The perfect storm that threatens the NHS
The NHS is facing an enormous funding crisis. To avert it, we must be more innovative in integrating our health and social services, says Chris Skidmore.
As Andrew Dilnot has stated, the fact that more of us are living for longer is something to be celebrated. But as the baby-boomers become the grand-boomers, with life expectancy increasing at a rate of three months every year, the challenge of the demographics cannot be denied. In this parliament, 1.4 million people will turn 65; by 2030, the number of people over 85 will have doubled. Already this is putting significant pressure upon the NHS – in the past two years, the number of patients over 80 being admitted to A&E has risen by 37 per cent to 1.2 million.
The need to find a way to care for our ageing population is immediate if the NHS is to avoid near-collapse within decades. Coupled with the rise in obesity – estimated to cost the NHS 25 per cent of its budget by 2020 – the increase in alcohol- and drug-related admissions, increases in levels of chronic disease and diabetes (which alone currently accounts for 11 per cent of the NHS budget), and the rising costs of medical technology and equipment, the NHS is facing a perfect storm, for which it is not prepared.
The problem is that spending has masked these fault lines for years, as politicians have focused on supply rather than demand. Healthcare spending rose from £38 billion in 1997 to £102 billion today. An extra £12.5 billion will have been poured in by 2015, and this is likely to continue to rise. Under current projections, the NHS is expected to require in real terms £230 billion in 2030, or twice its current budget.
Yes, savings can be made, and are – £20 billion over this Parliament, which will be reinvested into patient care in order to keep the show on the road. But there is a limit to what savings such as these can achieve: the NHS can only be squeezed so much.
Instead, we must focus on who is using the service. In 2007/08 there were 4.75 million unplanned hospital admissions in the NHS. This represents 65 per cent of all hospital bed days in England. And yet it is estimated that 60 per cent of all beds are occupied by elderly patients who shouldn’t be there, a situation that seems set to get worse as the population ages.
Of course, the situation Britain faces is the same for almost every Western democracy. We should learn the lessons of how they are managing to cope elsewhere. In the US, the non-profit health maintenance organisation Kaiser Permanente has a motto: “Unplanned hospital admissions are a sign of system failure.” In other words, patients who require such unplanned treatment did not receive the best care at an earlier stage.
With this motto in mind, the organisation shifted its focus is on care on the ground, above all integration of care: allowing patients to move between hospitals, where there was active management of patients; placing common conditions such as hip replacements on care pathways; making use of general physicians known as “hospitalists” to work in the inpatient environment. Above all underpinning Kaiser’s model of care was the idea of “multispeciality” – medical practices where specialists work alongside generalists. Doctors, rather than managers, take on leadership roles within these medical groups, and in doing so are actively committed to their success. Unlike the NHS, there is little sense of a false wall between primary and secondary care, since Kaiser’s care integration pathways straddle that divide. The results? Kaiser patients use less than one-third as many bed days than NHS patients.
Kaiser took their message to the UK back in 2003 with the establishment of their beacon sites programme. One such site was Torbay Care Trust, which, by linking their health, community and social care services seamlessly, has been able to reduce the number of hospital beds and associated costs to the NHS. At the same time they discovered that, for every £1 million spent on community services and social care, the local hospital saved £3 million.
Yet Torbay remains the exception. The rule elsewhere remains separate budgets, separate managers and separate staff between the NHS and social care, which since 1974 has been left in the lap of local authorities. The divide is a false one. What Kaiser, and in turn Torbay demonstrate is that the NHS and social care are very much two sides of the same coin. Neglect the one, and the likely consequence will be the other suffers: elderly patients crashing into A&E centres, taking up hospital beds when there is no need for them to do so.
While cross-party talks continue about how we can best care for our ageing population, and above all how we can pay for it in future years, the case for integration of health and social care has never been stronger. Currently less than 4 per cent of NHS and social care resources are used in joint-budgets which in turn drive joined-up thinking. This must change. To achieve this we will need a sea-change in the way we understand the value of social care. The future of the NHS depends upon it.
A THIRD of inmates at British youth jail are Muslims… and more convert to get better food
A third of inmates at one of Britain’s most notorious youth jails are Muslims and the religion is attracting a large number of converts.
There are 229 Muslims out of a total of 686 youngsters detained at Feltham Young Offenders’ Institution in West London, according to Ministry of Justice figures.
There are now so many worshippers at Friday prayers that they have to be split between Feltham’s mosque and its gym.
Sources claim that converts are attracted by the chance of better food and a more comfortable regime.
But there are also fears that some are being radicalised.
During Ramadan, Muslim prisoners are given food in separate hot and cold containers so they can eat what they choose at the end of their daylight fast.
A source revealed: ‘Over the last few years there has been a huge surge in those attending Muslim services. ‘The popularity of the faith has surprised people. We are seeing a large number of inmates converting to Islam.’
He added: ‘There is a difference between mainstream believers and extremists, but the fear is that some in the jail are being radicalised. ‘Others convert for protection or to have what they believe is an easier lifestyle.’
Prison insiders say most non-Muslims are locked up during Friday prayers because so many guards are needed to monitor the lunchtime service.
The Ministry of Justice said: ‘The Prison Service is committed to ensuring the religious needs of prisoners of all faiths are met.’
British millionaire wins right to ban official busybodies from nosing round his home
It is a country estate of such beauty that it inspired the composition of one of our best loved hymns. But the mansion behind ‘All Things Bright and Beautiful’ was the subject of an unholy row in court today over its modernised interior.
Conservation officials failed in their demand for access to Llanwenarth House to check on renovations and were told by the owner: ‘An Englishman’s home is his castle.’
Millionaire Kim Davies, 56, told a court how planning inspectors had made up to 20 visits to the country mansion after they feared the Grade II listed property had been given a ‘footballer’s wife-style’ makeover.
But he refused their request for an architectural historian to inspect the Elizabethan manor which is nestled in the idyllic Usk Valley in South Wales, and Brecon Beacons National Park Authority took him to court.
The home is currently for sale at £2.25million but work carried out Mr Davies has come in for close scrutiny.
National Park planning officer Clare Jones told the hearing she had visited the property at least 10 times and wanted to carry out further checks. She said: ‘The authority has now engaged a conservation expert who needs to advise us about the works that have taken place. ‘He will advise the authority if the history of the building has been compromised and on remedial work to put the building back to its original state.’
Mr Davies, a builder and car dealer, bought the house for £675,000 in 2007 and has since spent more than £1million on it. He admits that a new kitchen and bathrooms have been installed but claims the work falls outside the restrictions on listed buildings.
Planning officials were called in after it was compared to a ‘footballer’s wife monstrosity’ which may have damaged the historic gem and an injunction was taken out to stop further work.
Mr Davies told magistrates in Abergavenny that he had always complied with the regular inspections by the National Park officials. But he opposed the application for a warrant to enter the property saying: ‘Enough is enough.’ He continued: ‘I have to take a stand. No further work has taken place since their last visit. ‘My sister is suffering from cancer and is convalescing at my home at the moment. ‘They have been there up to 20 times and I’m not prepared to let them come again.’
Dr Charles Mynor, representing Mr Davies, told the hearing: ‘There is no evidence of any new works or that anything extra has happened. ‘It seems that the National Park are coming back for another bite of a cherry that has already been bitten on many occasions.’
The magistrates refused to grant the Brecon Beacons National Park a warrant to enter the property and awarded £500 costs to Mr Davies.
Chairman of the bench Dr Christopher Rowlands told the court: ‘Mr Davies has said under oath that no further work has been carried out on the property and on those grounds the application is refused.’
After the case, Mr Davies said: ‘I have always welcomed the National Park people when they have visited my home. ‘But it is my home and there has to be a limit to the number of times they want to have a look around. ‘I would get a letter one day saying they were coming the next. I opposed the warrant because quite simply enough is enough.
‘An Englishman’s home is his castle – only in this case it’s a Welshman’s home.’
Photographs used by the estate agent show the inside of the seven-bedroom house has changed considerably since the time of Mrs Alexander’s visit.
The kitchen has a large chandelier and granite tops while the bathroom boasts an ornamental Jacuzzi bath, and there is nothing Mrs Alexander would recognise about the high-ceilinged cinema room.
The estate agent description states: ‘Much of its character still remains yet the expansive home also embodies great comfort and ease of living.’
But the refurbishment work by property developer has not won universal songs of praise. Before the hearing Monmouthshire county councillor Christine Walby said: ‘The house is an architectural gem and the park authority has a legal obligation to ensure that listed buildings are preserved.
A quarter of British children aged 10 to 12 can’t do basic addition and one in five don’t know the difference between ‘there’, ‘their’ and ‘they’re’
Young children are leaving primary school unable to spell, add up or do their times tables because their parents are too busy to help them practise, a survey revealed today.
Half of children aged between 10 and 12 do not know what a noun is or cannot identify an adverb – while almost a third, 31 per cent, cannot use apostrophes correctly.
More than one in five – 22 per cent – could not use the correct version of ‘they’re’, ‘there’ and ‘their’ in a sentence and more than four in 10 couldn’t spell the word ‘secretaries’ correctly.
Maths didn’t fare much better in the survey by online tutor, mytutor, with more than a quarter of children being unable to add two small sums of money without using a calculator as they can’t do division and basic algebra.
Twenty-seven per cent of children surveyed could not add £2.36 and £1.49 to get £3.85. In addition, more than a third, 36 per cent, could not divide 415 by five and a quarter did not know the answer to seven multiplied by six.
Nick Smith, head of online tuition at mytutor, said: ‘Maths and English are key skills for children as they enter secondary school, yet our study shows that many are already slipping behind their peers and could be lacking confidence.’
The survey of 1,000 children aged between 10 and 12 found that one in four did not know their times tables, a quarter could not use decimal points and two in five could not spell simple plurals.
But the survey also discovered that most parents who are struggling to find a work-life balance spend less than 10 minutes a day helping their children with their learning because they are too busy.
Almost half of parents surveyed, 48 per cent, said they thought their child was worse at maths than they were at the same age and more than a third, 36 per cent, felt their child’s English was worse than theirs was at the same age.
Almost four in 10 parents – 39 per cent – said they spent less time learning with their children than their parents did with them a generation ago.
Only 30 per cent claimed to spend more time helping their child with their learning than their parents did.
And nearly six out of 10 parents – 59 per cent – spent less than an hour a week learning with their children – amounting to just eight-and-a-half minutes a day.
One in five parents spent less than 30 minutes a week learning with their offspring.
Mr Smith continued: ‘Despite half of parents thinking their children aren’t as good as they were at the same age, most parents only manage to spend fewer than 10 minutes a day reading with them, helping them with homework or doing educational activities at home.
‘Addressing these shortcomings early can make an enormous difference to a child’s school career, with tutored children generally making more than a year’s worth of progress with just 20 hours of tuition.
‘Hectic modern lifestyles are leaving parents with less and less time to spend learning with their children – whether that is helping with homework or other educational activities.
‘Many think that their child’s learning is suffering as a result, yet fewer than one in 10 of the parents we asked had used private tuition to give their children a boost to their learning – with many citing travelling time and a lack of suitable local tutors as reasons.’
Shadow education secretary Stephen Twigg added: ‘Clearly, as this reports demonstrates, there is still much to be done to ensure children leave primary school with a grip of the basics.
‘But the Tory-led Government is ignoring the warning signals in this report.
‘Instead of focusing on the 3Rs, they are cutting funding for programmes which provide one-to-one support for reading and writing. This means 9,000 more children will be at risk of falling behind this year alone.’
A Department for Education spokesman said: ‘Getting the basics right at primary school is vital. ‘That’s why we are placing such emphasis on improving pupils’ reading ability early on, using the proven method of synthetic phonics to teach children to read. ‘We are committed to improving standards in maths – bringing more specialist maths teachers into the classroom and focusing on basic arithmetic.’
The survey results come as a government maths education advisor has urged that maths be compulsory for the majority of students, no matter what they are studying, up until the age of 18.
Government education adviser Professor Steve Sparks argues that all students who continue with further education after 16 should also take a new maths qualification alongside their other subjects.
He claims that teaching post-16 students basic maths and statistics is vital for them to be able to compete in the modern world.