News from Nowhere 79  September 2019

It is difficult to make sense of  health politics, let alone keep up with it. News from Nowhere is the monthly bulletin of Health Matters magazine,  carrying stories about policy initiatives and events in the NHS, social care and the commercial health sector. News from Nowhere believes the devil is in the detail, doesn’t put up with conspiracy theories and gives provider capture short shrift. Share it with colleagues and comrades.

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Steve Iliffe, Co-Editor, Health Matters (, @wellbeing_org)


Ambulances in a gig economy.


Private ambulance company SSG UK Specialist Ambulance Service Ltd was put in administration in early September. The company mainly provides emergency and non-emergency transport services for the NHS. Private providers carry out up to 15 per cent of the South East Coast Ambulance trust’s 999 response activity.


Contracting out occurs on this scale because the NHS ambulance services cannot recruit and retain sufficient paramedics to staff enough ambulances to meet demand. Private ambulance companies can offer better pay and more flexibility than the NHS trusts, as they are not tied to Agenda For Change. Private ambulance providers tend to pay paramedics a higher hourly rate than the NHS but with less paid leave, less pension, less sickness pay, less paid training and less job security. For some staff this is a trade-off they seem willing to take. According to anonymous commentators in the HSJ, most private ambulance crew have contracts with several private firms, so they will probably just shift to a different company.


Transfer to the NHS can be difficult. The non-paramedic staff are often (not always, some are ex-NHS) not trained to the standard the NHS requires. Even those who are trained to the same standard may not have a transferable qualification, so would not be able to work for the NHS without starting from scratch with their training.


Source: Nick Carding   Large provider of 999 support enters administration   HSJ 9 September 2019


Time for a Pudding tax?


A new nationwide poll by the Oral Health Foundation has found the majority of us (54%) now support a ‘pudding tax’.  The tax was particularly popular among younger people, with more than four-in-five (84%) of under-35s expressing their support. A proposed levy could include puddings and desserts, biscuits, chocolate and sweet confectionary. The Oral Health Foundation is calling for government officials to act quickly by implementing a ‘pudding tax’ and stop Britain’s unhealthy association with sugar.


When it comes to sugar, 10% of a child’s intake comes from soft drinks, but more than twice that comes from puddings, ice cream and sweets.  As a population we are consuming far more sugar than we need to.  Latest government figures also show that by the age of ten, the average child has already exceeded the sugar intake of an 18-year-old. Tooth decay remains common in adults while NHS England spent £36m last year removing rotten teeth from children. Asking consumers to reduce their sugar consumption has proven extremely difficult and food manufacturers are highly unlikely to reformulate their products unprompted. 


Public Health England’s campaign to reduce the sugar content by a fifth by 2020 needs widespread support. It is, therefore, time for a pudding tax that increases pressure on manufacturers to reduce added sugar in some of the UK’s most popular snacks.


Source: Oral Health Foundation, Smile House, 2 East Union Street, Rugby, CV22 6AJ. Charity number: 263198.


Aligned views

There is no escape from Brexit, especially in the NHS. The Department of Health and Social Care insists that NHS Arms-Length Bodies (like NHS England) must obey instructions about discussing Brexit’s implications for the NHS. In February, the ALBs were told all communications must go through a DHSC approval process and could be passed to the Department for Exiting the EU for extra scrutiny. Now they have been told to make sure such communications are “aligned” to the government’s latest core messages, which will be distributed each week, perhaps to allow for subtle shifts. In March trusts were told to refuse to supply Freedom of Information requests for their risk assessments. 

NHS leaders are concerned that the health and social care secretary has been outside the prime minister’s powerful EU exit strategy committee, under both Theresa May and Boris Johnson. This concern has been expressed by 17 royal colleges and health charities in a letter coordinated by the Royal College of Physicians.

Source: HSJ Daily Insight 22/8/19

Gaming the system?


The number of hip and knee replacements carried out by Brighton and Sussex University Hospitals Trust has fallen by 30% (from 1,126 in 2015-16 to 784 in 2018-19), seemingly because patients were choosing to have their operations in private hospitals that take NHS patients. This reduction in workload may have negative consequences for training of orthopaedic surgeons. Comments on this story (published on the HSJ website) suggest that some patients may have been directed to the private hospitals, and given no choice at all. To add injury to insult, the seven CCGs in Sussex commissioning these services have adopted a policy which only supports referral for surgery where patients have been in “uncontrolled, intense, persistent” pain for six months.


Source: Alison Moore Surgery dwindles at major trauma centre as patients opt for private care HSJ 3 September 2019


Rationing in the private sector

UK employee benefits provider, Unum, has launched “Help@hand”, a new range of app-based services giving online access to medical support. Four key services are available to employees and their families with Unum’s Group Income Protection policies, at no additional cost. NfN moles note the rationing of access, and look forward to hearing about uptake.

  1. Remote GP –Unlimited face-to-face video consultations with a UK-based GP within two hours of requesting an appointment., any time, day or night, 365 days a year 
  2. Second opinion –two consultations per year, face-to-face or via video, provided by a UK-based specialist following a diagnosis from a treating doctor 
  3. Mental health support –up to eight consultations per year including an initial assessment 
  4. Physiotherapy –up to eight consultations per year including an initial assessment


Source: Unum press release September 3rd 2019


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