NHS Bosses 'trying to keep cuts secret'

[lollylou2876]

www.bbc.co.uk/news/health-37943379

Extremely worrying when patient consultation is purposely thrown out of the window.

Any thoughts?

[Suppermummy02]

Unfortunately its impossible to discuss reform of the NHS without hysteria about cuts and privatisation drowning out the debate. So its probably best these things are down without panicking the public.

Services need to be centralised to make care safer and more efficient but all you hear is screams of my local hospital is being shut down.

People are living longer so the burden on the NHS is increasing. New drugs are constantly being developed to treat more and more conditions at greater and greater expense. The amount spent on compensation is ballooning as everyone sues for any excuse they can find. So choices have to be made and we cant pay for every treatment, that's just the reality of life. You can scream about cuts but you cant square a circle.

[HelenaDove]

A friend of mine took the day off work today to take an elderly relative to hospital for an op. It was cancelled for another month after they got there because medication hadnt been organised. What about her lost wages?

[PausingFlatly]

"Hysteria" about cuts and privatisation?

Um, OK.

Are we allowed to have any discussion about cuts and privatisation, or is that too much to worry our fluffy little heads about?

[HelenaDove]

Discussion here Pausing..............



www.mumsnet.com/Talk/_chat/2779169-virgin-health-care

[PausingFlatly]

Thanks, Helena. Will go off and read that.

[Smellslikeoranges]

There is no other country that I know of where health care is free (please correct me if I am wrong). I know that one of the founding principles of the NHS that it should be free for all that use it, but as a PP said the cost of health care has exploded in comparison to when the NHS was set up. I live in Australia where there is a very complicated insurance health fund that runs alongside their version of the NHS - a lot is free, but if you need an ambulance you will have to pay hundreds. Having a baby there can cost thousands. In Ireland, you have to pay a lot for difference services (60 euro to see a GP for example). In all scandinavian countries you have to pay a nominal cost for all healthcare from seeing a GP to hospital treatment. There is compulsory health insurance in germany. My point is that politicians would rather cut costs than do the unthinkable of asking voters to contribute to the cost of their health. We already pay for the dentist and optician. Why not to see a GP and hospital treatment? The way things are going the NHS will be privatised with the tories in charge of it. That to me is a million times more scary, as I can envision an american-style system, than having to pay, say ten or twenty pounds, to see the GP.

[OhtoblazeswithElvira]

Spain springs to mind... I'm sure there are others.

[PausingFlatly]

The cost of healthcare has gone up anyway, because of new treatments and an ageing population. That will be true whether we pay for it through taxation and the NHS, or through some other method.

(Unless we withhold the treatments and have people die younger, of course.)

We actually SAVE money by not having "a very complicated insurance health fund". The bureaucracy of charging individuals per treatment is huge: other countries' health systems have to devote chunks of their income to charging, administering, chasing up, dealing with errors in billing for each single customer.

[PausingFlatly]

Last week we had the news that:

a) large-scale cuts to beds and whole wards are being planned: NHS cuts 'planned across England'

b) the Tories are planning a tax cut for people earning up to £150K. With the greatest benefit going to those earning over £43K: Autumn Statement 2016: Financial upheaval ahead for families

These are statements about what sort of country we want to be.

Not just about providing healthcare to an ageing population (which anyway won't go away by cutting or privatising the NHS).

[harvestmoon32]

Here's an article from today's Times: good news! The hospital that was part of the pilot scheme asking overseas patients to show ID before receiving NON EMERGENCY treatment has increased the recovery of funds from 37% of the total cost in 2012 to 95% of the total cost this year. This is the sort of reform we should all welcome surely?

"Mandatory identity checks have more than doubled the money recovered from overseas patients by one NHS hospital trust.

Figures from a pilot scheme in Peterborough suggest that the government’s plans to introduce passport checks before medical treatment, revealed on Monday, could help to recover millions in unpaid bills from abroad.

Doctors have threatened to boycott any crackdown on “health tourism”, saying that it is not medical staff’s job to act as immigration enforcers.

Mark Porter, chairman of the British Medical Association council, said: “Ensuring eligibility for NHS services is always important, but these proposals go much too far and it is unlikely they could ever be turned into a serious policy that would be accepted by patients and the public — that is, showing your passport before treatment.”

Peterborough and Stamford Hospitals NHS Foundation Trust, which introduced identity checks for all non-urgent treatment in 2013, said the policy had enabled it to increase the amount recovered from overseas patients by £145,000. The trust spends about £250,000 each year treating overseas patients. In 2012 it recovered 37 per cent of the cost; this year it has recouped 95 per cent.

Last year NHS trusts charged overseas visitors £289 million of the estimated £500 million cost of treating them. The National Audit Office calculates that about half of this was collected. Eight trusts failed to recoup any payment from overseas visitors.

All appointment letters for Peterborough and Stamford hospitals include instructions for patients to provide “proof of entitlement” — a passport, visa or details of any surcharge they have already paid for free NHS treatment if they are a visitor to the UK, or proof of UK residency. If they are unable to provide this they are asked to pay for treatment in advance.

Katherine Murphy, chief executive of the Patients Association, said that it was not acceptable to expect overworked staff to carry out identity checks. “NHS staff already have huge pressures placed on their time and they cannot take on any additional administrative burdens,” she said.

A spokeswoman for the Peterborough trust said that the proposals had not met any opposition from staff. She added: “The trust has not experienced a notable decrease in attendances of non-UK residents but we do identify non-eligible patients sooner, and at a higher volume than previously.”

On Monday Chris Wormald, permanent secretary at the Department of Health, admitted to the public accounts committee that the NHS was “light years away” from securing the £500 million predicted to be spent on overseas patients. In 2014-15 the government was charged £674 million for the care of British citizens in European economic area countries and recovered £50 million for the care of EEA citizens in NHS hospitals."

[Tanith]

"Services need to be centralised to make care safer and more efficient but all you hear is screams of my local hospital is being shut down. "

Safer and more efficient for whom?

My nearest hospital has centralised most of its services and it's been a disaster! More traffic clogging up the roads, missed appointments due to traffic jams and full carparks, people have had panic attacks because they couldn't find parking space in time for their clinic, and there have been several accidents, some fatal, at the junction serving the hospital.

That's without the added inconvenience to patients having to catch two or three buses in order to use public transport instead of popping into their local clinics.

[PausingFlatly]

Not sure what overseas visitors has to do with the cuts described in the OP.

But it's a bit odd if you're reading that scheme as a wonderful success that should be welcomed everywhere.

Here's the BBC report on the same Commons committee yesterday:
Head of the BMA council Dr Mark Porter said the discussions were a distraction given that so-called health tourism was "such a small problem" for the NHS.
...
Ms Hillier said she had constituents who had no photo ID.
She said: "Because they have never travelled, they have no passport; they have no driver's licence because they have never driven, they still live at home because they can't afford to move out so they've never had a utility bill in their name.
"Perfectly entitled to health care, British born, British resident; how are you going to make sure that people have access easily to the National Health Service without having to go through a very humiliating and impossible-to-meet set of demands?"
Proof of ID may be needed for NHS care, says health chief

Even the Times article states that, even in the Peterborough area (with particularly high numbers of non-residents), the recoup over a year only went up by £145,000 - and that's a gross figure, not including the costs of chasing.

There are long-standing issues with attempting to charge non-residents:

1. the costs of chasing vs net gain
   
2. the risk of refusing treatment to residents
   
3. the risk to public health when people fail to seek medical care because they believe - correctly or incorrectly - they will be charged. HIV is a major example.
   
   Like I say, not sure why you feel charging of overseas visitors is relevant to the current major restructuring, but it's a big and complex topic in itself.

[PausingFlatly]

costs of chasing vs net gain

[harvestmoon32]

Well I used to work in the NHS in London and trust me, it is a problem. Probably not one that is going to recoup billions of £££ but it will save some money. There is such a can't do attitude sometimes in the NHS and so many people think the only solution is to just keep pouring more money into it - that won't work either - the demand will far outstrip our ability to pay for it. So in my opinion something has to change. The layers of management bureaucracy are shocking - and it is the front line staff who feel the pressure (why I quit!!). There is a real reluctance to embrace change by all employees (normal human nature I suppose). I would rather see an efficient system for charging overseas patients introduced rather than the easier solution which is just to cut services and say we can't afford them. This is pretty low hanging fruit in terms of cost savings - I would also charge people who didn't show up for appointments. That is really annoying (but the break in the clinic is welcome by the HCP

Sorry for the derail.

[seminakedinsomebodyelsesroom]

The problem is the NHS is facing increasing costs with flatline or decreasing budget in real terms coupled with people living for longer with lots of different health conditions. There isn't currently enough focus or resources on preventing ill health, meaning people don't get help to stop smoking, lose weight, drink sensibly take enough exercise etc, as well as helping those who live in loneliness, poverty and deprivation - all of which impact on their health and make them more likely to be high users of NHS services in the longer term.

Also, we're quite inexplicably attached to our hospitals, which are very expensive to run - despite the fact care and treatment could be given else where (at home, at the GP surgery, in a local clinic) if the NHS could just re-organise itself a bit. But as soon as anyone says we need to reduce the number of hospital beds, for example, to make that happen people get really upset. Despite the fact that reducing those beds would free up money for much better services that would probably lead to fewer people needing to be admitted to hospital.

The 'secret plans' are basically saying that the NHS has to do a lot more care in local communities, and less in big hospitals because it's cheaper that way - and likely to be better for patients.

[PausingFlatly]

Charging people who announce they are overseas visitors is low-hanging fruit. Enforcing charging isn't - it requires a comprehensive system of ID production and checking for every patient.

Ie, MORE of this:
The layers of management bureaucracy are shocking - and it is the front line staff who feel the pressure

Some ideas feel emotionally appealing. But when they're worked through and costed, they turn out not to have the net results one wants.

[Smellslikeoranges]

Interesting article in today's guardian about the elderly and how lack of care for them is leading to more of them staying in hospital for longer because there is nowhere for them to have supervised care while recovering. They then take up beds and operations and the like are put back.

www.theguardian.com/society/2016/nov/26/nhs-elderly-care-close-to-collapse

[Itisnoteasybeingdifferent]

We must not forget that Gordon Brown mortgaged the NHS when he stitched up hospitals by foisting PFI on them.

By way iof example, Addenbrooks has a PFI funded unit. It costs hundreds to change a light bulb in a corridor because the building is owned and operated by the PFI company, (source, my SiL who is one of the senior staff). That contract costs the NHS millions. It will run for many many years bleeding the NHS of much needed funds. It was introduced by Brown.