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19 Mart 2017 Pazar

NHS services face "impossible" budget crisis, health trusts warn

Frontline NHS services face “mission impossible” in meeting next year’s targets, health trusts have said.


Longer waiting lists for operations and delays at accident and emergency departments in England loom under the present financial constraints, said NHS Providers, a trade association that represents acute, ambulance, community and mental health services.


Chief executive Chris Hopson said the government needed to “sit up and listen”, the BBC reported. “NHS trusts will strain every sinew to deliver the commitments made for the health service. But we now have a body of evidence showing that, with resources available, the NHS can no longer deliver what the NHS constitution requires of it.


“We fear that patient safety is increasingly at risk.”


NHS Providers predicted its members would receive £89.1bn in funding in 2017-18, an annual rise of 2.6% but less than the 5.2% demand is expected to grow by.


It warned the number of people waiting more than four hours in A&E would increase by 40% next year to 1.8 million, and the number waiting more than 18 weeks for routine operations would rise 150% to about 100,000.


The NHS is already under strain in the wake of the Brexit vote. The number of EU nationals registering as nurses in England has dropped by 92% since the referendum in June, and a record number are quitting the NHS.


Only 96 nurses joined the NHS from other European nations in December 2016 – a drop from 1,304 in July, the month after the referendum.


The service is also facing a long-term failure to hire enough people. Applications for nursing courses plummeted by almost a quarter in a year after the government axed bursaries for trainees in 2016. Numbers fell by 9,990 to 33,810 in 12 months, according to figures released in February by the university admissions service Ucas. Meanwhile, one in three nurses is due to retire in the next 10 years and there are 24,000 nurse jobs unfilled, Royal College of Nursing figures show.



NHS services face "impossible" budget crisis, health trusts warn

5 Şubat 2017 Pazar

Modern realities make caring for our aging parents impossible | Letters

David Mowat, a health minister, last week told a select committee that we need “to start thinking as a society about how we deal with the care of our own parents” (Care of elderly parents should be your responsibility, says minister, 31 January). He contrasted the approach with that of looking after children – “it is just what you do” – and argued that looking after our parents “is a similar responsibility in terms of our lifecycle”. The inference appeared to be that he does not believe that family carers are doing enough, despite him acknowledging that there are six million people in the country with caring responsibilities.


Such apparently muddled thinking is unhelpful, particularly when he went on to suggest that “part of the solution is properly bringing those informal carers into some kind of system”. Care happens within the context of a relationship, and trying to legislate for what that should look like is unnecessary and inappropriate. Mowat needs to understand the complexity and diversity of informal care – not everyone needing care has children, and the nature of modern life means that, even if they do, they aren’t always living in close proximity. Most care for older people actually comes from a spouse or partner, typically coping with their own advancing age and increasing ill health. Instead of arguing that society needs reminding of its responsibilities, and bringing such care into a “system”, Mowat should recognise that carers provide far more support than do health and social care services, and far from requiring a nudge to step up to their responsibilities, carers need proper recognition and support.
Dr Melanie Henwood
Hartwell, Northamptonshire


I invite David Mowat to bathe his mother when the time for care comes. Also to take her to the toilet and ensure her personal hygiene. Quite different from bathing a child and changing its nappy. On a minister’s salary, he may be able to pay for someone to do this, instead of denying his mother dignity and saving his own embarrassment. The reality is that it is mostly daughters who would do the caring, giving up their jobs, reducing their own pensions and facing such indignities. In this society, where family members are often long distances apart and women of all ages are expected to work, Mr Mowat’s suggestion lacks the kind of intelligent analysis one might expect from a health minister. It is not lack of love for our parents which has led to this situation, but an economy and a society which is very much changed since the 1950s, its extended families and lower life expectancy.
Moira Sykes
Manchester


After decades of being the Cinderella service of the welfare state, this year we can finally see social care beginning to rise to the top of the political agenda. From the British Red Cross to former ministers, it is now accepted that the system is in crisis and something must be done. The danger is that we repeat what’s happened in the past and set up yet another commission to tell us what we already know. As organisations whose members both deliver and receive care, we know that the public is way ahead of the politicians on this issue because they have experienced how the social care system has let their loved ones down: the flying 15-minute visits, the lack of training, low pay and high turnover of staff, the dubious financial structures of many large care providers and the withdrawal of help to some of our most vulnerable citizens have all been well documented.


Of course, at the heart of the crisis is the need for additional funding – but we need to put public money to the best possible use. Privatisation of care has mean that much of it is lost in debt financing and profit margins. New solutions and additional funding must mean better models of care and employment. In the fifth richest country in the world, we have to look not only at how we can share the cost of social care across society as a whole, but also how those services can be integrated into a publicly run health service. A new health and social care service, funded through effective taxation, is one obvious answer.
Dot Gibson General secretary, National Pensioners Convention, Heather Wakefield Head of local government, Unison


Could David Mowat explain how my wife and I, entering our 70s, could accommodate her mother, a 90-year-old Alzheimer’s sufferer with severe mobility problems, in our two-bedroom terraced house with space for one bathroom? My parents are recently deceased but it would have also been really useful to have had a government guide on how we might have accommodated my elderly mother – with dementia, incontinence and restricted mobility – in the same house or perhaps visited her daily from just under 300 miles away. Or cared for my father in his 90s who was attempting to care for his wife while dealing with his own failing kidneys, before his fatal fall.
Richard Hooper
Accrington


Care needs to be seen as a continuum and for some it may be impossible to remain at home; either their needs are too great or they make a positive choice to reside in another community. It is therefore essential that social care is put on an even footing with health care and funded accordingly.
Professor Martin Green
Chief executive, Care England


As an “ageing person” myself, the last thing I want in my declining years is to become an enforced, disruptive dependent, thrust into the busy lives of my offspring. The outstanding flaw in David Mowat’s analogy with caring for the kids we bring into the world, is that we voluntarily choose to bring them here, largely for our own gratification, and therefore we have an innate responsibility to them. Furthermore, civilisation does not survive without such care. Conversely, our children did not choose their own creation, or for us to be their parents, so therefore have no such automatic reciprocal obligation.
Alan Fowler
Newcastle upon Tyne


As a Labour councillor and former hedge fund trader I have some thoughts on Surrey’s proposed 15% rise in council tax. One of the problems with councils pleading poverty (Opinion, 21 January), is that so many of them, including Labour ones, took part in a Tory austerity scheme to freeze council tax bills. In 2010, George Osborne “bribed” hundreds of councils with “council tax freeze grants” – forcing them to replace percentage tax rises in line with inflation, with a commitment to freeze the cash level of tax. Haringey received around £8.5m in these payments from 2011 to 2015. But due to the compounding effects of money, once these ended (as they did in 2015), the effect of replacing proper, percentage, tax rises with one-off cash payments, meant the council tax base had fallen far behind inflation – and we were millions of pounds cumulatively worse off.


To illustrate, if Haringey council tax bills had simply kept up with RPI, they would be 20% higher today, or 15% higher once we knock out participation in Osborne’s final game, played with local authority finances, the “social care precept” (basically a council tax rise by another name)


. Likewise, Surrey wouldn’t be needing their referendum. And, of course, in all Osborne’s games the sums never really added up; proven by the £650bn in extra debt he left as his legacy of six years as the austerity chancellor – about as much as Labour added during 13 years in power (double the time frame). There is a lesson for Labour councils and politicians: when a Tory chancellor comes bearing “gifts” they’d be wise to recall Alex Ferguson’s infamous quote and “check under the sauce”. But sadly the Tories remain adept at duping both their rivals and the electorate about their supposed economic competence.
Cllr Patrick Berryman
Labour, Haringey


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Modern realities make caring for our aging parents impossible | Letters

29 Kasım 2016 Salı

Stop asking us to deliver the impossible, NHS trusts urge ministers

Ministers and NHS bosses are being urged to stop asking the health service to “deliver the impossible” of higher standards of care when it is being denied the money it needs to do its job properly.


The plea from the organisation that represents NHS trusts in England was accompanied by a blunt warning that care for patients is already deteriorating and that even a flu outbreak could “destabilise” some hospitals this winter.


NHS Providers, whose member trusts receive £65bn of the NHS’s £100bn annual budget, says the health secretary, Jeremy Hunt, and the NHS England chief executive, Simon Stevens, are making unrealistic demands of the service.


“The government has said there will be no more money. The government and our system leaders have said that the NHS still has to deliver everything that is currently being asked for,” Chris Hopson, the chief executive of NHS Providers, will say on Tuesday.


He will dismiss the idea that the NHS could hit its tough financial targets this year while also transforming how it delivers care, giving every patient high-quality care, meeting a host of waiting time targets, implementing the government’s “seven-day NHS” pledge and also improving patient safety.


Ministers and NHS bosses should scale back their expectations of what the NHS can do in all those areas given its parlous finances and the government’s refusal to boost its budget, Hopson argues.


Three-quarters (73%) of NHS trust bosses believe they do not have enough staff to function properly, according to a new NHS Providers report on the state of the NHS in England. More than half (55%) say they are worried or very worried by their organisation’s lack of staff. Many trust chairs and chief executives now say the difficulty in recruiting personnel is as onerous as balancing their books.


In a survey of 172 bosses from 136 of England’s 238 trusts, one said: “There are simply not enough high-quality clinical staff in the country to cover some specialities.” Another said: “Brexit has caused drying up of recruitment from the rest of Europe.” Widespread worry about the NHS’s workforce “concerns me more than the money”, said a third boss.


Just 10% are confident or very confident that they can maintain the level and quality of services they currently provide over the next six months because money is so tight. Nearly half (49%) expect their financial position to worsen over that time.


Hopson will tell his organisation’s annual conference that the government’s decision not to put more money into a cash-strapped NHS raises “four main risks. The first is that the service the NHS provides is now starting to deteriorate”, and that the deterioration will accelerate because of the “crisis” in social care services.


The NHS is also becoming less resilient, he will add. “When you run a system under as much pressure for as long as we have been running the NHS, it becomes much less able to absorb the shocks that any health system has to absorb – the winter flu outbreak [or] closure of a couple of care homes [or] a few experienced GPs retiring and being replaced by more risk-averse locums”.


In addition, Hopson will say, “pressure on staff and leaders becomes intolerable, which erodes morale”. Hopson is also worried that pressures are so great that “the invisible bond of mutual trust and faith between the government and NHS system leaders, on one hand, and frontline leaders, on the other, is starting to fray”.


NHS Providers’ warnings on staffing come as an audit of NHS stroke services in England, Wales and Northern Ireland found that patients who have suffered a stroke do not always receive optimum care because many units have too few nurses and doctors, especially at weekends.


Nearly half (49%) of stroke units do not have the recognised minimum number of nurses needed to ensure good care, according to the Sentinel Stroke National Audit Programme. At weekends as many as 80% of units do not have the three nurses per 10 beds that is recommended. In addition, 40% of units have at least one vacancy for a consultant and 28% do not provide consultant-led ward rounds every day of the week.


Staff shortages were a concern, the experts behind the audit said. A lack of nurses in stroke units has been shown to increase the risk of patients dying.


The Department of Health welcomed NHS Providers’ acknowledgement that trusts were treating record numbers of patients and also making good progress at reducing its collective deficit, which hit a record £2.45bn in 2015-16.



Stop asking us to deliver the impossible, NHS trusts urge ministers

3 Şubat 2014 Pazartesi

Psychological well being stigma: convincing my mates I was still "me" was nearly impossible

Out of the 5,000 people surveyed, it discovered 34 per cent said they come across discrimination on a weekly or monthly basis, and one particular in 10 explained they encounter it each day. But the strangest reality was that 53 per cent of girls encounter discrimination from their household and close friends, compared to 39 per cent of men.


Sue Baker, director of Time to Change, whose campaign is operating alongside Deputy Prime Minister Nick Clegg’s new action program for psychological well being, says: “It could be a single or two factors. Either, if ladies communicate out a lot more about psychological illness, they are probably to report stigma a lot more, but there is also the situation that women are often necessary to be strong for the total family members.”


In my situation, my family members have been very supportive. But, I did notice that out of my pals who handled me differently, it was usually the boys who did so. In retrospect, I feel it wasn’t the mental sickness itself that bothered them, but the meaning they attached to it. They believed I would no longer be the confident, entertaining, talkative person they knew, but instead would become weak and needy.


It was hurtful at the time, but now I know that guys view psychological well being difficulties differently to women. Studies display that men are significantly less comfortable speaking about mental overall health, and the Time to Change report exhibits that while guys do encounter much less of a stigma, in reality 55 per cent men encounter discrimination at work, in contrast to 50 per cent of females.


The final results are hardly surprising. Offices are usually macho environments exactly where men are discouraged from mentioning their emotions let alone a psychological sickness. When banking executives like Lloyds’ Antonio Horta-Osorio and Barclays’ Sir Hector Sants admitted they have been suffering from significant stress final yr, they assisted to break the taboo that many males (and girls) face at operate when it comes to mental overall health.


Baker says men could face discrimination much more because of cultural gender divides. She says: “One of our male situation scientific studies inform us, you are brought up with the knowing that males really do not cry. Pull oneself with each other, is all individuals of a specified generation have heard. Males uncover it hard to talk about psychological wellness in the workplace, but we do know each genders encounter stigma and discrimination.”


The standard stigma looks to come from a misunderstanding about what defines a psychological sickness. Numerous individuals do not know that pressure, depression and nervousness are all varieties of mental illnesses. Depression in certain can be witnessed as ‘just sadness’, but really it is a severe dilemma and impacts women twice as much as men, in accordance to a 2011 European research. In middle-aged girls, depression levels have doubled in the last forty years due to pressures of balancing work and youngsters.


Mental wellness nonetheless carries a large stigma, even with celebrities like Stephen Fry and Ruby Wax speaking publicly about their depression. But the only way the stigma and discrimination will stop is if far more people communicate up about psychological overall health, and discover precisely what it consists of.


I was lucky that the men and women I cared about stood by me while I struggled with my problem, but not absolutely everyone has that degree of assistance. I can only hope that campaigns like Time to Alter, and the government’s new plans, will open people’s eyes up to what psychological illness actually is so they can speak openly to buddies, loved ones and even colleagues without fear of discrimination.


Time to Change is calling for the public to aid lift the taboo about psychological health on Thursday 6 February when they will hold the 1st Time to Speak Day



Psychological well being stigma: convincing my mates I was still "me" was nearly impossible