challenging,” she said.

She also urged patients to go to hospital only when absolutely necessary.

“If people need medical help and it’s not an emergency they should consider NHS Choices, visit their local pharmacy, or call their GP or NHS 111 for more serious matters. If their condition is an emergency or life-threatening they should call 999 as usual or go to A&E.”

Doctors are providing emergency cover during the walkout, which ends on Friday morning, and consultants, nurses and midwives are all working in hospital as normal. GP surgeries are largely unaffected.

On Wednesday just over half of junior doctors expected in work did not turn up – a figure broadly in line with the previous strikes and to be expected considering the numbers needed to provide emergency care.

The latest walkout is the third in the long running dispute, but the first to last 48 hours.

So far 19,000 operations and treatments have had to be postponed because of industrial action. The NHS carries out about 30,000 procedures a day.

Thousands of check-ups, appointments and tests have been affected as well.

Katherine Murphy, of the Patients Association, said she had “growing concern” about the dispute.

“Whatever the rights and wrongs of the arguments put forward by either side, the failure to resolve the differences by agreement is bad for doctors, bad for the taxpayer, but above all bad for patients and the NHS.”

This week’s walkout is the first of three 48 hour stoppages planned by the British Medical Association as it continues its fight against the government’s plans to force through the changes to pay and conditions. The next two are planned for April.

The union has also said it will be launching a legal challenge to oppose the imposition of the contract that was announced following last month’s strike.

But ministers have said they will be pushing ahead with imposition regardless. The new contracts are due to go out in May and will come into force from August.

The BMA said it “deeply regretted” the disruption that was being caused, but the action was necessary because of the “unfair” changes being imposed on the profession.

NHS struggles to recruit thousands of healthcare professionals

More than two thirds of NHS trusts and health boards are struggling to recruit qualified healthcare professionals.

More than two thirds of NHS trusts and health boards are struggling to recruit qualified healthcare professionals

Data from a BBC Freedom of Information request shows that on 1 December 2015, the NHS in England, Wales and Northern Ireland had more than 23,443 nursing vacancies – equivalent to 9% of the workforce.

In comparison, the average vacancy rate across the UK economy from November to January 2016 was 2.7%, according to the Office for National Statistics.

The figures – which include 106 out of 166 trusts and health boards in England, Wales and Northern Ireland – also revealed:

  • Between 2013 and 2015, there has been a 50% increase in nursing vacancies, from 12,513 to 18,714.
  • For doctors, the number of vacancies went from 2,907 to 4,669 – an increase of roughly 60%.
  • In England and Wales, there were 1,265 vacancies for registered nurses in emergency departments – about 11% of the total.
  • For consultants in emergency medicine there were 243 vacancies – again 11% of the total.
  • Paediatric consultants – specialists in the care of babies, children and young people – were also hard to recruit, with 221 vacancies – about 7% of the total.

There are many reasons for the large number of vacancies in nursing and doctor posts on hospitals in England, Wales and Northern Ireland. One simple reason is that more posts now exist, but the number of trainees has not kept up.

In the wake of the 2008 financial crash, nursing places were cut, although they are now on the way back up. The BMA suggests it takes around 15 years between a medical student starting out at university and becoming a consultant so planning the NHS workforce supply and demand is a complicated process with a long lead-in time.

But there are also increasing pressures on the health service right across the UK which the NHS is having to respond to – a growing population that is older and sicker, with more complex health needs. In plain language “complex health needs” means more than one thing going on at a time, so an elderly person might be having to cope with arthritis, diabetes and heart problems.

But one other important factor is the “Francis effect” – the report by Sir Robert Francis into the scandal at Stafford Hospital identified a shortage of nurses as a key factor in the poor care of patients. Trusts in England in particular have been under pressure to recruit more staff. But when there is a shortage of qualified nurses they have resorted to expensive agency staff and that in turn has led to a growing financial crisis.

One solution to the staff shortage adopted by many trusts is employing doctors and nurses from overseas.

The figures show 69% – of all NHS trusts and health boards are seeking staff overseas.

And in just England and Wales, the figure is nearly three quarters of all trusts and health boards – 74%.

Meanwhile, the Royal College of Nursing and the British Medical Association blame poor workforce planning for the problems hospitals are having in finding qualified staff.

Janet Davies, chief executive of the Royal College of Nursing, said: “Nursing posts are often the first target when savings need to be made, leading the NHS to find itself dangerously short and having to spend more on agency staff and recruitment from other countries.”

A spokesman for the doctor’s union the BMA – which is currently locked in a dispute with the government in England over a new contract for junior doctors – said: “Poor workforce planning means we aren’t producing enough doctors and sending them to the right areas,” he said.

Junior doctors threaten exodus after Hunt’s ultimatum

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.After two strikes by junior doctors, the sticking point in negotiations remained the rates of pay for working Saturdays.

Under the new contract, 7am to 5pm on Saturdays will be regarded as a normal working day. But in a final concession, the Government offered a 30 per cent boost for any doctor working one or more Saturday a month.

Dr Johann Malawana, BMA junior doctor committee chairman said the union was now considering “all options open to us” warning of a “real risk that some will vote with their feet”.

This could mean further strikes – with an option of a full walkout by junior doctors, an attempt legal action by the union, or moves towards mass resignations.

On social media, junior doctors said they were considering emigrating, while others staged angry protests outside the Department of Health headquarters in Whitehall.

Labour accused Mr Hunt of “behaving like a recruiting agent for Australian hospitals” while the Labour Welsh health minister tried to lure medics over the border.

In a statement to the Commons, Mr Hunt said the BMA had proved “unwilling” to show flexibility and compromise.

He announced junior doctors would recieve a basic salary increase of 13.5 per cent – higher than the 11 per cent offered in November and insisted that no trainee working within contracted hours will have their pay cut.

The first new contracts would be imposed in August, on all new doctors graduating from medical school, and those changing contracts, during their training.

Some estimates suggest this means the majority of the 55,000 workforce would be on new contracts within a year.

Some doctors on longer contracts would not be affected, along with those who have completed their training, but not become a consultant.

In response, Dr Malawana had repeated the BMA’s offer of reducing basic pay in return for more unsociable hours payments.

Dr Malawana said: “The decision to impose a contract is a sign of total failure on the Government’s part.”

He accused Health Secretary Jeremy Hunt of “ploughing ahead with proposals that are fundamentally unfair” and warned that it had no plans just to accept the contract.

He said: “The Government’s shambolic handling of this process from start to finish has totally alienated a generation of junior doctors – the hospital doctors and GPs of the future, and there is a real risk that some will vote with their feet.

“Our message to the Government is clear – junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.”

Health Direct echos BMA council chairman Mark Porter views: “Nurses and other clinical staff who work in the NHS will know now that essentially the Government is coming for them. If the Government is prepared to impose a contract on junior doctors, it’ll be them next.”

David Bowie thanked by end of life care doctor

A doctor specialising in end of life care has  thanked David Bowie helping people to talk about death.

A doctor specialising in end of life care has thanked David Bowie helping people to talk about deathDr Mark Taubert, palliative care consultant at Velindre NHS Trust in Cardiff, said it prompted a “weighty” discussion with a dying woman.

His letter, published on the blogs website page of the British Medical Journal (BMJ), has been retweeted by Bowie’s son, Duncan Jones.

The singer died from cancer aged 69.

Mr Jones had not tweeted since confirming his father’s death, which happened in New York on 10 January.

But he retweeted a link to the letter, where Dr Taubert described the conversation he had with the woman after she had been told her cancer had spread and that she would not live much longer than a year.

Starting the letter with “Dear David”, Dr Taubert wrote: “We discussed your death and your music, and it got us talking about numerous weighty subjects, that are not always straightforward to discuss with someone facing their own demise.

“In fact, your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation.”

He went on: “We talked about palliative care and how it can help.

“She told me about her mother’s and her father’s death, and that she wanted to be at home when things progressed, not in a hospital or emergency room, but that she’d happily transfer to the local hospice should her symptoms be too challenging to treat at home.

“We both wondered who may have been around you when you took your last breath and whether anyone was holding your hand.

“I believe this was an aspect of the vision she had of her own dying moments that was of utmost importance to her, and you gave her a way of expressing this most personal longing to me, a relative stranger.”

Dr Taubert also said dying at home and the last photos of Bowie carrying “off a sharp suit” would help people deal with any fears they had about the last weeks of life.

“You looked great, as always, and it seemed in direct defiance of all the scary monsters that the last weeks of life can be associated with,” he added.