NHS to show cost of missed appointments to patients

Patients who miss appointments will be shown how much they have cost the NHS.

Patients who miss appointments will be shown how much they have cost the NHS.The NHS estimates more than 12 million appointments are missed each year

Overall, missed GP and hospital appointments cost the health service in England nearly £1bn a year, Jeremy Hunt said in a speech this week.

He said he sympathised with the idea of charging patients for missing GP appointments, although there are no plans for this to happen.

But he said people would have to “take personal responsibility” for NHS funds.

In a measure announced in a speech to the Local Government Association on Wednesday, Mr Hunt said he planned to display the cost of prescription medicines on packets.

The figure and the words “funded by the UK taxpayer” will be added to all packs costing more than £20 in England.

The move is part of efforts to reduce the £300 million bill for “wasted” medication, which is prescribed but not used.

In the same speech, he said missed GP appointments cost the taxpayer £162 million and missed hospital appointments cost £750 million.

Mr Hunt told the Question Time programme that NHS resources were stretched already, adding there would be more than one million extra people aged over 70 by the end of the current parliament.

“If we’re going to square the circle and have a fantastic NHS, despite all those pressures, then we have to take personal responsibility for the way that we use NHS resources,” he said.

Mr Hunt told the audience in Essex he did not have a “problem in principle with the idea of charging people for missed appointments.”

But he added: “I think in practical terms it could be difficult to do, but I’ve taken a step towards that this week by announcing that when people do miss an appointment they will be told how much that’s cost the NHS.”

NHS medical legal costs- excessive should be capped

The UK government plans to limit excessive fees some lawyers claim in medical negligence cases against the NHS.

UK government plans to limits "excessive fees" some lawyers claim in medical negligence cases against the NHSOfficials want a defined limit on legal costs in cases where the claims are below £100,000, saying that some lawyers submit bills that charge more than patients receive in compensation.

But solicitors warn the move could deny patients access to justice. Figures show the NHS was charged £259 million in legal fees for claims in 2013-14.

The NHS did recoup £74 million by challenging some claims made in 2013-14, but the Department of Health says taking these cases to court is costly and time consuming and believes further savings could be made.

Officials say their proposals, which will be open to public consultation in the autumn, would ensure lawyer’s fees are more proportionate and reflect the amount of compensation patients receive

They give as an example once case where a patient received £11,800 in damages but the legal fees, which the NHS had to recompense, totalled £175,000.

Health Minister, Ben Gummer, said: “Safe, compassionate care is my upmost priority and to achieve this, the NHS must make sure every penny counts.

“Unscrupulously, some lawyers have used patient claims to load grossly excessive costs onto the NHS and charge far more than the patient receives in compensation.”

The Medical Defence Union, which offers doctors guidance on medico-legal issues, supported the move.

Dr Matthew Lee, professional services director for the MDU, said: “Patients often need to meet part or all of these costs themselves but the system must provide access to justice where patients have been negligently harmed.”

“Legal fees must, therefore, be affordable and proportionate.”

“If it was decided to introduce a well-thought-out, fixed-cost structure for legal costs in clinical negligence claims that could only be a good thing and should result in legal fees becoming more affordable and proportionate to the compensation claimed by the patient.”

Hospital charges to rise for non EU patients

Visitors from outside the EU who receive treatment in NHS hospitals in England are now charged 150% of the cost.

Hospital charges to rise for non EU patientsThe charges however only apply to non EU citizens settling in the UK for longer than six months. The new rules from the Department of Health came into force on 6 April.

However primary care and Accident and Emergency treatment will continue to remain free.

Permanent residents of 32 European countries qualify for NHS treatment, which is then billed to their country of residence, but this new ruling applies to foreign migrants or visitors based in other countries, mainly those outside the EU.

These patients can be treated in an NHS hospital but are expected to repay the cost of most procedures afterwards.

But up to now, the DoH has only sought to reclaim the actual costs, without adding any extra charges.  The DoH hopes the changes will help it recoup up to £500 million a year by 2017-18.

The new guidelines do not require patients on trolleys in hospitals to produce passports before getting access to urgent care. Nor do they apply to accident and emergency or a visit to a GP.

What is covered is ongoing treatment on the NHS after an initial diagnosis or referral – for example an outpatient appointment.

The Department of Health is incentivising hospitals to be more vigilant in checking patient credentials by allowing them to charge more for treatment of people “not ordinarily resident” in the UK.

The department can recoup those costs from the patient’s member state if they are from the European Economic Area.

In the paperwork filled in by the patient before the appointment they will be asked for proof they are “ordinarily resident”.

This could be a utility bill, national insurance number or passport details. Some hospitals were doing this already but many were not.

The guidelines are designed to increase the chances that the treatment costs for a non UK resident can be recovered. Critics may ask why it has taken so long for the initiative to be launched.

The charges are based on the standard tariff for a range of procedures, ranging from about £1,860 for cataract surgery to about £8,570 for a hip replacement.

Similar charges can be imposed by the NHS in Northern Ireland, Scotland and Wales for hospital care received by non-EU residents.

Patients using hospital services have been required to show their passports and other immigration documents if their UK residence status was in doubt.

The “health surcharge” on visa applications for non-EU citizens comprises an annual fee of £200-a-year, which is reduced to £150 for students.

Certain individuals, such as Australian and New Zealand nationals, are exempt from the surcharge.

And non-EU citizens who are lawfully entitled to reside in the UK and usually live in the country will be entitled to free NHS care as they are now.

Poor hospital weekend care kills 4,000 a year

Poor care in hospitals at weekends is killing more than 4,000 lives a year, NHS officials have warned- so Health Direct wishes you Good Luck if you are going under the knife today.poor hospital weekend care kills 4,000 a yearThe disclosure comes in an official review of Britain’s emergency and urgent healthcare which says the current system is unsustainable, unaffordable and soaking up more than half of the health service budget.

Health officials will on Monday launch plans which attempt to tackle a deepening crisis in Accident & Emergency (A&E) units, hospital wards and out-of-hours GP services.

They have collected evidence of system buckling under the strain and placing patients at increased risk – especially if they fall sick at weekends.

The dossier is published as NHS England begins a public consultation on a review which could lead to a major restructuring of the NHS, with specialist services concentrated in larger units and changes to put hospitals on a “seven-day” footing, with more consultants and diagnostic tests available at weekends.

The damning official report warns of:

  •  More than 4,400 lives a year lost in England because hospital mortality rates are worse at weekends, largely because of shortages of senior doctors;
  • Spiralling numbers of patients readmitted to hospital because they were discharged too quickly, because of cuts to bed numbers;
  • Evidence of a 30 per cent rise in death rates when casualty units are crowded;
  • Widespread shortages of A&E doctors, with half of training posts unfilled for the past two years;
  • Confusion among the public about how to access urgent care and lack of confidence in the care provided by GPs;

Despite widespread concerns about failings of the non-emergency 111 telephone line, which was introduced in most parts of England this year, the official leading the review said the future model of urgent and emergency care will rely heavily on phone-led services.

The report comes amid increasing fears about the pressures on A&E departments, which senior doctors have likened to “warzones,” while the head of the NHS regulator has said emergency care is “out of control”.

Specific proposals will be published in September, but ideas under consideration include increasing specialisation of some services, such as stroke and trauma, a drive to train more A&E doctors, investment in telemedicine, and changes to the disastrous 111 non-emergency phoneline, so that more clinically-trained staff are involved in decisions.

Pressures on A&E units in recent months have come amid the national roll-out of the 111 phone line, which was supposed to reduce the number of people arriving at hospitals, by diverting those with minor complaints to out-of-hours GP services.

Instead, there have been widespread concerns about areas in which the service has collapsed under the pressure of calls, while in others, call handlers without clinical training dispatched paramedics to the most trivial cases, heaping pressure on A&E units.

There have been investigations into at least 22 potential “serious untoward incidents” since April, including three deaths.

The report does not single out any one factor for the current pressure on hospitals, but says public confidence in 999 services is far higher than that in family doctors, while one in ten patients who fail to get a suitable GP appointment turn up at A&E.

In less than a decade, the number of calls for ambulances has risen from 4.7 million to over 8 million.

IVF success rates may be boosted by time lapse embryo imaging

Time lapse imaging- which takes thousands of pictures of developing embryos can boost the success rate of IVF, according to British research.IVF success rates may be boosted by time lapse embryo imagingThe article Retrospective analysis of outcomes after IVF using an aneuploidy risk model derived from time-lapse imaging without PGS was reported in Reproductive BioMedicine Online, can be used to select embryos at low risk of defects.

Scientists at the CARE fertility group say such informed selection can improve birth rates by 56%.

Other experts say the result is exciting, but the study of 69 couples is too small to be definitive.

The research followed the couples at the CARE fertility clinic in Manchester last year, when 88 embryos were imaged and implanted.

The process involves putting the embryos into an incubator and imaged them every 10 to 20 minutes.

Continual embryo monitoring through time-lapse imaging is aimed at selecting those with the lowest risk of aneuploidy – where the cells have chromosome abnormalities. Aneuploidy is the single biggest cause of IVF failure.

But this form of embryo screening is a predictive rather than diagnostic tool.

Couples at high risk of passing on a chromosomal abnormality may prefer to have Pre-implantation Genetic Screening. This invasive test removes cells from the early embryo for analysis. It costs around £2,500 on top of the £3,000 charged for conventional IVF.

The researchers classified the embryos as low, medium or high risk of chromosome abnormalities based on their development at certain key points.

Eleven babies were born from the low risk group (61% success rate) compared to five from the medium risk group (19% success rate) and none from those deemed high risk.

“In the 35 years I have been in this field this is probably the most exciting and significant development that can be of value to all patients seeking IVF,” said Prof Simon Fishel, managing director of CARE Fertility Group.

“This technology can tell us which embryo is the most viable and has the highest potential to deliver a live birth – it will have huge potential. This is almost like having the embryo in the womb with a camera on them.”

In standard IVF, embryos are removed from the incubator once a day to be checked under the microscope. This means they briefly leave their temperature-controlled environment and single daily snapshots of their development are possible.

Care home companies face harder financial checks

Large providers of care homes in England are to have their financial records regularly checked in future to spot potential business problems.Care home companies face harder financial checksUnder the government’s plans, the Care Quality Commission and local authorities will also ensure care continues if a company does go bust.

It comes after provider Southern Cross collapsed, causing distress and anxiety to its residents and their families.

Care minister Norman Lamb said the move would give reassurance to people.

The Care Quality Commission (CQC) will start to make checks on between 50 and 60 of the largest care companies in England, including those that provide care in a person’s home.

CQC chief executive David Behan said the measures – to be set out in new legislation – would provide early warning of potential company failures in the care industry.

The CQC will have the power to:

  • Require regular financial and relevant performance information
  • Make the provider submit a “sustainability plan” to manage any risk to the organisation’s operation
  • Commission an independent business review to help the provider to return to financial stability
  • Get information from the provider to help manage a company collapse

The Department of Health said the powers would bring care in to line with other services such as hospitals and holiday operators, which have procedures to check on the “financial health” of organisations.

In the case of the collapse of a national provider the effects would be felt in many parts of the country, so it would be unfair for local councils to have to deal with the problem, the department said.

Mr Lamb said: “Everyone who receives care and support wants to know they will be protected if the company in charge of their care goes bust.

“The fear and upset that the Southern Cross collapse caused to care home residents and families was unacceptable.

“This early warning system will bring reassurance to people in care and will allow action to be taken to ensure care continues if a provider fails.”

Southern Cross, the country’s biggest care provider, had thousands of elderly residents at more than 750 care homes across the UK when it collapsed in 2011.

The firm was brought down by having to pay a £250m rent bill as local authorities made cuts.

After its collapse, other operators had to step in to take over the care of more than 30,000 people.

Missed hospital appointments cost east of England NHS £42 million

Patients who missed hospital appointments cost the NHS in the eastern region more than £42 million in the past year alone.Missed hospital appointments cost east of England NHS £42 millionThere were nearly five million appointments in the east’s 24 NHS hospital and foundation trusts in 2012.

But in about 418,000 cases- nearly ten per cent, the patients failed to turn up.

Automated reminders are cutting the number of wasted appointments but hospitals say patients must do their bit by not wasting resources.

The figures have come from a mix of Freedom of Information requests lodged with the various hospitals and data from the Department of Health.

Although the cost of missed appointments varies widely, a number of hospitals apply a rough figure of £100 – and this has been used to arrive at the £42 million overall cost amount.

A spokesman for Colchester Hospital University Trust said: “It is important that members of the public appreciate that they too have responsibilities, like not wasting precious NHS resources.”

One hospital to see a significant drop in the number of ”did not attends’ (DNAs) was the East and North Hertfordshire NHS Trust.

In April 2011, 4,173 DNAs cost it £417,000. By November 2012, the bill had fallen to £284,670 for 2,847 DNAs.

Dr Tim Walker, a consultant anaesthetist at East and North Hertfordshire, said: “It has been a significant issue because we have a limited capacity to see patients in clinics. If people then don’t turn up we have wasted capacity.

Cambridge University Hospitals had the highest number of DNAs last year with 35,225- it is also one of the region’s largest hospitals.

The cost of appointments varies widely. At James Paget University Hospitals, for example, first appointments tend to cost about £160 and follow-ups about £80

“We can be saving up to £1.5 million a year to the outpatient service without having to lose services or staff.”

Jason Foster, deputy general manager for the hospital’s outpatient service, said simply reminding patients had played a key role in reducing missed appointments.

While hospitals say they are making efforts to reduce the number of DNAs, not all hospital staff regard them as a problem.

One hospital spokesman, who asked not to be identified, said: “Some doctors actually like DNAs because it means they can spend more time with the patients who do show up.

“In terms of the patient experience it can be a good thing – it is not uncommon for consultants to complain about clinics being overbooked, which is one of the reasons why they overrun.”

NHS could charge fees to call out a doctor

Calling out a doctor to your home could cost £8.50 under radical proposals to shore up the finances of the NHS.NHS could charge fees to call out a doctorThe proposals are being outlined as a way of tackling the financial hole in the accounts of the Health Service.

The moves sparked outrage with claims they amount to a patients’ tax and undermine the “free at point of use” principle of the NHS.

There are also fears that ill patients will be discouraged from seeking treatment.

The NHS Confederation, which represents all Health Service trusts, outlined the proposals as a way of generating extra funds and as one option in dealing with the hole in the NHS budget.

The group gave an example of a pilot scheme in Germany where 10 euros was charged for a call out by a doctor.

The federation said there was no plans to suggest charging but frank discussions were needed.

The chief executive Mike Farrar said: “We need to talk openly and honestly about why our Health Service needs to change.  We cannot risk the wheels coming off and patient care suffering.”

The report claims the radical proposals may be needed as the NHS faces soaring costs of caring for an ageing population and increasing levels of obesity.

Katherine Murphy, chief executive of the Patients Association, said the proposals undermine a fundamental tenet of the NHS.

“Some of these proposals amount to what would effectively be a “patients’ tax”, she said.  “It would be absolutely unacceptable for patients to foot bill for reform through new charges.”

Surveys have found 27 per cent of patients would delay calling out a doctor and 18 per cent would avoid it altogether if they had to pay.

However, some trusts are already considering imposing a £10-a-day fee to watch TV.

Last year, an NHS trust went into administration for the first time and officials estimate there are around 20 more in severe crisis, with combined debts of about £130 million.

The costs of propping up Private Finance Initiative (PFI) under Labour’s deal will worsen the position even more in the next decade.

Social care cost caps brought forward

The government will bring forward its overhaul of social care funding by a year the chancellor has announced.
Social care cost cap brought forwardA cap on the amount the elderly pay for social care in England – which was to be £75,000 but will now be £72,000 – would start in the same year.

Mr Osborne promised in his budget to “help people who are young and people who are old”, while sticking with the government’s deficit reduction programme.

The cap on social care costs, originally planned to be set at £75,000 and introduced in 2017, will now be introduced in 2016 at a level of £72,000.

This would only cover the cost of social care and people would still have to pay for accommodation and food – although some support will be provided.

Mr Osborne said the cap would protect people from “getting a disease in later life and having to sell their house” to pay bills.

For Labour, shadow minister for care and older people Liz Kendall said: “George Osborne is still failing older people and their families. Today’s minor adjustments to the government’s plan will still leave far too many selling their homes to pay for care.”

She added that any cap above £50,000 would not “provide adequate protection” for people on low incomes.

Ms Kendall said: “We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people stay healthy and living independently in their own homes for as long as possible.”

Mr Osborne said: “I agree that we need to spend more on capital, which is why I had taken the decision in December to increase the spending on capital – but paid for.

“In the end this country has got to pay its way. We can’t just keep on thinking the answer to our problem is more borrowing. You can’t get out of a debt crisis by borrowing more and more.”

But the chancellor defended the ring-fenced budgets for the National Health Service and international aid.

He said the 0.7% of national income earmarked for overseas aid was a “moral commitment” and “sound foreign policy for Britain”.

Elderly suffer from poor home care

A quarter of home care services provided to the elderly in England are failing to meet quality and safety standards, inspectors say.Elderly suffer from poor home careMore than 700,000 people above the age of 65 rely on home help for activities such as washing, dressing and eating.

But the Care Quality Commission found evidence of rushed appointments and botched assessments during its review of 250 services.

Campaigners said it was a sign of how much pressure the system was under.

Ministers have recently announced plans for a £75,000 cap on the amount the elderly will have to pay for social care in England – only the poorest get it free.

The proposal aims to stop the elderly having to sell their homes to pay for care.

But the move will do nothing to get extra money into the system, something the sector believes is vital if the quality of services is going to be improved.

Home help services are considered essential in keeping people out of more expensive care homes.

The numbers getting help is pretty evenly split between self-funders and those who get council-funded care.

This review looked at the support being provided to both – and found too many were struggling to maintain standards.

A total of 26% failed on at least one standard. One of the most common issues identified related to late, rushed or missed visits.

The regulator also highlighted assessments that had missed vital information, such as a diagnosis of diabetes, and care records that were incomplete, meaning problems such as pressure ulcers could be missed by carers.

Concerns were also raised about the way services were monitored and complaints handled.

The regulator said home care providers, many of which are private companies, needed to work closely with local authorities to remedy the problems.

It warned the problems identified could have a “significant impact” on the elderly, many of whom did not complain because of a fear of reprisals or loyalty to their carer.