NHS

NHS Bureaucracy DOUBLES During Pandemic – But Nurses Increase Just 7%

NHS bureaucracy has doubled since the start of the pandemic despite little change in the size of the frontline workforce, with nurses increasing just 7%, a new report reveals. The Telegraph has more.

The figures come as a record 6.4 million people – one in nine of the population – are on waiting lists, with record trolley waits in Accident & Emergency departments. 

And it follows concern that an extra £12 billion a year funding boost, funded by a 1.25% National Insurance hike, which came in last month, will be swallowed on management salaries, instead of clearing the backlogs. 

The new analysis shows that the number of officials working in the Department of Health and NHS England has more than doubled in two years, with even sharper rises seen at the most senior levels. Meanwhile the number of nurses rose by just 7%, thinktank the Policy Exchange found. Its experts said the trends showed an “astonishing” explosion in central bureaucracy, calling for an urgent review and action to slim down and streamline its workings. 

The findings come ahead of a review of leadership in the NHS by a former army general. Sir Gordon Messenger has been sent in by Sajid Javid, the Health Secretary, amid concern over the quality of management in the NHS as the service faces the biggest backlogs in its history. The general has been asked to stamp out “waste and wokery” in the health service and ensure “every pound is well spent”.

The analysis shows that the total pay bill at the Government department and central body in charge of the NHS has doubled in the two years since February 2020, from £42 million to £83 million.

The workforce of the bodies rose from 7,883 to 14,515 over the period, with the number of senior officials rising by 125%. 

Even these figures exclude health agencies – such as the U.K. Health Security Agency – and its predecessor Public Health England, which expanded during the pandemic. 

Meanwhile, the nursing workforce rose by just 7% – from 298,632 to 319,808, despite desperate shortages of frontline staff. 

It comes as Boris Johnson orders a Civil Service cull, with 91,000 jobs due to go in order to cut costs by £3.5 billion…

The report shows some of the steepest rises in bureaucracy come at the top of the health bodies. The figures show a 130% increase in senior roles at NHS England in just two years, while the senior headcount at the Department of Health doubled.

Why Does Your Doctor Want to Keep You Masked?

There follows a guest post by Paul Stevens, who is part of the Smile Free campaign to end forced masking in the U.K., which is currently inviting signatures to its open letter to the NHS Chief Executives to remove the mask requirement from healthcare settings.

Walk into your General Practitioner surgery and what will you see? Notices demanding that you ‘wear a mask’ and people with ill-fitting face coverings, most of which having been frequently touched, reused, rarely washed and improperly stored.

By contrast, in public spaces such as hospitality venues, retail settings and transportation hubs, you’ll find a lack of signage and a marked reduction in mask-wearing. More and more, people aren’t wearing them.

It’s as if we are living in two worlds: one where we have begun to return to a rational unmasked normality; and one, in healthcare settings including GP surgeries, where we are instructed to remain featureless and compliant with the facemask diktats of nameless NHS bureaucrats.

To understand how, and why, these worlds co-exist we need to start by looking at the frame of reference within which GPs operate. As independent contractors, for all intents and purposes GPs work within the NHS; and many are members of a single body, the British Medical Association (BMA). The NHS and BMA, one guiding and enabling the other, have played major parts in establishing and maintaining masking within healthcare settings.

The NHS has been a major advocate of masking and, as published on the Government’s “COVID-19: Infection prevention and control” (IPC) webpages, its current guidance for mask-wearing within health and care settings remains that facemasks for staff and facemasks or coverings for all patients and visitors are “recommended”.

The NHS is Failing – and the Public Know It. Do the Politicians?

The NHS may be popular with politicians but it no longer is with the public – and with good reason, according to a new report from think tank Civitas. Tim Knox, the report author, has summarised his findings in the Spectator, and they are not kind to the once-hallowed health service, supposedly regarded as the ‘envy of the world’.

While MPs compete to shout the loudest in their support of the UK’s health services (‘save our NHS!’), the British public has fallen out of love with it. More people are now dissatisfied with the NHS than are happy with it. This is true across all ages, income groups, sexes and voters of different political parties. Support for the NHS is now at the lowest level for a quarter of a century.

The public is right, the NHS is just not that good. Compare it, as I have done in a new report published today, with the health systems of 19 similarly well-off countries and it is hard to come to any other conclusion. UK life expectancy is down at 17 out of these 19 comparable nations. Our cancer survival rates are shockingly low. We are the worst for strokes and heart attacks. We are one from bottom for preventing treatable diseases. We are third from bottom for infant mortality. The only thing we top the charts on is helping diabetics avoid amputation. Sadly, despite the great efforts of NHS staff, our health system does not match the success rates of other nations: we come bottom of the league tables four times – more than any other country – and are in the bottom three for eight out of the 16 measures.

Ah, the supporters of the NHS might say: you are just cherry-picking the countries you are comparing us with, or the diseases, or using dodgy data. Not so. The comparison countries and health outcomes were those used in a report co-published a few years ago by the three leading health think tanks, the Health Foundation, the Nuffield Trust and the King’s Fund, together with the Institute for Fiscal Studies. And all the numbers behind the health outcomes come from the extraordinarily detailed OECD health database.

So, with an unimpeachable methodology and a highly regarded database, another line of attack may be that somehow the only alternative is the American system. Again, nothing could be further from the truth. If there is one country that clearly has a worse system than the UK, it is America. Extraordinarily low life expectancy, vast costs and often poor treatment means that it would be a crazy model to imitate. But that doesn’t mean we should discount an insurance model altogether. Plenty of European and western countries are able to effectively use such a model without the massive health failures we see in the US.

Is this all about money? We hear endless accusations that ‘our’ NHS has been starved of funding. But again, not so. The OECD data are clear: in comparison to other wealthy countries, our spending in 2019 at 10.2% of GDP exactly matched the average spending of the comparable countries. For spending, if not for outcomes, we are bang in the middle of the league table.

The final claim may be that at least the NHS provides care, free at the point of use, for everyone. True of course (except for the fact that waiting lists mean that that care is rationed). But it also overlooks the fact that, again according to the OECD database, every other economically advanced country – apart from America – provides universal care to everyone.

Worth reading in full.

Doctors Claim NHS Facing Worse Crisis Since Records Began – But it’s Nothing to Do With Covid!

An exodus of social care staff to better-paid jobs in supermarkets, retail and hospitality is fuelling the worst NHS crisis since records began. The Times has more.

Leading doctors told the Times that the “frightening” situation in A&Es was now worse than during the Covid peak but said the solution was to “give money to social care – not us”.

Social care is due to receive only £5.4 billion of the government’s new £36 billion package for healthcare reform, funded through a rise in national insurance that was introduced this month.

NHS chiefs warned that the “bottleneck” in hospitals would deteriorate further unless social care capacity was increased so that patients could be safely discharged from wards.

Medical organisations said it was vital that carers receive a pay rise so they earn more than they would “stacking shelves in Tesco”.

Some 410,000 staff quit social care last year. Vacancies in the sector have almost doubled in the past year, with one in ten posts now empty – a shortage of about 160,000 staff.

Widespread labour shortages and the cost-of-living crisis means staff are being lured to jobs in supermarkets with higher wages, while companies such as Amazon are offering “golden handshakes” of up to £3,000.

This has reduced capacity in care homes, with four in ten refusing to take on new admissions – meaning elderly and vulnerable patients end up stranded on hospital wards.

NHS England figures show a record 13,000 patients a day are taking up beds because they cannot be discharged, creating a logjam in hospitals and ambulance services that is “costing lives”.

Worth reading in full.

Stop Press: Many people have claimed that this crisis has been caused by the Government’s insistence that care home workers had to be jabbed from November 11th 2021 as a condition of remaining employed. That may well be a contributory factor, but it’s worth pointing out that that policy was revoked on March 15th.

The Rise and Fall of General Practitioners

We’re publishing an original essay by Jon Garvey, a doctor who retired from General Practice in 2008 for the reasons he sets out here. He thinks the bureaucratisation of General Practitioners spearheaded by New Labour account in large part for the current failures of the health service.

The 2004 GP contract is a handy hook on which to hang the decline of British General Practice into the calamitous state in which we would now find it, if we could ever get an appointment. The usual accusation is that it made GPs overpaid and underworked and enabled them to spend all day on the golf course, but we should know by now that scapegoats are products of propaganda.

I was senior partner of a large General Practice at the time of the contract, and since it led directly to my taking early retirement four years later, certain aspects stick in my memory. One is that it was Gordon Brown (then Chancellor of the Exchequer and in overall charge of the negotiations) whose erroneous belief that GPs already did spend all day on the golf course led to some of its worst outcomes.

In truth, the rot had set in long before, following the same trajectory that some U.S. front-line Covid doctors have identified over there. A profession of inquisitive minds, gaining expertise from seeing patients and from peer-to-peer discussion, gradually shifted towards a top-down model of centrally planned protocols and ‘best practice’, executed by technical operatives and, increasingly, controlled by Big Pharma and government PR.

I came into General Practice at its possible zenith, when it had ceased to be a bolt-hole for people falling off the hospital consultant ladder, and had become a skilled speciality in its own right. It had inherited the early-NHS model of independent practices contracted to the NHS, which once wedded to high professional standards served to put the doctor-patient relationship centre-stage, rather than the relationship between doctors and their managers.

Moreover, recruits came from hospital jobs with insane hours, in my case 112 hours a week on call for my pre-registration house jobs, and then around 85 hours as a Senior House Officer on a General Practice rotation. That made the 65 hours required in my practice to cover 14,000 patients 24/7 seem a perk. Missing one’s family growing up was par for the course, and the pay was pretty reasonable.

NHS Calls For Volunteer Ambulance Drivers

Volunteers are being asked to drive 999 patients to hospital, as part of efforts to relieve pressures on ambulance services. The Telegraph has more.

The London Ambulance Service (LAS) is to start piloting the system within weeks, as senior doctors warn of “staggeringly bad” delays to emergency care in some parts of the country.

Although volunteers are regularly used by hospitals and charities to take patients to outpatient appointments, this is thought to be the first time that non-professionals will be used to ferry emergency cases.

The ambulance service already sends taxis to take some patients to hospital. The new scheme is aimed at patients who are classed as “category 3” – meaning they should get an urgent response within two hours – and who need help because of mobility problems.

LAS officials said that NHS England is looking to use it as the basis for a “national volunteer transport” system.

Across the country, ambulance response times are the lowest on record, with average waits of more than an hour for heart attack and stroke victims in March, against a target of 18 minutes.

In the capital, average waits for such emergencies were almost 51 minutes, data show.

So far, 22 volunteers have been signed up and trained for the scheme, which is currently using “community first responders” trained by St. John’s Ambulance.

Responders, who have training in emergency first aid, are normally deployed to get to emergency calls quickly and provide on-the-spot help before ambulance crews can get there.

The service told a board meeting last month: “The project is supported by NHS England and NHS Improvement who are looking to implement a national volunteer transport model based on using our model.”

NHS England is understood to have provided £100,000 funding for the pilots, set to be launched in May, using LAS cars based at each of the six ambulance stations across the capital.

The new scheme comes amid warnings of “appalling” waits for ambulances in some parts of the country.

Worth reading in full.

Lockdown Backlog: NHS Waiting List Hits New High of 6.2 Million as Stroke and Heart Attack Victims Wait Over an Hour for Ambulance

The number of patients waiting for routine hospital treatment in England has soared to a new record of 6.18 million, as ambulance and emergency department waits also reach all-time highs. MailOnline has the story.

NHS data show one in nine people were in the queue, often in pain, for elective operations such as hip and knee replacements and cataracts surgery by February – up from 6.1 million in January. 

Separate data show A&E performance plummeted to its worst ever level in March, with a record 22,506 people waiting 12 hours to be treated, three times longer than the NHS target. Just seven in 10 patients in casualty units were seen within the four-hour threshold, marking the worst performance yet.

Ambulance figures reveal heart attack and stroke patients were left waiting for more than an hour for paramedics to arrive on average – another record.

Health bosses argue the NHS has faced its busiest ever winter and a slight drop among the longest waiters show it is tackling the backlog.  

NHS leaders said the health service needs more cash to fill its 110,000 vacancies and ongoing problems in social care, despite receiving a record £136.1 billion this year to help it recover from Covid.

Ministers announced an elective recovery plan earlier this year, setting out how waiting lists will finally start to fall from March 2024, while two-year waits would be scrapped by the summer. But experts today warned “it is hard to imagine an end in sight, with lengthy waits for healthcare firmly here to stay”.

It comes as doctors today say record-high Covid infection are leading to operations being cancelled across England, despite daily admissions and the number of infected patients in hospital trending downwards. 

How can this winter have been the “busiest ever” when excess deaths were trending below average throughout. Surely last winter, with the Alpha Covid wave in full swing, was much busier. Hard to sort the truth from the exaggeration in the messages coming out from the health service, particularly with health bosses lobbying for the return of restrictions.

Have they forgotten it’s the restrictions that got us into this mess, by telling people to stay at home when they’re ill, cancelling operations ‘because Covid’ and storing up the mother of all backlogs?

Worth reading in full.

NHS Panjandrums Demand the Return of Masks and Re-Imposition of Covid Restrictions

Health chiefs want Britons to follow a string of new Covid measures to fight record infection rates in the U.K. and ease pressure on the NHS. MailOnline has more.

The NHS Confederation accused No.10 of “abandoning any interest in Covid whatsoever”, warning that hospitals are set to deal with a “brutal Easter as bad as any winter”.

The group, which acts as a representative for hospitals and ambulance trusts, called for “mitigating actions” to stop the spread of the virus, such as not meeting people indoors and wearing masks in crowded spaces.

It comes just weeks after Covid restrictions, including the legal requirement to self-isolate, were scrapped under Boris Johnson’s ‘living with Covid’ plan. And England’s £2 billion-a-month mass-testing scheme was scrapped at the start of April.

The easing of rules has coincided with infection rates spiralling to the highest levels seen throughout the pandemic, with one in 13 people estimated to be infected at the start of the month.

Health bosses say the situation – fuelled by rising Covid rates and staff sickness – is impacting its ability to tackle the record backlog of patients needing care.

Millions of patients have already been told to stay away from busy A&E units unless they are genuinely dying, while ambulance services have urged some to make their own way to hospital.

The number of virus-infected patients in hospital last week breached 20,000 – the highest since February 2021. Although, figures also show thousands aren’t primarily ill with the virus.

“The brutal reality for staff and patients is that this Easter in the NHS is as bad as any winter,” said Matthew Taylor, Chief Executive of the NHS Confederation.

“But instead of the understanding and support NHS staff received during 2020 and 2021, we have a Government that seems to want to wash its hands of responsibility for what is occurring in plain sight in local services up and down the country. No.10 has seemingly abandoned any interest in Covid whatsoever. NHS leaders and their teams feel abandoned by the Government and they deserve better.”

“Mitigating actions” – including not meeting people indoors and wearing masks in crowded spaces – were needed to prevent the spread of the virus, the group said.

Worth reading in full, including the sidebar suggesting infections have peaked, based on the latest ONS infection survey.

For a less hysterical take on the ‘perfect storm’ currently afflicting the NHS, see this piece by the Daily Sceptic’s in-house doctor from yesterday.

If Hospitals Are Currently Under Pressure, They Only Have Themselves to Blame

There follows a guest post by our in-house doctor, a former senior NHS medic, who says the latest ‘perfect storm’ causing pressure on the health service in parts of the country is more a self-induced squall.

In the middle of last week, several NHS Trusts issued warnings about the acute strain their services were under. The South Central Ambulance Service went so far as to declare a critical incident – normally reserved for a situation in which demands on the service exceed the capacity to manage those demands. I was surprised that so many NHS bodies spread over a wide geographical area issued public warnings about their failure to cope at the same time. Statements referred to high demand on services (hardly news) and lacked any specific detail about critical capacity constraints. Accordingly, the Daily Sceptic asked me to interrogate the available data to work out the extent to which a Covid resurgence might be responsible for the latest ‘perfect storm’ to hit the NHS.

Graph 1 shows daily admissions of Covid positive patients from the community. Admissions have risen in the last few weeks, but seem to be tailing off. Data from Graph 1 have been the subject of hysterical articles in the mainstream press implying the latest Omicron BA.2 subvariant may be triggering a new wave of acute Covid infections. It’s not sensible to interpret Graph 1 as a stand-alone figure without considering contextual information from other datasets.

Hospitals Clogged With ‘Well’ Patients – 16% of Patients Are Fit to Be Discharged But Are Blocking Beds

NHS beds are being blocked by “well” patients, new figures show, with three quarters still on wards, adding to hospital pressures. The Telegraph has the story.

Of the 87,775 patients in ward beds as of April 5th, around one in seven (16%, 14,487) had Covid, the highest proportion since February 17th.

But separate figures published on Thursday by NHS England show 71% of patients deemed medically fit to leave remained stuck. 

Only 5,178 of the 17,968 deemed medically fit on April 3rd were discharged. 

In response to increasing pressures, one NHS boss has asked families to help discharge their loved ones from hospital even if they’re still testing positive. 

Dr. Derek Sandeman, Chief Medical Officer for Hampshire and Isle of Wight Integrated Care System (ICS), said staff sickness rates, rising Covid cases and “high numbers” of people needing treatment has created a “perfect storm” across the region.

If hospitals are ‘under pressure’, as was reported this week, then rather than telling sick people to stay away, promptly moving well people on would seem a good place to start.

Worth reading in full.