Posts Tagged ‘health care’

Single-Payer Health Care Isn’t Worth Waiting For (In November an Ontario woman learned she’d have to wait 4½ years to see a neurologist)

January 22, 2018

An orthopedic surgeon challenges Canada’s ban on most privately funded procedures.

When Brian Day opened the Cambie Surgery Centre in 1996, he had a simple goal. Dr. Day, an orthopedic surgeon from Vancouver, British Columbia, wanted to provide timely, state-of-the-art medical care to Canadians who were unwilling to wait months—even years—for surgery they needed. Canada’s single-payer health-care system, known as Medicare, is notoriously sluggish. But private clinics like Cambie are prohibited from charging most patients for operations that public hospitals provide free.

Dr. Day is challenging that prohibition before the provincial Supreme Court. If it rules in his favor, it could alter the future of Canadian health care.

Most Canadian hospitals are privately owned and operated but have just one paying “client”—the provincial government. The federal government in Ottawa helps fund the system, but the provinces pay directly for care. Some Canadians have other options, however. Private clinics like Cambie initially sprang up to treat members of the armed forces, Royal Canadian Mounted Police officers, those covered by workers’ compensation and other protected classes exempt from the single-payer system.

People stuck on Medicare waiting lists can only dream of timely care. Last year, the median wait between referral from a general practitioner and treatment from a specialist was 21.2 weeks, or about five months—more than double the wait a quarter-century ago. Worse, the provincial governments lie about the extent of the problem. The official clock starts only when a surgeon books the patient, not when a general practitioner makes the referral. That adds months and sometimes much longer. In November an Ontario woman learned she’d have to wait 4½ years to see a neurologist.

Single-Payer Health Care Isn’t Worth Waiting For
PHOTO: ISTOCK/GETTY IMAGES

Some patients would gladly go to a clinic like Cambie for expedited care, paying either directly with their own money or indirectly via private insurance. But Canadian law bans private coverage for “medically necessary care” the public system provides and effectively forbids clinics from charging patients directly for such services. The government views this behavior as paying doctors to cut in line. Doctors who accept such payments can be booted from the single-payer system.

Dr. Day’s lawsuit aims to overturn these provisions. It alleges that the government’s legal restrictions on private care are to blame for the needless “suffering and deaths of people on wait lists.” Dr. Day argues that the current system violates citizens’ rights to “life, liberty, and security of the person,” as guaranteed by the Canadian Charter of Rights and Freedoms, the equivalent of the U.S. Bill of Rights.

Moreover, Dr. Day claims the government has long tacitly approved of patients paying private clinics out of their own pockets. For decades, he argues, conservative and liberal politicians have offered him quiet praise and encouragement even as they publicly defend the single-payer system. It’s easy to understand why Canada’s leaders would talk out of both sides of their mouths. Private clinics perform more than 60,000 operations a year, saving the public treasury about $240 million.

British Columbia’s lawyers know that Dr. Day could embarrass Canada’s double-talking politicians by naming them at trial. This could explain the endless stream of seemingly deliberate delays that have kept the court proceedings moving at a snail’s pace. Dr. Day and his colleagues were supposed to testify in November but may not take the witness stand until February or March at the earliest.

Canadians have suffered long enough under single-payer waiting lists. There shouldn’t be a waiting list for justice, too.

Ms. Pipes is president and CEO of the Pacific Research Institute and author of “The False Promise of Single-Payer Health Care,” forthcoming from Encounter.

Appeared in the January 22, 2018, print edition.

 https://www.wsj.com/articles/single-payer-health-care-isnt-worth-waiting-for-1516566456
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Why single payer health care is a terrible option

CNN

(CNN) — The Affordable Care Act (ACA) is failing. Without regard for consequences, the law expanded government insurance programs and imposed considerable federal authority over US health care via new mandates, regulations and taxes. Insurance premiums skyrocketed even as deductibles rose; consumer choices of insurance on state marketplaces have rapidly vanished; and for those with ACA coverage, doctor and hospital choices have narrowed dramatically. Meanwhile, consolidation across the health care sector has accelerated at a record pace, portending further harm to consumers, including higher prices of medical care.

Almost inexplicably, even more top-down control — single-payer health care, a system in which the government provides nationalized health insurance, sets all fees for medical care and pays those fees to doctors and hospitals — has found new support from the left. And this despite its decades of documented failures in other countries to provide timely, quality medical care, and in the face of similar problems in our own single-payer Veterans Affairs system.
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Scott W. Atlas

Clearly, this moment cries out for the truth about single-payer health care — conclusions from historical evidence and data.
Single-payer health care is proven to be consistently plagued by these characteristics:

Massive waiting lists and dangerous delays for medical appointments

In those countries with the longest experience of single-payer government insurance, published data demonstrates massive waiting lists and unconscionable delays that are unheard of in the United States.
.In England alone, approximately 3.9 million patients are on NHS waiting lists; over 362,000 patients waited longer than 18 weeks for hospital treatment in March 2017, an increase of almost 64,000 on the previous year; and 95,252 have been waiting more than six months for treatment — all after already waiting for and receiving initial diagnosis and referral.
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In Canada’s single-payer system, the 2016 median wait for a referral from a general practitioner appointment to the specialist appointment was 9.4 weeks; when added to the median wait of 10.6 weeks from specialist to first treatment, the median wait after seeing a doctor to start treatment was 20 weeks, or about 4.5 months.
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Ironically, US media outrage was widespread when pre-ACA 2009 data showed that time-to-appointment for Americans averaged 20.5 days for five common specialties. That selective reporting failed to note that those waits were for healthy check-ups in almost all cases, by definition the lowest medical priority. Even for simple physical exams and purely elective, routine appointments, US wait times before ACA were shorter than for seriously ill patients in countries with nationalized, single-payer insurance.

Life-threatening delays for treatment, even for patients requiring urgent cancer treatment or critical brain surgery

Those same insured patients in single-payer systems are dying while waiting for the most critical care, including those referred by doctors for “urgent treatment” for already diagnosed cancer (almost 19% wait more than two months) and brain surgery (17% wait more than four months). In Canada’s single-payer system, the median wait for neurosurgery after already seeing the doctor was a shocking 46.9 weeks — about 10 months. And in Canada, if you needed life-changing orthopedic surgery, like hip or knee replacement, you would wait a startling 38 weeks — about the same time it takes from fertilization to a full-term human life.

Delayed availability of life-saving drugs

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Americans enjoy the world’s quickest access to the newest prescription drugs, in stark contrast to patients in single-payer systems. In Joshua Cohen’s 2006 study of patient access to 71 drugs, between 1999 and 2005 the UK government’s guidelines board, NICE, had been slower than the United States to authorize 64 of these. Before the ACA, the United States was by far the most frequent country where new cancer drugs were first launched — by a factor of at least four — compared to any country studied in the previous decade, including Germany, Japan, Switzerland, France, Canada, Italy and the UK, according to the Annals of Oncology in 2007.
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In a 2011 Health Affairs study, of 35 new cancer drugs submitted from 2000-2011, the US Food and Drug Administration (FDA) had approved 32 while the European Medicines Agency (EMA) approved only 26. Median time to approval in the United States was about half of that in Europe. All 23 drugs approved by both were available to US patients first. Even in the most recent data, two-thirds of the novel drugs approved in 2015 (29 of 45, 64%) were approved in the United States before any other country. And yet, only months ago, NHS in England introduced a new “Budget Impact Test” to cap drug prices, a measure that is specifically designed to further restrict drug access even though the delays will break their own NHS Constitution pledges to its citizens.

Worse availability of screening tests

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Despite what some might suppose about a likely strength of a government-centralized system, the facts show that single-payer systems cannot even outperform our system in something as scheduled and routine as cancer screening tests. Confirming numerous prior OECD studies, a Health Affairs study reported in 2009, before any Affordable Care Act screening requirements, that the United States had superior screening rates to all 10 European countries with nationalized systems for all cancers. Likewise, the single payer system of Canada fails to deliver screening tests for the most common cancers as broadly as the US system, including PAP smears and colonoscopies. And Americans are more likely to be screened younger for cancer than in Europe, when the expected benefit is greatest. Not surprisingly, US patients have had less advanced disease at diagnosis than in Europe for almost all cancers.
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Significantly worse outcomes from serious diseases

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It might be said that the bottom line about a health care system is the data on outcomes from treatable illnesses. To no one’s surprise, the consequences of delayed access to medications, diagnosis and treatment are significantly worse outcomes from virtually all serious diseases, including cancerheart diseasestroke, high blood pressure and diabetes compared to Americans.
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And while some studies have noted that Canadians and Germans, for example, have longer life expectancies and lower infant mortality rates than Americans do, they are misleading. Those statistics are extremely coarse and depend on a wide array of complex inputs having little to do with health care, including differences in lifestyle (smoking, obesity, hygiene, safe sex), population heterogeneity, environmental conditions, incidence of suicide and homicide and even differences in what counts as a live birth.
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The truth is that the UK, Canada and other European countries for decades have used wait lists for surgery, diagnostic procedures and doctor appointments specifically as a means of rationing care. And long waits for needed care are not simply inconvenient. Research (for example, here) has consistently shown that waiting for medical care has serious consequences, including pain and suffering, worse medical outcomes and significant costs to individuals in foregone wages and to the overall economy. In contrast to countries with single-payer health systems, it is broadly acknowledged that “waiting lists are not a feature in the United States” for medical care, as stated by Dr. Sharon Wilcox in her study comparing strategies to measure and reduce this important failure of centralized health systems.
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What has been the response to the public outcry about unacceptable waits for care in single-payer systems? First, a growing list of European governments have issued dozens of “guarantees” with intentionally lax targets, and even those targets continue to be missed. Second, many single-payer systems now funnel taxpayer money to private care to solve their systems’ inadequacies, just as we now do in our own Veteran Affairs system, and even use taxpayer money for care in other countries.
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Instead of judging health system reforms by the number of people classified as “insured,” reforms should focus on making excellent medical care more broadly available and affordable without restricting its use or creating obstacles to future innovation. Reducing the cost of medical care requires creating conditions long proven to bring down prices while improving quality: increasing the supply of medical care, stimulating competition among providers and incentivizing empowered consumers to consider price.
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Single-payer systems in countries with decades of experience have been proven in numerous peer-reviewed scientific journals to be inferior to the US system in terms of both access and quality. Americans enjoy superior access to health care — whether defined by access to screening; wait-times for diagnosis, treatment, or specialists; timeliness of surgery; or availability of technology and drugs. As those countries turn to privatization to solve their systems’ failures, progressives here illogically pursue that failed model.
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And make no mistake about it — America’s most vulnerable, the poor, as well as the middle class, will undoubtedly suffer the most if the system turns to single-payer health care, because they will be unable to circumvent that system.
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Boris Johnson warns Theresa May she must commit to giving NHS extra £100m a week to defeat Jeremy Corbyn

January 17, 2018

Image result for nhs, a&e, photos

By 

Boris Johnson has warned Theresa May that the Government must make a public commitment to giving the NHS an extra £100million a week after Brexit if the Tories are to beat Jeremy Corbyn at the next election.

The Foreign Secretary believes that the Government must adopt the flagship Vote Leave pledge and spend £5.2billion a year that would have been paid into Brussels on the health service instead.

His intervention comes as hospitals struggle to cope with the winter flu crisis amid an ongoing row between the Government and NHS England over funding.

Mr Corbyn, the Labour leader, has put the issue at the forefront of his campaigning. Mr Johnson is likely to have the support of Michael Gove, the Environment Secretary and leading Leave campaigner, alongside senior Eurosceptic Tory MPs as he makes his case for the commitment.

Read more (Paywall):

http://www.telegraph.co.uk/politics/2018/01/16/exclusive-boris-johnson-warns-theresa-may-must-commit-52bn-brexit/

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Boris Johnson suggests Brexit could fund NHS

Boris Johnson said Vote Leave had underestimated the amount that Britain gives to Brussels each week
Boris Johnson said Vote Leave had underestimated the amount that Britain gives to Brussels each weekMATT CARDY/GETTY IMAGES

Boris Johnson has suggested that additional NHS funding should come from the Brexit dividend rather than a new tax.

The foreign secretary joined the heated debate among senior Conservatives about how much to put into the NHS after the funding settlement runs out in 2020 and how to pay for it.

Jeremy Hunt, the health secretary, is prepared to look at a new tax among other options, The Times revealed yesterday. Nick Boles, the Tory MP for Grantham & Stamford, has backed an additional levy, as has Nick Macpherson, former permanent secretary to the Treasury.

However, Mr Johnson told The Guardian that the cash should come from funds now paid to Brussels that may be available after Brexit, depending on how much the UK continues…

 

For Businesses, Donald Trump’s First Year Is a Net Success

January 16, 2018

CEOs’ relationship with the president had some tense moments, but most corporate chiefs welcomed the big corporate tax cut and push to ease regulations

WASHINGTON—The tax overhaul that President Donald Trump signed into law last month capped a year in which his initiatives on taxes, regulation—and many of his public pronouncements on the economy—have been broadly welcomed by business.

It hasn’t all been smooth sailing for the president most closely aligned with business interests in decades: he was roundly criticized for his remarks about a deadly white supremacists’ rally in Charlottesville, Va., last August. After that, several CEOs resigned in protest from his business advisory councils, although administration officials say they had largely fizzled out by then.

In pure policy terms, however, business groups and executives say the $1.5 trillion of corporate-focused tax changes and the bevy of completed and proposed rule changes aimed at cutting regulatory burdens on business have made 2017 a net success for business.

“If Hillary [Clinton] had been elected, we would have had more regulation and higher taxes,” said Byron Wien, an executive at Blackstone Group L.P . , on a recent investor call. “Trump was elected; we have less regulation and lower taxes.”

TRUMP’S FIRST YEAR

  • Stock Market Roared During Donald Trump’s First Year, Boosted by Earnings and Tax Cut

Heading into his second year, the president faces some significant decisions that could create tension with business on issues executives care about, such as trade, immigration and health care.

Some of this was captured by Chamber of Commerce President Tom Donohue last week in his annual address on the state of business. He urged the president not to pull out of the North American Free Trade Agreement, to preserve temporary residency for some 200,000 workers the administration wants to deport and to avoid a confrontation with North Korea. Mr. Donohue also offered support to embattled tech firms who have come under new scrutiny in the past year.

Image result for Chamber of Commerce President Tom Donohue, photos

Chamber of Commerce President Tom Donohue

Trade presents some particularly difficult decisions. Nafta, and the president’s threat to pull the U.S. out of it, remains a concern both for U.S. companies that have grown up around the free trade it brought to the continent, and farmers who have taken advantage of markets in Mexico and Canada that the pact has opened for their exports.

China brings its own set of challenges. Many multinational companies and ardent free-traders have grown frustrated, along with Mr. Trump, with what they see as Beijing’s backsliding on market-opening promises in recent years. Even many officials from the previous Obama administration now say they should have steered a harder line on Chinese trade practices, while many business groups share Mr. Trump’s criticisms of China.

Still, the companies are nervous about how his administration will ramp up pressure on Beijing. While American executives generally still favor intensified negotiations over trade sanctions, they worry that Trump aides will deploy tariffs, quotas and investment limits that could prompt swift retaliation, triggering a costly trade war.

In October, the U.S. Trade Representative’s office held a public hearing seeking business input for a continuing probe into widespread complaints about China forcing U.S. companies to turn over intellectual property. While many witnesses confirmed the problems and said they supported the Trump administration probe, they warned against overreach.

Erin Ennis, a top official at the U.S.-China Business Council, cautioned against “simply seeking to impose penalties or to restrict trade which could have the effect of inhibiting commercial cooperation that benefits U.S. companies and U.S. citizens.”

Image result for china's new airliner, photos

China’s new air liner — C919

Business leaders are also eager for the Trump administration to make good on a push to refurbish the nation’s infrastructure, which has raised expectations for companies across the economy, especially in heavy machinery and construction services. But an almost certain fight looms over how to pay for it, conspiring with election-year pressures to make it that much more difficult.

Other promises from the administration and allies in Congress—like an effort to rein in entitlement programs—are viewed with even more skepticism as the time before midterm congressional elections dwindles.

“Mark my words, there is no way in hell that they are that dumb to take up Medicare or Social Security in the election year,” said Tommy Thompson, the former Republican governor of Wisconsin and a board member of Centene Corp. , which administers some health programs, at a presentation for investors. “It would be tantamount to saying, ‘We don’t want to govern anymore.’”

Mr. Thompson said a bipartisan infrastructure bill could have a chance of passage, and an attempt to dig into more divisive issues, such as Social Security and Medicare, could come in 2019.

While executives have praised Mr. Trump’s efforts to slash rules—especially those put in place by his predecessor, Barack Obama —many of them could end up in court, to be fought all over again. That includes the Federal Communications Commission’s December action dismantling Obama-era “net neutrality” rules that required internet-service providers to treat all traffic on their networks the same. Another is Mr. Trump’s reversal of his predecessor’s “clean power plan,” along with a number of other energy and environment rules.

For some executives, life under Mr. Trump has sometimes meant reassuring investors that their companies aren’t his targets—a reference to both his policies and his actions during the presidential campaign, when he singled out companies such as United Technologies Corp. and Lockheed Martin Inc. for criticism.

On an investor call earlier this month, the chief executive of Lakeland Industries Inc., a New York-based maker of protective clothing and work gear, sought to reassure analysts that the Trump administration’s efforts to curb trade deals were aimed at changes in the automotive industry, and wouldn’t hurt Lakeland’s business.

“The apparel business,” CEO Christopher Ryan said, “is not what Mr. Trump is trying to change.”

Business advocates are hoping to channel the administration’s energies in the coming year, as Mr. Trump hopes to pivot to infrastructure and entitlement changes.

“Business is determined to be a voice of reason and a bridge between sides,” Mr. Donohue said. “We’re determined to help, and when necessary, correct our government as it does the nation’s business.”

—Jacob M. Schlesinger contributed to this article.

Write to Ted Mann at ted.mann@wsj.com

UnitedHealth Profit Rises as Both Healthcare, Optum Businesses Grow

January 16, 2018

Health insurer raises raises its 2018 outlook, citing recent tax reform

Image may contain: sky, tree, outdoor and nature

UnitedHealth Group Inc.’s quarterly profit beat analysts’ expectations and the health insurer raised its yearly outlook, as revenue from both its health care and health care services businesses increased.

Earnings during the quarter were $3.62 billion, or $3.65 a share, more than double the $1.68 billion, or $1.74 a share, the company earned during the same period a year prior. Adjusted earnings were $2.59 a share compared to $2.11 a share a year ago.

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Insurer UnitedHealth’s 4Q earnings, 2018 guidance soar

The Associated Press

January 16, 2018 04:09 AM

With Fireworks, Washington Returns to the Core Trump Agenda

January 15, 2018

President’s focus on immigration, trade and infrastructure is in line with his base—just as election year gets going

President Donald Trump spoke to reporters at Trump International Golf Club in West Palm Beach on Jan. 14, 2018.
President Donald Trump spoke to reporters at Trump International Golf Club in West Palm Beach on Jan. 14, 2018. PHOTO: NICHOLAS KAMM/AGENCE FRANCE-PRESSE/GETTY IMAGES

If there were three signature Donald Trump issues during the 2016 presidential campaign—ones he stressed repeatedly at rallies and in debates—they were immigration, trade and infrastructure.

And so far the Trump emphasis this year is on…immigration, trade and infrastructure.

That represents a significant turn in the Washington agenda for 2018, one little-noticed amid the controversy over the alleged presidential remark disparaging immigration from “shithole” countries. After a year focused more on tax cuts, health care and deregulation—issues that tend to appeal more to traditional Republicans—the focus so far this year has moved decisively back to standard Trump issues.

That shift has the potential to help shore up and energize the Trump base in time for this year’s crucial elections for control of Congress. It also presents an opportunity to look back at the condition of that Trump base after one year—as well as why people voted for President Trump in the first place, a question that has become clouded by mythology.

First, a look at that Trump base. A dive into Wall Street Journal/NBC News polling suggests that, after Mr. Trump’s tumultuous first year in office, the president’s support among his staunchest proponents has eroded some, though still is pretty solid. Among whites without a college degree—a core Trump support group—approval of the job he is doing as president slipped to 55% in December from 59% in February. Disapproval has risen to 41% from 32%.

Similarly, the share of whites without a college degree who have a negative image of Mr. Trump personally has risen to 40% from 33%.

Those still are pretty solid numbers, and significantly better than those the president gets among other Americans. Among whites with a college education, for example, almost six in 10 disapprove of the job he is doing and hold a negative view of him personally.

In short, the base is still the base, though it has eroded around the edges.

So a return to the signature Trump issues would seem to be a way to end and perhaps reverse that erosion at the base. And it probably does. But here, there also are some surprises.

There is no doubt that immigration already has moved to the top of the Washington agenda in 2018. Mr. Trump is locked in either negotiations or a fight—and it’s hard to know from day to day which it is—with Democrats over the fate of “Dreamer” immigrants who came here illegally as children, over paying for a wall along the Mexican border and over broader immigration reform.

Given how much Mr. Trump talked about immigration and a wall during the campaign, this turn isn’t surprising. What is surprising is how low immigration and the wall ranked on the list of reasons his supports actually voted for him.

When his voters were asked last December, shortly after the election, why they backed Mr. Trump, just 20% said taking a tough approach on immigration and the wall was the most important reason. More than twice as many said simply improving the economy overall was most important.

Similarly, in polling around the time Mr. Trump was inaugurated in January, just 31% of whites without a college degree—again, a strong Trump constituency—said building a wall was an absolute priority.

Trade and infrastructure improvements, by contrast, ranked far higher as a matter of concern. Among those same white noncollege Americans, 65% said imposing tariffs against countries that take advantage of trade agreements was a top priority, and the same share cited improving infrastructure.

So there is little doubt he’s speaking to his people on trade, a subject about to start rising in visibility. The administration is approaching decisions on imposing tariffs on imported steel and aluminum, on steps to slow imports of solar panels and washing machines, and on penalties against China for seizing American intellectual property. And talks to renegotiate the North American Free Trade Agreement are reaching a critical juncture.

Similarly, the White House is promising action soon on infrastructure, an issue Mr. Trump has started bringing up with more regularity.

Of course, much of Mr. Trump’s campaign appeal was based not on specific policy positions, but more on his pugilistic attitude—and the simple fact he wasn’t Hillary Clinton, an object of hatred for many Trump voters. More than four in 10 Trump voters said making sure she didn’t become president was the top reason they voted for him.

Still, the evidence suggests that Mr. Trump is speaking directly to his base with his 2018 emphasis on trade and infrastructure—but also expending a lot of capital and earning a lot of enmity at home and abroad on immigration and building a wall, subjects not as central for his supporters as commonly supposed.

Write to Gerald F. Seib at jerry.seib@wsj.com

https://www.wsj.com/articles/with-fireworks-washington-returns-to-the-core-trump-agenda-1516035795

Britain’s National Health Service Crisis: NHS crisis fuelled by closure of 1,000 care homes housing more than 30,000 pensioners

January 13, 2018

NHS figures show the worst Accident & Emergency crisis on record CREDIT: CHRIS J. RATCLIFF

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The growing NHS crisis has been fuelled by the closure of almost 1,000 care homes housing more than 30,000 pensioners, research suggests.

It comes as NHS figures show the worst Accident & Emergency crisis on record, amid a 37 per cent rise in the numbers stuck in hospital for want of social care, since 2010.

Experts said hospitals were being overwhelmed by the spread of flubecause they had almost no spare capacity to cope with surges in demand.

The report by industry analysts shows that in the last decade, 929 care homes housing 31,201 pensioners have closed, at a time when the population is ageing rapidly.

The research from LaingBuisson show care homes going out of business at an ever increasing rate, with 224 care homes closed between March 2016 and March 2017, amounting to more than 2,000 beds.

The research from LaingBuisson show care homes going out of business at an ever increasing rate
The research from LaingBuisson show care homes going out of business at an ever increasing rateCREDIT: JEFF J MITCHELL

Britain’s National Health Service (NHS): ‘No longer able to meet standards in its constitution’

January 13, 2018

‘Rising numbers of flu cases and more respiratory illness have placed intolerable pressures on staff’

By Samuel OsborneAlex Matthews-King

The Independent Online

The National Health Service is at a “watershed moment” and cannot deliver care to the standards required by its constitution with the funding it receives, Jeremy Hunt has been told.

Chris Hopson, chief executive of NHS Providers, which acts as as bridge between trusts and the Department of Health, has written to the Secretary of State for Health and Social Care to call for extra investment on a long-term basis to address the “fragility of the wider NHS”.

The three-page letter calls for the Government to commit to increasing the NHS budget to £153bn by 2022/23 – a sum the Office for Budget Responsibility said was needed, given projected increased demand for services.

But Mr Hopson has warned that, due to the current state of NHS finances, “substantial progress” must be made before the Autumn Budget this year.

Mr Hopson said: “Despite planning for winter more thoroughly and extensively than before, it hasn’t been sufficient. Rising numbers of flu cases and more respiratory illness have placed intolerable pressures on staff.

“The NHS is no longer able to deliver the constitutional standards to which it is committed. We need to be realistic about what we can provide on the funding available.

“If we continue to run the NHS at close to 100 per cent capacity day in, day out, permanently in the red zone, it’s not surprising that the service can’t cope when we get a high, but entirely predictable, spike in demand.”

Warning that failure to act would lead to targets moving further out of reach, he said: “There is so much at stake. We can fix this, but there must be no more delay. The ball is now firmly in the Government’s court.”

The letter follows the Health Secretary’s admission on Wednesday that the NHS will need substantially increased funding in future, which should be delivered across a 10-year spending period.

The letter adds: “The Government now needs to set out how it will create the sustainable, long-term health and care funding settlement you have rightly called for.”

NHS Providers has said the Government must commit to review this year’s winter preparations, which Prime Minister Theresa May has repeatedly said are “the best ever”, despite hospitals relying on a last-minute allocation of £335m in the Budget.

The Government has also guaranteed hospitals will be protected against further funding squeezes if they fail to hit increasingly remote financial targets.

The cancellation of non-urgent care, as advised by the NHS last week, will mean trusts, which are paid on a fee-for-service basis, miss out on income from these operations.

Jeremy Hunt apologises to patients as thousands of operations delayed

This will also make it harder to hit strict savings and performance targets and unlock the associated funding for delivering them.

NHS Providers’s intervention comes on the day after a leaked memo revealed Oxford’s Churchill Hospital was having to consider cutting back chemotherapy services for cancer patients because of staff shortages.

A letter from the hospital’s head of chemotherapy, Dr Andrew Weaver, said nurse numbers were down 40 per cent, and chemotherapy start dates may have to be pushed back or the number of cycles reduced.

Norman Lamb, a former Liberal Democrat minister, said the country had been “honest” about how to give the NHS more funding.

His party has called for adding a penny in the pound on income tax.

“The clear message from NHS leaders is that the Government must drop its sticking-plaster approach to the health service,” he said.

“The gap between demand and resources in the NHS is growing each year, with tragic human consequences across the country.

“The stark reality is that the current winter crisis is just a taster of what is to come unless ministers get to grips with the long-term funding shortfall facing the health service.”

A Department of Health and Social Care spokesman said: “The NHS was given top priority in the recent Budget with an extra £2.8bn allocated over the next two years, and was recently ranked as the best and safest healthcare system in the world.

“We know there is a great deal of pressure in A&E departments and that flu rates are going up, and we are grateful to all NHS staff for their incredible work in challenging circumstances.

“That’s why we recently announced the largest single increase in doctor training places in the history of the NHS – a 25 per cent expansion.”

Additional reporting by Press Association

http://www.independent.co.uk/news/health/nhs-constitution-standards-crisis-jeremy-hunt-beds-hospitals-privatisation-latest-a8152836.html

Britain’s Hospitals: Patients Are Dying Amid ‘Intolerable’ Safety Risks, Theresa May Told

January 11, 2018

NHS chief executives say this winter is the worst the health service has experienced for three decades  CREDIT: ANDREW FOX

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The heads of more than 60 Accident & Emergency units have written to the Prime Minister warning that patients are “dying prematurely” amid “intolerable” safety risks.

It came as official figures show Accident and Emergency performance at major units is the worst on record, with fears the situation will worsen amid rising cases of norovirus and flu.

The letter from the most senior doctors at A&E units across the country said the health service is “chronically underfunded” and ill-prepared for winter.

They said more than 50 patients at a time had been left waiting for beds in casualty units, with 120 patients a day being managed in corridors, “some dying prematurely”.

The letter,  reported by the Health Service Journal, told the prime minister that shortages of beds and staff meant patients were being put at higher risk of death.

Monthly figures from NHS England show just 77.3 per cent of patients treated at major units – known as type 1 A&Es – were seen within four hours – against a target of 95 per cent.

This is the worst performance since records began – below the previous low of 77.6 per cent recorded in January 2017 and the 79.3 per cent seen in December 2016.

The worst performance was at  Blackpool Teaching Hospitals Foundation Trust, with just 40 per cent of patients seen within four hours last month, the figures show.

At Hillingdon Hospitals Foundation Trust and Royal Cornwall Hospitals Trust the figure was just 58 per cent, with 59 per cent recorded at London North West Healthcare Trust and University Hospitals Of North Midlands Trust.

Across all A&E units, performance was 85.1 per cent, the same as last January, which was the worst on record.

Just three out of 134 NHS trusts hit the 95 per cent A&E target, with just two trusts with major units achieving it, the figures show.

The latest statistics from NHS England show crowding on hospital wards is continuing to worsen, while levels of norovirus have risen by almost one third in a week.

Bed occupancy levels, which dropped over Christmas, are now back up to 95 per cent, the figures show.

The weekly figures show 16,690 ambulance handover delays in the week ending 7  January  – including 5,082 waits of at least an hour.

In total, 944 beds were closed because of winter vomiting and norovirus, compared with 731 the week before – a rise of 29 per cent.

Latest figures show hospitalisations because of flu almost tripled the previous week, with new figures due to be published later today. One in four cases in hospital has the strain dubbed “Aussie flu”.

The new statistics show hospital occupancy rates have now reached 95 per cent – a rise from 91.7 per cent in one week.

In the letter to the Prime Minister, the clinical leads from 68 A&E units apologise to patients for putting safety at risk, as they demand a major cash injection.

As well as calling for “a significant increase in Social Care Funding to allow patients who are fit to be discharged from acute beds to be cared for in the community” they call for a review of hospital beds, which have been reduced in recent decades.

“In the meantime we would like to apologise to our patients for being unable to fulfil our pledge for a safe efficient service and acknowledge the hard work and dedication of the staff,” the letter states.

In the letter to the Prime Minister, the clinical leads from 62 A&E units state: “We feel compelled to speak out in support of our hardworking and dedicated nursing, medical and allied health professional colleagues and for the very serious concerns we have for the safety of our patients.

“This current level of safety compromise is at times intolerable, despite the best efforts of staff.

“It has been stated that the NHS was better prepared for this winter than ever before. There is no question that a huge amount of effort and energy has been spent both locally and nationally on drawing up plans for coping with NHS winter pressures. Our experience at the front line is that these plans have failed to deliver anywhere near what was needed. ”

Acknowledging efforts across the NHS to tackle the pressures, it continues:  “The facts remain however that the NHS is severely and chronically underfunded. We have insufficient hospital and community beds and staff of all disciplines especially at the front door to cope with our ageing population’s health needs.

“As you will know a number of scientific publications have shown that crowded Emergency Departments are dangerous for patients. The longer that the patients stay in ED after their treatment has been completed, the greater is their morbidity and associated mortality.

“Recent media coverage has reported numerous anecdotal accounts of how appalling the situation in an increasing number of our Emergency Departments has become. These departments are not outliers. Many of the trusts we work in are in similar positions,” it warns.

NHS England has stopped publishing weekly figures measuring A&E performance. But the figures, from those in charge of around half of A&E departments state: “Last week’s 4 hour performance target was between 45 and 75%. Thousands of patients are waiting in ambulances for hours as the hospitals lack adequate space. ”

The senior doctors said their hospitals were dealing with:

  • Over 120 patients a day managed in corridors, some dying prematurely
  • An average of 10-12 hours from decision to admit a patient until they are transferred to a bed
  • Over 50 patients at a time waiting beds in the Emergency Department
  • Patients sleeping in clinics as makeshift wards

It comes as hospital chiefs said the NHS was at a  “watershed moment” and needs tens of billions in extra cash to deliver the required levels of care.

NHS Providers, the trade body which represents NHS services, had previously warned the health service was “not where it would want to be” heading into winter amid concerns over a bad strain of flu.

A letter, written to Jeremy Hunt, the Health and Social Care Secretary, calls for extra investment on a long-term basis – and help with the immediate financial impact of “exceptional winter pressures” – to address the “fragility of the wider NHS”.

Chris Hopson, chief executive of NHS Providers, said last year was “the first time ever” in NHS history that all of its key targets for A&E, cancer and planned operations across the UK had been missed.

He said hospitals were short of 10,000-15,000 beds, calling on the Government to invest billions more on the NHS.

Tens of thousands of non-urgent operations and routine outpatient appointments have been shelved by NHS England to ease pressures on hospitals.

Dr Nick Scriven, president of the Society for Acute Medicine, said today’s data showed the NHS was struggling to cope, but hid the misery and lack of dignity for patients.

“These figures support the messages we have been getting from our members about conditions across the NHS and the struggle they are facing to provide safe and compassionate care in exceedingly difficult conditions,” he said.

And he warned worse could come as flu spreads across England.

Dr Scriven said:  “NHS Providers is right when it says we are at a watershed moment in the health service and the government must recognise this – it has had long enough and been warned of this dangers enough times in the last two years alone.

“The data hides the misery and lack of dignity some people are being treated with and it is a potentially worrying side note that the Care Quality Commission is postponing inspections during ‘winter,'” he added.

Liberal Democrat former Health Minister Norman Lamb said: “The NHS is facing record levels of pressure – meaning every day patients are dying and experiencing dreadful failures of care.

“Yet all the government does is offer inadequate sums of money which barely keep our health service going. “Theresa May cannot ignore this crisis any longer. Ministers have a choice: agree to work with others to deliver a proper, sustainable settlement for the NHS or be left with blood on their hands.”

Health officials said the four-hour A&E performance in December was the same as it was last January, even though the NHS had treated almost 40,000 more patients within four hours.

Latest figures show a tripling in patients hospitalised with flu, with one in four cases suffering from the deadliest strain, dubbed Australian flu, after it fuelled the country’s worst season for two decades.

Across England, around 4.5m people are estimated to be suffering from flu-like symptoms, while across the channel, France has declared an epidemic.

The Department of Health says ambulance crews should be able to hand patients over to A&E staff within 15 minutes of arrival at hospital, and not doing so increases the risk to patients due to delays in diagnosis and treatment, as well as the chance that a patient will get worse while waiting on a trolley. But 16,690 patients waited at least half an hour in the last week, the figures show.

Meanwhile there were record calls to 111, with 1.68 million such calls last December, up from 1.48 million the previous year.

A spokesperson for the Royal College of Surgeons said: “December’s A&E performance is disappointing and shows a system under pressure. It further demonstrates why it has been necessary to cancel patients’ non-urgent procedures until the end of January.

“Despite the best efforts and dedication of NHS staff to treat patients quickly, waiting times for non-urgent care have also deteriorated again in the past year.

“Last week, NHS England advised that hospitals defer non-urgent inpatient planned care until the end of January and that day-case procedures and routine patient appointments should also be deferred where this will release clinical time for emergency care.  Although this should help relieve some of the pressures on hospitals and avoid last-minute cancellations, it is a short term solution and will cause huge disruption to those patients whose appointments and operations have been cancelled. The fact remains that we do not have adequate funding or capacity in our health or social care services.”

An NHS England spokesman said: “Despite the clear pressure on the NHS in December, with rising levels of flu and record numbers of 111 calls and hospital admissions, we managed to hold A&E performance at the same level as last January.

“We also saw the best seasonal performance on NHS delayed transfers of Care in four years, and went into winter with cancer and routine surgery waits both showing improvements.”

The latest weekly figures show 23 trusts which hit 100 per cent occupancy in the week ending 7 January.

Three trusts – The Hillingdon Hospitals NHS Foundation Trust, James Paget University Hospitals NHS Foundation Trust  and Walsall Healthcare NHS Trust – were at full capacity on every day of the week.

Last year, the British Red Cross provoked outrage by declaring a “humanitarian crisis” in the NHS as pressures mounted.

Today its chief executive Mike Adamson said:  “Despite the best efforts of hardworking NHS staff, many A&Es and emergency departments remain under serious pressure this winter.

“It is increasingly clear that we will never address the ongoing pressures on hospitals by focusing on the NHS in isolation. We need a joined-up approach to health and social care, because we know that many people’s health problems start in the home.”

http://www.telegraph.co.uk/news/2018/01/11/hospital-crowding-soars-amid-rising-cases-norovirus-aussie-flu/

Hospitals which hit 100 per cent capacity in the week ending January 7

The Hillingdon Hospitals NHS Foundation Trust

James Paget University Hospitals NHS Foundation Trust

Walsall Healthcare NHS Trust

Barnsley Hospital NHS Foundation Trust

Weston Area Health NHS Trust

The Princess Alexandra Hospital NHS Trust

East Cheshire NHS Trust

North Middlesex University Hospital NHS Trust

The Whittington Hospital NHS Trust

Kettering General Hospital NHS Foundation Trust

Isle Of Wight NHS Trust

Croydon Health Services NHS Trust

Lewisham And Greenwich NHS Trust

Northampton General Hospital NHS Trust

West Suffolk NHS Foundation Trust

Tameside And Glossop Integrated Care NHS Foundation Trust

East And North Hertfordshire NHS Trust

Milton Keynes University Hospital NHS Foundation Trust

Bolton NHS Foundation Trust

Leeds Teaching Hospitals NHS Trust

Salford Royal NHS Foundation Trust

South Tyneside NHS Foundation Trust

University Hospitals Of Morecambe Bay NHS Foundation Trust

Source: NHS England

http://www.telegraph.co.uk/news/2018/01/11/hospital-crowding-soars-amid-rising-cases-norovirus-aussie-flu/

British PM faces pressure over healthcare crisis — “third-world conditions”

January 10, 2018

AFP

© AFP/File | Healthcare crisis at her door? Britain’s Theresa May came under fire in parliament over severe delays in patient treatment at the state-run National Health Service (NHS)

LONDON (AFP) – 

A healthcare crisis put British Prime Minister Theresa May on the defensive at her first weekly parliamentary questions of 2018 on Wednesday following a report about cuts in cancer care.

The questions followed a report in Wednesday’s edition of The Times which said a leading hospital was delaying the start of chemotherapy for patients due to a 40-percent shortfall of nurses in the relevant medical unit.

Andrew Weaver, head of chemotherapy at Churchill Hospital in Oxford, is also reportedly considering reducing the number of treatment cycles used to alleviate symptoms, rather than cure patients, due to staff shortages.

The hospital has denied any change in policy.

May dismissed the report but apologised for the postponement of tens of thousands of operations over January due to a surge in demand at the state-run National Health Service during the winter period.

“I fully accept that the NHS is under pressure over winter… I apologise to those people who have had their operations delayed,” May said after a barrage of questions from Labour leader Jeremy Corbyn.

“The reality in our NHS is that we are seeing 2.9 million more people now going to accident and emergency, over two million more operations taking place each year,” she said.

Corbyn also mocked May over reports that she had intended to sack Health Secretary Jeremy Hunt but was “too weak” to do so in a cabinet reshuffle earlier this week.

NHS staffing levels have been in crisis for months.

There are 40,000 vacant nurse posts in England, according to the Royal College of Nursing, but the numbers applying to study the subject are also falling.

According to the Nursing and Midwifery Council, 27 percent more nurses and midwives left the job between 2016 and 2017 than joined.

Numerous doctors have taken to social media in recent weeks to apologise to patients, with one emergency doctor in central England warning of “third-world conditions”.

NHS England last week recommended all hospitals defer non-urgent appointments and operations until the end of the month, except for cancer operations and “time-critical procedures”.

Related:

Britain’s Unavoidable Health-Care Choice

January 9, 2018

Bloomberg Editorial

Low taxes or free, high-quality medical services: Pick one.
.
The NHS needs more than emergency treatment. Photographer: Jack Taylor/Getty Images

Can a relatively low-tax country run a high-quality, taxpayer-funded health service that’s free to all? Britain’s National Health Service suggests the answer is no.

The NHS is good at some things but bad, bordering on disastrous, at others. Its great virtue is truly universal coverage, no questions asked — and by international standards, the system is also cheap to run. As a result, though, it’s perpetually short of money, and the service is erratic. Today the NHS is yet again dealing with a financial crisis and a surge of complaints about standards.

Prime Minister Theresa May has had to apologize to patients for a winter breakdown that has seen operations postponed and emergency-room waiting times rise well over the promised four-hour maximum. That comes a year after the British Red Cross declared the service was on the verge of a “humanitarian crisis.”

The NHS’s problems — too many patients and not enough staff — aren’t seasonal. Britain’s population is growing and getting older, and as medicine advances, treatments become more sophisticated and expensive.

Many years of meager funding are taking their toll. In relation to population, the U.K. has fewer doctors, CT scanners and MRI units per capita than most other EU countries, and ranks toward to the bottom of the league on infant mortality. Other universal-coverage systems score better on avoidable deaths, cancer survival, innovation, consistency of service, and other measures. Long waiting times for some non-urgent treatments are leading more patients, many suffering chronic pain, to tap savings or borrow for private treatment.

Granted, more money by itself won’t cure the system. One former head of the Treasury called the NHS a “bottomless pit.” Even so, bearing in mind how little the NHS costs, more money is surely part of the answer, as long as it’s combined with further efforts to run the system more efficiently. For instance, social care for the elderly and other groups hasn’t kept pace with what’s required, placing an added burden on more costly medical professionals. Fixing that kind of misallocation would improve the system’s value for money.

The public’s devotion to the principle underlying the NHS is undiminished: The British see health care as a right. Increasingly, though, they are also demanding higher standards of care, and those come at a price. Taxpayers must either dig deeper to maintain the current service — deeper still to improve it — or else accept that the NHS will continue to disappoint.

To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net .

https://www.bloomberg.com/view/articles/2018-01-09/britain-s-unavoidable-health-care-choice