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Rise In Nhs Trusts In Financial Difficulties

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http://www.bbc.co.uk/news/health-28439323

Nineteen NHS trusts have been referred to ministers after auditors raised concerns about their financial health.

The Audit Commission made the move after reviewing the health of 98 trusts running a combination of hospital, ambulance and community services.

The referrals have been made because the trusts have failed to break even and do not have robust enough plans to balance the books in the coming years.

The number represents nearly a four-fold rise from five last year.

It is another sign of the growing financial problems being seen in the health service. Earlier this month the Nuffield Trust warned that a quarter of trusts had finished the year in deficit, but that included nearly 250 trusts across the whole health service

...

The 19 trusts are: Barking, Havering and Redbridge University Hospitals NHS Trust; Barnet and Chase Farm Hospitals NHS Trust; Epsom and St Helier University Hospitals NHS Trust; George Eliot Hospital NHS Trust; Hinchingbrooke Health Care NHS Trust; Ipswich Hospital NHS Trust; Leeds Teaching Hospitals NHS Trust; Mid Essex Hospital Services NHS Trust; Mid Yorkshire Hospitals NHS Trust; North Bristol NHS Trust; North Cumbria University Hospitals NHS Trust; North West London Hospitals NHS Trust; Shrewsbury and Telford Hospital NHS Trust; Surrey and Sussex Healthcare NHS Trust; The Princess Alexandra Hospital NHS Trust; United Lincolnshire Hospitals NHS Trust; University Hospital of North Staffordshire NHS Trust; Weston Area Health NHS Trust; Worcestershire Acute Hospitals NHS Trust.

I wonder how many have a large number of affordable PFI contracts?

Still I'm sure there are plenty of highly paid managers effectively sorting out the problem.

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Was speaking to an old boy last week...he remembers the NHS when the nurses were well dressed and polite, if you were ill they looked after you, you'd be taken into the hospital and given a bed and sent home when you were better.

Now, it's about spending vast amounts of money then asking for more. For breast enlargements, for anti-depressants, for foreign people to get free treatment, for political gain. The NHS is no long the NHS, it's the National Healthcare Shame.

If the NHS were a private company you simply would not use their service.

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The health service is in a mess.

It's taken my Doctor just over a month to write a referral letter.

I can't grumble too much about our local GP surgery and the people i've encountered at the hospital have been great, but if you've ever had the luxury ( if that's the right work ) of going private then they are chalk and cheese. I stand by my..."If the NHS were a private company you simply would not use their service". The sad thing is we pay through this teeth for this shoddy public service. There has got to be a better way.

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One of the perceived disadvantages of living Ireland is there is no free public health service. You find most employers give you health care as part of your package (usually including pension).

The problem with the UK NHS is it's chocked full of obese boomers and people who should have expired 10 years ago being kept alive for the sake of it.

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If the NHS were a private company you simply would not use their service.

Very true, although mainly because if it was private it would end up monopolised to the point where most of us wouldn't be able to afford it.

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I can't grumble too much about our local GP surgery and the people i've encountered at the hospital have been great, but if you've ever had the luxury ( if that's the right work ) of going private then they are chalk and cheese. I stand by my..."If the NHS were a private company you simply would not use their service". The sad thing is we pay through this teeth for this shoddy public service. There has got to be a better way.

Except we don't. We spend far less as a percentage of GDP on healthcare as compared to similar nations. 15-25% less.

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PFI and privatised services. This is the reason. Private services all have a chunk skimmed by those who own the companies so services are poorer than the NHS equivalent.

And don't get so excited about private hospitals. Death rates are higher for the same reasons but you get a nice room. I'd rather live but share a bay with 5 others.

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Except we don't. We spend far less as a percentage of GDP on healthcare as compared to similar nations. 15-25% less.

I don't really get why people think private healthcare would be cheaper.

Privatisation of state housing = 400% increase in the HB bill (despite the same number of claimants).

Private railways = state paying 3 times what it did when they were public owned, and passengers paying much higher fares (in effect they pay more twice).

Private water + electric = bills up for all, and much of the infrastructure sold bought up by other nations (so it's bad for our state to own anything, but fine for other states to own it is it?)

Privisation is BRILLIANT, but only in areas where proper competition can flourish and monopolies can be kept to a minimum.

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Privatisation of state housing = 400% increase in the HB bill (despite the same number of claimants).

Private railways = state paying 3 times what it did when they were public owned, and passengers paying much higher fares (in effect they pay more twice).

Private water + electric = bills up for all, and much of the infrastructure sold bought up by other nations (so it's bad for our state to own anything, but fine for other states to own it is it?)

Privisation is BRILLIANT, but only in areas where proper competition can flourish and monopolies can be kept to a minimum.

As promoted by all major political parties.

Funny that....

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I don't really get why people think private healthcare would be cheaper.

Privatisation of state housing = 400% increase in the HB bill (despite the same number of claimants).

Private railways = state paying 3 times what it did when they were public owned, and passengers paying much higher fares (in effect they pay more twice).

Private water + electric = bills up for all, and much of the infrastructure sold bought up by other nations (so it's bad for our state to own anything, but fine for other states to own it is it?)

Privisation is BRILLIANT, but only in areas where proper competition can flourish and monopolies can be kept to a minimum.

The thing we seem to confuse in Britain is private payment vs private provision. The idea that the state should provide the healthcare as well as administer what is, in effect, an insurance scheme paid for from general taxation has become some kind of Rubicon over which only swivel eyed loons dare to step. Meanwhile the rest of the civilised world is happy to try all sorts of different models involving more commercial competition for some or all services.

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We are arriving at a point with costly ever more complex procedures being developed all the time where we must start weighing up what it can do.

It's all very well ignoring this but in private the medical profession develops procedures without any thought to the cost. If only one insurance company chose to fund this then its assumed the the NHS should.

I personally am grateful to the NHS as they saved my life and I had to spend close to six months as an inpatient. But we can't just continue to ignore its plight.

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PFI and privatised services. This is the reason. Private services all have a chunk skimmed by those who own the companies so services are poorer than the NHS equivalent.

And don't get so excited about private hospitals. Death rates are higher for the same reasons but you get a nice room. I'd rather live but share a bay with 5 others.

If it looks nice and is presented well it must be good "service" right?

Like you I'd much rather have the money spent where it improves patient treatment rather than on providing a nice shiny personal room.

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The thing we seem to confuse in Britain is private payment vs private provision. The idea that the state should provide the healthcare as well as administer what is, in effect, an insurance scheme paid for from general taxation has become some kind of Rubicon over which only swivel eyed loons dare to step. Meanwhile the rest of the civilised world is happy to try all sorts of different models involving more commercial competition for some or all services.

The question though is there truly competition in healthcare in these "other" nations? This is the raison d'etre for private involvement in healthcare. Can the average person for example, if they break their leg, quickly and easily choose between 3-4 different hospitals or providers. Ditto the same for cancer care. Can the average citizen knowledgably choose the best provider/doctor who will give them the best outcome at a particular price point?

My own experiences from living in the USA are 100% the exact opposite of this.

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There are many reasons why some NHS trusts are falling into deficit.

Looking away from PFI, and sky rocketing inflation for essentials (energy, waste disposal, raw materials, etc.) and even allowing for the pay freezes that have been in place for many years, there are a number of reasons.

1. The way that the NHS is funded. This is something called "payment by results". When an NHS trust correctly diagnoses a condition and treats it, they are paid based upon that diagnosis. This was calculated a number of years ago, based upon the national average total cost of treating that condition - e.g. if a hospital diagnoses pneumonia of moderate severity. Then they get paid a flat fee, which needs to cover the in-patient costs, cost of tests, antibiotics, oxygen, consumables, bed and board, etc. It doesn't matter if there are 3 days in hospital or 7 days; it doesn't matter if the doctor prescribed penicillin, or if it turns out that the infection is some weird resistant thing that they contracted while on holiday in the tropics, and requires 14 days antibiotics costing 10x their weight in gold. The fee is reviewed annual, but is generally not recalculated; instead it is indexed to inflation at CPI - 5%; it is this insidious cut that is doing a lot of damage - it is supposed to force efficiency savings, without top down management (fair enough, I suppose), but there is little guidance from the top as to how individual trusts are to implement this.

The problem is that a lot more effort is spent in getting the correct diagnosis. There are a lot more tests done (which are not paid for in the payment by results system), etc. There are also a lot more treatments available (not all of which necessarily work), previously untreatable conditions are now treatable - often at huge expense. This is particularly the case for various types of cancer treatment where there has not been time for a proper health-economics view from NICE. There is still a bit of a postcode lottery for these type of treatments, with some regions being much stricter on this than others.

2. Numerous high cost initiatives to address problems.

A well recognised potentially catastrophic mistake is to transfuse the wrong group of blood. There are many places where a mistake can be made that can result in this. However, there has been a big initiative to address a particular type of error known as "wrong name on tube". Someone, usually a junior doctor, draws blood in the event of a major trauma call to A&E resuscitation area. They sit down at the nearby worktop to label the blood tube and order a transfusion, but the patient in the next resus cubicle's notes are open. In a split second lapse of concentration, they write the wrong name on the tube. It goes to the lab, who prepare the transfusion. Then the doctor treating the neighbouring patient rings the transfusion lab and orders some blood - the lab see they have a sample to hand, and match the blood. Patient 2 receives a mismatched transfusion and becomes ill and potentially dies.

The new dictat is that laboratories must have at least 2 sources of proof of blood grouping. In other words, they must have 2 separate samples, taken by different people at least 30 minutes apart, which are then analysed and proven to match in the lab. I asked in the annual "mandatory training" session (out of curiosity, not because I ever transfuse blood) how much this would cost. £400 million over 5 years was the answer. "I see. How many wrong transfusion incidents will the be expected to prevent?" "In the last 5 years, there have been 4 incidents of which 1 caused death and 2 caused moderate illness". "Do you think £400 million to save 1 life and prevent 2 minor injuries is appropriate?" "Absolutely. How could it not be!" "That could pay for 100,000 hip replacement operations, or 40,000 cancer operations". Anyway, this argument when on for a while at which point I got bored. I later got a letter from the chief exec of some safety committee, telling me, how dare I criticise important safety policy, etc.

3. Difficulties retaining staff and increasing reliance on agency

Once a place gets a bit of a bad reputation, the rats start leaving the sinking ship. Things then inevitably deteriorate, as fewer staff who know what they are doing remain, and more agency staff are brought in at enormous cost; or work gets farmed out to the private sector in the form of private providers who cherry pick the easy and profitable stuff, and leave anything else.

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NHS care cost something like £4,000 per person per year

You can get a BUPA scheme for around £30 to £50 per month - £400 odd per year

seems cheap right

But what people don't realise is that these private schemes have a list of exclusions as long as your arm, basically anything you are likely to need is excluded, anything expensive is excluded and the things you are covered for have limits.

For a real comparison, look at the USA where the costs of insurance are more like £8000 per year, and they still have limits on whats covered should you get really sick.

Strangely you will never see politicians (or the UK press) discuss the actual numbers like this.

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2. Numerous high cost initiatives to address problems.

A well recognised potentially catastrophic mistake is to transfuse the wrong group of blood. There are many places where a mistake can be made that can result in this. However, there has been a big initiative to address a particular type of error known as "wrong name on tube". Someone, usually a junior doctor, draws blood in the event of a major trauma call to A&E resuscitation area. They sit down at the nearby worktop to label the blood tube and order a transfusion, but the patient in the next resus cubicle's notes are open. In a split second lapse of concentration, they write the wrong name on the tube. It goes to the lab, who prepare the transfusion. Then the doctor treating the neighbouring patient rings the transfusion lab and orders some blood - the lab see they have a sample to hand, and match the blood. Patient 2 receives a mismatched transfusion and becomes ill and potentially dies.

The new dictat is that laboratories must have at least 2 sources of proof of blood grouping. In other words, they must have 2 separate samples, taken by different people at least 30 minutes apart, which are then analysed and proven to match in the lab. I asked in the annual "mandatory training" session (out of curiosity, not because I ever transfuse blood) how much this would cost. £400 million over 5 years was the answer. "I see. How many wrong transfusion incidents will the be expected to prevent?" "In the last 5 years, there have been 4 incidents of which 1 caused death and 2 caused moderate illness". "Do you think £400 million to save 1 life and prevent 2 minor injuries is appropriate?" "Absolutely. How could it not be!" "That could pay for 100,000 hip replacement operations, or 40,000 cancer operations". Anyway, this argument when on for a while at which point I got bored. I later got a letter from the chief exec of some safety committee, telling me, how dare I criticise important safety policy, etc.

I knew a middle manager earning very well in an NHS organisation (some kind of central planning) who had genuinely never heard of the phrase " value for money " in a business context

Of course you can place a value on a life, it's just being rational

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The question though is there truly competition in healthcare in these "other" nations? This is the raison d'etre for private involvement in healthcare. Can the average person for example, if they break their leg, quickly and easily choose between 3-4 different hospitals or providers. Ditto the same for cancer care. Can the average citizen knowledgably choose the best provider/doctor who will give them the best outcome at a particular price point?

My own experiences from living in the USA are 100% the exact opposite of this.

The US has private provision of the insurance part too, which is the difference. Taking the system in Canada, where the provinces provide the insurance and anyone can provide the health care according to a set scale of charges, it's clear that competition works pretty well for certain types of service. For example, we have a lot of walk in clinics compared to the UK, most operated commercially. It means I can go and see a doctor near to where I work for minor stuff, rather than have to mess about with an appointment to see my own GP. The big items are mostly provided by semi-state run hospitals but, again, for quite a lot of specialist services outside of major surgical intervention, there are clinics run separately from the major hospitals. It's not perfect by any means, but I'd say it's more patient focussed than the UK system on the whole. The French system, which also uses a lot of private services, is worth a look too.

The US is a terrible model to copy and the idea that the only alternative to the state running absolutely everything is the American system is bonkers. The American system is actually the outlier globally speaking and, despite them spending a lot of money compared to elsewhere, their healthcare outcomes are poor on average.

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The US has private provision of the insurance part too, which is the difference. Taking the system in Canada, where the provinces provide the insurance and anyone can provide the health care according to a set scale of charges, it's clear that competition works pretty well for certain types of service. For example, we have a lot of walk in clinics compared to the UK, most operated commercially. It means I can go and see a doctor near to where I work for minor stuff, rather than have to mess about with an appointment to see my own GP. The big items are mostly provided by semi-state run hospitals but, again, for quite a lot of specialist services outside of major surgical intervention, there are clinics run separately from the major hospitals. It's not perfect by any means, but I'd say it's more patient focussed than the UK system on the whole. The French system, which also uses a lot of private services, is worth a look too.

The US is a terrible model to copy and the idea that the only alternative to the state running absolutely everything is the American system is bonkers. The American system is actually the outlier globally speaking and, despite them spending a lot of money compared to elsewhere, their healthcare outcomes are poor on average.

Excellent post

The us healthcare system is far too often quoted, it is a central straw man argument

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