Category Archives: NHS

Revealed: Chief Exec’s leaked memo on breaking up NHS Direct

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Nick Chapman; chief Exec NHS Direct – now just 34 per cent of NHS 111 Pic courtesy: ehi.co.uk

Next April the NHS Direct service relied on by millions to get instant professional medical advice in emergency will cease to exist. Instead a cheaper localised services known as NHS 111 will take its place with varying quality and money will be made by companies handling their calls.

Now Nick Chapman, the NHS Direct, has admitted in a private memo that it has lost bids for 66 per cent of the population and will  decline dramatically as a result. On December 3 a consultation will begin on the future of over 1,200 of the 2500 staff who will either lose their jobs or be transferred to other organisations. Read the story and the memo in full at http:///www.exaronews.com .

Chapman says: “The new organisation will look and feel very different to the current NHS Direct. The type and number of jobs at each of the new 111 sites – both for front line and supporting staff, and the processes for appointing staff into these, has not yet been finalised but we do know that the overall number of jobs in NHS Direct will be substantially lower than it is currently – most probably less than half the current number.”

He also admits that where people are being transferred to either out of hours doctors’ services or to profit-making company, Care UK Ltd which has won 12 contracts, there are no guarantees for staff pay and conditions.

As he put it: ” movement of staff to non-NHS providers (such as GP out-of-hours providers) have encountered legal problems relating to the protection of employment rights. We have sought a resolution of these problems with the Department of Health but have not been able to find one. This is no reflection on the non-NHS providers and is not of their making; indeed many of these providers are very keen to have NHS Direct staff transfer to them to help with their own mobilisation of the 111 service. The position which I can now confirm is that the movement of staff in the areas won by non-NHS providers will proceed now on a volunteers-only basis.  Only staff who volunteer to move to non-NHS providers (in the full knowledge of what employment protection rights they do have) will do so.”

In other words Jeremy Hunt and Andrew Lansley, health secretaries, have deliberately wanted worse conditions for  transferred staff.

I must say I am highly suspicious of this move which is happening without the general public realising what is going on. I agree with Glenn Turp, Northern Director of the Royal College of Nursing, who said:

“The public don’t realise that this Government is abolishing NHS Direct. They may have heard of 111, but they think it is basically a rebranding exercise, and that it will still be NHS Direct on the phone. It will not.  This is a completely misguided, ill-conceived plan, that is wrecking another excellent NHS service. It’s not simply a change of phone number, the new service from 111 is significantly inferior.”

Research from Sheffield University into the first pilot  suggests this could be true and  it is not clear yet whether this will be a saving or end up costing taxpayers more. The report said : “Assuming 7.8 million NHS 111 calls per year, the estimated monthly cost impact to the NHS would be a saving of £2.5million, although his could vary between a saving of £12million and an additional cost of £7 million. These estimates are based on considerable assumptions and limited cost data and should be treated with caution. ” As clears as mud, I would say.

The  main reason for increased costs is that the service is leading to increased use of the ambulance service because people can’t get the right advice. As it says

“One year after launch, the [111] pilots had not delivered the expected benefits in terms of improving satisfaction with urgent care or improving efficiency by directing patients to urgent rather than emergency care services. There was evidence of a reduction in calls to NHS Direct but an increase in emergency ambulance incidents.”

Anecdotally I can add to that. My  one year grandson  who is recovering from scarlet fever was referred by Nottinghamshire ‘s out of hours service to accident and emergency. The doctor not knowing my daughter has a journalist as a father said they had received 154 referrals that night from the service – who incidentally had wrongly diagnosed it as eczema. I gather doctors there routinely refer people to  hospitals to avoid being sued. And these are the services  who are going to run  many NHS 111 services. I hope for millions of patients this is sorted out, or Jeremy Hunt will get a deserved bloodied nose.

How Jeremy Hunt plans to implement Lansley’s sick funding scheme for NHS

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new health secretary Jeremy Hunt: Supporter of switching NHS cash from poor to the rich elderly

Four months ago I wrote a blog (see http://wp.me/pHiYZ-xu)  revealing a dastardly plan to switch NHS funding away from the poorest parts of England to the wealthiest areas under the guise of helping the elderly.

The scheme which drew attacks from Labour effectively meant tearing up the funding formula adopted since Clement Atlee which saw that the poorest deprived areas got more cash than the wealthy. To implement it Lansley was planning to get a health quango to recommend the changes. Thankfully since then nothing has happened..until today.

Jeremy Hunt, the newly appointed health secretary, it turns out is a passionate believer in such a scheme – as it would give loadsa state money to his own constituents in Surrey at the expense of Labour voting people in places like Newcastle upon Tyne and Sunderland.

I am indebted to a contact for alerting me to this information on Jeremy Hunt’ s own blog.

In his own words he says:

the real problem lies with the inherent  bias in the Government’s NHS funding formula of areas like Surrey. Guildford and Waverley’s population is weighted 9.1% upwards for market forces and 2.0% upwards for age structure but is weighted 25.3% downwards for additional need. The result of this is that the former Guildford & Waverley PCT’s target allocation per un-weighted head of population was £1,176, 15.3% less than the England average of £1,388. This means that even in an area with a large population of older people, the Royal Surrey is losing out”. Jeremy Hunt website (24 July, 2007, http://www.jeremyhunt.org/campaignshow.aspx?id=112&ref=50)
The extend of what this means is brilliantly explained in a user-friendly map by Dr Eoin Clarke – see http://eoin-clarke.blogspot.co.uk/2012/09/camerons-new-man-in-charge-of-nhs.html.
So this reshuffle may mean an even worse future for the NHS from the man who befriends Rupert Murdoch. It will great news for  the Tory voting upper middle classes  from Esher to Guildford, but every, very bad news for deprived areas where Labour has a huge majority. It will allow Tory voters to live longer in safe seats and contribute to Labour voters dying  before their they have another chance to vote.Clever man, Mr Hunt. You can quiz him, by e-mailing at huntj@parliament.uk

Exclusive: Bye,Bye NHS Direct – chief’s leaked e-mail

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Colourful protest against the end of NHS Direct. Pic courtesy:Urban75 blog

The hugely popular NHS Direct service is facing near extinction next year. Health secretary  Andrew Lansley’s decision to replace the well-regarded national service with a piecemeal local service run by any English local provider could mean it will be running nothing by the end of next year.

So far despite providing some of the trials for new cheaper NHS 111 phone line in Luton,Nottingham and Lincolnshire, NHS Direct has failed to secure a single contract.

 This dire news is contained in a confidential e-mail from Nick Chapman, chief executive of the doomed organisation, which is on the Exaro News website ( http://www.exaronews.com).

 It shows with a third of the local areas already choosing their preferred provider for the service NHS Direct has secured the ” preferred provider ” status in just three areas, covering a mere four per cent of the population – Cornwall and the Isles of Scilly, Somerset and one other area. But even this guarantees nothing.

As Mr Chapman says: “No contracts have yet been signed and there is still a lot of work to be done to agree the final contracts before we start delivering the service.”

And where NHS Direct is putting through pilots, these will be up for grabs by anyone else, once the period is over.

So who is getting them? Despite publicity showing that three of the main for profit providers, Care UK, Capita and Serco have pulled out – this has left   Harmoni  grabbing the biggest share with  Hillingdon, Croydon, Wandsworth, Suffolk, parts of Kent and Sussex and Wiltshire and parts of North Somerset, all now to be run for profit. And the promise of a six month delay may merely serve to persuade more private firms to move in – rather than defend the existing state provided service.

The rest has gone to various trusts and  social enterprises ( some well run by GPs like in Devon, others not so well run) taking over. NHS Direct is being cautious -saying commercial confidentiality stops them revealing the full picture.

 Should we care? According to the BMA we should.

 As Dr Laurance Buckman, chairman of the BMA’s GP committee, said: “A potentially dangerous version of NHS 111 is set to burst forth upon an unsuspecting public from April. Patients may end up being sent to the wrong place, waiting longer, blocking A&E and using ambulances needlessly, when a little more consideration might make it all work properly.”

Of course ministers like Simon Burns say it is fine and good value for the taxpayer. But I wonder if the public will like it – particularly if it to be mainly staffed by people with just 90 days training – rather than nurses who might have a better knowledge of medical matters. One wonders whether like a recent call I made to Blackberry, the centre will be spending their time looking up articles on Google to provide the best advice . Very worrying if you are an anxious mother or have a sick child.

 If it ain’t broke, why tear it apart.

Stuff the poor to help the elderly:Hunt moves to adopt Lansley’s bad plan for the NHS

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Andrew Lansley: let’s kill off the poor to help the elderly

Update: The new NHS Commissioning Board announced this week it was proceeding with scrapping the existing formula from next April – by adopting a flat rate increase  for funding this year. It also announced it will ” conduct an urgent fundamental review of the approach to allocations, drawing on the expert advice of ACRA and involving all partners whose functions impact on outcomes and inequalities.” This will come into force in 2014-15.

In fact this will mean a redistribution to areas with large numbers of elderly people at the expense of poorer areas like the North East of England, Central Manchester  and Salford and the London borough of Tower Hamlets. All this will be in place for the run up to the next general election.

Fresh from creating chaos as part of his so-called NHS ” reforms” Andrew Lansley has let slip another dastardly plan to cope with the genuine burgeoning costs of a growing elderly population.

Basically it’s very simple: Take away  the NHS cash from the poorest parts of England and give to the relatively affluent seaside resorts and the suburbs.

I am indebted to hawk-eyed reporter David Williamson at the Health Services Journal ( behind a pay wall at http://bit.ly/K7dceG ) for spotting a virtually unreported speech in London during the Parliamentary recess to new commissioning bodies who will  be spending the NHS cash from next year.

He told them they “should be looking at what is in… population data that is likely to give rise to a demand for NHS services”.

“What is likely to make the biggest difference, therefore? Actually it’s elderly population, who were not in substantial deprivation”.

He added :“Some of the lowest spending on stroke and cancer services were in areas with high elderly populations such as Fylde and Eastbourne, places where there were quite a lot of older people who weren’t poor”.

What Lansley is proposing – and the Department of Health is helpfully not making his speech available on its website is seismic in NHS terms. Ever since Clement Attlee set up the NHS, its main aim has been to improve the life chances of the poor most of them die long  before affluent and middle classes.

The Royal College of Nursing in the North East and Newcastle MP former Labour minister, Nick Brown, have spotted exactly what it means.

As Glen Turp, regional director of the RCN put it: “It is well-known that in areas of social disadvantage, local populations experience higher incidents of heart disease, cancer, emphysema, diabetes, as well as a range of other diseases caused in part by our industrial history and the work that our communities undertook. Health outcomes are directly linked to poverty and inequality, and to use age as the measure rather than inequality is simply the wrong thing to do. ”

To ram home his point: “The shocking truth is that if you live in Chelsea and Westminster in London, a man can expect to live to 86 years of age. However, in Hendon, in Sunderland, male life expectancy is only 69. That’s a 17 year difference. It’s nothing short of obscene, and frankly that is what the NHS funding formula should be all about.”

For those interested in more details Tom Gorman has tweeted me a map – showing some of the changes – the link is http://goo.gl/dyuGe .

Lansley plans to be even nastier in the way he plans to implement it. He intends to deny the government is doing it by tipping the wink to a quango  – the Advisory Committee on Resource Allocation which recommends how NHS budgets should be split up.

At the Conference, Lansley gave the game away: “The advisory committee will do this, I won’t— the number crunching should get progressively to a greater focus on what the actual determinants of health need” and that “Age is the principal determinant of health need”.

But there is also a cynical political side to this. By withdrawing money from poor areas, he can halt  the trend of living longer among mainly Labour voters, save the pension bill by ensuring that if they die off at 69 or even younger, they will in future not even need to receive a state pension.

But in the sunlight uplands of mainly Tory areas, the cuts that will inevitably come will be blunted or services improved in time for the 2015 election. And it won’t cost him an extra penny, all the money will be taken from Labour areas.

The formula is almost a Tory right winger’s wet dream.  Ed Miliband’s supporters dying off as they wait for operations in Labour seats, and the prospect of Tory and Liberal Democrat voters living longer and longer in Chelsea, Bournemouth, Eastbourne and Torquay.

Perhaps Mr Lansley should be told what we think of this. His emails are: lansleya@parliament.uk  and andrew.lansley@doh.gov.uk. If that fails perhaps the faceless people who sit on this quango, the Advisory Committee on Resource Allocation, should be contacted. Interestingly, the Department of Health, has not updated their membership since 2008 and archived the list. Perhaps Mr Lansley doesn’t want us to know.

After all , should Mr Lansley be allowed to get away with literally killing off the opposition.

Lansley’s outrageous ban covering up risks in his NHS reform

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Today the information commissioner publishes his findings to Parliament on the outrageous veto by Andrew Lansley in preventing publication of the NHS risk register.(see – report here http://bit.ly/MfEPVi )

The health secretary would have us believe that the public and the press are so naive that they must not be seduced in his words  by ” sensationalised reporting and debate ” of its findings.

In other words this is all right from Cabinet ministers and senior officials to read all the risky details  of his reforms – but the public must be treated like children, not capable of understanding the issues. What patronising piffle!

What I really suspect is that Mr Lansley does not want the public to read the full facts – something that when in opposition his Cabinet colleague, transport secretary,Justine Greening, rightly disagreed when it came to the risks of building a further runway at Heathrow.

But now in government it is of course all different, no one must know the real consequences of Mr Lansley’s decisions. I am delighted that Chris Graham, the Information Commissioner, stood firm on this one.

 But I suspect this decision is all part of an attempt by the government to row back on freedom of information. It fits in with Lord O’Donnell’s claim that if this goes on – it will have a chilling effect on discussion. The establishment both in the form of Jack Straw, Tony Blair and now Andrew Lansley, would love a world where we all lived in deference to ministers and senior civil servants.

No doubt charges for FOI will soon follow. Frankly if the government is planning to revert to a closed society, there is one simple solution. The risk register must be leaked.

Buried in the Budget:Freelance company tax rules ” shake up ” on way

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Almost entirely missed by the press coverage of the Budget this morning, George Osborne, the Chancellor, announced a radical review of  freelance  tax employment rules through what is known as IR 35.

Not mentioned in his speech – the changes were hidden away in the full Budget document. The full story of this change written by Alison Winward  and Frederika Whitehead is on the Exaro news website  at http://www.exaronews.com.

For those worried by the changes to the IR 35 rules   the official Treasury document uses the dreaded word simplification – the same phrase used by the Chancellor to impose a ” Granny Tax ” – a  future loss of  income for 4.5 million pensioners  by freezing tax allowances for most of  those who have  incomes above the state pension. Like pensioners this could affect millions of people.

The full section in the Treasury  reads:

 ” Personal service companies and IR35 –

 The Government will introduce a package of measures to tackle avoidance through the use of personal service companies and to make the IR35 legislation easier to understand for those who are genuinely in business.

This will include: strengthening up specialist compliance teams to tackle avoidance of employment income; simplifying the way IR35 is administered;

and subject to consultation, requiring office holders/controlling persons who are integral to the running of an organisation to have PAYE and NICs deducted at source by the organisation by which they are engaged. (Finance Bill 2013)”

Basically Hmrc are giving a warning that the  wheeze that enabled Student Loans Company chief Ed Lester to hold one official position in Whitehall, will be banned everywhere. It will also effect local government, the NHS and now the private sector, as people won’t be able to claim it as freelance earnings through a  personal services company. They will have to go through PAYE and pay national insurance.

There is at least a year’s grace before this happens – as legislation is planned for next year’s finance bill – and implementation could be delayed until 2014.

In the meantime the small print announces a crackdown from Hmrc on freelances who use this method. The revenge of Danny Alexander, chief secretary of the Treasury, who missed the whole Ed Lester arrangement when he personally approved all high paid Whitehall staff, looks like being rather more widespread than people anticipated.

Revealed: Lansley’s simply crazy commissioning guide for your operation

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Lansley's latest complicated NHS Commissioning diagram:Uploaded with help of Political Scrapbook

Commissioning-Intelligence-Model-v13

 Feeling ill and need to see your doctor. Well here’s a bit of draft helpful advice under the Lansley reform measures.  Click on the link above and  get a big surprise. Just a simple commissioning guide so the NHS can smoothly run to help meet David Cameron’s ” NHS is in my DNA ” pledge.
This was sent to me as part of the big response to the NHS London board  diagram of how the NHS will look which I published on Sunday night. I can verify  its contents and it comes from @nhs_supporters and  the respected and informed  Health Service Journal. It makes interesting bedtime reading.
This appears to lay out a few guidelines. By the time they have answered all these questions I suspect you might be dead. Notice that GPs will have to send in monthly accounts and that a lot of computer programmes (more waste on IT) will be employed to work out the mix of services. It sound a nightmare to me.
But I am sure you will be eternally grateful to the huge cut in bureaucracy needed to answer all these points. Have a good time at your doctor’s surgery. Or alternatively why not e-mail Mr Lansley himself on lansleya@parliament.uk and ask him to go through the process with you. He claims to have spent five years thinking all this up. Pity he didn’t bother to tell the voters at the election.

Revealed: Blueprint for Lansley’s bureaucrat free simple NHS (This document is real!)

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Can you understand this document reproduced below?

Simplified Map of how the London NHS will look after Lansley has finished with it

No, thought so.Well this is the all singing, dancing model of the remains of the National Health Service after Andrew Lansley has finished with it. It is being distributed by the NHS Commissioning Board and a copy has come my way.Have you seen such a complicated diagram with different arrangements for accountability and funding? Far from creating fewer bodies it seems to create a plethora of new bureaucratic ones who will  have more complicated relationships than a man with 20 mistresses.

Note where the public and the patient – supposedly the focus of David Cameron’s reforms. They are hidden under three levels of bureaucracy at the bottom of this diagram – obviously the least important people around.

 Note all the new bodies, Public Health England, London Health Education, the NHS Commissioning Body, London;The NHS Trust Development Authority, London; Clinical Senates, Clinical Commissioning Groups,  Patch teams ( I think they put sticking plaster on people when it all falls apart) the Care Quality Commission ( the body whose boss has just quit before being pushed and finds it difficult to monitor one home let alone all the rest) and a role for local authorities who being stripped of cash anyway by Eric Pickles, the communities secretary.

There are also Commissioning Support Services – I think this is the bit where the private sector make their millions from the taxpayers before they take over the running of the hospitals.

In my view this document gives a complete lie to the idea that some how  we are going to have a wonderful bureaucrat free NHS with thousands of new doctors and nurses and patients with a sensational choice for everybody in England to go any hospital they want, regardless of cost.

It more looks like a recipe for chaos, fragmentation, confused accountability and irresponsibility with taxpayer’s cash. This diagram illustrates why it is costing £1.3 billion to do this.

Andrew Lansley becomes excited when he see this wonderful NHS blueprint!

There still a little time left before collective madness sets it. If it wasn’t an insult to the thousands of mentally ill people suffering in this country, I would suggest that Mr Lansley ought to be sectioned under the Mental Health Act for all this mayhem he is about to cause. You can off course tell him he is mad yourself. His direct e-mail in the House of Commons is: lansleya@parliament.uk

Update: Whitehall tax avoidance – more evidence on the way

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Since this blog  revealing the Exaro News (http://www.exaronews.com) and BBC Newsnight investigation into the tax arrangement ministers approved for  Ed Lester, chief executive of the Student Loans Company, I have received a number of calls and e-mails suggesting this practice is more widespread than  just Whitehall. Danny Alexander, chief secretary to the Treasury, has rightly ordered a Whitehall wide review to find out the scale of the arrangements, which he appears to have unwittingly endorsed. It looks like Mr Lester  will have to pay tax in the way everybody does when they hold down a full-time equivalent job – through PAYE.

Some 2500 people has so far viewed this blog on top of millions who would have seen it on TV, on the radio  and read it  in newspapers from the The Guardian to the Daily Telegraph and Daily Mail.

 I am now gathering more information to continue this investigation and would like to thank a number of people who have already contacted me. However if you know of a similar practice where you work  you can contact me direct on my e-mail david.hencke@gmail.com. All information will be treated in confidence and all sources – like the original tip-off – that led to the exposure – will be protected under the journalist’s code of practice.

Also if you know of consultancy firms  who make big charges for supplying these people  to the government and the public sector and then help them arrange how to avoid paying their full tax, let me know. Their fees are coming out of your taxes.

 Help stamp out people ripping you off by using your taxes from your hard-earned cash – by avoiding pay their fair share of tax – and stop HM Revenue and Customs having one rule for the workers and kid glove treatment for those with the money to exploit every loophole possible.

Lansley’s unhealthy double whammy: What you won’t know or find out about the NHS

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Andrew Lansley's unhealthy changes. Pic courtesy:www.bexleymonitoringgroup.co.uk

Update:Department of Health has replied to this blog defending their position on Freedom of Information and cutting statistics – see comments.

While battle rages over the government’s  controversial reforms of the NHS, the Department of Health has sneaked out two toxic  changes that could  seriously damage your health by promoting ignorance and restricting your rights as a citizen.

The two changes appear to be unconnected  but are extremely helpful to new private providers of  NHS medical services. One will limit information the private firms  have to provide under the Freedom of Information Act to patients and relatives, the other will help them by abolishing the collection of health statistics on the services they provide and  the quality of  staff they employ.

The first has been revealed by the authoritative Campaign for Freedom of Information who are rightly demanding that Andrew Lansley, the health secretary, amends the law so patients can be protected. See their letter at   http://bit.ly/q35AsQ .                   .

This is incredibly serious as this example  by their director Maurice Frankel  shows here.

“Suppose there is concern about the use of potentially contaminated medical supplies by hospitals. For an NHS hospital, the FOI Act could be used to obtain details of stocks of the product, the number of doses administered, the numbers of affected patients, the quality control measures in place, correspondence with suppliers, minutes of meetings at which the problem was discussed and information showing what measures were considered, what action was taken, how promptly and with what results.
This level of information would clearly not be available in relation to independent providers treating NHS patients. This would represent a major loss of existing information rights.”

The second comes from a very convoluted consultation exercise launched the day after the August bank holiday and trumpeted by Anne Milton, the public health minister, as a drive against ” red tape”.

This proposes to slash the collection of statistics by the Department of Health by 25 per cent in a rather uneven and unclear way. But it is clear that the aim is to ” minimise the burden” on the NHS and in particular the new private providers.

Half the statistics collected on the NHS workforce – which are used to improve staff training and forecast the need for skilled staff – are to be dropped. The consultation document says: “This will be of significance for non-NHS providers of NHS services as it will determine the minimum workforce information they would be required to provide.”

And also being reduced are the statistics on the very sensitive political area of waiting times, targets for treatments and capacity of hospitals. The paper says: “the content and frequency.. should remain under review so that the right information is provided by the NHS at a sensible frequency and in so doing the burden to the NHS is minimised.”

Collection of  statistics giving the national picture on mental health are being abolished and the collection of statistics on patient safety look like being hived off to a private firm.

The one area that is being improved is cancer statistic collection which seems to be tied to a pledge by David Cameron.

What is particularly disturbing is that despite the document running to 55 pages at no point is a definitive list published of what is being scrapped. See document if you can bear to here:http://bit.ly/npcHmC .

Frankly Andrew Lansley should not be allowed to get away with either of these moves. The Department needs to change its position on the former and come clean on the latter. I suggest that you make your views known to Mr Lansley at his private office at the Department of Health the email address is  mb-sofs@dh.gsi.gov.uk. If  Zetter’s Parliamentary Companion is right his direct e-mail at andrew.lansley@dh.gsi.gov.uk.