‘Foreigners abusing system’ claim contradicted by research that also shows more people go overseas for treatment than arrive
Medical tourism is a lucrative source of income for the NHS, according to a major new study that contradicts many of the assumptions behind the government’s announcement that it will clamp down on foreigners abusing the health service.
Eighteen hospitals – those deemed most likely to be making money from overseas patients – earned £42m in 2010, according to researchers from the London School of Hygiene and Tropical Medicine and York University. Medical tourists spent an estimated £219m on hotels, restaurants, shopping and transport in the UK.
The researchers also found that more people leave the UK seeking medical treatment abroad than arrive in this country for care: about 63,000 people from the country travelled to hospitals and clinics abroad in 2010, while considerably fewer, about 52,000 people, came here.
He said on Tuesday: “It’s time for action to ensure the NHS is a national health service – not an international one. With the NHS already under pressure from an ageing population, it cannot be right that large amounts of taxpayers’ money is being lost through treating people who should be paying from foreign countries.”
But the lead author of the new study, Johanna Hanefeld, from the faculty of public health and policy at the LSHTM, said the government-commissioned research published on Tuesday was “much more across the government immigration agenda than anything to do with health”.
A former adviser to Tony Blair who has spent a decade at the top of an American private healthcare giant has been appointed to run the NHS in England.
Simon Stevens, the architect of Labour’s health reforms who left the UK in 2004 to take up a lucrative post at the American company UnitedHealth, was welcomed by the Health Secretary, Jeremy Hunt, as a “reformer and an innovator”.
But his selection as chief executive of NHS England will raise concerns among critics who claim the NHS is being “softened up for privatisation”.
… one senior doctor told The Independent that the medical profession may view Mr Stevens with suspicion. “Clinicians will remember him as an architect of New Labour’s marketisation of the health service,” he said. “He was very pro the idea of opening up provision to multiple providers. He was keen on having competition as a lever in the NHS… Nicholson was seen as a centralist, very into the state. Stevens will be seen as the opposite. A lot of the profession, especially those committed to traditional NHS values will see this as a very different slant.”
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Doctors say prime minister’s pledge is unachievable, as analysis shows only 1% of surgeries open all weekend
Dr Clare Gerada, chairwoman of the Royal College of GPs said: ‘you do not find a solution by beating us around the head constantly, but by supporting and investing in us.’ Photograph: Frank Baron for the Guardian
Senior doctors have condemned the prime minister’s pledge that GP surgeries will open from 8am to 8pm seven days a week as unrealistic and unachievable, as a Guardian analysis of existing opening times showed that just 1% of practices see patients on both weekend days and three-quarters are shut all weekend.
Only 100 (1%) of the 9,871 surgeries in England listed on the NHS Choices website are currently open for part of Saturday and part of Sunday, while overall just one in seven – 1,439 (14.6%) – open at all on a Saturday.
Those that are open offer access to a GP for on average only three hours and 25 minutes, far less than during an 8am to 6.30pm standard weekday. Three out of four (7,561 – 75.6%) surgeries are shut all weekend.
Even at surgeries that do see patients at the weekend, opening hours can be brief. Although four practices in Sheffield, Coventry, Wirral and King’s Lynn open for 14 hours on a Saturday, the Village Hall surgery in Nottingham is open for just 30 minutes that day. More than 30 others open for an hour or less.
The findings underline the scale of the task David Cameron faces in honouring his promise, which earned widespread media coverage when he announced it at the Tory conference. Millions who find it hard to see a GP at a suitable time would benefit from the dramatic extension of opening hours, he pledged: “We want to support GPs to modernise their services so they can see patients from 8am to 8pm, seven days a week.”
But doctors’ leaders claim there are far too few GPs to staff such an expansion of opening times and the NHS is too cash-strapped to afford it. They have also questioned whether enough patients will want to see a GP outside normal weekday surgery hours, especially at weekends, to justify the move.
Family doctors’ organisations warn that a large majority of patients who visit surgeries during usual weekday opening hours could face longer waiting times and not be able to see their regular GP if ministers press ahead with the plan.
Thirty-nine departments failed to see 95% of patients within four hours in England, up from 14 units for same period in 2012
Accident and emergency
The number of A&E units failing to meet the government’s four-hour target has almost trebled in a year.
A total of 39 departments failed to meet the target of seeing 95% of patients within four hours between July and September, according to NHS England data. This compares with 14 units during the same period last year.
The target covers all A&E types, including minor injury units and walk-in centres, and the number discharged, admitted or transferred within four hours of arrival.
The NHS as a whole across England is still hitting the target, with 96% of all patients seen within the time between July and September. But this is only because some units perform way above the target, with some consistently hitting 100%.
In August, David Cameron announced £500m of extra funding over the next two years to support A&E.
The cash is intended to help units through the winter, cutting delays and reducing the number of admissions.
The shadow health secretary, Andy Burnham, said: “David Cameron’s ill-judged re-organisation has placed the NHS in the danger zone. The government cannot continue to ignore the warnings. Until ministers face up to the fundamental causes – the collapse of social care and frontline job losses – the NHS will continue to struggle.
“This is further proof you can’t trust David Cameron with the NHS. We can’t have another year in the NHS like the last one – he needs to urgently get a grip.”
The NHS faces unexpected cuts of £500m that threaten frontline services, according to a body that represents hospital trusts.
Despite the government’s pledge to protect frontline services with real-terms increases in funding, Monitor, the NHS watchdog, has proposed that in 2014-15 hospitals should be paid 4% less for operations than they were the previous year.
While hospitals were braced for a cut of about £1bn in funding, the Foundation Trust Network, which represents all 160 hospital trusts in England, calculates that Monitor is now asking for another £500m in savings – roughly £3m from each trust.
Chris Hopson, chief executive of the Foundation Trust Network, said cuts to frontline services would be deeper than expected and questioned whether the NHS could invest in much needed changes to the way hospital services work, recommended by the Francis report into failings at Mid Staffordshire NHS Trust.
He warned that hospitals were facing a “quadruple whammy” of “implementing the Francis report’s recommendations on quality such as improving staff-to-patient ratios, putting seven-day working in place, coping with increasing demand and investing in much needed change”.
“The level of efficiency savings the NHS has delivered over the last three years is unprecedented, but this level of performance cannot be sustained year on year till 2021. We need a reality check here – in the end you get what you pay for, and trusts can’t perform miracles out of thin air.”
Officials at Monitor were unrepentant, saying the forcing of hospitals to charge less for operations would free more money for clinical commissioning groups – clumps of GPs who purchase care on behalf of patients – to spend on the public.
However, Labour said it was another example of how the coalition’s reforms were silently squeezing the NHS.
The government promised parliament that NHS competition would not be compulsory under their new laws. New evidence emerges today that these promises were false.
Local health bosses are saying they are legally obliged to put NHS services out to competition, despite repeated government promises to the contrary, it emerged today.
A survey in today’s Pulse magazine revealed that since April, Clinical Commissioning Groups have put 63% of contracts to provide NHS services out to tender, with a further 9% using the slightly different ‘Any Qualified Provider’ route. The contracts that have been opened up to private healthcare companies to take over include every aspect of NHS services and total billions of pounds.
“When asked whether they had awarded contracts without putting it out to competition, many Clinical Commissioning Groups – including Cambridgeshire and Peterborough – answered: ‘This would be contrary to the section 75 regulations.’”
The revelation will re-open controversy about broken government promises on NHS privatisation.
The Section 75 regulations were made under the Health & Social Care Act in April this year. They appeared to force competition on the NHS in contravention of ministerial promises made during the stormy passage of the Act itself. At a critical juncture then health secretary Andrew Lansley wrote to the new local health bosses (Clinical Commissioning Groups) telling them that,
“I know many of you have read that you will be forced to fragment services, or put them out to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators – should decide when and how competition should be used to serve your patients interests.”
And he told the House of Commons,”There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector”
Days later Tory health minister Earl Howe promised the Lords “Clinicians will be free to commission services in the way they consider best. We intend to make it clear that commissioners will have a full range of options and that they will be under no legal obligation to create new markets, particularly where competition would not be effective in driving high standards and value for patients. As I have already explained, this will be made absolutely clear through secondary legislation and supporting guidance as a result of the Bill.”
However when this secondary legislation emerged in February this year – the Section 75 regulations – it appeared to break these promises and give local health commissioners no choice but to put NHS services out to competition, as first highlighted on OurNHS openDemocracy and by Keep Our NHS Public.
A storm of protest errupted. Over 1000 health professionals wrote to the Telegraph urging for the regulations to be scrapped. Both the unions and the Royal Colleges – even those who had been muted in their opposition to the Act itself – and were up in arms at what the Association of Royal Colleges called ‘privatisation by stealth’. Over 300,000 38 Degrees members signed a petition for them to be dropped. Polly Toynbee called for the Lib Dems not to stand for any more lies on the NHS and many Lib Dem activists raised concerns.
Lib Dem health minister Norman Lamb told parliament “We are looking at this extremely seriously. Clear assurances were given in the other place during the passage of this legislation and it is important they are complied with in the regulations.”
A few recent news articles about the UK’s Conservative and Liberal-Democrat(Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.
I’ll do a proper NHS news review later – I have to go out and do some nonsense. Just one article featured for now.
Literary festival hears rallying cry against ‘Bill that will kill the health service’
Leading health academics Colin Leys and Allyson Pollock yesterday issued a rallying call to everyone who wants to save the NHS. This is, they both said, a crucial fortnight. With the Liberal Democrat conference looming, which they both saw as a last-chance opportunity to stop the Lansley reforms, they largely ignored their brief from the Bath Festival of Literature – to talk about the long-term future of the service at an Independent Voices debate entitled “Is the NHS sacred?”
“This Bill will destroy the NHS,” said Ms Pollock, London University professor of Health Policy and Health Services Research. “If you care for the future, you need to focus now on stopping the Bill. This is a terrifying, Big-Bang moment, because Lansley and his team are moving us to a mixed-financing system similar to that in the US.”
“It will be the end of free care for all,” said Mr Leys, emeritus professor of political science at Goldsmiths’ College. The future he foresaw would be one in which “community care will contract and decline, everyone who can afford to will go private and all we’ll be left with is a much-reduced service for the poor”.
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Health secretary says Liberal Democrats instrumental in making reforms ‘stronger’
The Liberal Democrats were fundamental in helping to make the controversial NHS reforms “stronger”, embattled health secretary Andrew Lansley has said.
Lansley insisted his cabinet colleagues were on board with the massive shakeup – despite claims that three fellow Tories had deep concerns about the plans – and praised the input of his party’s coalition partners.
“If there had been a Conservative government, we would have started out in a different place,” he told BBC2’s Newsnight. “The bill is better as a result of the coalition coming together to shape it.”
He admitted he had always known there would be uproar over the bill, noting that all previous health secretaries who had attempted to push through changes had faced the same response.
“There’s always noise,” he said. “The NHS matters so people make a lot of passionate remarks about it. Ken Clarke, who is a fabulous communicator, far better than I am, he tried reform in the early 1990s and the BMA [British Medical Association] said that it was the end of the NHS as we know it.
“There is no way of undertaking major reform imagining that you’re not going to be misrepresented and distorted … We’ve reached the stage where quite a lot of the disinformation out there is a problem, because people are saying things that are literally not true.”
What do you think those determined to save the NHS can do at this stage?
The important thing is not to let up. Everyone should just intensify what they are already doing. The time between now and the end of the parliamentary session is critical. People are tired, but so are the government. They are badly rattled. A good illustration of this was the ill-judged so-called summit with representatives of the medical professions called by Cameron on 20 February, to which only representatives of the few who support the bill were invited. This was so obvious that as a public relations exercise it proved seriously counter-productive. Government spokespeople were left lamely claiming that there would be other summits to which (they implied) those who had been excluded would be invited. The more people show that their opposition is deep and will be long-lasting, the more rattled the government will become.
The charade of the report stage in the Lords, which is about to begin, needs to be exposed. The media are already describing the new amendments as important when they are not. Pressure needs to be kept on the media, and not least the BBC, to show some objectivity and balance their coverage by inviting genuine expert critics of the bill to take part in their panel discussions of it.
It is important to focus on the Lib Dems. Lansley’s ham-fistedness has attracted most of the flak but the Lib Dem MPs and peers are providing him with cover by going through the motions of obtaining ‘concessions’ while in reality enabling the bill to be passed. The Lib Dem President, Tim Farron, has already blinked, calling for the competition chapter of the bill to be removed, while acknowledging that this may not go far enough for Lib Dem activists (it won’t). Delegates to the Lib Dem conference, and Lib Dem councillors standing in the forthcoming local elections, need to be heavily lobbied. Everyone should also write a letter to as many Lib Dem MPs and peers as they can, and get others to do the same.
The bill wasn’t in the Conservatives’ election manifesto, let alone in the Lib Dems’, nor was it in the coalition agreement. It has no electoral mandate. It is a private sector ramp, masterminded by McKinsey. Lib Dems must be left under no illusions. They need to understand that if they allow the Conservatives’ bill to become law they are morally and electorally finished.
The Royal College of Physicians (RCP) , representing hospital doctors, has chosen to ballot its 26,000 members on the Health and Social Care / Destroy the NHS Bill.
We were told that the bill would make the NHS more efficient and more cost effective. It won’t. Management costs in the NHS are about 5% of the total budget. In the US healthcare system, where the market rules, they are above 25%. If the bill is passed, management consultants such as McKinsey and KPMG will make millions from the NHS budget “advising” clients on both sides of the purchaser/provider split, with additional contracts “advising” government and health regulators how to cope with the tangled web of contracts the new system would create.
We were told that the bill would make things less bureaucratic. It won’t. It will replace three layers of management in the NHS with at least six new ones, and a seventh if you count the health and wellbeing boards to be established at the local authority level. For example, 152 primary care trusts will be replaced with well over 200 clinical commissioning groups. Almost half the staff of primary care trusts have already gone, but many are returning to work for the commissioning groups and commissioning support services, often as consultants on a higher rate than their previous salaries.
We were told that the bill was essential to control spiralling healthcare costs. It isn’t. Britain spends less per head on healthcare than most other European Union countries, and far less than the United States. Market competition in health is inherently wasteful, because it implies the existence of spare capacity in the system. It is likely to drive up costs for each patient, as charges for healthcare have to rise to ensure that providers can carry the costs of under-used people, building and equipment.
We were told that the bill means more choice for patients and more control over their healthcare. It doesn’t. Instead, it will strain to breaking point the essential relationship of trust between doctors and their patients. GPs in particular will be put in the invidious position of having on the one hand to diagnose their patients and recommend the best course of treatment, and on the other hand to refuse to supply it because as commissioners their budgets are under pressure.
For all these reasons and others, doctors, nurses and other health professionals have finally concluded that the bill is beyond rescue. Opinion polls show that view is shared by a large majority of the British public.
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NHS care to be severely rationed. People will need health insurance like the United States.
Services are already being pulled in an unannounced, piecemeal way. If the bill passes, the health secretary won’t be accountable
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Under the bill the range of what is available for free seems certain to contract further. Commissioning groups will have fixed budgets. The for-profit “support organisations” that are being lined up to do most of the commissioning for them will have a strong incentive to limit costs, and therefore the treatments to be paid for. CCGs also look likely to be free to decide that some treatments recommended by hospital specialists are “unreasonably” expensive, and refuse to pay for them, as health maintenance organisations do in the US.
A core of free NHS services will remain, but they will be of declining quality, because for-profit providers will cherry-pick the most profitable services. NHS hospitals will be left with the more costly work, so staffing levels and standards of care will be forced down and waiting times will get longer. To be sure of getting good healthcare people will increasingly take out private insurance, if they can afford it. At first most people will take out the cheaper insurance plans now on offer that cover just what is no longer free from the NHS, but gradually insurance for most forms of care will become normal. The poor will be left with a limited package of free services of lower quality.
What is available on the NHS should be determined nationally, in a transparent and democratic way, not by unelected local bodies. The bill will allow the secretary of state to deny responsibility when good, comprehensive, free care has become a thing of the past.
85% of family doctors think health service will have to cut back on provision
More than eight in ten GPs believe that there will be greater rationing of care in the NHS as a result of the financial challenges facing the health service.
Research published this week suggests that 85% of family doctors believe that the government will have to set out more clearly what care is – and is not – freely available on the NHS in England.
A survey of 821 English GPs carried out by the Nuffield Trust, an independent health think tank, and doctors.net.uk found that only half of GPs believe that the NHS will be able to improve efficiency enough over the next five years to avoid having to scale back on the services that are currently funded.
In addition, the vast majority of GPs (83%) believe handing responsibility to local clinical commissioning groups for setting priorities for spending NHS funds will be likely to lead to greater variations in what services are provided to patients throughout England.
Lib-Dem activists force Nick Clegg to make further demands for changes to the bill. It should be recognised that Nick Clegg is and has been fully supportive of plans to destroy the NHS.
The future of a prestigious health service which helps children suffering severe abuse is in doubt because of government cuts, a mental health expert has warned.
The Tavistock’s Monroe Assessment Service provides treatment for families going through care proceedings and assesses many children subjected to sexual and physical abuse or neglect.
But a new cap on the amount of funding these expert court witnesses receive has left the prestigious service operating at a loss, and many families without adequate support, a consultant social worker has warned.
Tim Kent said: “We are seeing the highest number of applications for care orders in the family courts for a decade, but the work of expert witnesses has been hit by savage cuts.
“Cases are getting stuck in the legal system and children’s lives are on hold for longer. We fear that the risk of courts making bad decisions about the best interests of the child is growing.
I consider this posting to comply with copyright laws since
a. Only a small portion of the original article has been quoted satisfying the fair use criteria, and / or
b. This posting satisfies the requirements of a derivative work.
Please be assured that this blog is a non-commercial blog (weblog) which does not feature advertising and has not ever produced any income.
A few recent news articles about the UK’s Conservative and Liberal-Democrat (Conservative) coalition government – the ConDem’s – brutal attack on the National Health Service.
The BMJ, HSJ and Nursing Times have published the same editorial comment on the Health and Social Care Bill. The editorial is critical of Andrew Lansley and the ConDems for the poor progress of the bill and the resulting “unholy mess”. The editors claim that further NHS reforms will be needed to clear up that “unholy mess”.
As the editors of the BMJ, HSJ and Nursing Times, we have divergent views on the NHS reforms and its beleaguered Health and Social Care Bill. But on one thing we are agreed: the resulting upheaval has been unnecessary, poorly conceived, badly communicated and a dangerous distraction at a time when the NHS is required to make unprecedented savings. Worse, it has destabilised and damaged one of this country’s greatest achievements: a system that embodies social justice and has delivered widespread patient satisfaction, public support, and value for money. We must make sure that nothing like this ever happens again.
Health interest groups differ in their stance on whether to oppose the bill outright or to work with the government to try to improve it. But there can be no doubting the deep distress and lack of confidence in the plans among those who must deliver the service.
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The reforms did not have to result in this unholy mess. The coalition agreement released in the honeymoon period immediately after the election focused on clinical leadership and patient and public empowerment. It was generally well received by those whose daggers are drawn against the reforms.
But through a combination of poor political judgement and reluctance to engage with criticism, a set of (mostly) reasonable objectives morphed into an old fashioned top-down reorganisation. This was the very thing the agreement had pledged to avoid. It also resulted in a bloated piece of legislation, whose goals could have largely been achieved by other, more effective, means.
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Unions representing hundreds of thousands of healthcare professionals and workers from across the NHS are to step up the pressure on peers with a central London rally as the Health and Social Care Bill enters its final crucial parliamentary stages.
On Wednesday 7 March – under the banner of the All Together for the NHS campaign – nurses, midwives, doctors, physiotherapists, managers, paramedics, radiographers, cleaners, porters and other employees from across the health service will join with patients to fill Central Hall Westminster for a 6pm ‘Save our NHS’ rally.
The Bill is hugely unpopular with NHS employees and patients, who have major concerns over the effect the draft legislation will have on healthcare by pushing through competition and markets on to the NHS, and allowing the private sector to take over delivering NHS services.
The All Together for the NHS campaign has called the rally over concerns that an NHS with a future based on competition will fragment the health service, worsen the care available to patients, and mean continued uncertainty for NHS employees, with the quality of training and their terms and conditions likely to suffer.
The pressure on the Secretary of State, Andrew Lansley, has been growing in recent weeks with more professional bodies joining the calls to amend significantly or withdraw the Bill completely. The March rally is intended to add to that pressure by demonstrating the broad coalition of opposition to Bill.Unions representing hundreds of thousands of healthcare professionals and workers from across the NHS are to step up the pressure on peers with a central London rally as the Health and Social Care Bill enters its final crucial parliamentary stages.
On Wednesday 7 March – under the banner of the All Together for the NHS campaign – nurses, midwives, doctors, physiotherapists, managers, paramedics, radiographers, cleaners, porters and other employees from across the health service will join with patients to fill Central Hall Westminster for a 6pm ‘Save our NHS’ rally.
The Bill is hugely unpopular with NHS employees and patients, who have major concerns over the effect the draft legislation will have on healthcare by pushing through competition and markets on to the NHS, and allowing the private sector to take over delivering NHS services.
The All Together for the NHS campaign has called the rally over concerns that an NHS with a future based on competition will fragment the health service, worsen the care available to patients, and mean continued uncertainty for NHS employees, with the quality of training and their terms and conditions likely to suffer.
The pressure on the Secretary of State, Andrew Lansley, has been growing in recent weeks with more professional bodies joining the calls to amend significantly or withdraw the Bill completely. The March rally is intended to add to that pressure by demonstrating the broad coalition of opposition to Bill.
…
Two thirds of NHS staff believe maternity care will change under Andrew Lansley’s contentious reforms, according to a survey.
In a YouGov poll of over 1600 staff, 68% said they believe the bill will lead to changes for ‘basic services’.
Along with maternity care, this also includes services such as cancer screening and the ambulance service.
The poll also shows 71% think the health secretary is doing bad job, and 78% believe more patients will be excluded from NHS care under the reforms.
It is the first independent poll on the NHS plans to be conducted across all the medical professions, at a range of management levels.
David Babbs is executive director of 38 Degrees – the non-profit political activist group whose members paid for the poll.
He said: ‘For over a year 38 Degrees members have been telling Andrew Lansley to stop ploughing on regardless and to start listening to the concerns of the public and health care professionals.
‘Time and again Lansley’s tried to claim that the silent majority of NHS staff support him. This poll shows that’s not true.’
The survey was conducted on 17-26 January this year and also shows that 84% of health workers surveyed have no confidence that the right balance between competition and collaboration will be struck.
The full poll results are available to download here.
