News from Nowhere 78  July 2019

Treasury says No

University College London Hospital Foundation Trust thinks it can save £30 million a year by terminating its PFI bill at a cost of £550 million. The Trust would need to borrow this sum from the Department of Health, but the Department opposes the Trust’s plan. The Department argues that such a loan would take a disproportionate amount out of its capital funds, depriving other hospitals with greater needs of much-needed capital funding. The Treasury opposes shutting down PFI payments too, on the grounds that the Department loan, if provided, would appear in the books as public sector borrowing. The PFI programme was designed to avoid exactly this, with private finance carrying the loan. News from Nowhere moles half agree with the Department – why should mighty teaching hospitals deny less affluent Trusts of funding? But the Treasury’s reaction sounds like the same trickery that made PFI attractive all those years ago. 

Source: HSJ 27/7/2019


Silver linings

Primary Care Medical Chambers continues to thrive, finding GPs for vacancies and vacancies for GPs. This month’s day rates for locum jobs range from £650 to over £1,000, with hourly rates between £90 and £125. These offers are about the same as we reported a year ago, so the sellers’ market continues.

Source: Primary Care Medical Chambers 26/7/19



In 2015 the Royal College of Paediatrics and Child Health submitted a report to Great Ormond Street Hospital about concerns that children were needlessly given potentially dangerous drugs and invasive tests in the gastroenterology service. The 2015 report has not been published. A follow-up report in 2017 was intended to measure how much change had occurred at the hospital, and contained “multiple damning criticisms” of the service. The 2017 report was presented to the Care Quality Commission and NHS England and NHS Improvement in a version that included these criticisms, but without appendices containing parents’ complaints. Subsequently the full 2017 report with appendices has been published. Some of the parents’ comments about professional conduct and service administration are very harsh. NfN moles don’t expect to know what has happened at GOSH for a good while yet.

Source: HSJ Ben Clover 18/7/19


Glass half full?

Can hospital admissions really be reduced by better care in the community?  One way to answer this is to categorise admissions as Ambulatory care sensitive or Urgent care sensitive.  Ambulatory care sensitive conditions are those where better community care could help avoid hospital admission. Urgent care sensitive conditions are acute exacerbations of conditions which could be managed close to home and without the need for hospital admission in many cases. A recent Nuffield Trust report analyses data over a decade, from 2008/9. 

In the decade between 2008/09 and 2017/18, the number of emergency admissions increased from just over 5 million to just over 6 million. Admissions for Ambulatory Care Sensitive (ACS) conditions and Urgent Care Sensitive (UCS) conditions increased by 9% and 11% respectively (unfortunately the Nuffield Trust report does not supply the data for this). However, rates of emergency admissions for these conditions remained relatively stable over the decade. Less than one in a hundred people are admitted with ACS conditions, and 2.3 in a hundred with UCS conditions, in a year. The Nuffield report feels these figures are high; NfN thinks their stability over a decade of population ageing is evidence that community services are working well. No doubt they could do better.

Source:  Nuffield Trust Primary Care 18/7/19


What do you mean by privatisation?

The British Medical Association has criticised what it claims are “record amounts” of taxpayers’ money being diverted out of the NHS, despite Matt Hancock’s promise to MPs in January 2019 that there would be “no privatisation of the NHS on my watch.” Labour’s Jonathan Ashworth made the same point. The NHS spent £9.18bn on the independent sector in 2018-19, compared with £8.76bn the previous year. However, spending on the independent sector accounted for 7.3% of total NHS commissioning in both 2014-15 and 2018-19; in other words, subcontracting to the private sector keeps pace with growth in the NHS budget.

When the BMA and Jonathan Ashworth speak about NHS privatisation they do not mean the same thing as Matt Hancock. Hancock’s privatisation refers to sale of NHS services to the private sector, whilst Ashworth and the BMA refer to contracting out services to private providers. Land surplus to requirements aside, the NHS is not being sold, and for the moment there are no plans to do so, so Hancock can make an easy promise. Contracting out, on the other hand, keeps pace with growth in the NHS budget, despite signals from the top of the NHS that the private sector should be side-lined. 

Contracting out services has always been a problem for Labour because 90% of the NHS footfall occurs in contracted out services – general practice, dentistry, community optical services and pharmacy – that were built into the NHS’ public domain in 1948, not into the public sector. Worse, if contracting-out is equivalent to privatisation, the greatest of all privatisers was Aneurin Bevan, the architect of the NHS. 

Sources: Dennis Campbell Private firms win record £9.2bn NHS slice despite vow to rein in outsourcing   Guardian 22nd July,  and Adrian O’Dowd NHS is spending more on private providers despite government pledges BMJ 2019;366:l4812

 Medicinal cannabis

A group of doctors have launched Sapphire Medical Clinic, the first clinic in the UK offering access to medicinal cannabis for all conditions acknowledged to benefit from it. The Harley Street, London, based clinic will offer access to medicinal cannabis as part of a comprehensive treatment pathway that includes other conventional pharmaceutical drugs and treatments. The Sapphire team includes specialists in paediatric & adult neurology, palliative care, psychiatry, gastroenterology, acute general medicine and neuropathic pain. The team will replicate the multi-disciplinary approach championed by NHS England as the safe and proper way to consider medicinal cannabis prescriptions. The clinics will operate primarily on a second-opinion basis whereby patients can be referred by their GP or Hospital Consultant.



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