Join the back of the queue: Waiting times set to soar as NHS trusts suffer from tough cuts
Patient waiting times may increase as a growing number of hospitals face financial difficulties, a report warned today.
NHS foundation trusts, a marker of excellence in the NHS, are facing the challenge of improving quality of care while being forced to make cuts.
Trusts have told the regulator Monitor they are coming under ‘increasing pressure’ to meet accident and emergency waiting times and referral to treatment targets.
Under Labour, hospitals were told patients should be have to wait no longer than four hours to be treated in A&E, and should be given hospital treatment within 18 weeks if they are referred there by a doctor. But struggling hospitals warn these targets may not be met as they face tough financial difficulties.
The report, based on the annual plans of individual trusts, found that around one in three trusts are predicting a decline in their financial risk rating in the next year.
The hospitals which face the greatest monetary troubles are small and medium-sized district general hospitals and trusts with large private finance initiatives (PFIs), Monitor said.
Just last month an NHS Trust grappling with two huge PFI deals became the first in the country to be put under the control of a special administrator.
South London Healthcare NHS Trust was put on the ‘unsustainable providers regime’ and an administrator has been tasked with putting it on a viable footing.
Monitor’s chief operating officer Stephen Hay said: ‘In the short term, the sector’s balance sheet is in good shape overall and trusts have planned sufficient cost savings in the year ahead.
‘However, Monitor’s review suggests that an increasing number of individual trusts will face financial difficulties by the end of this period, with different issues affecting different trusts.
‘Our experience of reviewing these plans tells us there are indications that the sector’s finances will be weaker by the end of 2015. ‘We expect an increasing number of trusts could be placed in significant breach for financial reasons. ‘Particular challenges come from the need to improve the quality of care while delivering considerable savings each year.
‘Foundation trusts are planning to do this without planning to treat fewer patients or reduce the level and quality of care they provide.
‘To achieve this, they will need to look at making significant changes in the way services are delivered to meet patients’ changing needs.’
NHS Confederation deputy chief executive David Stout added that more radical action is going to be needed to ensure sustainability in the future.
‘NHS leaders are expressing some confidence in meeting the immediate financial challenge,’ he said. ‘But pressures are continuing to grow across the NHS, with increasing numbers of organisations starting to experience significant financial pressures. ‘To maintain quality in light of these pressures, the report rightly highlights the need for significant changes in the way services are delivered.
‘NHS leaders know the real challenge is to tackle a flat budget while managing the increased costs of treating an ageing population, advanced technology and the growing rates of lifestyle diseases such as obesity. ‘And they know that doing this will require more radical action. It will require further integration of services and expanding community-based care.
‘This is necessary to avoid financial pressures harming patient care, and to ensure the NHS keeps up with the needs of local populations.
‘To tackle these challenges successfully, NHS leaders need to get the public on board with some very difficult decisions. ‘They need to persuade people that we need to change services to improve the quality of patient care and make the most of the resources we have.’
Health minister Simon Burns said: ‘Waiting times are low and stable. ‘The number of patients waiting longer than 18 weeks before starting treatment is over 50,000 lower than in May 2010.
‘Nationally, the NHS delivered the standard – to ensure 92 per cent of patients still waiting to start treatment do not wait longer than 18 weeks – earlier than required from January 2012 and has continued to deliver it in the first three months of 2012/13.
‘The NHS is in good financial health and at the end of 2011/12, delivered a £1.6bn surplus. For the small number of organisations struggling to manage their finances, the Department is continuing to work with the local NHS to ensure there are robust plans in place for financial recovery, while continuing to improve the quality of services provided to patients.’
Milking the NHS: Nigerian woman told she needs Caesarean immediately flies into Britain for operation – costing UK taxpayers £10,000
A Heavily-pregnant woman flew from her home in Nigeria to take advantage of the NHS by having her baby in Britain. She had £10,000 of treatment but is understood to have returned to Nigeria with her baby without paying a penny.
The woman travelled 3,200 miles from Lagos to Manchester because she was worried about the standard of care in her own country and thought she would be in safer hands. On arrival she went straight to Wythenshawe Hospital where she told doctors that there were complications with her pregnancy.
Two midwives, two urology consultants, a radiology consultant, two obstetric consultants and two anaesthetists attended her in the delivery room before her healthy baby was born by emergency Caesarean section on Wednesday of last week.
Before she was discharged on Monday, hospital staff sought billing details for the woman and told her the cost of the treatment was around £10,000. However, she is not thought to have paid anything.
Last night MPs called for an inquiry and accused the unnamed woman of ‘effectively stealing’ from the British taxpayer.
The Government said it hoped new measures would tackle ‘health tourists’ who fly to Britain to take advantage of the world-renowned NHS. Health minister Simon Burns said: ‘We won’t tolerate abuse of our health service. The NHS has a duty to anyone whose life or long-term health is at immediate risk but it is not there to serve the health needs of the globe.’
Hospitals are allowed to bill non-EU patients who travel from their home countries to the UK for medical treatment on the NHS.
But health sources say that in reality patients often return to their homeland without paying and the debts are then almost impossible to recover.
The Harvard-educated woman flew to Manchester Airport and went directly to Wythenshawe Hospital. It is believed she chose the well-respected university hospital because she knew it had a maternity unit and was less than two miles from the airport.
On arrival she told doctors she had undergone an ultrasound scan in Nigeria which revealed complications with her pregnancy which suggested a Caesarean was advisable.
Nigeria offers free maternity treatment but the quality of the care is very poor and there is a high mortality rate. A woman there has a one in 13 chance of dying during pregnancy or childbirth, according to recent statistics.
Her baby was born at Wythenshawe without complication.
Mr Burns said: ‘There are comprehensive rules and procedures to charge visitors for hospital treatment but we know that the system needs to be improved.
‘That is why we are currently reviewing those arrangements to prevent inappropriate free access to the NHS and provide a fairer more balanced system. Hospitals have a legal duty to recover any charges made to overseas patients.’
Shadow Health Secretary Andy Burnham said: ‘We need a full inquiry into the circumstances and how the hospital has been left in this position. There are clear rules about health tourism and the NHS must be able to recover its costs.’
Graham Stringer, Labour MP for the Manchester seat of Blackley and Broughton, added: ‘This is simply a foreigner choosing to effectively steal off the NHS and the Government should use whatever powers it has to get the money back.’
University Hospital of South Manchester NHS Foundation Trust – which runs Wythenshawe – is short of funds and is having to cut £17.5million this year.
The hospital has a dedicated team who pursue payment by invoicing patients, but once they leave the UK the hospitals are almost powerless to act. However hospitals can inform the UK Border Agency and repeat entry into the UK by visa may be withheld until the bill is settled.
A hospital spokesman said: ‘If a patient is a non-UK resident and treatment is considered necessary or urgent then it would never be withheld.
‘In regards to reclaiming costs from non-UK residents who use our services, we adhere to guidelines issued by the Department of Health.’
Figures revealed by Wythenshawe Hospital showed the number of non-EU patients treated rose from 78 in 2008/09 to 133 in 2011/12.
Hundreds of British schools facing closure over stalling High School results
Hundreds of schools face being closed or taken over as GCSE results stall for the first time in the exam’s 25-year history.
Results for nearly 700,000 pupils this morning are expected to show little or no improvement on last year and grades falling in some subjects.
Ministers are also driving up the minimum GCSE performance target for secondary schools.
Heads must ensure that at least 40 per cent of pupils achieve five GCSEs at grades A* to C including English and maths – up from 35 per cent for the past two years.
Schools which miss the target risk being closed or converted into academies – state-funded schools outside local authority control.
Last year’s GCSE results suggest that more than 250 schools are below the tough new floor target.
If hoped-for improvements in results fail to materialise today, a similar number could find themselves falling short this year.
Moves by exam watchdogs to contain ‘grade inflation’ are expected to end the era of large year-on-year increases in results. In addition the number of pupils sitting easier vocational qualifications has been cut and science exams have been toughened.
Last week, for the first time in more than 20 years, A-level results showed a drop in the proportion of A grades awarded.
Living proof that the food Fascists are wrong
Some more proof of extremely limited diets being quite viable
When William Staub died of natural causes at the age of 96 last month, his longevity seemed a tribute to the benefits of healthy living. After all, in the Sixties Staub invented the first mass-produced running treadmill, which found its way into millions of homes and gyms. He was still using his own treadmill right up to the last weeks of his life.
But there was also something odd about his lifestyle — an extremely restricted diet that runs contrary to all sensible ideas of nutrition. For most of his long life, Mr Staub lived solely on tomatoes, plain toast and tea — occasionally brightened by a slice of cheese and lettuce. How can anyone exist on such a regime for a month — let alone many decades?
Mr Staub’s story is just the latest in a long line of strange tales of people who, for years, will eat only a few odd foods, such as cheese and chips, or even just Monster Munch crisps (and only the one flavour, at that).
Why are they still alive? After all, we are constantly reminded how we must enjoy balanced diets that include five-a-day fruit and veg, along with the right proportions of protein, dairy and carbs, and all the vitamins, minerals that a body needs (and not too much of anything, remember!).
Nevertheless, thousands get along by eating far more restricted fare every day of their lives. Infamously, Lord Lucan would only ever have the same food for dinner: pork chops.
According to Muriel Spark, the novelist who researched Lucan’s life, the missing peer’s idea of variety was to have the chops glazed in gelatine during the summer months, while in winter he would have them grilled. Lucan’s friends claimed this as evidence that he was too dull to have done anything so bold as to attempt to murder his wife, kill his nanny by mistake and then disappear.
But it is not only the famous or infamous who are affected. Last month Abi Stroud, an 18-year-old from Newport, South Wales, revealed that she has eaten only cheese and chips for the past eight years. The regime might sound like teenage heaven to some kids, but Stroud says it has been utter hell. She eats three blocks of mature cheddar and three bags of chips a week. She will eat white bread — but only one particular brand.
The A-level student says that this is not through choice. She has a deep phobia of new foods. They terrify her, she says. Even the sight of a banana being peeled makes her gag.
As a result, her social life is as sorely restricted as her diet. ‘I never go out for dinner with friends or eat with other people because so I’m worried about being expected to eat something else,’ she told reporters. ‘When people ask me to try something different, I feel sick and dizzy. A teacher tried to get me to eat a chicken nugget and I burst into tears.’
Now Miss Stroud has been diagnosed by specialists with a condition called Selective Eating Disorder. Her food aversion began when she was ten, and she believes it was linked to the death of her grandmother. Her condition saw her weight spiral to 15st when she was 16. Exercise then saw her slim down to 13st.
She is off to university next month, and she hopes her diagnosis can help her to break her phobic cycle. ‘Now I know it’s not just me being a fussy eater, I’m determined to try something new,’ she says.
Selective eating disorder (SED) is such a newly identified condition that it has not yet been accepted into the ‘bible’ of psychiatry, the American Diagnostic and Statistical Manual of Mental Disorders. It is expected to be included in the 2013 edition.
Meanwhile, The British Journal of Clinical Child Psychology and Psychiatry has described SED as: ‘A little-studied phenomenon of eating a highly limited range of foods, associated with an unwillingness to try new foods. When this happens social avoidance, anxiety and conflict can result.’
Pilot studies in America have found many thousands of people who seem to fit the criteria for the disorder. But SED should not be confused with normal childhood fussiness.
According to the Royal College of Psychiatrists, about 12 per cent of three-year-olds suffer from persistent selective eating — extremely faddy about their food — but fewer than one per cent carry it into adulthood.
Debbie Taylor is one of this minority. For more than a decade, the 32-year-old has eaten nothing but crisps. For the past two years, she has eaten only beef-flavoured Monster Munch for breakfast, lunch and dinner — two family-size bags a day.
The mother of a 12-year-old son, she says she has always been a fussy eater. ‘I can remember my mum trying everything to get me to eat healthily, cooking spaghetti bolognese and chopping up veg, which I refused to eat. She finally said: “If you don’t eat that, there’s nothing else.” I replied: “Fine. I don’t want anything.”’
Her food aversions led to anorexia and bulimia as a schoolgirl. In her late teens, she ate only dry-roasted peanuts, and bread sprinkled with salt. At the age of 25, she bought a packet of barbecue-flavoured crisps and fell in love with them. ‘I didn’t eat anything else for the next eight years, until the day I decided to go wild and try Monster Munch. They had been a childhood treat, and they became my crisp of choice,’ she has said.
The amazing thing is that Ms Taylor looks remarkably healthy, as do many selective eaters.
So how on earth do their bodies manage to survive? The secret lies in the human frame’s remarkable diversity and adaptability, according to Rick Miller, a registered dietitian and spokesman for the British Dietetic Association.
He says the dietary guidelines put out by Government experts are our best scientific guess at a one-size-fits-all recommendation. But our individual nutritional needs vary widely — and at the far edges of this spectrum are people whose bodies exist happily on strange diets.
‘The human body is a fascinating organism. It has been built for survival, and people’s nutritional requirements can differ from person to person,’ Mr Miller explains.
‘The official recommended daily intakes of nutrients — called Dietary Reference Values (DRVs) are only a guide. There are individuals who can survive on very little, as well as those who need a lot more every day. So some people can be apparently healthy on very restricted diets. However, they may be missing out on vital vitamins and minerals.’
On top of this, our systems can hoard scarce nutrients, which may also help people to survive on bizarre food regimes.
Mr Miller adds: ‘The body can store minerals, iron and B vitamins in the liver, so people on restricted diets can rely on their own stores for a while. People with SED may also have tastes that reflect their body’s vital nutritional needs. ‘We see cravings for certain nutrients in pregnant women, and there might be something similar happening with some selective eaters.’
And he has a warning for healthy-diet evangelists: the worst thing you could ever do to someone with SED is to make them suddenly eat a ‘proper’ meal.
‘If you force someone with SED to suddenly take on lots of other nutrients, it can send their body into a form of shock,’ he says, ‘This is called “re-feeding syndrome” and can have serious consequences, such as causing heart attacks.’
Of course, no one with conventional tastes should try voluntarily eating a severely restricted diet. But if one had to do it, what would be the best thing to eat?
Scientists have looked into this question and found that Sophie Ray, 19, from Wrexham, North Wales, might be on the right track. She has reportedly eaten nothing but cheese and tomato pizza for the past eight years after a attack of the stomach bug gastroenteritis left her with an extreme fear of food. She says: ‘I love pizza. The thought of trying other foods makes me very anxious, I feel sick and clam up.’
Naturally, she would be healthier on a full-spectrum diet, but an investigation in 1997 by Dr Marion Nestle, a professor of nutrition and food studies at New York University, has shown real cheese pizza with real tomato sauce can provide us with sufficient nutrients to survive.
Professor Nestle says pizza mixes a lot of ingredients and can provide protein (from wheat crust and cheese) and essential nutrients, such as vitamin B12 (again from cheese) and vitamin C (from tomato), along with antioxidants and other nutrients. The olive oil used for good Italian pizza provides both calories and vitamin E.
‘Vitamin D can come from the sun, there is a fair amount of vitamin A in tomatoes,’ she says. ‘And to top it off, tomato sauce is a good source of nutrients such as lycopenes, with their rich anti-oxidant potential. ‘If you are stuck on a desert island that happened to have a pizza parlour, you could do a lot worse.’
Only one food might be better — it is the food that many of us consumed solely for six months or more. And that is breast milk.
According to Jo Ann Hattner, a nutrition consultant and the author of Gut Insight, a book about digestive health: ‘Mother’s milk is a complete food. We may add some solid foods to an infant’s diet in the first year of life to provide more iron and other nutrients, but there is a little bit of everything in human milk.’
Technically, adults could survive on breast milk, too. The only problem (outside of the comedy world of Little Britain) would be finding a woman willing to provide it — and in sufficient quantities to keep a grown-up supplied.
Having it all? More like doing it all, say frazzled British mothers struggling to juggle career and children
If you’re a woman under 50, chances are you grew up being told you could ‘have it all’. In reality, however, you’re more likely to be doing it all. Most mothers are struggling to juggle their careers and their families, leaving them stressed out at work and frazzled at home, a survey found.
On top of all that, many said they fretted about making sure they looked good.
They say their lives are tougher than their own mothers’ were 30 years ago, because they were allowed to stay at home and raise their children without the pressure to work.
Of those who worked, almost half said they felt guilty that their career had stopped them from spending enough quality time with their offspring. This was compounded by the fact that a quarter of working women said they were their household’s main breadwinner.
More than 5,000 mothers aged 20 to 70 were questioned on their work-life balance. Many of those surveyed called themselves the ‘doing it all, not having it all’ generation. While 54 per cent said it was important for them to have a good job, 73 per cent admitted feeling under pressure to keep their homes clean and tidy.
Seven out of ten said they still did all the cooking and cleaning, and eight of ten did the washing and ironing too.
Nearly three quarters believed they were responsible for making the household run smoothly, with 77 per cent saying they were left to manage the household finances.
More than 82 per cent said they were responsible for sending birthday cards and keeping in touch with relatives, while a third said they also took charge of the family’s health and cared for elderly relatives.
With all that to cope with, 83 per cent said having more help from their husband or partner would make their lives easier and almost a quarter (22 per cent) resented their other half’s lack of support.
They also said they fretted about their image, with 68 per cent saying they were expected to keep in shape and wear fashionable clothes.
Those who worked said they worried about devoting enough time to their children, with half saying they felt anxious that they were not getting it right and one in three saying they felt under pressure to be a perfect mother.
The survey, commissioned by Asda, also asked participants to rate how optimistic they felt about four areas on a scale of five to minus five: the outlook for the UK economy; their household finances; quality of life and local community. These ratings were added together for a total ‘optimism score.’
Most didn’t feel there was much to look forward to. The average score was minus 16, down eight since a similar survey was carried out in February.
Eight out of ten women were also pessimistic about their own daughters’ futures, with 87 per cent predicting women’s lives will only get worse.
Judith McKenna, of Asda, said: ‘There is an overall downward trend in mums’ optimism, driven by a downward trend in optimism in their household finances and their family’s quality of life.
‘Our research shows the average mum is no longer constrained by old-fashioned male or female stereotypes – either within the home or outside it. ‘But with these increased responsibilities comes increased pressure – the expectation that mums can “have it all” weighs heavy, and mums don’t see those pressures easing off for future generations.’
‘Mums are calling for a fairer future,’ she added. ‘They’d like to share domestic duties and fulfil their own career ambitions. They’d like employers to be more flexible.’
June O’Sullivan, of the London Early Years Foundation, said: ‘It would help if mums were allowed to feel less guilty about using childcare to support them to work. ‘We know that the better qualified the mother, the better chances of children doing well at school and in the future. ‘We also know that it is not the amount of time mothers spend with their children that makes the difference it is what they do with the time they have.’