Lowdown 100 – our recent content

Long-term workforce plan for social care staff published

Skills for Care, the workforce development body for adult social care in England, has published the first ever adult social care sector Workforce Strategy. The previous government had refused to develop a strategy or be involved, so Skills for Care, in collaboration with a number of other organisations, went ahead without government involvement. Now Skills

Social care pay but not reform in King’s Speech

The first steps to social care workers getting fair pay and conditions were announced in the King’s Speech on the 17th July. A welcome move for a sector with serious workforce issues, but it’s not the reform that those in the sector want and that has been promised for so long. And there is still

Independent investigation into nursing regulator called for by nursing leaders

Nursing leaders have called for the government to launch an independent investigation into the Nursing and Midwifery Council (NMC), following the release of a damning report by former chief crown prosecutor Nazir Afzal, and Rise Associates. Nursing leaders are concerned that despite promises from the NMC, little will change and public confidence will not be

Labour’s strong mandate to fix “broken” NHS

After 14 long years of real-terms cuts in funding alongside increased pressures on the NHS, its 76th birthday (July 5) saw a change of government, and promises of a change in policy. The first was Labour’s new Health and Social Care Secretary Wes Streeting stating clearly that the NHS has been “broken” – and needs

Now Labour is in, press for action to rescue the NHS

With 412 Labour MPs and a huge majority in the House of Commons, Keir Starmer’s Labour government clearly now has the power to bring in real change for the NHS. The challenge for campaigners now is to ensure the new government seizes this opportunity to repair and rebuild the NHS, which is facing a long

Rolling back privatisation?

Few campaigners or union activists appear to have noticed or commented upon Labour’s Manifesto commitment to roll back privatisation in public services. Some of Labour’s manifesto promises go further than many union activists and campaigners have realised. The Manifesto promises (under ‘Kick start economic growth’) to “introduce legislation within 100 days to implement in full”

Leading private mental health provider to the NHS narrowly avoids liquidation

Active Care Group, a company owned by private equity that cares for hundreds of vulnerable patients for the NHS, has narrowly avoided going out of business. After months of escalating financial difficulties, an administrator was appointed 29 May 2024, who immediately sold the company’s assets in what is known as a ‘pre-packaged sale’ to avoid

Urgent investment in nursing needed to keep patients safe say RCN

The Royal College of Nursing (RCN) is calling for the new government to urgently invest in the nursing workforce and put into law nurse-to-patient ratios, as the current chronic nursing shortage is putting patients’ safety at risk. Investment includes in nursing education as at the moment cuts are taking place to courses and educators, which

Shocking state of A&E in Dispatches programme surprises no one who works in emergency care

The recently aired Channel 4 Dispatches programme, Undercover A&E: NHS in crisis has received widespread coverage due to its exposure of the “suffering and indignity faced by patients on a daily basis” in the the Royal Shrewsbury Hospital’s emergency department, where an undercover reporter worked as a trainee healthcare assistant for two months. The footage

Battles rage over Physician Associates

The pace and intensity of the row over the role and regulation of Physicians Associates (PAs) and Anaesthesia Associates (AAs) have both rapidly increased in this pre-election period, forcing a major climbdown and apology in Bradford, a Royal College President to stand down, another Royal College to change course, and two separate legal challenges to

Primary care services with no money for doctors

The BMA has just identified another growing problem that will face the next government, the chronic underfunding of GP practices, and is urging patients to advocate for better support during the election. The campaign, called ‘GPs are on your side’, warns that general practice is ‘collapsing’, and that ‘every practice across England is struggling to

Main manifestos all lead to NHS decline, warns Nuffield Trust

The publication of the manifestos of the three major parties has been followed by a barrage of useful information on the state of the NHS, from the Guardian and the Nuffield Trust, and a new Dashboard on GP services from the Health Foundation. The common message is that after 14 years of under-funding and under-investment,

Labour manifesto pledge to build new hospitals

Almost casually, and with no real coverage in the mainstream national news media, the Labour Party has abandoned its previous reluctance to commit to spending, and its caution on promising new hospital projects – and committed to delivering the new hospital projects notoriously promised by Boris Johnson. A patchily-covered series of statements targeted at areas

Corridor care – the new hazard for A&E patients

NHS England published a new plan in May, aimed at speeding up the response of A&E services and reducing waiting times, setting a new target of 78% of A&E patients to be seen within four hours – way short of the 95% target that was being regularly achieved prior to 2010. On the same day

Cash strapped trusts and commissioners face new demand to make cuts

While Rishi Sunak flies around the country claiming to be spending ‘record amounts’ on the NHS, NHS England has been increasingly cracking the whip over Integrated Care Boards (ICBs) and trusts, seeking to squeeze down the estimated £3bn deficit for 2024/25. The underlying problem is that this financial year real terms funding for England’s NHS,

Secret plan to outsource Colchester services 

East Suffolk and North Essex Foundation Trust seems determined to outsource nonclinical support services at Colchester Hospital, 12 years after boasting of the Colchester trust’s success at bringing them back in-house.  But why they have chosen to do so, and why they have not considered any other options remains a mystery, since the Trust has

Public say how they want health cash to be spent

The public wants the next government to shift funding to GP and community services and away from hospital services, according to a new report from the health think-tank The Health Foundation, and is willing to pay more taxes to improve services. The results of polling, carried out in Autumn 2023 by Ipsos on behalf of

Measuring the cost of alcohol consumption

The harm from alcohol costs society in England £27.44 billion a year, according to a new analysis by the Institute of Alcohol Studies. The cost of alcohol to society has risen 37% in just over 20 years since 2003, which was when the last comparable research was carried out by The Cabinet Office, which then

Private GP company in breach of NHS contract

A private equity-owned company that holds contracts for almost 50 GP surgeries in London has been found to be in “serious breach” of its contracts by local commissioners, something which was highlighted by Campaigners from North East London Save Our NHS in April this year. The company Operose, once a subsidiary of US corporation Centene,

Not so different after all: Scottish NHS suffering familiar problems

John Lister begins what we hope will be regular Lowdown coverage of the NHS in Scotland, with an overview of current key issues and an interview with UNISON’s Scottish Head of Health Matt McLaughlin. The news media in England carries little information on the NHS in Scotland, which is controlled by the Scottish government, which

Workforce shortages and budget crisis push the NHS to the limit

Survey of 19 Integrated Care Boards (part 2 of 2), Key points: (West Midlands, South East and South West of the country – 19 ICBs) Workforce pressure continues to push “trust leaders to the limit” with difficult choices. Pressure on leaders to avoid deficits is stalling progress and leading to discussions about cuts. ICBs are

Opposition to North West London experiment is still growing

A bizarre experiment is being acted out in North West London. Its Integrated Care Board, covering the third largest population of all 42 ICBs in England was discovered at the end of January to be embarking on a scheme to fundamentally change primary care services by April 1 – with no plan for consultation with

Lifting the lid on use of private sector

The Lowdown survey of 23 ICBs has revealed interesting new information on the extent of local dependence upon private sector clinical services, and the extent to which ICBs and trusts view the private contracts to be a liability rather than an asset. Thirteen ICBs from the sample of 23 refer to the use of private

ICBs tight-lipped on deficits and consequences

Survey of Integrated Care Boards, Key points: (East of England, London, East Midlands, North East and Yorkshire and North West regions – part 1 of 2) 18 out of the 23 ICBs surveyed finished the financial year in deficit. and 10 already forecast bigger deficits for 2024-25. Greater Manchester: “the ICS finds itself starting from

Private equity: the new face of privatisation?

Big privateers, like Virgin and Operose, may have abandoned their interests in NHS contracts – facing shifts in government policy and elusive profits. The private equity investor though is gaining a stronger foothold. Involved in the care and education sectors for many years,  private equity has added to their interests in mental health and elective

Private equity owner of NHS GP surgeries accused of contract breach

A chain of GP surgeries in London run by a private company has been operating “without permission” from NHS commissioners since December 2023, according to campaigners from North East London Save Our NHS – in a “serious contract breach”  The 49 surgeries were originally owned by US corporation Centene, via its UK subsidiary Operose, but

Campaign for fair pay spreads and enjoys success

UNISON’s Pay Fair for Patient Care campaign continues across the country, with new strikes in Leicestershire, strikes continuing in Teesside, and the threat of strikes in Surrey. Hundreds of healthcare assistants at the University Hospitals of Leicester NHS Trust (Leicester General Hospital, Glenfield Hospital, and Leicester Royal Infirmary) began strike action 11 April in a

Emergency departments still struggling to cope with rising demand

The latest raft of performance figures have shown that the NHS is still mired in a chronic capacity problem and hamstrung by the lack of adequate provision of community health and social care to support patients ready for discharge. The Royal College of Emergency Medicine (RCEM) notes that the final weekly winter ‘situation report’ figures released

Mental health services breaking down under pressure

New research commissioned by the NHS Confederation’s Mental Health Network shows the cost of mental ill health for England was a staggering £300 billion in 2022. The study, conducted by the Centre for Mental Health, shows that the £300bn figure breaks down into: £110bn – economic costs such as sickness absence, ‘presenteeism’, staff turnover and unemployment £130bn –

Streeting’s private sector positioning could cost votes

(adapted from an article for Labour Outlook) Wes Streeting has been winding up health workers, campaigners and Labour activists once again, with more loose talk about turning to the private sector rather than investing in expanded NHS services to reduce waiting lists. It follows his promise last November to “hold the door wide open” for

Waiting lists “stable” despite claims of progress

Press reports of the wafer-thin reduction in the NHS waiting list in England were divided, with some reports buying the NHS England interpretation that the numbers had reduced for the “fifth month in a row.” However others were more nuanced. Business news from Bloomberg reported “NHS Waiting Lists Decline, But Still Fall Short of Sunak

Closure of mental healthcare service for medics stopped after outcry

Doctors were shocked to discover the latest cash-saving wheeze from NHS England to axe the dedicated mental health support for hospital doctors offered by the Practitioner Health Programme (PHP), but after an outcry from across the medical profession, the scheme was given a last-minute reprieve. The service – the largest publicly-funded mental health staff treatment

NHS faces biggest actual cut in spending since 1970s – IFS

With an election looming, on past form NHS chiefs might have been expected to hold back on driving through ‘unpalatable’ measures to cut spending this year, partly because ministers would not normally want to see unpopular cuts in the run up to polling, and partly in the hope of some relief to come if there

Bullying can’t hide performance failures

But while hospital beds clog up with thousands of patients who cannot be discharged for lack of services to support them, and the queues for beds back up into Emergency Departments, NHS England has resorted to desperate tactics in their efforts to force an apparent improvement in A&E performance. The HSJ revealed that on the

British Social Attitudes survey primes debate for the election

The British Social Attitudes (BSA) survey shows just how far satisfaction in the NHS has fallen – it is now at an all-time low of just 24%; in 2010 it stood at 70%. Figures for social care services were even worse – just 13% of respondents were satisfied with social care and 57% were very

Gloomy news behind the hype for private hospitals

The business press and private sector spin doctors are doing their best to talk up the growth of the private hospital sector despite increasing signs that the prices of private care are unaffordable. The most recent flurry of puff came as a result of analysis by independent consultancy Broadstone, which showed admissions using private medical insurance increased to

How can Physician Associates best be used to improve NHS care?

There have been many calls for better access to GPs, but no clamour at all from patients to be able to get an appointment with a Physician Associate: yet that may be all that is on offer to 2.4 million patients in nine North West London boroughs if plans to reshape primary care services are

BMA steps in with professional guidelines on role of PAs

The battle over the proper delineation of the role of Physician Associates (PAs) in particular has been taken in to the once prestigious Royal College of Physicians (RCP), which in recent years has strongly embraced the idea of PAs. Unlike the Royal College of Anaesthetists, which last October convened an extraordinary general meeting at which over 90%

Action on social conditions needed to improve health inequalities

Tackling poverty and its negative effects on health should be as high a priority as addressing the NHS waiting lists, according to a new report by The Kings Fund and the Joseph Rowntree Foundation.  The report – Illustrating the Relationship Between Poverty and NHS Services – found that despite poverty being very bad for your

Where is the money for crumbling hospitals?

Last week’s budget gave the NHS’s capital budget, used for infrastructure, a boost of £3.4 billion, but there is a catch. It is all earmarked for technology, digital and AI projects and is dependent on productivity increases – that are almost double anything asked for previously. Meanwhile, parts of NHS buildings are falling on patients

Dodgy figures for the private sector?

Private health bosses have again been pumping out press releases to give the impression that private hospitals and insurers across the UK are booming as a spin-off from bloated NHS waiting lists. Aviva has reported sales of health insurance were up by 41% in 2023 compared with the previous year, with more businesses and individual

What did the budget deliver for the NHS?

The Spring Budget delivered by Chancellor Jeremy Hunt last week contained little for the NHS, and what was given is largely dependent on huge productivity increases being achieved. Money for Tech and Digital The main funding pledge was £3.4 billion of capital investment primarily for technology and digital transformation, which the Chancellor claimed doubles the

“privatisation has almost never had a positive effect on the quality of care”

Privatisation of healthcare results in a reduction in quality of care according to a review paper published this week (1 March 2024) in The Lancet. The study’s authors from the University of Oxford, concluded that:  “At the very least, health-care privatisation has almost never had a positive effect on the quality of care.” Adding that

Labour plans for GP shakeup must avoid mistakes of the past.

Proposals put forward by the Labour Party to develop a national network of ‘neighbourhood health centers’- should they win the next election, have raised big questions about how the idea would work and what it might cost Impressed by the Australian model of polyclinics, Labour health spokesman Wes Streeting has announced his intention to replicate

Restoring the People’s NHS

In the run-up to the election, The Lowdown is inviting a range of NHS commentators, staff and campaigners to give us their policy priorities for the NHS. Here Tony O’Sullivan, co-chair of Keep Our NHS Public, outlines the arguments and principles behind the call to restore a people’s NHS In the countdown to this year’s

A&E situation worsens as hospital beds fill up

The Urgent and Emergency Care Situation Reports (Sitreps) published by NHS England show that for the week 12-18 February the average daily acute bed occupancy stood at 95.5%. This is a further increase from the average 94.7% occupancy a week earlier, and higher than the highest suggested target level of occupancy. The Royal College of Emergency

Empty apologies – as Primary Care chiefs press on with plans

The scale and weight of GP antagonism towards plans in North West London  to roll out a system of “same day access hubs” that would make minimal use of GPs (see Lowdown February 15) has forced the Integrated Care Board (ICB) into a limited retreat. A letter to GPs from ‘NW London Primary Care’  dated

Ex Labour health minister goes in to bat for PFI investors

John Hutton signed off thirteen NHS Private Finance Initiative (PFI) building projects as a Labour health minister in 2002 (see footnote). Last month he was appointed to speak up for private sector investors ahead of likely disputes as some of the earliest PFI contracts draw to a close. (Now Lord) John Hutton has been installed

Call on Chancellor to fund public health to boost the economy

The Chancellor’s Spring budget is imminent and the message from the public health and health sectors is that poverty is a public health crisis, which he would be wise to target if the economy is to improve. A letter signed by 60 organisations and individuals, including the Association of Public Health Directors (APHD), leaders of

Problems lurch from bad to worse in King’s

King’s College Hospital Foundation Trust has been chronically financially challenged for many years now. So seriously challenged we might have expected it to be included amongst the most troubled group of trusts in in NHS England’s ‘System Oversight Framework’ (SOF). (See our recent article on SOF and the latest NHSE ratings of trusts and ICBs). But in

ICSs and Trusts on NHS naughty step

According to NHS England, more than half (23) of the 42 Integrated Care Systems (ICSs) in charge of commissioning services have “Significant support needs” as they struggle to meet financial, operational, or strategic targets. They fall into Segment 3 of NHSE’s NHS Oversight Framework, effectively the NHS ‘naughty step’. Only one ICS – Frimley –

Row over exclusion of GPs from ‘improved’ GP services

Hammersmith & Fulham Save Our NHS (HAFSON) campaigners in North West London have told The Lowdown of a brewing row over leaked plans to force through a wholesale reorganisation of primary care services that would exclude GPs from almost all provision of ‘same day’ GP care for over 2 million people across the Integrated Care

False economies as GPs face redundancy

The NW London row has broken as tensions rise across the NHS over perceived efforts by government and NHS England to squeeze out fully qualified GPs and consultants and replace them with much less well qualified Physician Associates and equivalents. The Lowdown reported on this brewing controversy at the end of November, but since then

BMJ Commission’s call to action to relaunch the NHS

Many people may have been unaware of the existence of the British Medical Journal’s Commission on the Future of the NHS: but most will welcome its first report, which combines full support for the founding principles of the NHS with the call for the next government after the general election to declare a “national health

Bring them back in house

New regulations will reduce some forms of outsourcing in the NHS, but there are significant gaps which a UNISON campaign is aiming to fix. A reduction in the competitive tendering for NHS contracts is expected to follow the introduction of the new procurement regulations –  the Provider Selection Regime (PSR) which came into force in

Where is it? – “the largest and fastest-ever improvement in emergency waiting times in the NHS’s history”

It was a year ago that Rishi Sunak tried to regain public trust in the government’s running of England’s NHS by promising to open an extra 5,000 “sustainable” front line beds and 800 new ambulances … backed by “a dedicated £1 billion fund.” He promised this would deliver “the largest and fastest-ever improvement in emergency

In defence of the NHS (Part 2)

In Part 2 of his response to some of the criticisms of the NHS, John Puntis (ex-NHS consultant and Co-chair of Keep Our NHS Public) rebuts the view that the NHS is wasteful. (Part 1) “The NHS is unproductive and wastes money” In responding to this point, there is an instructive analogy from the 99%

More confusion over new hospitals

Following on our recent Lowdown report on the chaos of the New Hospitals Programme (NHP), there are more signs that the organisation supposedly coordinating plans for “40 new hospitals” is mired in confusion and increasingly aware of how badly the whole project has been under-funded. The HSJ has revealed that controversial NHP assumptions that the

Why we need more public health services

Contributors: Sylvia Davidson / Paul Evans Key points The public health grant has been cut by 26% on a real-terms per person basis since 2015/16. Public health services provide preventative services, including smoking cessation, drug and alcohol services, children’s health services, including health visitors and vaccination programmes, and sexual health services Research suggests that investing

Premature deaths show action needed on social determinants of health

More than 1 million people in England died prematurely in the decade following 2011 due to a combination of poverty, austerity policies and Covid, according to a study by the Institute of Health Equity (IHE) at University College London led by Sir Michael Marmot. The report – Health Inequalities, Lives Cut Short – found that

Fresh increase in NHS spending on private providers

The latest Department of Health and Social Care Annual Report and Accounts (2022-23) have updated the published figures on NHS spending on private sector and non-NHS providers. They show that the private sector spend went UP in cash terms by £600m last year, while the DHSC’s total budget actually went DOWN by £6.7bn (from £183.548bn

New hospitals – the chaos continues

The prevailing aura of chronic, shambolic failure hangs over the government’s much-vaunted “New Hospitals Programme,” a brainchild of Boris Johnson, whose 2019 manifesto seeking to convince the electorate promised 40 new hospitals plus 20 ‘hospital upgrades’. Ministers even claimed in 2019 that six new “large hospital builds” had received funding to “go ahead at once,”

Shropshire plan gets rubber stamp

It’s one step forward two steps back for a controversial and long-running hospital reconfiguration plan that predates the promise of 40 new hospitals. The Outline Business Case for Shropshire ICB’s ‘Future Fit’ plan to centralise emergency services in Shrewsbury and downgrade Telford’s Princess Royal Hospital has been rubber stamped at national level, and the go-ahead

In defence of the NHS

The NHS is attacked on a variety of spurious grounds. Negative statements often being repeated uncritically and ad nauseam by some sections of the media until they become ‘common knowledge’. Here, John Puntis examines some of the most prominent, considers the evidence, and offers some counterarguments (Part 2 of this article).   “If the NHS

Post Office scandal has lessons for NHS

Lowdown readers will have seen the widespread outrage about the latest revelations around Horizon and the Post Office, but many who have campaigned against privatisation and outsourcing won’t be too surprised. This is an opportunity to once again look at the issue and also to do so in the context of our NHS and what

Fighting on for fair pay

The new year has brought fresh determination to win two quite different long-running battles for fair pay, one in north London and the other in the North West of England. In Barnet mental health social workers employed by Barnet council have announced another five days of strike action from Monday January 15, and a Rally

Grim warnings as NHS plunged into another under-funded winter

Key points: No significant improvement in winter pressures performance data compared to last year Deaths from longer waiting waits are still high The target for 5000 extra beds by this winter was not met Pressure from each NHS area to stay within budget, but without sufficient funds to achieve it All last year ministers promised

Lowdown on the key issues in 2023

Throughout the year the Lowdown has reported on the major policy topics affecting health and care in this country. While NHS staff worked hard to treat over a million people everyday, the rising waiting lists lay bare the reality that the NHS does not have the capacity to keep pace with demand.  The growing crisis

North East campaigners fight to open up ICBs and decision-making

Campaigners struggling to follow decision-making and policy proposals in the giant North East and North Cumbria Integrated Care System (NENC ICS) have written to the principal NHS leaders in the area to express their concerns at the loss of local democratic accountability since July 2022, when 42 “Integrated Care Systems” took over responsibility for health

When ‘extra’ capacity is not really extra

Keen-eyed HSJ reporters have spotted evidence of a sharp uptick in trusts’ use of outsourced (mainly “independent”) providers in England at the end of the last financial year. The figures are tucked away in NHS England’s cumbersome quarterly reports, which retrospectively report on the deficits and the levels of spending across England’s NHS trusts. They

How Wes Streeting’s latest thinking signals further jeopardy for the NHS

By Samatha Wathen – Press and Media Officer for Keep Our NHS Public (KONP) Last weekend, Shadow Health Secretary Wes Streeting was interviewed by the Sunday Times about his ambitions for the future of the NHS should Labour win the next general election. In the piece he championed Singapore as an example of best practice ‘a

Ideas for the future of General Practice

NHS England has just launched a public consultation on the future for GPs.  You may never see any evidence of this consultation since it is securely hidden away in the morass of the DHSC website, and the consultation text is not downloadable as a coherent document. It’s not clear who it is aimed at. For

Labour will not “turn on the spending tap”

Keir Starmer and Shadow Health secretary Wes Streeting want to play it both ways. On the one hand Labour has been posting on social media claiming: “The longer the Tories are in power, the longer patients will wait. Only Labour has a plan to cut NHS waiting lists and get patients treated on time again.”

Growing backlog bill as trusts lack cash for vital repairs 

New official figures show England’s NHS backlog of maintenance has rocketed by 13.6% in the last 12 months to a massive £11.6 billion. The annual Estates Returns Information Collection makes clear that this total is over and above what should be routine spending on maintenance and replacing/upgrading clapped out equipment: “‘Backlog maintenance’ is a measure

No increased budget for NHS as winter sets in

The latest emergency services data make grim reading: and the Royal College of Emergency Medicine is warning things are set to get even worse, after Jeremy Hunt’s autumn statement came up with no extra cash to address the growing capacity gaps in the NHS. The RCEM (doing work that really should be done by NHS

Operose flogged off, with 60 GP practices

By John Lister The giant American health corporation Centene has now completed a divestment of all its health care investments in England by selling off its subsidiary Operose, which had controversially acquired 60 GP practices, mainly in London. This marks the end of what the Financial Times saw as an attempt by Centene to open

Still no boom in private health care despite record NHS waiting lists

The latest figures from the Private Healthcare Information Network (PHIN) make worrying reading for private hospital bosses, with no sign of the long-expected boost in numbers of patients dipping in to savings or borrowing money to pay up front for tests or operations to escape growing NHS waiting lists and delays. Overall numbers of patients

Health inequalities continue for people with learning difficulties or autism

People with learning difficulties and those with autism are not receiving the same standard of healthcare as the general population leading to shorter lives and many more avoidable deaths, according to data from recent studies. The annual Learning Disability Mortality Review (LeDeR), published at the end of November, found that people with learning difficulties in

New NHS deal “too generous to big pharma” say campaigners

Concerns over the privatisation of health services tend to be focused on the outsourcing of elective clinical care, mental health, diagnostics, support services and data management. The staggering (and still rising) £19.2 billion annual bill for pharmaceuticals in England (2022/23) is often overlooked, even though it has increasingly been reported as a key factor in

…Rushing to Consultation

There seems to be no such thing as too early to start a consultation in Hampshire, although it seems health chiefs have rather jumped the gun in announcing a 12-week consultation. The debate will be over plans that would downgrade the A&E services currently at Royal Hampshire County Hospital in Winchester – and develop a brand

UnitedHealth – the company at the heart of US healthcare

American health giant UnitedHealth made occasional unsuccessful forays into primary care in the UK in the 2000s, and more recently its Optum subsidiary has been picking up lucrative contracts for NHS support services including IT, number-crunching and back-office systems. But so far it has shown little sign of any more serious effort to invade much

Abuse of migrant care workers widespread, Unison reports

Carers recruited from overseas are suffering appalling levels of exploitation, financial abuse and threats from unscrupulous employees, according to the Unison report – Expendable Labour. Unison is now calling on the UK government and the Home Office to bring in measures to help safeguard against the shocking practices highlighted in the report. Measures, including a

New cash squeeze on England’s NHS

The worsening financial plight of England’s 42 Integrated Care Systems (ICSs) is widening the gulf between NHS England issuing demands for further cutbacks to balance the books and trusts struggling to make ends meet on the ground. The situation has been worsened by the government (Treasury) refusal to allocate any additional money to the NHS

Serious failings in homecare medicine services from private companies

Patients are coming to serious harm by a lack of regulation of the private companies in the homecare medicines sector, according to a damning report by the House of Lords Public Services Committee. The failure of regulation, noted the Lords, means that: “No one—not the Government, not NHS England, not patient groups, not regulators—knows how

Community mental health services failing children and young people

One in five children and young people in England aged eight to 25 have a probable mental disorder, according to a new survey from NHS England, with large rises in the last few years in the number with eating disorders. But years of underinvestment in community mental health services means these children and young people

Physician associates – who are they and why are they in the media

The increasing use of physician associates (PAs) within the NHS has hit the headlines in recent months, with numerous social media discussions, many of which has been acrimonious, and negative headlines in the mainstream media about their work. Such is the concern over their use, and the related profession of anaesthetic associate (AA), that the

NHS dentistry – where did it all go wrong?

By Ollie Jupes (the pseudonym of a retired NHS dental practitioner) Imagine for a moment, that you are a freelance reporter and for one of your clients you have a contract to provide 1200 words per week for a fixed fee. You have been working for this client for many years and although the work

MPs conclude that NHS workforce plan cannot deliver

The cross-party Public Accounts Committee has heavily criticised the government’s 15 year workforce plan in a new report, in particular the lack of funding estimates and have “serious doubts” on how the plan will be achieved.  The committee notes that the “unfunded and uncosted” workforce plan, which promises to train thousands more GPs and double

Private sector research explains lack of self-pay boom

More evidence is emerging on the failure of the private hospital sector to make the expected gains from the chronic crisis of the NHS and its lengthening waiting lists. Far from booming, numbers of self-pay patients, those digging in to their savings or taking out loans to pay for private treatment, have remained stuck at

South West

South West ICBs –  a postcode lottery By John Lister This latest Lowdown survey of the seven Integrated Care Boards (ICBs) covering the South West of England has revealed a complete spectrum of situations, plans, proposals and solutions to the generic problems facing all ICBs – historic under-funding, inflation, inadequate capacity, staff shortages, gaps in

North East and Yorkshire

Humber and North Yorkshire ICB Minutes of the May Board meeting show the Board increasing the risk rating on the financial deficit for 2023/24 and the impact of the pause on recruitment flowing from the financial deficit from 15 to a maximum 25. (p3) The ICB had agreed a plan with NHS England that would deliver

North West – ICB roundup

Cheshire & Merseyside ICB (C&M) Local campaigners are challenging the ICB Chair’s announcement at the July Integrated Care Board (ICB) meeting of a move from meeting in public every month to every two months, with unspecified “other Board meetings” in private. The campaigners note that: “It’s unclear if this means there will be no public access to

East of England

Bedfordshire, Luton and Milton Keynes ICB – BLMK Despite the large apparent long-term gap between needs and resources, referred to above, BLMK ICB claims that the underlying deficit in 2023/24 is as little as £22m, and the efficiency savings required are as low as £18.5m, with just one third of this yet to be identified. (p227) The July

NHS ENGLAND – What’s the state of your local NHS?

NHS England regional ICB update - (latest Oct 2023) In England Integrated Commissioning Boards plan and commission the majority of local health services. This is the latest (Sep-Oct 2023) in a series of Lowdown investigations into their financial state, and into how these decisions makers are to responding to financial challenges. Each snapshot is based

London – ICB roundup

North Central London ICB (NCL) July Board papers reveal (in minutes from the May meeting) the extent to which NCL bowed to NHS England pressure to reduce the apparent scale of the deficit they face for 2023/24 without securing any additional income. “This had been an extremely challenging planning round, with a hugely demanding financial position

Decisions over outsourcing in the NHS

Competitive tendering for contracts in the NHS is set to reduce significantly once the new framework for the procurement of health services – the Provider Selection Regime (PSR) – launches in January 2024. The new draft guidance outlining the PSR, published a few days ago, should consign to history the large-scale competitive tendering regime brought

Whatever happened to those promised extra beds?

As the promises made by Rishi Sunak and his ministers back in January fade further into the past, they gradually reappear … as much smaller and more conditional pledges, before – ministers no doubt hope – being forgotten altogether. Back at the beginning of the year Sunak unveiled a “plan for emergency care” that promised

South East – ICB roundup

October 2023   Buckinghamshire, Oxfordshire and Berkshire West ICB (BOBICB) The July Board heard that by Month 2 of the current financial year this system was £10.9million adrift from the planned position. The problem was blamed on inflation, industrial action, staff shortages, and under delivery of planned efficiencies/ savings. The Board was told BOB ICS

Midlands – ICB roundup

October 2023   Birmingham & Solihull The September Board papers show a month 4 position of £30.1m deficit, compared with a planned deficit of just £3.9m. The situation has significantly deteriorated since Month 3, when the deficit stood at £18.4m, compared with a target of £3.6m. The Finance Report admits that plans for 73% of

Time for solutions on social care workforce

A 15 year workforce strategy is to be developed for social care by Skills for Care, the workforce development body, in an effort to address the ongoing crisis in the workforce. The plan, which will be similar to that unveiled for the NHS in June 2023, will be developed in collaboration with several other organisations,

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