Tag Archives: royal college of nursing

The next NHS scandal: Taking cash from the deprived and handing it to the affluent

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Sunderland Clinical Commissioning Group- the biggest loser of NHS funds in England

Sunderland Clinical Commissioning Group- the biggest loser of NHS funds in England

Next April NHS England plans to take away money from some of the most deprived parts of the country and give it to areas that are the most affluent.
An arcane formula that decides how much your local NHS clinical commissioning body has to spend on you is expected to be changed by removing a weighting that automatically gives a bit of extra cash to areas of social deprivation. It will also mean that less money will go to areas where people die younger and more to areas where people live longer.
I am indebted to research by the Royal College of Nursing who have recalculated the effect of the change and I have already written about it for Tribune Magazine.
The political implications of this change- just over a year before the next general election are enormous. While NHS England is obviously not a branch of Conservative Central Office, its decisions will be remarkably helpful to the coalition government.
Without spending an extra penny it will appear that there is more spending on the NHS in many Conservative and Liberal Democrat marginals by election day and far less spending in many Labour strongholds where there is more social deprivation.
As the table illustrates the changes at the top and bottom are going to be dramatic.
Losers and Gainers; Health spending per head

Losers and Gainers; Health spending per head


Translate this into Westminster politics this means extra help for Tory and Liberal Democrat seats in the south. Gainers include Tory strongholds in Royal Windsor, Ascot and Maidenhead – the latter the seat held by Theresa May, the home secretary; South East Hampshire, Eastbourne, Hailsham and Seaford ( Liberal Democrat seats); the West Sussex coast, Gosport and Fareham and Newbury.
Most useful is Reading North and West, which includes a Tory marginal, and has an extra £98 per person to spend; Dorset (£89) which is both a Liberal Democrat and Tory area, and South Gloucestershire, part of the Cotswolds, which gains £86.
While the losers with the exception of Carlisle ( a Labour Tory marginal with a 853 Tory majority) are all Labour.Worst affected will be Sunderland which will lose health care spending worth £146 per person. Nearly equally badly affected will be South Tyneside, Newcastle West and Gateshead.
Also if you take the latest Office of National Statistics life expectancy figures you will live much longer in Dorset than in Blackpool.
In 2009–11, male life expectancy at birth was highest in East Dorset (83.0 years); 9.2 years
higher than in Blackpool, which had the lowest figure (73.8 years).
• For females, life expectancy at birth was also highest in East Dorset at 86.4 years and lowest in
Manchester where females could expect to live for 79.3 years.
• According to 2009–11 mortality rates, approximately 91% of baby boys and 94% of girls in East
Dorset at birth will reach their 65th birthday. The comparable figures were 77% and 86% in
Blackpool and Manchester respectively.
No wonder the RCN is furious. As Glenn Turp, regional director for the RCN Northern region says: “The North East and Cumbria suffers from some of the worst health inequalities in the country. NHS England should be aiming to reduce inequalities in health outcomes, not make them worse.
“Given the size of health inequalities in this region, I believe that NHS England should actually be increasing funds to the areas with the worst outcomes. However, NHS England’s own data shows these proposals will do the opposite.”
Of course this figures are not yet in stone. But taken together with welfare cuts, big drops in the standard of living for the majority,and slashing support for the disabled – NHS England is merely helping the wealthy and rich in Windsor, Maidenhead and Hampshire villages get better NHS services all paid by the taxpayer at the expense of a Sunderland council tenant. All helping the coalition win the next general election.

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.

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.