More than half of NHS trusts rationing treatments
This trifling with people’s sight is appalling. When it was decided that I needed a cataract operation it was expertly done within a couple of few weeks — under private health insurance. Pity anybody who has to wait on the government
More than half of NHS trusts have admitted they are rationing treatment to patients, the National Audit Office revealed as it called for national guidelines to guarantee hip, knee and cataract operations across the country.
Some 56 per cent of primary care trust clusters told the NAO they had either introduced or tightened criteteria determining which patients are eligible for at least one type of common operation.
Hospitals in certain areas have stopped offering elective treatments for smokers or people above a certain level of obesity, while in others cateract patients are being forced to wait until their eyesight deteriorates further before being allowed surgery.
The figures are revealed today in a report on how well the NHS in England is performing in its attempt to make “efficiency savings” of between £15 billion and £20 billion by March 2015.
Rationing elective operations “essentially defers, rather than avoids, spending”, the report said, which noted that the health service “is making increased use of demand management measures to reduce the growth in hospital activity”.
The NAO called for senior NHS civil servants to introduce a national framework to prevent patients in some areas being subjected to tough new rules on qualifying for treatment while those in others are not.
The newly established NHS Commissioning Board should step in to prevent the worst cases of so-called postcode lotteries determining whether patients are eligible for treatment, the report suggested.
Sight loss charities say cataracts operations have been particularly hard hit by cost-cutting measures, with patients in some areas having to wait until they are unable to drive or even read before being deemed suitable for surgery. The new report confirmed the number of cateract surgeries in England fell last year.
Orthopaedic surgeons also cite hip and knee replacements, saying that in some parts of the country patients are being left immobile while operations are delayed but in others patients with similar levels of pain or disability are receiving treatment.
In the summer, the heads of Britain’s top surgical organisations warned that patients’ welfare was being compromised by “unproven and arbitrary” rationing that was only a financial “quick fix” for cash-strapped NHS trusts.
Andy Burnham, the shadow health secretary, has also called for an “immediate review into rationing in the NHS”. Labour has found 125 treatments have been restricted or stopped altogether in the last two years.
Growth in hospital activity came down from 3.7 per cent in 2010-11 to 1.2 per cent in 2011-12.
Lowering eligibility criteria for “low priority” procedures could prevent patients getting timely treatment and raise the risk of their needing emergency procedures in later years or reduce the effectiveness of future operations, the report claimed.
In most cases primary care trusts said eligibility had been restricted for clinical reasons, but 11 per cent of clusters said rationing measures had been brought in primarily to save money.
More than one in five clusters also reported that financial caps had been set on GP referrals, or that minimum waiting times had been put in place for certain procedures.
The Department of Health told the NAO it does not routinely monitor primary care trust clusters to ensure patients’ treatment is not being unfairly rationed, but added that it had investigated individual cases and found no breach of policies which prohibit blanket bans on treatment.
The NAO report said: “The aim is to control demand without inappropriately restricting patients’ access to care, but the Department [of Health] has no way of routinely gaining assurance that this is being achieved.”
It recommended that the department “should take a more active interest in demand management and develop ways of gaining routine assurance that patients’ access to healthcare is not being inappropriately restricted”.
Local policies on restricting treatment should be “transparent so that commissioners can be held to account”.
It continued: “For areas of concern, the NHS Commissioning Board should consider whether it would be useful to establish national access policies.”
Mr Burnham, Labour’s Shadow Health Secretary, said ministers should now accept the advice of the NAO and intervene to end the “burgeoning postcode lottery in the NHS”.
“They promised to overturn cost-based restrictions if presented with evidence. The NAO has provided that. There is now no excuse for their continued failure to act,” he said.
“Older people are being hit hardest as cataract, hip and knee replacements are amongst the most commonly restricted treatments. On David Cameron’s watch patients are suffering, losing their independence or facing the agonising choice of going without or paying to go private.”
Mr Burnham said he had written to Jeremy Hunt, the health secretary, about the issue.
The report found that the NHS had made £5.8 billion of savings in 2011-12, principally through the public sector pay freeze and a reduction in the prices primary care trusts pay for treatment.
But it added the figure was uncertain because the savings were reported by the chief executives of primary care trusts and the Department of Health had not independently verified the figures.
Amyas Morse, head of the National Audit Office, said the NHS had made a “good start” in making savings but “to build on these savings and keep pace with the growing demand for healthcare it will need to change the way health services are provided and to do so more quickly.”
New Labour’s immigration revolution has transformed England, and not entirely for the better
I wonder what odds bookmakers are giving on the Conservatives winning the 2016 mayoral elections, now that Greater London has a white British minority for the first time in history (the figures for London proper are even more startling, especially in areas like Newham).
Yesterday’s census figures are Tony Blair’s legacy: a demographic revolution unprecedented in English history. As Kevin Myers once put it, “London has undergone a demographic transplant unlike that experienced by any European capital since the Fall of Constantinople in 1483”. Vast numbers of foreign nationals now live in Britain, including not just Indians, Poles and Pakistanis, but a surprising number of groups like Germans; only the Irish have declined in number, the Celtic Tiger having brought back some emigrants. (Ireland’s population, now at 6.2 million, is the largest since the famine, yet still smaller than it was in the 1820s. Even Germany and Russia, which endured wars and genocides in the modern era, are triple and double their early 19th-century populations respectively.)
There are many people who welcome this, and not just cynical Labour Party apparatchiks who realise that most immigrants vote Labour (as will their children). Aside from the cultural (and culinary) benefits of diversity, which are in fact sated by fairly small levels of immigration, a society that breaks down the barriers feels nicer. London is, all things considered, a pretty amazing achievement: a city where anyone can walk down the street holding hands with whoever they want.
But much as I like the psychological absence of barriers, we should not pretend that it does not come with huge costs, and that these are mostly borne by the less privileged. How many liberal commentators send their children to inner-city schools that aren’t inside those precious middle-class catchment areas?. Those commentators, often rural-based, talk about unhappy people stuck in high-immigrant areas in the same way conservatives talk about those in areas of high unemployment – move, loser!
I have a book out early in the New Year setting out the arguments against mass immigration, which should make me tremendously popular in the middle-class part of Haringey where I live: an area where the Greens finished ahead of the Tories in the last council election. The truth is I quite like living in a liberal part of town because, aside from the food obviously being better, liberal environments are quite pleasant. It’s that environment which has made England, and in particular London, so open to the world.
But you can have too much of a good thing, and liberalism is a fragile prize. The main cornerstones of liberalism, things such as the jury system and parliamentary rule, are themselves products of very mono-ethnic societies, namely England, Denmark and the Netherlands, where people felt a lot of trust for fellow citizens. The Left likes “diversity” because it hates racism, and because immigrants overwhelmingly vote for the Left, they assume it can only make the country more liberal. But what I suspect (and perhaps fear) is that this demographic experiment our leaders have embarked upon (without asking whether or not we wanted it) is going to make us less liberal. All the evidence, from social sciences and from history, tells us that that highly diverse societies tend to be less trusting, less free, more unequal and more corrupt. These are not the sorts of societies where people will willingly pay for each other’s housing when hard times fall.
That’s probably not what people in nicely diverse middle-class areas of London want to hear, because tolerance is so highly prized. But tolerance is not a faultless good; it can also be the flipside of apathy and selfishness. That’s why “celebrating diversity” is so easy to do.
Migrants ‘will push England’s house prices up by an extra 10%’, Theresa May warns
House prices will rise by more than 10 per cent unless mass immigration is controlled, Theresa May warned yesterday. The increases in the years to come would go beyond other pressures on the housing market – dealing a blow to young Britons already struggling to get on the property ladder.
In a speech in London, the Home Secretary delivered a blunt analysis of the impact of Labour’s ‘open door’ immigration policy.
She said the influx had driven down wages for the working classes and placed huge pressure on schools and social cohesion. Mrs May cited house prices as an example of how demand created by migrants was having an impact on the wider public.
Her officials pointed to research by Professor Stephen Nickell which predicted that, if net immigration runs at 190,000 a year, house prices will end up 13 per cent higher over the next two decades than they would if migration were at zero.
Currently, net migration – the difference between the number of people arriving in the UK and those leaving – is 183,000, though Mrs May has vowed to reduce it to the ‘tens of thousands’.
She said: ‘More than one third of all new housing demand in Britain is caused by immigration. ‘And there is evidence that without the demand caused by mass immigration, house prices could be 10 per cent lower over a 20 year period.’
Mrs May delivered her speech to the Policy Exchange think-tank only 24 hours after publication of the 2011 census.
The survey showed how, under ten years of Labour, nearly four million immigrants joined the population of England and Wales.
In total, 7.5million people who were born abroad were living here last year – and more than half of these have arrived since 2001.
In a blistering attack on the Labour years, Mrs May criticised the last government for failing to measure the impact of immigration on public services and housing, and for assuming it had no impact on the jobs and wages of the settled population.
She warned that mass immigration undermines social cohesion by making it ‘impossible’ to establish the relationships, family ties and social bonds that create a community.
Mrs May said the Migration Advisory Committee, which is a panel of government advisers, had found ‘a clear association between non-European immigration and employment in the UK’ – with 160,000 British workers ‘displaced’ between 1995 and 2010.
Some 23 British workers were kept out of employment for every additional 100 immigrants employed, she said, adding: ‘For those on lower wages, more immigration means more workers competing for a limited number of low-skilled jobs.
farm pay driven by influx.jpg
‘The result is lower wages – and the people who lose out are working-class families, as well as ethnic minority communities and recent immigrants themselves.’
In future, government impact assessments will no longer assume that migrants make a positive contribution to the economy by paying taxes and spending their wages.
The burden they place on public services will also be considered, she said.
Mrs May also denounced the student visa policy inherited from Labour as a ‘mess’ which was ‘abused on an industrial scale’.
Last night Sir Andrew Green, chairman of Migration Watch, said: ‘At last we have a Home Secretary who is honest about the consequences of mass immigration and ready to take on the bogus arguments for it.’
Fewer than one in every 150 last-ditch immigration appeals is successful, ministers will reveal today as they launch plans to combat ‘spurious’ court actions. Critics say the appeals are often a ploy to let illegal immigrants and failed asylum seekers prolong their time in Britain.
Disability handouts to be cut or stopped for 330,000 claimants as British Government aims to end ‘welfare for life’
The Government is to reduce or stop disability allowance for hundreds of thousands of claimants in a bid to end unchecked ‘welfare for life’.
The clampdown comes as new figures suggest that seven in ten of those claiming the benefit go through the system without proper checks.
Ministers intend to reassess an initial 560,000 claimants, and expect that 330,000 – nearly 60 per cent – will get no award or a reduced sum after the checks.
There are currently 3.2million adults claiming disability living allowance (DLA), costing Britain £13.2billion a year – equivalent to the entire budget for the Department for Transport.
The number of claimants has more than trebled since the benefit was created in 1992.
Disability minister Esther McVey said without reform, one in every 17 adults would be claiming DLA by 2018.
The Tory minister said the vast majority of claimants – 71 per cent – get the benefit ‘for life’, often having filled in an initial claim form about their capability themselves.
She added that about a third of people with a disability had a change in a condition in a year – some for the worse, but many for the better.
This suggests that in many cases claimants may no longer need the full benefit or any allowance at all.
The first 560,000 claimants will be reassessed by October 2015.
The group consists of those who report a change in circumstance or who have been given a time-limited award that comes to an end.
In a concession to critics, the Government will slow down the timetable for checks on the remaining claimants, which will begin in 2015. It is not clear that the same proportion will see benefits reduced in the second stage as in the first.
An independent review of the first stage of reform will be conducted in 2014.
The Government has already identified £630million in overpayments and £190million in underpayments, highlighting the turmoil in the welfare system.
Miss McVey said: ‘It has been considered a static benefit, not a dynamic one. But there will be people getting better thanks to medical advances or who overcome an impairment. So we need new and more regular assessments. ‘DLA is an outdated benefit introduced over 20 years ago.
‘At the moment the vast majority of people get the benefit for life without systematic checks to see if their condition has changed.’ The Coalition is replacing DLA with a new benefit, called the personal independence payment.
It will be designed to target more generous support towards ‘those who need it most’.
The new system will involve a medical expert assessing a claim in a face-to-face appointment, and regular later checks.
Last night, charities voiced a chorus of protest at plans to slash the disability benefit bill.
A poll by campaign group Disability Alliance found that 9 per cent of survey respondents said losing the disability living allowance ‘may make life not worth living’.
The group has also protested that the Government had identified cuts in spending before consulting on which elements of benefits needed to be reformed.
The clampdown on disability benefit emerged as the Conservatives and Labour traded increasingly bitter blows over efforts to cut the vast welfare budget.
At Prime Minister’s Questions yesterday, David Cameron condemned Labour as the party of ‘unlimited welfare’.
Ed Miliband made clear Labour will oppose Government plans to cap most out-of-work benefits and tax credits to a below-inflation 1 per cent increase for the next three years.
Labour claims that the squeeze will hit lower income families who are in work but in receipt of tax credits as well as the unemployed, but the Prime Minister insisted that such concern is misplaced.
Working families would be more than compensated by other measures, most notably, a record increase in the basic rate income tax threshold to £9,440, Mr Cameron said.
Officials say the average working family would be £125 a year better off next year once the income tax break, the tax credit squeeze and the cancellation of a 3p rise in fuel duty are taken into account.
Savings from the welfare cap are so significant that it would take a 1p rise income tax to plug the gap.
Mr Miliband accused the Government of seeking to ‘divide and rule’, by portraying benefit claimants as ‘scroungers’.
British government: dock teachers’ pay if they ‘work to rule’
Teachers should have their pay docked if they “work to rule” in protests against the Government’s school reforms, the Education Secretary has said.
In an escalation of tensions with trade unions, Michael Gove has written to head teachers urging a “robust reponse” towards all staff who take part in a new wave of industrial action.
The Cabinet minister condemned the “irresponsible” unions for telling teachers to stick narrowly to their job descriptions and refuse any extra tasks. This disrupts the education of children and causes long-term “damage to pupil outcomes”, he said.
Mr Gove said pay can legitimately be docked from teachers who attempt this kind of behaviour, which he described as “damaging the reputation of the profession”.
The Government’s relationship with the teaching unions has deteriorated since George Osborne outlined plans to link teachers’ pay to classroom standards in the Autumn Statement last week.
The unions are already angry at the Government’s “erosion of working conditions and pay” and ministers’ “daily criticisms” of the profession.
The NUT and NASUWT unions have advised teachers they can legally refuse to cover colleagues’ sickness absence, submit lesson plans, allow more than three hours of observation per year or write more than one school report per year.
However, the Education Secretary yesterday told head teachers that staff in unions who take this action are likely to be in breach of their contracts.
He published legal advice to teachers and a letter from his department saying that docking up to a day’s pay is a “proportionate” response. “The legal position is clear: teachers who are following this industrial action are very likely to be in breach of their contracts,” the Education Secretary wrote. “Pay deductions represent a lawful response, and the advice sets out how deductions can be made in a proportionate and reasonable way.”
He condemned the unions for causing “unnecessary disruptions” to children’s educations. “I would be very grateful if you could support your school in taking a robust response, including through pay deductions where appropriate,” he wrote. “I am convinced that by working together in a coordinated way we can protect the pupils, parents, teachers and headteachers who would otherwise suffer because of this irresponsible industrial action.”
A few schools have already seen their teachers work to rule over Mr Gove’s education reforms, leading to further strikes in some cases.
More than 15 teachers took part in a separate one-day strike at Westfield Sports Academy in Sheffield because teachers had not being told in advance exactly what time observations of their lessons would take place. Seven members of the NASUWT union have also walked out of Dunston Primary School for two days in protest at the “intrusive and unnecessary” monitoring of their teaching.
Last night, teaching unions reacted angrily to Mr Gove’s letter. Chris Keates, General Secretary of the NASUWT, said|: “The Secretary of State is recklessly encouraging schools to take punitive action against teachers on the basis of advice which is littered with caveats and ambiguities. “It demonstrates quite clearly that the Secretary of State is unable to state categorically that any action being taken by NASUWT and NUT members is in breach of contract. “In the light of this, any school which acts on his advice leaves itself vulnerable to extensive and expensive litigation and escalation of industrial action.”
Mr Gove is now reportedly considering new anti-strike laws to challenge the right of teachers to take industrial action.
‘Fracking’ to resume in search for shale gas in Britain but government promises tougher rules to prevent earthquakes
Energy Secretary Ed Davey made a statement to Parliament on the government’s new policy on shale gas. Drilling to explore Britain’s reserves of shale gas is to be restarted, despite major concerns about the threat it could trigger earthquakes.
Ministers today cleared gas firm Cuadrilla to resume the controversial process of ‘fracking’ in Lancashire, 18 months after drilling was halted when the use of high-pressure liquid to split rock and extract gas caused two small earthquakes.
Energy Secretary Ed Davey said tough new rules were being put in place to mitigate the risks of further tremors.
‘Shale gas represents a promising new potential energy resource for the UK,’ he said. ‘It could contribute significantly to our energy security, reducing our reliance on imported gas, as we move to a low carbon economy.’
Fracking, or hydraulic fracturing, is the process of injecting liquid deep underground to fracture shale rock and release gas contained in it.
Mr Davey insisted his decision to resume fracking was based on evidence. The development of fracking ‘should not come at the expense of local communities or the environment’ and the public ‘must be confident that it is safe’, he added.
New controls to prevent more earthquakes include:
* A major review before fracking can begin to assess the risk of earthquakes and the existence of faults in the earth’s crust
* Ministers must be told in a report to the Energy department how seismic risks are being countered
* A new traffic lights system will grade seismic risk with fracking halted in certain conditions
Cuadrilla Resources suspended test-drilling in June last year after its operation caused two small earthquakes, of 2.3 and 1.5 magnitude, which hit Lancashire’s Fylde coast.
Francis Egan, chief executive of Cuadrilla, said: ‘Today’s news is a turning point for the country’s energy future. Shale gas has the potential to create jobs, generate tax revenues, reduce our reliance on imported gas, and improve our balance of payments.
‘Our exploration has shown that under Lancashire there is a belt of gas-filled shale over one mile thick. Today’s decision will allow continued exploration and testing of the UK’s very significant shale resources in a way that fulfils the highest environmental and community standards.’
Tories in the coalition have pushed for Britain to exploit reserves of gas trapped deep in shale rock, believing it could secure energy supplies for decades and curb increases in household bills.
But environmentalists have warned about the risk posed to the stability of communities nearby, and suggested a ‘dash for gas’ could come at the expense of investment in greener technologies.
Greenpeace Energy Campaigner Leila Deen said: ‘George Osborne’s dream of building Dallas in Lancashire is dangerous fantasy.
However, Chancellor George Osborne has urged a more aggressive push to exploit shale gas. The sharp decline in North Sea gas reserves makes Britain more reliant on energy supplies from Qatar, Russia and the US.
The new Office for Unconventional Gas and Oil will join up responsibilities across government departments to provide a single point of contact for investors and streamline the regulatory process.
The rural splendour of George Osborne’s constituency in Cheshire could be blighted by his enthusiasm for shale gas exploration.
Tatton includes unspoilt countryside, the historic towns of Knutsford and Wilmslow, and villages such as Alderley Edge – said to have more millionaires per square mile than anywhere else in the country.
Professor Peter Styles of Keele University said the rocks in Tatton are of interest to energy firms as they are from the same period as those in Lancashire, where exploratory drilling suggests there could be enough shale gas to power Britain for decades. He added shale gas exploration requires ‘around a football pitch worth of land’ per site.
Mr Osborne indicated the government’s determination to press ahead with the expansion of gas exploration in Britain in his Autumn Statement last week.
The Chancellor unveiled a ‘generous new tax regime’ to encourage fracking exploration and unlock shale gas reserves that could be worth £1.5trillion to Britain’s economy.
Mr Osborne told MPs: ‘We must ensure we make the best use of lower cost gas power, including new sources of gas under the land. ‘We don’t want British families and businesses to be left behind as gas prices tumble on the other side of the Atlantic.
‘We are consulting on new tax incentives for shale gas and announcing the creation of a single office so that regulation is safe but simple.’
In the US, gas prices have tumbled as reserves of shale gas have been brought to the surface.
But there have been horror stories about tap water igniting when a match is lit and claims of contaminated water making people ill..
France has banned fracking from shale rock, while New York state introduced a moratorium.
The industry itself vigorously denies that shale gas is unsafe and blames pollution incidents as examples of bad practice, rather than an inherently risky technique.