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.”

UK pays less for cancer drugs than some countries

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology.

The UK is paying less for new cancer drugs than a number of other high income countries, according to a report in The Lancet Oncology

While the UK, Greece, Spain and Portugal pay the least, on average, for the drugs they use, Germany, Sweden and Switzerland pay the most.

The authors said more transparency was needed because some countries risked overpaying for drugs. The pharmaceutical industry said the UK was getting a fair deal on medicines.

Prices of cancer drugs have risen steeply in recent years, placing major stress on many healthcare systems, including the NHS.

The report said drugs had accounted for nearly a third of the EU’s £37 billion cancer healthcare spending in 2009.

And the researchers then compared the 2013 price of 31 cancer drugs in 18 high-income countries, including the UK, Australia, New Zealand, France, Greece, Switzerland, Sweden and Portugal.

Prices in Greece were the lowest for 14 out of the 24 cancer drugs available there.

The price of drugs in the UK was also low.

Prices of drugs in Switzerland, Germany and Sweden were frequently the highest – and for some drugs, such as interferon alfa 2b to treat leukaemia and skin cancer, were twice as high.

The price figures come from the Pharma Price Information service in Austria, which details what manufacturers charge per unit – a single tablet or vial of a drug, for example.

But although the official list prices published in this report are freely available, any further discounts – which are often negotiated by organisations in different countries – remain confidential.

David Watson, director of pricing and reimbursement at the Association of the British Pharmaceutical Industry, said the report was evidence that newer medicines “are affordable in the UK”.

He said the UK was “getting a fair deal with regards to medicines pricing” and the NHS was “getting good value for money”.

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.

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.”

Obese smokers denied surgery

The Royal College of Surgeons found a third of local NHS health bosses put restrictions on surgery for smokers and the obese.

The Royal College of Surgeons found a third of local NHS health bosses put restrictions on surgery for smokers and the obeseThe Royal College of Surgeons (RCS) has been increasingly alarmed about the rationing of surgery in the NHS in the tough financial climate. However, some local NHS groups criticised in the report say their polices are based on good evidence.

Its report is based on freedom of information returns from nearly all of the 209 clinical commissioning groups in England and all seven health boards in Wales.

While some CCGs have voluntary policies in place, where patients are encouraged to stop smoking or lose weight, others have introduced mandatory policies, which means patients have to meet fixed criteria before surgery.

The college says mandatory policies are “a cause for concern” and it fears patients with a high body mass index (BMI) or who smoke are becoming “soft targets” for NHS savings.

The report reveals 31% of CCGs and one health board in Wales have at least one policy requiring people to lose weight or stop smoking before they can be referred for routine surgery.

The report suggests one in five CCGs has mandatory policies on BMI levels before hip and knee replacement surgery, while 4% have mandatory policies on getting patients to stop smoking before hip and knee replacement surgery.

Of the CCGs that responded, 22% reported having at least one “voluntary” policy in place.

The Royal College of Surgeons said any blanket ban on surgery based on a patient’s weight or whether they smoked was wrong and not supported by national guidance.

Instead, president RCS Clare Marx said, patients should be encouraged to sign up to programmes to help them stop smoking and manage their weight while awaiting surgery.

“NHS surgical treatment should be based on clinical guidance and patients should be dealt with on a case-by-case basis,” she said.

“In some instances, a patient might need surgery in order to help them to do exercise and lose weight. While it is difficult to categorically prove such policies are aimed at saving money, it is unlikely to be a coincidence that many financially challenged CCGs are restricting access to surgery.”

She added National Institute for Curbing Expenditure (NICE) guidance did not support these mandatory bans for routine surgery.

British Orthopaedic Association president Tim Wilton said there was no clinical or financial justification for refusing to fund hip or knee replacements.

“Good outcomes can be achieved for patients regardless of whether they smoke or are obese, even at BMIs of over 50, and these surgeries are highly cost effective, typically delivering sustained pain relief for a cost that equates to just £7.50 a week,” he said.

“Hard and fast rules also undermine the NHS’s ability to involve patients in decisions about their own care, and are a distraction from the task at hand: making sure patients receive the best possible advice and care, to enable them to make the best possible decisions for their health – including losing weight and stopping smoking where appropriate.”

Doctors want new cosmetic surgery laws

Surgeons want new laws to protect patients undergoing cosmetic surgery

Surgeons want new laws to protect patients undergoing cosmetic surgeryThe Royal College of Surgeons (RCS) has called on the government to introduce legislation in the next Queen’s Speech to protect patients undergoing cosmetic surgery, as the organisation and the General Medical Council (GMC) publish new standards on cosmetic procedures.

The RCS’s new Professional Standards for Cosmetic Surgery are intended to improve patient safety and standards in the industry, by stipulating that only surgeons with the appropriate training and experience should undertake cosmetic surgery, as well as the ethics and behaviour expected of them.

They supplement new guidance the GMC has published today for all doctors who carry out cosmetic interventions, including non-surgical procedures such as Botox and hair transplants, and are intended to be read alongside it.

However, to help make the regulation of cosmetic surgery as robust as possible, the RCS believes the government should also give the GMC a new regulatory power to highlight to the public and employers which surgeons have been certified by the RCS to carry out cosmetic surgery.

Mr Stephen Cannon, Chair of the Cosmetic Surgery Interspecialty Committee and Vice President of the Royal College of Surgeons, said:

“Cosmetic surgery is a booming industry, but the law currently allows any doctor – surgeon or otherwise – to perform cosmetic surgery in the private sector. This can make it difficult for patients to identify an experienced, highly trained surgeon from someone who should not be practising.

“To correct this, we will launch a new system of certification later this year which will help patients to find a certified surgeon, who has the appropriate training, experience and insurance to carry out a procedure – such as a tummy tuck or nose job.

Today’s new Professional Standards for Cosmetic Surgery will underpin the new system of certification. By adhering to the RCS’s new Professional Standards for Cosmetic Surgery, surgeons will ensure that the needs of individual patients are at the centre of the consultation discussion, and that they are fully informed about the potential risks and likely outcome of the procedure.

The proposed cosmetic surgery guidelines recommend that:

  • Surgeons performing cosmetic surgery should be certified in the area in which they practise.
  • The operating surgeon should lead the consultation with the patient to outline the risks of the procedure, likely outcome and to provide the information that will help them decide whether or not to undergo surgery.
  • The operating surgeon must also obtain written consent from a patient themselves – and not delegate it to a colleague.
  • Patients should be offered a cooling off period of at least two weeks before they consent to an operation to give them time to reflect on a decision.
  • Surgeons must make sure they have appropriate indemnity insurance to cover the procedures they are undertaking.
  • Surgeons should refrain from using financial inducements such as time-limited offers and discounts.

Health Direct approves of anything that will end botched and unethical healthcare procedures. These guidelines appear to be an overdue common sence step in that direction.

Over 1000 NHS ‘never events’ a disgrace says Patients Association

Over 1,000 NHS patients have suffered from medical mistakes so serious they should never have happened.

Over 1,000 NHS patients have suffered from medical mistakes so serious they should never have happenedThe so called never events included the case of a man who had a whole testicle removed rather than just a cyst. In another, a woman’s fallopian tubes were taken out instead of her appendix.

Other “never events” included the wrong legs, eyes or knees being operated on and hundreds of cases of foreign objects such as scalpels being left inside bodies after operations.

Whilst NHS England insisted that such events were rare- the Patients Association said that they were a “disgrace”.

The research by the Press Association analysis also found that patients’ lives were put in danger when feeding tubes were put into their lungs instead of their stomachs.

Patients were given the wrong type of blood during transfusions and others were given the wrong drugs or doses of drugs.

The analysis showed there were:

  • 254 never events from April 2015 to the end of December 2015
  • 306 never events from April 2014 to March 2015
  • 338 never events from April 2013 to March 2014
  • 290 never events from April 2012 to March 2013

Katherine Murphy, chief executive of the Patients Association, said: “It is a disgrace that such supposed ‘never’ incidents are still so prevalent.

“How are such basic, avoidable mistakes still happening? There is clearly a lack of learning in the NHS. It is especially unforgivable to operate on the wrong organ, and many such mistakes can never be rectified.”

NHS England insisted never events were rare – affecting one in every 20,000 procedures – and that the majority of the 4.6 million hospital operations each year were safe.

A spokeswoman said: “One never event is too many and we mustn’t underestimate the effect on the patients concerned.

“To better understand the reasons why, in 2013 we commissioned a taskforce to investigate, leading to a new set of national standards being published last year specifically to support doctors, nurses and hospitals to prevent these mistakes.

More than 400 people have suffered due to “wrong site surgery”, while more than 420 have also had “foreign objects” left inside them after operations – including gauzes, swabs, drill guides, scalpel blades and needles.

Others have been given the wrong type of implant or joint replacement, some patients have been mixed up with others, and some patients have been given the wrong type of blood during a transfusion.

Some patients have also been given far too high doses of drugs, including oral methotrexate, which is used for the treatment of severe arthritis, psoriasis and leukaemia.

Health Direct notes that the vast majority of the 4.6 million hospital operations each year are safe- but if a plane crashed after every 20,000 flights then people might stop flying.

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.