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    Material designed to be practically useful in campaigns. More contributions very welcome!

    This is NHS Check report no 3 originally published by Labour’s Shadow Health Team in  October 2012

    The Government’s Health and Social Care Act 2012 legislated for a market in the NHS.  In this report, Labour can reveal new evidence of accelerating privatisation across all areas of the NHS:

    Community services

    • This week, contracts for 396 services across England (including diagnostic tests, podiatry and adult hearing) worth over a quarter of a billion pounds begin to be signed in the biggest act of privatisation ever seen in the NHS
    • Government ordered services to be put out – even though local commissioners had no plans
    • A further 39 services will be forced out in a major expansion of Any Qualified Provider tendering in community services
    • Details withheld from public scrutiny under “commercial confidentiality” exposed through Freedom of Information requests Continue reading »
    Tagged | Comments Off on Cameron’s Great Nhs Carve-Up

    Thanks to Radiance Health for this useful graphic.  It’s focussed on South London, but the principles are of wider application, and there are many areas with similar problems.

    It shows that

    • there is no NHS deficit. The NHS saved £3bn last year. The NHS is in surplus – and the money was given to the Treasury. There is a strong argument for saying that all surpluses should be ploughed back into the NHS, not given up.

    The NHS should not be paying for procedures of little value.  We are committed to evidence based medicine. However, the Labour Party showed that PCTs are stopping procedures of good clinical value (such as bariatric surgery and cataracts).  There will always be rationing of medical treament. But it needs to be done rationally and accountably. Continue reading »

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    The Socialist Health Association is concerned with promoting health and well-being through policy development and campaigns. Admittedly a bit of a mouthful. Many of the issues we tackle are abstract – inequality in health, mental wellbeing, democracy, public participation and engagement, marketisation and privatisation (this isn’t a comprehensive list – there are more to be found on our website ).
    Which is why we are keen to build a catalogue of visuals highlighting the impact and context of these issues.

    Public Need before Private Greed

    We are keen to improve our visual material to help enliven our website and to dramatise our campaigning activities. We want to engage and excite and encourage the politically curious to take a more active part in shaping the future of how health care is organised and delivered in the UK.  This could be photographs, graphics, video, diagrams, or cartoons.
    We are interested in material which illustrates both the good and bad: ways people have tackled these problems in the past; ways they are tackling it now; illustrations of their impact on people like you and me.
    We are also interested in more indepth visual analysis of how these problem arise and what they mean.  There is a lot of visual material produced by speakers at our conferences on our Slideshare site.   Some of that could be used. There are opportunities to work with our academics and clinicians.
    The visuals would be used on our website and by like minded politicians and organisations for campaigning purposes. We are the leading think tank when it comes to health care in a socially responsible setting and feel that now that it is clear that the NHS and Health Care Services will be one of the central themes of the upcoming elections we have an opportunity and duty to raise our profile and encourage the public debate by offering visually powerful material as a basis for discussion and debate. We want to support local campaigners, primarily in the Labour Party, who will be producing leaflets for door-to-door distribution and want something visual but easy to reproduce.We can pay although probably not commercial rates.  But we have a huge mailing list and work with prominent groups and individuals in Parliament and Academics so we could offer wide exposure for the material.
    Some examples of treatments we thing work:
    We would appreciate if you could e-mail us with proposals
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    The Health Service Journal organised a poll of 2000 voters across England in June.

    They found that 70% of those questioned agreed that the principle of healthcare free at the time of delivery was under threat.  Of course no politician has actually proposed such a thing, but the idea is repeatedly raised by people within the NHS. And a large majority agreed with the statement that “The NHS is under threat from private healthcare companies”.  But half of them agreed that “If care is free it doesn’t matter if it’s publicly or privately run”, so it’s not very clear exactly how they though the NHS was threatened.  But 97% believed the NHS was worth fighting for, and 92% that it was integral to maintaining social equality.

    It was closure of Accident and Emergency departments which most worried people 75%, while only 50% were worried about the possibility of introducing some charges and around 55% worrying about restrictions on medication or treatment.  The idea of moving services out of hospitals into the community was popular. 79% of young people were enthusiastic using smartphones to monitor their health. Older people, unsurprisingly, were less enthusiastic.  Younger people, though showing lower levels of support for the basic principles of the NHS, said they were more likely to change their vote based on NHS policy. This might be because they were generally more likely to change their vote than older people.

    NHS Polling

    90% agreed that NHS funding should rise as the economy improves. As usual most people felt the Labour Party understood the NHS and most thought the Conservative Party threatened it, but this advantage was much less when asked about running the service efficiently.  HSJ plans to repeat its survey quarterly until the General Election.

    Two weeks ago Ipsos MORI did a survey for the British Medical Association of 1970 people across Great Britain. The BMA were no doubt pleased to find  66% are in favour of doctors having a greater say in how the NHS is run, and that 73% believe policies about the NHS from political parties are designed to win votes, not to do what is best for the NHS. They might have been disappointed to find that only 21% wanted to see less involvement by NHS managers in running the NHS.  However 64% agreed that “The NHS should manage itself, without the involvement of politicians, as it understands how best to provide healthcare.”

    56% were satisfied with the running of the NHS.

    Ipsos MORI Social Research Institute did a  Tracker Survey of Public Perceptions of the NHS for the Department of Health between Spring 2000 and Spring 2012. They seem to have abandoned it now, perhaps because they found a fall in agreement that “the government has the right policies for the NHS since December 2009 (from 28% to 22%)  continuing a steady decline since 37% was recorded in December 2009. 45% then disagreed that the government had the right policies.

    There was a marked North/South gradient in responses to the question “Overall, how satisfied or dissatisfied are you with the running of the National Health Service nowadays?” 72% were satisfied in the North East, but only 61% in the South East.  There were similar gradients in social class.  72% of those in social classes D and E were satisfied compared to 64% of those in social classes A and B.  But the most significant feature was the marked reduction in satisfaction among those who were not actually users of the service – presumably because of the bad publicity generated by the campaign against the Health and Social Care Act.

    NHS Satisfaction 2003-12 59% thought the reforms would make services worse for patients. 70% blaming both closures and privatisation.

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    I went  to see an interesting play, This May Hurt a Bit, about the NHS in Bolton three weeks ago and thoroughly enjoyed it.  It is mostly about the politics of the NHS in England. I especially enjoyed the appearances of Nye Bevan, Winston Churchill and the Grim Reaper.  It’s on at the St James Theatre in London from 14 May – 21 June 2014

    The producers, Out of Joint,  have kindly sent me a copy of the script.  There are 26 characters.  They produce it with a cast of 8, doubling up.  The set isn’t complicated.  It would be perfectly possible for amateurs to produce.

    The play starts with Nye Bevan’s speech on the appointed day and moves quickly forward to 2011 where David Cameron is looking through the Health and Social Care Bill, which he confesses not to have read, and being briefed by Sir Humphrey.  From there we go to hospital where a surgeon is examining Nicholas’s prostrate gland, and then to outpatients.  The hospital is clearly struggling and Cassandra, a woman all too reminiscent of many NHS campaigners I have met, bursts out of the audience talking about the trade treaty which will enable US companies to take over our public services.

    In the next scene a 65 year old confused lady turns out to be the NHS, hooked up to a life support machine, who explains the difficult relationships she has had with a series of Prime Ministers.

    Stephanie Cole

    Stephanie Cole

    Nicholas’s sister turns out to be married to an American surgeon, called Hank, who is an advocate of commercial medicine, but his mother Iris  (played by the wonderful Stephanie Cole) is a powerful, if surprisingly foul mouthed, advocate for the NHS.  The family dinner party is interrupted from the audience by the interventions of Winston Churchill, and Bevan.  Their political argument is then interrupted by a lesson on the Private Finance Initiative.

    Subsequently Iris has a fall which causes her to lose her memory and believe herself to be in the 1970s. Transient Global Amnesia, it’s described as, which to my surprise is a genuine diagnosis. The visiting paramedics have more words of political wisdom about the futility of changing structures.  So does the lady from the weather centre, who tells us about hospital closures.  The hospital ward is pretty chaotic. So is the Board of Directors.  But Iris continues to defend the NHS against Hank, who wants to send her to a private hospital.

    Tagged | Comments Off on This May Hurt a Bit

    It was back in 2004, that the then Conservative shadow chancellor, Oliver Letwin, astonished his audience (of businessmen in Dorset) was reported as saying that within five years of a Conservative election victory “the NHS will not exist anymore.   Well look what happened – they’ve only been back in for 4 years and the NHS is already on its knees.  He may not have got the timescale quite right, but if the Tories get back in next year, the NHS that we have known for 65 years – the envy of the world, the greatest British achievement of the post war years, will disappear into a morass of private insurance, multinational run, cash rationed, postcode lottery chaos. 

    NHS for people not for profit

    The documentary film, One Thousand Thank Yous, shows what can happen though, if local groups fight back.  We don’t have to take it!  Please pledge.

    1 Comment

    The new “Workers’ Party” Anthem

     The people’s flag is deepest blue

    We’ll take your rights away from you

    Your pay is getting less and less

    And we’re selling off the NHS


    We say there’s an economic boom

    Then tax you for your extra room

    We’ve torn up Health & Safety rules

    And Gove is meddling with your schools


    We’ve made you easier to sack

    You’ll never get your old job back

    And when we’ve got you on your knees

    You can’t afford Tribunal fees


    We’ll destroy the workers’ powers

    So here’s a job on zero hours

    The only “workers” we’ll defend

    Are all our wealthy Banker friends

    1 Comment

    This is  Labour Party  NHS Check 9  originally published by Labour’s Shadow Health Team in 2013

    Cameron’s NHS: Hospitals ‘full to bursting’

    REVEALED: Hospitals across England too full and patient care put at risk

    Official NHS figures for winter 2012/13 show that:

    • Every hospital trust in England operated above recommended safe occupancy levels on a least one day last winter.
    • Almost four in five hospitals filled all standard beds at one point over the winter
    • Half of hospitals filled all standard and extra beds on at least one day – not a single bed available to new patients.

    Hospitals have standard ‘core’ beds and use additional ‘escalation’ beds according to demand. During the winter months the Department of Health publishes data on 159 hospital trusts, in Weekly Situation Reports, on bed occupancy levels.
    All 159 hospital trusts operated above the recommended safe 85% occupancy at least once over winter. The ‘Dr Foster’ NHS performance watchdog, half Government-owned, warned that above this level quality of care can deteriorate.

    The Dr Foster Hospital Guide 2012 said:
    “When occupancy rates rise above 85% it can start to affect the quality of care provided to patients and the orderly running of the hospital.”2
    In addition:

    • More than half of hospital trusts (86) operated at an average rate of over 95% occupancy
    • 78 trusts have experienced at least one day where there were no beds available at all
    • 27 trusts experienced 10 or more days with no standard or core beds available

    Crisis in England’s A&Es

    The NHS faced the worst winter in nearly a decade. At every stage of a patient’s journey, waiting times are getting longer. Patients have to wait longer for an ambulance to arrive; patients have to wait longer in ambulances, outside A&Es; patients have to wait longer in A&E before being treated; patients have to wait longer on trolleys before being admitted.

    The number of patients waiting longer than four hours in A&E is almost three times higher than in Labour’s last year in office and an extra 161,890 patients waited for more than 4 hours in the last 6 months, compared with the same period last year.

    Casualty waitsThere are increasing reports of long waits in A&E departments, with some patients waiting more than 12 hours to be admitted.
    “Waiting times are routinely reaching 12 hours in parts of the country, while “queue nurses” have been appointed in others to watch over patients brought in by ambulance until doctors become available.
    Official figures submitted by NHS trusts to the Department of Health show that 27,247 patients spent longer than four hours in an emergency department in the week ending March 17, compared with 13,200 in the same week last year.
    Telegraph, 24 April 2013

    Earlier this month the Norfolk and Norwich University Hospital set up a major incident tent outside its A&E as ambulances queued up outside
    “A major incident tent had to be set up outside a Norfolk hospital because ambulances were left to queue outside the A&E department for hours. The mobile treatment area was set up at the Norfolk and Norwich University Hospital after 15 ambulances had to queue up on Monday. The East of England Ambulance Service said each vehicle had to wait for up to three hours to hand over patients. The hospital said demand at the A&E department had been high.
    BBC News, 2 April 2013

    Low staffing levels

    According to the Care Quality Commission, more than 1 in 10 hospitals are operating below safe staffing levels:
    “CQC also saw some improvement in staffing levels. However, this was from a low base and the providers still have some way to go. Hospital services met the standard in 89% of inspections.
    Care Quality Commission, Care Update Issue 2, March 2013, p. 17

    Comments Off on Bed Occupancy: Trusts Operating at Dangerous Levels

    This is  Labour Party  NHS Check 5 originally published by Labour’s Shadow Health Team in December 2012


    •The government has broken its promise to protect funding for cancer networks and heart and stroke networks – vital groups of clinicians and other experts that drive improvements in patient care.

    •Cancer networks say their budgets have been cut by a quarter, and their staff by a fifth since 2009/10. Heart and stroke networks say their budgets have been cut by 12% and their staff by 16%.

    Funding for both types of networks has fallen year on year under the government, and is now 21% lower than when labour left office.

    These cuts mean vital work to improve patient care for cancer and cardiac disease – Britain’s biggest killers –‐ is being scaled back or dropped altogether.

    The government’s NHS reorganisation has caused huge uncertainty and confusion about the future of clinical networks, and risks losing vital local specialist expertise


    • A Freedom of Information survey by Labour reveals severe cuts to budgets and staff in cancer, stroke and heart disease networks, despite repeated reassurances from the Government that funding for clinical networks has been protected.

    • Labour received responses from 86% of all Cancer Networks and 82% of Cardiac Networks in England.

    Cuts to budgets:

    • Responses from Cancer Networks show that their funding has been cut by 26% between 2009/10 and 2012/13. • Stroke and Heart (Cardiac) Network budgets have been cut by 12% in the same period.

    Fall in the budgets of Cancer and Cardiac Networks in England (in millions of pounds):

    Fall in the budgets of Cancer and Cardiac Networks in England (in millions of pounds)

    Cuts to staffing levels:

    • Cancer Networks have lost at least 72 members of staff,  20% of their workforce , since 2009/10

    • Cardiac Networks have lost at least 38 members of staff, 16% of their workforce, since 2009/10

    Fall in the number of staff employed by Cancer and Cardiac Networks in England:

    Fall in the number of staff employed by Cancer and Cardiac Networks in England

    Cuts, chaos and confusion

    Funding cuts combined with the Government’s massive NHS reorganisation have caused huge uncertainty and confusion about the future of clinical networks.

    Cancer and Heart and Stroke Networks were supported by regional Strategic Health Authorities. They received funding from  a number of sources including both core and specific project funding from the Department of Health, funding from Strategic Health Authorities and Primary Care Trusts (PCTs), and charities like Macmillan Cancer Support.
    Strategic Health Authorities and PCTs were abolished under the Health and Social Care Act 2012. Networks will now be hosted centrally by the new NHS Commissioning Board. Cancer and Cardiac Networks are being merged to cover larger geographical areas and with networks for other medical conditions.
    Networks say they are unclear both about their own future and how the new structures will work. This lack of clarity has had a considerable impact on their work:
    • Uncertainty as to what will happen after March 2013 has resulted in Networks reducing the number of existing and future projects and initiatives.
    • Many have not replaced leaving members of staff due to their unsure future.
    • Networks are very concerned that they will have fewer staff to cover wider geographical areas, reducing the effectiveness of their work and risking the loss of vital local specialist expertise.
    • At least one network was forced to decline additional grants from charities as this would have required them to make commitments into 2013/14, which they were not in a position to make.


    ‘The cancer networks funding is guaranteed during the course of 2011-­‐12. There is not a gap, because from April 2012 onwards the NHS commissioning board will take up its responsibilities.’

    Andrew Lansley, then Secretary of State  for Health, Second Reading of the Health and Social Care Bill, 31st January 2011
    ‘Cancer networks are here to stay and their budget  has been protected. They are extremely important’

    Jeremy Hunt, Secretary of State for Health, Health Questions, 27th November 2012.

    The budget through which the clinical networks are funded is increasing (… ) those clinical networks are extremely important and will continue.’

    Jeremy Hunt, Secretary of State for Health, debate on the NHS Commissioning Board Mandate, 13th November 2012.

    Labour has repeatedly warned about reductions to clinical networks and how such cuts might harm the crucial work that these networks do:

    Liz Kendall: “Funding [for clinical networks] is crucial. In response to a parliamentary question on 21 May this year, the Minister stated that strategic health authorities will be given £18.5 million to fund cancer networks in 2012-­‐13, just as in the previous two years.  Page 6 of the recent document from the Department of Health, “Progress Update on the Design of the NHSCB” states: “Around £10 million of the costs of supporting Networks and Senates are expected to count against running costs.” (…) Will the Minister say whether the £10 million referred to in the document about the future functioning of the NHS Commissioning Board covers all networks, or cancer networks alone? That is a real concern for people who work in cancer networks and are already worried about the future.”

    Paul Burstow MP: “(…) On funding cancer networks, my right hon. Friend the Secretary of State has made the position clear. We have provided funding for the remaining year for which the Department is responsible. Indicative figures have been set out. A review is going on of clinical networks and how they are governed. That will ultimately determine precisely how much resource is allocated. There is no final figure at this stage.
    Westminster Hall debate on cancer treatments, 19th June 2012

    Liz Kendall: “Cancer networks have played a crucial role in improving patient care, including by earlier diagnosis. The former Health Secretary promised this House that their funding would be guaranteed in 2011, but the South East London Cancer Network now says its budget was cut by 40% between 2009 and 2011. This year, it has been slashed by a further 55% and its staff have been cut from 15 to eight. Will the Minister now admit that her Government have cut funding for vital front-­‐line cancer experts and have broken their explicit promises on cancer care?”

    Anna Soubry: ” My information is that any 40% reduction is a result of cuts in administration—and that, if I may say so, seems the right way to go about things. This Government are determined to make sure that when we make cuts of that nature, they are not actually cuts.”
    Health Questions, 23rd October 2012

    Liz Kendall: “The reality is that the Government are ripping away the foundations of better cancer care. The former Health Secretary made a clear promise from the Dispatch Box to protect cancer network funding, but the NHS South East London and Greater Midlands cancer networks both say that their budgets and staff have been slashed. The NHS medical director, Sir Bruce Keogh, says that cancer networks are an NHS success story, and Macmillan Cancer Support says it is nonsensical to cut their specialist expertise. Why do the Government not agree?”

    Jeremy Hunt: “Cancer networks are here to stay and their budget has been protected.”

    Health Questions, 27th November 2012

    NETWORKS REPORT ‐ Impact of budget cuts

    ‘A network chemotherapy nurse post was not replaced due to the future uncertainty of the networks.’
    Arden Cancer Network

    ‘We lost our stroke education and training lead and as a result have not run the enormous number of training sessions covering care homes, enablement, community and acute trust rehabilitation service that we have previously organised, supported and delivered.’
    Bedfordshire and Hertfordshire Heart and Stroke Network

    ‘From  April 2013 budgets and staffing will be cut further and this will mean that we will be able to achieve less than we have previously.’
    Merseyside and Cheshire Heart and Stroke Network

    ‘There has been reduced clinical training in the Stroke work stream …. the lower funding has meant a reduction in the number  of work streams that are priorities. In addition we were asked to cover two additional work streams – complex vascular surgery and interventional radiology’
    North East London Cardiac and Stroke Network

    ‘In the new structures the network will be unable to provide the wide range of training and educational programmes we offered in previous years and our ability to continue to offer this support in terms of training/education and service improvement support will be greatly reduced in 2013/14.’
    Greater Manchester Heart and Stroke Network

    ‘(…) we have had to decline the offer of £150,000 from Macmillan to support a Survivorship programme as this would have required commitments into 2013/14, which we were not in a position to make. Other support has stopped due to the transition of the NHS.’
    Peninsula Cancer Network.

    ‘…. a reduction is anticipated in 2013/14 in the following functions: training and education; patient and public involvement; Information support; service improvement’
    North of England Cardiovascular Network

    ‘….posts have been removed from the structure as a result of requirements to make savings.. The new structure does not have enough posts for current staff. We are all in a redeployment pool. We have been told that we should know by the 31st December as to whether or not we have a post from 31st March. With no presence in Essex from 1.4.13 for the network current skill set from current staff will be lost.’

    Essex Cancer Network

    ‘Please also note that central project funding in previous years for stroke enabled us to support more projects than we are currently able to.’
    South London Heart and Stroke Network

    ‘This smaller team will also be expected to cover a much larger foot print to include Lancashire and South Cumbria.’
    Greater Manchester Heart and Stroke Network

    ‘….we clearly have rather less capacity overall for all our areas of work.’
    Coventry and Warwickshire Cancer Network

    NETWORKS REPORT -­‐ Uncertainty about future

    ‘Uncertainty and transition has resulted in Network reducing the number of new projects and initiatives reducing the size in line with available support.’
    South East London Cancer network

    ‘….a great many [staff] have left and I have not replaced them for financial reasons and also because of uncertainty.’
    South West London Cancer Network

    ‘….some Network staff may ultimately be made redundant as a result of transition to new organisational structures. Details cannot be confirmed at this stage’
    Central South Coast Cancer  Network

    ‘No there will be no Essex Cardiac and Stroke Network. Networks will sit within a senate. There will be a very small support team for senates and networks under the East Anglia Local Area Team, covering the whole of the East of England and more areas. Numbers of staff are not yet clear…. Working locally with stakeholders has been key to the networks success. There is no clear direction on who will undertake the Networks work forward within Essex when it ceases at the end of March 2013.’
    Essex Cardiac and Stroke Network

    ‘The exact operational format has not yet been released to us, but it will not be as it is now’
    Surrey Heart and Stroke Network

    ‘The process for transferring the functions of the Network (including work responsibilities and staff) has yet to be determined.’
    South London Heart and Stroke Network

    “It is unclear at this point whether or not there will be an outpost in the Beds, Herts and Milton Keynes region anywhere.‘
    Bedfordshire and Hertfordshire Heart and Stroke Network

    ‘The exact format of these new structures is being developed at present, and the final architecture is due to be released in the coming weeks.’
    Black Country Cardiovascular Network

    ‘Details of new structures and supporting arrangements have yet to be finalised.’
    Coventry and Warwickshire Cardiovascular Network

    ‘Cardiac and stroke will be incorporated in the Cardiovascular Disease Strategic Clinical Network which will also incorporate diabetes and  some renal. The design of the Strategic Clinical Network is still in development and it has yet to be established if there will be a local office base within the Peninsula.’
    Peninsula Heart and Stroke Network

    ‘…. The final format is still to be confirmed for the area….’
    Sussex Heart Network

    ‘The details of how this is to be organised and what arrangements will be put in place underneath this  [The Clinical Network] specifically for West Yorkshire are currently under discussion’
    West Yorkshire Cardiovascular Network

    ‘There are indications that there may be a support team based on the current LSCCN footprint which could continue some of the current cancer work streams – although there is a lack of clarity regarding what these might be.’
    Lancashire and South Cumbria Cancer Network

    ‘Detailed arrangements for the future of the Yorkshire Cancer Network in the financial year 2013/14 remain unclear.’
    Yorkshire Cancer Network


    • Clinical Networks are teams of experts who help GPs and hospitals to deliver the best outcomes for cancer, heart disease and stroke patients.
    • The previous Labour Government established Cancer Networks in the 2000 Cancer Plan and Cardiac Networks in the 2007 National Stroke Strategy to drive up the quality of clinical services delivered to cancer and stroke patients and improve patients’ experience of care.
    • Clinical Networks employ both clinical specialists (doctors and nurses) and project managers to put in place a range of programmes to improve cancer and cardiac care.
    • Networks have played a vital role in reducing waiting times, such as the crucial maximum 2-­‐week wait between a referral and first appointment at hospital for suspected cancer. For example one cancer network worked to reduce chest x-­‐ray waiting times from an average of 15 to just 3 days
    • Networks help avoid unnecessary emergency admissions, reduce the length of time patients need to stay in hospitals, and speed up patients’
    recovery for example by informing the patient of the correct dietary requirements or giving them information and exercises to perform after leaving hospital.
    • Networks provide information and support to patients on how to deal with their disease during and after their treatment, for example through organising cancer survivor networks. They also work with NHS staff to deliver specialist training and educational programmes, for example on increasing awareness of symptoms to improve early diagnosis, on the best new drugs and treatments, and on how to manage the side effects of cancer treatment and support patients’ recovery.
    • Networks also do important work on prevention, for example Cancer Networks have worked to increase breast cancer screening uptake, whilst  heart and stroke networks have worked to identify those at high risk of heart disease in local communities.


    Cancer, heart disease and strokes are Britain’s biggest killers, accounting for over 300,000 deaths each year – 6 in 10 of all deaths in the UK. Under the last Labour Government significant improvements were made in the treatment of heart, stroke and cancer patients. Mortality as a result of stroke and heart disease fell by over 50%, and cancer by 16%,  during the 13 years Labour was in government. (House of Commons calculations based on NHS Information Centre Indicator Portal data, December 2012).  Five year survival rates for nearly all types of cancer improved.

    The incidence of stroke fell by 29% between 1999 and 2008 and survivors’ chances of recovering without having a major disability increased.

    Local clinical leadership, including from Cancer and Heart and Stroke Networks, has played a vital role in making these improvements. Their work is crucial to making further progress patients need in the years ahead.

    Clinical networks, both formal and informal, are an NHS success story… For more than 10  years’ we have seen improvements brought about by networks. Combining the experience of clinicians, the input of patients and the organisational vision of NHS staff, they have supported and improved the way we deliver care in distinct areas by enhancing integration across primary, secondary and often tertiary care.
    Sir Bruce Keogh, the NHS Medical Director, 9th Aug 2012

    “I value very highly the important work currently being done by cancer and cardiovascular networks which enable doctors and nurses to share insight and advice for patient treatment”
    Prof Mike Richards, the government’s former cancer tsar who is now the NHS Commissioning Board’s director for reducing premature mortality, 16th Oct 2012

    “Heart and stroke networks do very important work. They have made a huge contribution to the NHS. (…) I’m very concerned about the current plans. It would be a tragedy if we started losing things we have  already gained.”
    Prof Tony Rudd, the NHS’s stroke director for London, 4th Oct 201213

    “Cancer networks provide a valuable service to patients. Their expertise provides support where necessary. This allows clinicians to spend more of their time on what is most important – their patient. It is essential that this expertise is retained within the NHS, yet we risk losing it.”
    John Baron MP, chair of the All-­‐Party Parliamentary Group on Cancer, 4th Oct 201214

    ‘Cancer networks have played a central role in driving up the quality of cancer services and ensuring that patients get the care that  they deserve’
    Mike Hobday, Director of Policy and Research at Macmillan Cancer Support, 26th Jul 2012

    ‘The opportunity to improve outcomes for cancer patients is clear, and cancer networks, established as strategic clinical networks, can and should play a significant role in helping to achieve the Government’s ambition of saving 5,000 lives every year. However, there is a danger that the progress that has  been made in improving cancer outcomes and mortality in recent years could be threatened by the uncertainty in the structures of the new NHS.’
    Cancer Campaigning Group, “Developing excellence in cancer networks”, February 2012


    Cameron’s hidden dementia taxes hit vulnerable hardest


    • Older and disabled people will pay an average of £655 more for home help this year compared to four years ago
    • Dial-a-ride transport services double in price over same period
    • ‘Meals on wheels’ cost 65p more – older people paying an extra £235 per year

    Government cuts to local authority care budgets have left the most vulnerable people in society paying spiralling charges for their own care.

    A Labour survey of council social care departments reveals the care charges older and disabled people will pay this year.
    Government cuts to local authority budgets, which pay for social care, have left councils no choice but to increase the costs billed to individuals and families. These support services include home help – that help people get up, washed and dressed – alongside ‘meals on wheels’ and dial-a-ride transport services.

    Last week, an independent survey of social care finances by the Association of Directors of Adult Social Services (ADASS) revealed that Government cuts to councils will mean a further £800m taken from care budgets in the next year – totalling £2.68 billion so far under the current Government.

    More than a third of local authorities supplied information to the Labour survey – 64 out of 150 responsible councils.
    Labour’s findings show the average charges for an hour of home care increased by 10.6% between 2009/10 and 2013/14 – from £11.87 to £13.13.

    An average care user – defined by experts as an individual receiving 10 hours of care each week (The Personal Social Services Research Unit’s report ‘Unit Costs of Health and Social Care 2010’) – will pay £655 more this year compared to four years ago (from £6,172 in 2009/10 to £6,827 in 2013/14).

    The cost of council-run ‘Ring and Ride’ and other transport services, to assist people with reduced mobility to travel to day centres and medical appointments, has more than doubled in 4 years – from an average of £1.98 to £4.12 per ride.
    Additionally, the average price of a ‘meal on wheels’ has increased from £3.01 in 2009/10 to £3.66 in 2013/14. An extra 65p per meal will add £237 over a year – on the basis of one council-provided meal per day – taking the 2009/10 average annual total of £1095 to £1332 in 2013/14.

    Growing ‘postcode lottery’ in care

    The survey findings show considerable variation in the price of home care, meals and transport services between different councils.

    Whilst responsibility for such huge cuts to care services lies squarely with central Government, it is noticeable that older and disabled people in Conservative areas pay more for each of these on average than friends and family in Labour-controlled areas.

    Home care:

    An hour of home help costs £20 in Brighton and Hove, whilst Tower Hamlets in London offers it for free.

    Older and disabled people receiving services from Conservative councils pay on average £15 per week, or £780 per year, more than neighbours in Labour-controlled areas (based on Conservative councils charging £1.50 per hour more and people receiving an average of 10 hours care per week).


    Several councils provide free transport services to people with reduced mobility, whilst Warwickshire charge as much as £12 per ride. Conservative-run Warwickshire has increased its fare by almost £11 in last four years, now charging three times the national average.

    Conservative councils charge £5 on average, £2.10 more than in Labour-controlled areas.


    The most expensive council charges close to three times more for a meal than the cheapest – £5.99 in Richmond compared to £2.30 in Warrington.
    A meal in a Conservative area costs 45p more on average than in a Labour-controlled area – adding up to an extra £160 a year on the basis of one meal per day.

    Meals services:

    Cost of a meal in £

    Authority Control 2009/10 2010/11 2011/12 2012/13 2013/14
    East Riding of Yorkshire Council Con 3 3.1 3.2 3.35 Service not provided
    Bournemouth Borough Council Con 4 4.1 4.1 4.1 Service not provided
    London Borough of Bromley Con 3.1 3.2 3.3 n/a Service not provided
    Cheshire West and Chester Con 3.03 3.1 3.18 3.26 Service not provided
    Milton Keynes Council Con 4 4.2 4.98 5.19 5.19
    Isle of Wight Council Con 3 3.1 n/a n/a 5
    Dorset County Council Con 4.1 4.1 4.1 4.2 4.5
    Herefordshire Council Con 4.4
    West Sussex County Council Con 3.3 3.4 3.7 4 4.1
    Lancashire County Council Con 3.25 3.25 4.05 4.05 4.05
    Essex County Council Con 3.5 3.5 3.5 3.95 3.95
    Buckinghamshire County Council Con 3.45 3.5 3.6 3.8 3.9
    Spelthorne Borough Council Con 3.3 3.5 3.6 3.7 3.8
    Kent County Council Con 3.3 3.4 3.5 3.65 3.75
    Surrey Heath Borough Con 2.95 3.5 3.6 3.6 3.6
    Waverley Con 3.3 3.4 3.5 3.6 3.6
    Gloucestershire County Council Con 2.5 3 3.5 3.5 3.5
    Hampshire County Council Con 3.1 3.2 3.3 3.4 3.5
    East Sussex County Council Con 3.3 3.3 3.35 3.35 3.4
    Woking Con 3.3 3.3 3.3 3.3 3.4
    Norfolk County Council Con 3.18 3.24 3.3 3.3 3.37
    Lincolnshire County Council Con n/a 2.7 2.79 2.79 2.85
    North Yorkshire County Council Con 1.9 2.1 2.2 2.25 2.3
    Kensington and Chelsea Con 3.2 3.2 3.3 3.4 3.55
    Richmond Con 3.1 3.15 3.3 3.4 5.99
    St Helens Metropolitan Borough Council Lab 3.08 3.16 3.24 3.32 Service not provided
    Doncaster Metropolitan Borough Council Lab 2.3 2.4 2.5 3 Service not provided
    Birmingham City Council Lab 2.7 3.2 3.9 4.1 Service not provided
    Barnsley Metropolitan Borough Council Lab N/A N/A N/A N/A N/A
    City of York Council Lab 2.45 2.5 2.5 2.5 n/a
    Wigan Metropolitan Borough Council Lab 2.8 2.95 3.2 3.85 4.2
    Wolverhampton Council Lab 2.4 3.4 3.4 3.95 4.15
    Bury Metropolitan Borough Council Lab 3.4 3.5 3.7 3.7 3.9
    Hartlepool Borough Council Lab 3.6 3.65 3.65 3.65 3.65
    London Borough of Enfield Lab 3.4 3.47 3.5 3.5 3.5
    London Borough of Brent Lab 3.5 3.5 3.5 3.5 3.5
    Plymouth City Council Lab 2.65 2.65 3 3 3.5
    London Borough of Haringey Lab 3 3.2 3.2 3.3 3.4
    City of Wakefield Metropolitan District Council Lab 3.1 3.2 3.2 3.3 3.3
    Derby City Council Lab 3 3 3.1 3.1 3.2
    Halton Borough Council Lab 2.82 2.88 2.94 3.1 3.2
    Blackburn with Darwen Borough Council Lab 2.97 2.97 2.97 2.97 2.97
    Tameside Metropolitan Borough Council Lab 1.99 2.05 2.6 2.68 2.78
    Metropolitan Borough of Wirral Lab 2.6 2.6 2.6 2.68 2.68
    Stoke-on-Trent City Council Lab 2.4 2.4 2.4 2.5 2.6
    Kingston-Upon-Hull City Council Lab 1.95 2 2.1 2.15 2.55
    Warrington Borough Council Lab 2.15 2.2 2.24 2.27 2.3
    Gateshead Lab 2.4 2.6 3 3.15 3.2
    Islington Lab 3 3 3 3 No extra cost
    Newham Lab 2.2 2.2 2.2 5.35 Service not provided
    Darlington Lab 3.6 3.65 3.65 3.65 3.65
    Waltham Forest Lab 3.61 3.66 3.77 3.94 4.05
    Nottingham City Lab 2.5 2.6 3 3.25 3.25
    Hounslow Lab 4 4.1 4.1 5.1 5.1
    Newcastle City Council Lab 2.45 2.45 2.45 3 3
    Hackney Lab 3.6 3.65 3.75 3.75 3.8
    Knowsley Lab 2.55 2.55 Service not provided Service not provided Service not provided
    Oldham Lab 3.6 3.7 3.8 3.9 4

    Community Transport Services

    (Charge per ride):

    Authority Political control 2009/10 2010/11 2011/12 2012/13 2013/14
    Norfolk County Council Con 1.16 1.18 1.2 1.22 1.22
    Chesire West and Chester Con 1.63 1.67 1.71 1.75 1.79
    Trafford Metropolitan Borough Council Con 1 1 1 2 2
    North Yorkshire County Council Con 1.8 2 2.2 2.3 2.4
    Dorset County Council Con 2.5 2.5 2.5 2.5 2.5
    Milton Keynes Council Con 2 2.3 2.3 2.65 2.65
    Woking Con 4 4 4 4 4.2
    Surrey Heath Con 3.45 4.1 4.1 4.5 4.5
    West Sussex County Council Con 3 3.2 5 5 5.1
    Lincolnshire County Council Con 0 0 5 5 5.1
    Spelthorne Borough Council Con 4.5 5 6 6.5 6.7
    Bournemouth Borough Council Con 5.55 5.7 5.7 5.7 7.81
    Buckinghamshire County Council Con n/a n/a n/a 8 8
    Warwickshire County Council Con 1.27 1.3 5.29 12.23 12.13
    Kensington and Chelsea Con 0 8 8.3 8.7 8.9
    Richmond Con 5 5 5 5 5
    Plymouth City Council Lab 0 0 0 0 0
    Rotherham Metropolitan Borough Council Lab 0.5 0.5 0.5 0.5 0.5
    Blackburn with Darwen Borough Council Lab 1 1 1 1 1
    Barnsley Metropolitan Borough Council Lab 0.5 0.5 0.5 0.5 1
    City of Wakefield Metropolitan District Council Lab 0.45 1 1 1 1.1
    Halton Borough Council Lab 1.03 1.05 1.07 1.09 1.31
    Tameside Metropolitan Borough Council Lab 1.4 1.45 1.49 1.53 1.59
    Doncaster Metropolitan Borough Council Lab n/a n/a n/a n/a 2
    Derby City Council Lab 3 3 3.1 3.1 3.2
    Warrington Borough Council Lab 1.6 1.6 3.35 3.35 3.38
    St Helens Metropolitan Borough Council Lab 2.56 2.62 3.71 3.8 3.9
    City of York Council Lab 1.8 1.8 3 3 4
    Stoke-on-Trent City Council Lab 0.42 0.45 0.5 0.55 4
    Bury Metropolitan Borough Council Lab 3.7 3.8 4 4.1 4.2
    Metropolitan Borough of Wirral Lab 4.64 4.78 4.78 4.78 4.78
    Hartlepool Borough Council Lab 0 0 0 6.9 6.9
    Gateshead Lab 1.09 1.2 1.38 1.45 1.5
    Islington Lab 5 5 5 5 5
    Darlington Lab n/a n/a n/a 6.9 6.9
    Nottingham City Lab 2.5 2.6 4 5 5
    Hackney Lab 0 0 0 0 0
    Oldham Lab 2.5 2.5 2.6 2.7 2.8

    Home Care Costs:

    Authority Control 2009/10 2010/11 2011/12 2012/13 2013/14
    East Riding of Yorkshire Council Con 10.4 10.6 10.6 10.7 10.8
    Bournemouth Borough Council Con 16 13.96 13.96 13.96 13.95
    London Borough of Bromley Con 15.76 16.2 14.64 14.64 14.64
    Cheshire West and Chester Con 12.78 12.78
    Milton Keynes Council Con 14 15 14.12
    Trafford Metropolitan Borough Council Con 7.7 8.1 8.5 8.92 12.5
    Dorset County Council Con 15 15 15 15 15
    Herefordshire Council Con 15.15
    Solihull Metropolitan Borough Council Con 16.25 16.65 16.65 16.65 12.68
    Lancashire County Council Con 11.9 11.96 11.96 11.96 11.96
    Essex County Council Con 13.32 13.52 13.52 13.52 13.64
    Buckinghamshire County Council Con 13.8 14.2 18 18 18
    East Sussex County Council Con 13 13 13 13 13
    Warwickshire County Council Con 9.22 11.36 13.37 14.24 14.24
    Kensington and Chelsea Con 7.2 14.3 14.3 14.3 14.3
    Hampshire County Council Con 14.4 14.8 15.2 Up to Actual Cost Up to Actual Cost
    Norfolk County Council Con 14.04 14.32 14.62
    Lincolnshire County Council Con 10.5 10.5 11.93 11.93 11.93
    North Yorkshire County Council Con 15 16 16.5 16.9 17.3
    Bexley Con n/a n/a n/a n/a 12.6
    Richmond Con n/a n/a n/a n/a 12.5
    St Helens Metropolitan Borough Council Lab 9.36 9.59 9.83 10.08 10.33
    Doncaster Metropolitan Borough Council Lab 9.85 10.15 10.72 11.28 11.28
    Birmingham City Council Lab 14.91 16.4 17 17 15
    Barnsley Metropolitan Borough Council Lab 5 5 13 13 13
    City of York Council Lab 15.75 16 16 16 16
    Wigan Metropolitan Borough Council Lab 9.64 9.8 10.8 13.05 13.48
    Wolverhampton Council Lab 13.48 13.48 13.48 13.48 13
    Bury Metropolitan Borough Council Lab 11.5 11.5 12 12.4 12.7
    Greenwich Lab 9.7 9.7 11.2 12.5 13
    London Borough of Enfield Lab 16.6 16.6 16.6 16.6 16.6
    London Borough of Brent Lab 17.48 17.48 17.48 full cost full cost
    Rotherham Metropolitan Borough Council Lab 11.9 12.85 13.9 14.5 14.85
    London Borough of Haringey Lab 10.85 11 11 11 11.35
    City of Wakefield Metropolitan District Council Lab 9.2 10.45 10.45 11 11
    Derby City Council Lab 8 8 11.31 11.72 12.08
    Halton Borough Council Lab 11.35 11.35 11.35 11.35 11.46
    Blackburn with Darwen Borough Council Lab 9.64 9.72 11.04 11.04 11.04
    Tameside Metropolitan Borough Council Lab 10.92 11.25 11.58 11.93 12.37
    Metropolitan Borough of Wirral Lab 12 12.28 12.28 12.28 12.28
    Stoke-on-Trent City Council Lab 12.8 13.2 13.8 13.2 13.2
    Gateshead Lab 9.5 11 10.5 11.48 11.48
    Islington Lab 13.64 13.52 13.66 13.66 13.64
    Newham Lab n/a n/a n/a 11.62 11.62
    Darlington Lab 10.51 full cost full cost full cost full cost
    Waltham Forest Lab 15.04 15.28 15.94 16.45 16.94
    Nottingham City Lab 8.9 9.2 11.5 13.66 13.66
    Newcastle City Council Lab 9.75 10 10 11.72 11
    Hackney Lab 10.85 11 11 11 11.35
    Tower Hamlets Lab 0 0 0 0 0
    Oldham Lab 12.5 12.5 12.95 12.95 12.95

    Weekly Care Charge Cap:

    Authority Control 2009/10 2010/11 2011/12 2012/13 2013/14
    Lincolnshire County Council Con 126 126 250 250 250
    Stockport Metropolitan Borough Council Con 245 250 258 271 278
    Norfolk County Council Con 273 278 283.56 283.56 289.22
    Essex County Council Con 439.11 445.69 459.48 459.48 464.1
    Lancashire County Council Con 595 595 625 655 655
    Bournemouth Borough Council Con 440 no cap no cap no cap no cap
    Buckinghamshire County Council Con 280 no cap no cap no cap no cap
    Hampshire County Council Con 435.82 440.23 440.23 no cap no cap
    North Yorkshire County Council Con 260 no cap no cap no cap no cap
    Trafford Metropolitan Borough Council Con 176 185 194.25 203.96 no cap
    Richmond Council Con 310 320 no cap no cap no cap
    Kingston-Upon-Hull City Council Lab 99 99 99 99 99
    Barnsley Metropolitan Borough Council Lab 60 60 90 9 105
    Derby City Council Lab 80 80 125 125 125
    Tameside Metropolitan Borough Council Lab 182.52 188 193.64 199.44 206.82
    Rotherham Metropolitan Borough Council Lab 200 200 230 240 246
    Doncaster Metropolitan Borough Council Lab 338.91 342.3 335.46 335.46 335.46
    Bury Metropolitan Borough Council Lab 400 400 400 400 400
    City of Wakefield Metropolitan District Council Lab 113 402 402 402 402
    London Borough of Brent Lab 415.44 415.44 415.44 no cap no cap
    Plymouth City Council Lab 270 270 no cap no cap no cap
    St Helens Metropolitan Borough Council Lab no cap no cap no cap no cap no cap
    Stoke-on-Trent City Council Lab 128 132 no cap no cap no cap
    Gateshead Lab 150 160 184 194 199
    Newham Lab n/a n/a n/a 200 200
    Waltham Forest Lab 230 233.5 233.5 233.5 no cap
    Nottingham City Lab 78.5 81 no cap no cap no cap
    Newcastle Lab 150 150 150 200 400
    Knowsley Lab 150 150 200 200 200
    Tagged | Comments Off on Cameron’s hidden dementia taxes

    This is NHS Check report no 11 originally published by Labour’s Shadow Health Team in June 2013


    • 66% increase in over 90 year olds arriving at A&E – 110,000 extra patients
    • Cuts to council Adult Social Care budgets now total £1.8 billion since the election

    Huge cuts to council social care budgets are leaving older people and their families without the care they need. Without this daily support, increasing numbers face no alternative but to turn to A&E departments.

    Labour would invest £1.2 billion of the NHS underspend – which Jeremy Hunt handed back to the Treasury – over the next two years to ease the crisis in social care and tackle this root cause of the pressure on A&E.

    Rise in elderly patients arriving at A&E

    Official NHS Hospital Episode Statistics reveal a hugely disproportionate increase in the numbers of elderly people arriving at A&E in ambulances in the first two years of this Government.

    The most recent data, for the year 2011-12, shows a 66% increase in over 90 year olds arriving at A&E compared to Labour’s last year – an extra 110,000 patients. A&Es saw a 19% rise in attendances from over 80 years olds too – 121,000 patients.

     Age group 2009/10 2011/12 % change 2009/10 to 2011/12
    0-9 273,207 263,687 -3.50%
    10-11 346,527 278,557 -19.60%
    20-29 413,346 449,675 8.80%
    30-39 361,469 367,277 1.60%
    40-49 404,799 435,371 7.60%
    50-59 347,329 390,456 12.40%
    60-69 395,486 435,698 10.20%
    70-79 562,854 601,637 6.90%
    80-89 635,834 757,555 19.10%
    90+ 165,910 275,883 66.30%
    Unknown 18,158 1,088
    Total 3,924,919 4,256,884 8.50%

    Cuts to council care budgets

    Figures from the House of Commons Library reveal year on year real terms cuts to local authority Adult Social Care budgets across England, now totalling £1.8 billion since the election.

    £000s 2009/10 2010/11 2011/12 2012/13
    Total Expenditure (including DH funds directed via PCTs) 14,902,492 14,439,270 15,353,842 15,173,007
    Projected Real Terms Expenditure if 2009/10 figures increased in line with GDP 14,902,492 15,306,968 15,622,862 15,825,959
    Real Terms Cut 867,698 269,020 652,952
    Comments Off on Elderly bear the brunt of A&E crisis

    This is  Labour Party  NHS Check 12  originally published by Labour’s Shadow Health Team in October 2013

    • Survey Reveals NHS On Road To Us-Style Healthcare
    • New Evidence Of NHS Hospitals Charging For Essential Treatments That Were Previously Free And Still Free Elsewhere
    • Thousands Of People Missing Out On Essential Treatment As David Cameron’s Postcode Lottery Grows
    • Labour Calls On The Government To Order An Immediate Review Of Rationing In The NHS And To Intervene To Stop Rationing On Grounds Of Cost

    This report shows that hospitals are beginning to charge patients for some treatments which were previously free on the NHS and continue to be freely available in other parts of the country.

    A Labour survey has revealed the details of punitive new restrictions put in place by Clinical Commissioning Groups. This follows an investigation by the British Medical Journal which found that as many as 1-in-7 of the new bodies have increased the rationing of treatments.

    Last year, Labour found that almost half of Primary Care Trusts were restricting routine treatments. Despite warnings from Labour and professional bodies, the problem has worsened – leaving patients facing an agonising decision of going without treatment or paying for private care.

    Increases in rationing are leading to a growing postcode lottery

    Labour’s Shadow Health Team surveyed all Clinical Commissioning Groups following reports that increasing numbers of patients were being denied GP referrals for treatment previously accessible on the NHS.

    An investigation by the BMJ in summer 2013 revealed that in the last six months, since they took control of the new NHS in April, 27 CCGs of 195 CCGs responding to the survey – close to 1 in 7 – had introduced new treatment restrictions. These included 8 CCGs restricting treatment for Foramen Ovale for recurrent migraines, 3 CCGs restricting hip or knee replacement surgery, 2 CCGs restricting cataract surgery, 4 CCGs restricting Caesarean for non-medical reasons, 2 CCGs restricting treatment for carpal tunnel syndrome, and 8 CCGs restricting therapeutic use of ultrasound. The full list of restrictions is listed in the table below.

    • Asymptomatic gall Stones 9
    • Foramen Ovale Closures for recurrent Migraines 8
    • Therapeutic use of ultrasound 8
    • Ganglions 7
    • Hallux Valgus 6
    • Skin Lesions 5
    • Caesarean for non medical reasons 4
    • Tonsilitis 3
    • Knee Surgery/replacements /hip 3
    • Varicose Veins 2
    • Cataracts 2
    • Carpal Tunnel Syndrome 2
    • IVF 1
    • Dupuytrens Contracture 1
    • Myringotomy 1
    • Hysteroscopy 1
    • Trigger Finger 1
    • Dilation and Curettage 1

    Labour’s Freedom of Information survey enabled investigation of the consequences of increasing rationing for access to treatment. It revealed wide variation across the country for the same treatment, with some NHS bodies setting down extra conditions before they fund the treatment. For example:

    • Patients in South Reading are required to lose more of their eyesight before they receive cataract surgery than patients in South Kent who qualify sooner.
    • Patients in the Black Country are forced to prove greater levels of pain and attempted weight loss before qualifying for knee replacement surgery, whilst South West London will fund patients in lower levels of pain.
    • Likewise for hip surgery, South West London and Stoke on Trent and North Staffordshire have different pain criteria.

    There is a legitimate debate to be had about the effectiveness of particular treatments or their use in particular contexts. But Labour FOIs have added to the growing evidence that some patients are being unfairly denied access to vital treatments.

    And as the next section shows, it seems that some hospital trusts are now introducing new private care options for treatments that are being rationed in the local area.

    Postcode lottery in cataract surgery


    In the 1990s, it was not uncommon for patients to wait up to two years for a cataract operation. The previous Labour Government took action to address this delay. It included issuing good practice guidance which established eligibility criteria and ensured patients should have access to surgery.

    The guidance stated that patients should be referred for surgery by their GP if a cataract leaves them with reduced vision or if it negatively impacts their quality of life.

    The guidance did not establish visual acuity thresholds – the measure of vision relating to how far a person can read down an eye chart – before a patient qualifies for treatment.

    The Royal College of Ophthalmologists cataract guidelines published in 2010 reinforced this guidance.

    Hospital Episode Statistics

    The latest figures show that the number of elective admissions for cataract surgery declined between 2010/11 and 2011/12 by over 5,000.

    These figures are precisely the opposite of what experts would expect. The RNIB have said “We would expect to see both the number of operations and spells to increase as the population ages and demand for surgery rises.”

    The figures suggest that since 2009/10, PCTs and CCGs have been introducing restrictions to cataract surgery.

    Clinical commentary and patient impact

    “Such absolute restrictions have no clinical imperatives. There is now evidence that early cataract surgery is beneficial to patients, and the over reliance of Visual Acuity as a measure is outdated. Delaying surgery leads to more ophthalmic complications, making surgery more risky, and in the event proves costlier”

    CCG referral policies – the variations

    Labour has uncovered evidence of CCGs who have implemented new restrictions on cataract operations in the last year. Earlier this year, the RNIB found widespread evidence of CCGs implementing restrictive commissioning policies that are not in line with either Department of Health guidance or Royal College guidance.

    South Reading CCG’s commissioning policy states: “cataract surgery is only routinely commissioned for patients who, after correction (eg, with glasses), have a visual acuity of 6/12 or worse in their cataract-affected eye.”

    However, Brighton and Hove CCG have no arbitrary restrictions on cataract operations and surgery is based on clinical need.

    Postcode lottery in knee replacement surgery

    Clinical commentary and patient impact:

    “Orthopaedic operations such as knee and hip surgery can be due to a traumatic injury such as a sports injury or accidents, or a degenerative disease such as arthritis. Such rationing would aim to discriminate against the latter mainly, as these are chronic conditions. But the disability, pain, reduced social mobility, will cause a lot of suffering to these patients.”

    CCG referral policies – the variations

    NHS Black Country Cluster will only operate on patients with a BMI of 40 or over if they have documented proof that they have participated in a “comprehensive weight management programme” of at least 6 months duration prior to surgery.

    All other patients (ie those with a BMI of less than 40) are now required to meet a range of other criteria before they become eligible which include:

    • Conservative means (e.g. Analgesics, NSAIDS, physiotherapy, advice on walking aids, home adaptations , curtailment of inappropriate activities and general counselling as regards to the potential benefits of joint replacement) have failed to alleviate the patients pain and disability
    • AND Pain and disability should be sufficiently significant to interfere with the patients’ daily life and or ability to sleep/patients whose pain is so severe
    • AND Underlying medical conditions should have been investigated and the patient’s condition optimised before referral

    In contrast, Kingston CCG will fund elective surgery on any patient who has an Oxford Knee score – the questionnaire on function and pain – of less than 20 on the 0 to 48 system or greater than 40 on the 60 to 12 system.

    Postcode lottery in hip replacement

    Clinical commentary and patient impact:

    “ Restrictions on hip replacement could well discriminate against older people, for whom hip surgery is not cosmetic but essential to relieve pain, further worsening of their condition and also major social handicaps if surgery did not happen.”

    CCG referral policies – the variations

    Stoke on Trent CCG will only commission hip surgery if a patient scores 20 or under on the Oxford Hip Score (the equivalent questionnaire).

    Merton CCG will fund surgery for patients with a score of 26 or under.

    However, Hammersmith and Fulham CCG’s referral policy makes no reference to the Oxford Hip Score.

    NHS hospitals charge for rationed treatment

    In October 2012, the Government gave NHS Foundation Trusts the freedom to generate up to 49% of their income from private patients. A Labour Freedom of Information request to hospital trusts, on the income generated from private work in the first year of the new arrangements, reveals a significant increase. In 2012/13, hospitals generated £434 million – an additional £47 million on 2010/11. Meanwhile, trusts’ projections show that they envisage this will increase by a further £45 million to £479 million this year.

    Labour’s research has uncovered examples of treatments that are now rationed by the GP-led bodies and charged-for by hospitals– so-called ‘self-funding’ patients. This is where NHS hospitals offer to treat people as private patients but charge “NHS rates”.

    • In the last six months, James Paget University Hospitals NHS Foundation Trust has started offering self-funding options for Ophthalmology. Meanwhile, the local CCG NHS Great Yarmouth and Waveney has a restrictive commissioning policy for cataract operations – out of line with Department of Health and Royal College guidance.
    • Earlier this year, Southampton CCG was “red rated” by the RNIB – labelling its policy on cataract operations “very restrictive”. The local trust, Southampton University Hospitals, has a self-funding option in place for treatment in Ophthalmology services. Private patients can choose to benefit from high quality eye care by local NHS consultants at Southampton General Hospital. The hospital trusts website boasts: “Fewer non-urgent services can be paid for by the NHS but we know that patients still want to see our expert staff and be treated within the advanced care environment of a specialist teaching hospital. We offer the full range of consultations, investigations and treatments that you would expect from a specialist hospital […].”1 Also adding: “Our premier cataract service offers a new option, between the traditional private sector and the NHS, bringing private healthcare within the reach of many more people. This service offers you the option of cataract surgery even if your vision is better than the current level required for NHS surgery. We offer surgery when you feel you need it.”
    • Warrington and Halton Hospitals NHS Foundation Trust now offers a self funding option for removal of varicose veins. Their website states: “There are some treatments provided in the past that may no longer be accessible through local NHS funding… However, we know that many patients still want to have these procedures with us. In order to give our patients choice around their care, we have developed the MyChoice service. This allows you to pay (self-fund) to have these procedures with us at the standard NHS price. Private health insurance may also cover the cost of these procedures with us.”
    • Chelsea and Westminster hospital offer self funding options on “All medical and surgical specialities.” NHS North West London have tightened their criteria on a number of treatments in the last year. In June 2013, they updated their policies on removal of benign skin lesions, dupuytren’s contracture, carpal tunnel syndrome and cataract surgery.