Saturday, 9 January 2016

Report: 100 ways the Tories have failed the NHS (evidence based with links to data), By Eoin Clarke

If you cannot see the report properly above, or do not link the format layout below, you can get a link to my report by following this link (click here). Happy New Year.

GP Services

1.      The number of unfilled GP posts has nearly quadrupled in 3 years (2.1% in 2010 to 7.9% in 2013) (evidence)
2.      England’s GP to Patient ratio has worsened by 4% as population increases and unfilled GP vacancies grow (evidence)
3.      Of 27 EU Countries, the UK is ranked 24th for the number of working doctors it has per head of population (just 2.71 per 1,000 people) (evidence & evidence)
4.      518 GPs surgeries have closed or merged under the Tories. The rate is accelerating with 90 closing in the first 5 months of 2014 (evidence & evidence)
5.      GPs spend cash more efficiently than any other part of the NHS. It is sheer folly that the Tories have delivered a real terms funding cut of £987m to GPs (evidence)
6.      Despite Cameron’s promise that he will extend GP opening hours to 7 days a day, the number of GPs surgeries offering extended opening hours actually declined by 5.7% (or an extrapolated 477 surgeries) in just 1 year to 2012 (evidence & evidence)

A&E Services
7.      Performance at England’s A&Es has fallen to its worst levels since January 2004 (evidence & evidence)
8.      4 million A&E patients have been keep waiting more than 4 hours under the Tories since Cameron became PM, a near tripling on a weekly basis (evidence)
9.      Despite promising voters that no local NHS service would close without public consultation, 66 A&E and Maternity Wards have been closed or facing closure as a result of Tory Cuts (evidence)
10.  The Tories scrapped Labour’s 98% target at England’s A&Es. This corresponded with an immediate deterioration in A&E waiting times (evidence & evidence
11.  The Tories have shut or downgraded 1/3 of NHS Walk In Centres releasing up to 2million patients a year back in a struggling A&E system (evidence)
12.  16% of A&Es all types have closed since 2010 (evidence & evidence)
13.  The North East of England was completed ignored when extra cash was apportioned to deal with the A&E Crisis (evidence)
14.  Avoidable admissions of over 75s presenting themselves at A&Es is up 34% since 2008 putting untold pressure on our A&Es (evidence)

Waiting Lists
15.  The number of emergency operations cancelled for a second time has climbed 42% in the most recent year compared to 2010-11. The number of cancelled operations, overall, appears to have stabilised (evidence)
16.  The average patient is now waiting 1 week longer under the Tories for treatment after referral (evidence)
17.  Under Labour, 92.9% of patients were being treated within 18 weeks of referral. That figure has fallen to 89.0% in the most recent month under the Tories (evidence)
18.  3.2million patients are currently languishing on NHS Waiting Lists for treatment. This year’s figures are the highest in at least 6 years (evidence)

NHS ethics & accountability
19.   The Tories broke their promise not to have another top-down reorganisation of the NHS. They did so by introducing the Health & Social Care Act that abolished SHAs & PCTS and replaced them with CCGs (evidence)
20.   Without permission, or little warning, the Tories have made patient records (anonymised) available to these private health firms (evidence)
21.   The Tories defied a Judge ruling & instructions by the Information Commissioner to publish the NHS Risk Register so that people could assess the dangers of the unprecedented NHS Reorganisation caused by the 2012 Act (evidence)
22.   1/3 of the GPs making decisions on CCGs as to who wins NHS Contracts actually has a financial link to a Private Health Firm themselves (evidence)
23.   The Tories have handed over billions of pounds of NHS contracts to firms and at the same time exempted them from the Freedom of Information Act on the grounds that prying folk such as I will damage the commercial confidentiality of the companies. Labour have introduced a bill to try and change this (evidence)
24.   The UK Statistics Authority reprimanded Jeremy Hunt for claiming that median waits at A&Es had halved under the Tories. The reality is that A&E performance is at its worst in 11 years (evidence)
25.   High Court Judge & an Appeal Court Judge both found Jeremy Hunt to have acted improperly in downgrading Lewisham Hospital (evidence & evidence)
26.   New clauses added to NHS legislation are designed to take power away from the public and concentrate it in the hands of private firms. The Tories have insisted that healthcare will not be exempt from TTIP. They have passed clauses to allow Jeremy Hunt to force NHS closures against the say of the local public, and diminish the court’s role in holding him accountable. He has also passed regulations to push commercial competition in the NHS much more forcefully. All of this is anti-democratic (evidence, evidence & evidence)
27.   Jeremy Hunt & David Cameron have taken the ethics of the Department of Health to an all-time low.  In particular, he seems hell bent on distorting or exploiting data to smear Andy Burnham. In particular, the use of unreliable hospital mortality data which has been rubbished by all major senior NHS experts has caused offence. Several senior NHS figures, Robert Francis, Bruce Keogh & Baroness Young have had to formally intervene to apologise, or ask Cameron & Hunt to desist (evidence & evidence evidence)
28.   The links between Private Health lobbyists at the Tories are extensive. This blurs the accountability and transparency of policy making. For an insight into just how deeply intertwined lobbyists & the Tories have become, see some of this (evidence & evidence)
29.   Despite gaining billions of pounds in NHS contracts, Private Health firms are paying very little tax. You can measure the amount of tax each Private Health Firm pays by typing their name into this database (see here). You can also view an investigative report into Private Firms and tax avoidance here (evidence)
30.   Tory MPs earn cash, shares, directorships and more from Private Health that firms that are profiting from NHS privatisation. They, mostly, declare this income and you can view it for yourself here (evidence)
31.   The Tories are at fault for scapegoating immigrants and blaming them for NHS budgetary pressures. For example, Jeremy Hunt said health tourists cost the NHS £2bn, but evidence shows this was a gross exaggeration (evidence)

NHS Staff Pay & Conditions
32.  78% of Nurses report increased stress levels in the last year, a further year on year increase this time of 5% (evidence & evidence)
33.  The number of physical assaults on NHS Staff has climbed 21% under the Tories reaching record levels this year, and there have been ¼ million attacks on staff since 2010 (evidence & evidence)
34.  In cash terms, the basic pay of an NHS Senior Manager has grown by 500% more than NHS Nursing & Midwifery Staff under the Tories (evidence)
35.  Whilst the mean annual earnings of Senior NHS Managers has climbed £6,556 under the Tories, Trainee Doctors have seen a £2,200+ fall, and Registrars a £1,366 drop in earnings. While the mean basic pay of a Senior Manager has jumped 15% it has fallen 4% for a trainee doctor, and that is before we even consider inflation (evidence)
36.  In 2010, 377,000 worked in other Health & Social Care non-NHS roles. Today that figure is just 263,000 (evidence & evidence)
37.  There are almost 137,900 Zero Hours Contracts in the Health & Social Care Sector. These contracts have more than tripled (up 270%) since 2010 (evidence & evidence)
38.  In 2010, 1.596m worked in the NHS. Today, that figure is 21,000 less (evidence & evidence)
39.  The percentage of NHS Staff who feel bullied or harassed has doubled to 28% in just 3 years of Tory rule, 2010-13. This in part can be attributed to another imposed and needless top down reorganisation of the NHS (evidence)
40.  The percentage of staff reporting experiencing physical violence from patients has doubled in just 3 years, 2010-13. This is in part due to mental health cut backs and leadership from the very highest accusing nurses of lacking compassion (evidence)
41.  The percentage of staff suffering work-related stress in all NHS Trusts has jumped from 28% to 38% in just 3 years, 2010-13. This in part is caused by cut backs and a cloud of negativity over staff (evidence)
42.  Jeremy Hunt has subjected the majority of NHS Nurses to a real terms pay cut over 4 years. Nurses’ pay has declined £2,000 in real terms. It is unacceptable that bankers’ pay now grows six times faster than nurses (evidence, evidence)
43.  The Tories attempted to force in regional pay for NHS staff, beginning in the South West of England. Although they were defeated after a very strong public campaign, their intention is clear. The deal would have led to less pay, and poorer working entitlements for staff in regional areas outside London, initially in the South West (evidence)

NHS Privatisation
44.  Private Firms have been invited to bid for NHS contracts with a value of more than £16bn. On average, these firms say they will make a profit of between 5-8%. The funding pressures on the NHS mean that it has no room facilitate £800m-£1.3bn of profit on the contracts mentioned above, should they go to the Private Sector (evidence & evidence)
45.  33%, 56% or 70% of NHS Contracts tendered are now being won by the private sector depending on which data you read (evidence, evidence & evidence)
46.  Number of GPs now advising their patients to take out Private Medical Insurance has more than doubled from 24% to 58% since the Tory NHS Act (evidence & evidence)
47.  Tories said Doctors would control GP commissioning but less than 0.5% of GPs are involved in commissioning decisions. The proportion of GPS on CCGs has fallen from 56%, in their shadow format, to 49% and then 43% in the most recent year. Doctors are not even a majority of the people responsible for GP commissioning (evidence)
48.  Persons or firms with a financial interest in private health have donated to the Tory Party in various ways. In 2012 the Tory Party passed the Health & Social Care Act which expanded the role of private medical firms. Among the chief beneficiaries of these developments have been firms with donor links to the Tory Party. This causes a blurring that does our democracy few favours. In total, it is possible to link 744 donations from persons with past or present links to Private Health to the Tory Party.
49.  There are now 500 hospitals being run by Private Health. The Private Health Sector now enjoys a £40bn share of the market. Its share of the acute sector has grown by £3bn in 4 years according to Laing & Buisson (evidence, evidence)
50.  Referrals of NHS Patients to Private Hospitals, especially SPIRE & BMI has jumped 500% since 2010. This drain of cash away from NHS Hospitals is hurting the Trust Sector (evidence)
51.  Private Patient Income at NHS Trusts has grown by 12% (£50m) from 2010-2013. We have no official data thereafter but some Trusts have reported an increase of up to 40% from PPI. At a time when hospitals are clearly struggling to manage public demand from NHS patients, it is imprudent that they increase the work they carry out for Private Patients (evidence, evidence, evidence)
52.  In 2009, 83.9% of the UK’s Health Sector was in Public ownership. Today, that figure is 82.5% and falling. Experts Laing Buisson, say that Private Health now controls £40bn of the health market, and that this has grown £0.7bn in 2 years (evidence & evidence)
53.  Tories often cite their reason for accelerating NHS Marketisation as an effort to improve patient outcomes. That pretence was well and truly exposed when they sold Blood Plasma services to a US Hedge Fund (evidence)
54.  The Tories are selling off NHS land at a rapid scale. Already, the Tories have put at least 418 pieces of NHS amounting to 19 hectares up for sale to private property developers. They have set a target to sell off £5bn worth over the next 5 years. When NHS Propco was set up as a private firm, the Tories denied it was to pave the way for a large scale land sell off. Now, plans are indeed afoot for a major sell off (evidence, evidence and evidence)

Wasting Taxpayers’ Money
55.  In 2009-10 the NHS spent £1.1bn Agency Staff. That has risen to £3.2bn for 2011-12 (evidence p.193) £3.9bn for 2012-13 and £2.9bn for 2013-14 (Evidence p.20 & evidence p. 193 & evidencep.197)
56.  In 2009-10 £13m was spent by the NHS on redundancy pay-outs. That figure jumped to £211m in 2010-11 (evidence p.89) and £426m in 2011-2 (evidence p.118). It was £444m in 2012-3 and a further £196m in 2013-14 (evidence p.125)
57.  After spending at least £1.1bn on NHS Redundancies, the NHS then rehired at least 18.7% of those initially made redundant. That includes 2,570 on a permanent basis and 1,380 on a temporary basis (evidence, evidence p.89, evidence p.118, evidence p.125). Other commentators put the figure closer to 40% see (here).
58.  The number of delayed transfers of care due to unavailability of care elsewhere has reached a record high in the most recent month. 6.14m bed spaces have been ‘blocked’ since August 2010, at a cost of £1.5bn to the taxpayer. The instances of gaps in Social Care provision being cited as the main reason are now at a record high (evidence)
59.  The Top-Down Reorganisation of the NHS has wasted at least £1.1bn of taxpayers’ cash at a time when the funding squeeze it at its worst since 1979 (evidence)
60.  The Tories have been dishonest about the claimed savings their reforms have delivered the NHS. The National Audit Office was unable to confirm at least £2.4 billion of the Savings the NHS claims it delivered (evidence
61.  NHS Spend on outside consultancy has climbed from £468m in 2009-10 to £456m in 2011-12 (evidence p.193), £596m in 2012-13 & £584.7m in 2013-14 (evidence p.20 &evidence p. 193 & evidence p. 197)
62.  Despite the government’s boasts about savings made from the NHS efficiency drive, a detailed study showed that 40% of NHS Trusts have failed to achieve their QIPP savings (evidence)

NHS Direct
63.   The Tories shut down a highly efficient NHS Direct and replaced by a for-profit NHS111 service that botched its initial launch (evidence)
64.   78% of the NHS111 staff who process 111 calls have no clinical expertise. This has caused all sorts of pressures, including additional admissions at A&E (evidence)
65.   It has been reported that there have been 22 deaths or serious injuries which were caused by failures in the launch of NHS 111 (evidence)
66.   A piloted study of NHS111 showed 40,000+ waiting longer than 1 minute for their call to be answered (evidence)

NHS Finances
67.  The Tories broke their manifesto promise (page 45) to deliver real terms increases in NHS Spending every year, says the UK Statistics Authority (evidence)
68.  The Tories have delivered the tightest budget arrangements for the NHS since 1979. They are on course to cut NHS Spending per patient by 9.1% by 2018-9. Spending as a proportion of GDP has shrunk considerably (evidence, evidence, evidence and evidence)
69.  ¼ of NHS Trusts are now in deficit. 44 new trusts moved into deficit in 2013-14. The total deficit for NHS Trust more than doubled from £297m to £743m in 2013-4 (evidence p.6)

70.  Ambulance Response Times for Category A (8 minute) calls has dropped from 75% to 69% in just 3 years (evidence)
71.  Ambulance Trusts have made large cuts to their staff and fleet since April 2010. For example, EMAS has cut staff by 13% and its fleet size by 100 (evidence)
72.  At the same time as Ambulance Response times have been worsening, the Tories have oversaw the axing of 60+ stations ( herehereherehere, here, here, hereherehere & here)
73.  Expenditure on Private Ambulances for use in the NHS has doubled in 3 years an investigation revealed (evidence)

A Crisis in Mental Health Provision
74.  1,876 Mental Illness Beds have been axed in little since Q1 2010. At least 7 mental health patients have taken their own lives as a result ((evidence & evidence)
75.  228,000 have spent up to 12 hours in A&E during the past year. This number has more than doubled in 3 years (evidence)
76.  Mental Health Nursing has suffered severe cuts. To explain, there has been an 8,737 reduction in the number of Specialist Nurses in Maternity, Disability, Psychiatric and Community services since 30 April 2010. This is only partly explainable in the re-designation of 4,854 nurses into Neo-Natal services. It still leaves a shortfall of c4k staff with Mental Health being the worse affected (evidence)

Social Care Crisis
77.   The number of people self-financing their social care has jumped 36% since 2006. This is a failing of both recent governments. 1 million people have had to sell their own homes to pay for elderly care in the last 5 years, thus this a problem that began under Labour but continues to worsen under the Tories (evidence & evidence)
78.   In 1 year 530,000 patient admissions of over 65s, 390,000 of whom were over 75s could have been avoided say the CQC. Nuffield trust also say that avoidable admissions are at a record high (1 in 5). Cuts to GP funding (£0.9bn) & Social Care funding (£1.8-£2.8bn funding) are putting causing unnecessary discomfort to elderly patients (evidence & evidence)
79.   There has been a 311,000 cut in the number of adults in receipt of Social Care since 2010 (evidence & evidence)
80.   Funding for elderly Social Care has decreased 10% in real terms since 2010 & Council spend on Social Care has been cut £2.8bn in real terms (evidence)
81.   Elderly users of Social Care are paying £588 more for care than they were in 2010. Some outlets argue the rise has been even higher at £2,400 (evidence & evidence)
82.   George Osborne ignored Andrew Dilnot’s plea to fund his Dilnot Report recommendations from a separate pool to NHS funding. The resultant consequence is that an already stretched NHS is being stretched further still and is failing to meet Social Care costs  (evidence & evidence)
83.   Social Care funding for nursing homes, residential care and community care has been cut by £160m, £331 and £559 respectively from 2010 to 2013. Further cuts are still to come (evidence)
84.   At a time when Dual Energy Bills are up 30%, David Cameron scrapped the Warm Homes Health People Fund despite a report’s conclusion that it saved lives (evidence & evidence)

NHS Treatment Rationing & Cuts
85.   In the early years of this Tory Government, spending on Cancer Services declined 3.6% in real terms under the Tories (evidence)
86.   An early report into the life of this government shows that Funding for Clinical Networks on Chest, Heart & Stroke were cut by 12%+ (evidence)
87.   56% of CCGs are restricting some NHS Treatments for patients who smoke or have a high BMI found the NAO (Page 29)
88.   An NHS, free at the point of use, does not exist for many patients. At least 20+ treatments are no longer free at the point of use for patients in 60+ parts of England’s NHS (evidenceevidence)
89.   52,000 patients were denied patients due to cost considerations in just 1 year. This is just one of several examples where the concept of an NHS free at the point of use is in jeopardy (evidence)
90.   In 2014, 42% of Maternity Units shut their doors to the public at least once. This is an increase from 28% in 2012 (evidence & evidence)
91.   There is a 2,300 shortage of Midwives according to the National Audit Office. This could explain why 42% of Maternity Wards closed their doors last year (evidence)
92.   Of the 27 EU Countries, the UK now has one of the worst Bed to Citizen Ratios in the EU (evidence & evidence)
93.   9,746 NHS Beds have been axed since 2010 (Q1) (evidence)

Patient Safety & Satisfaction
94.   Labour left an NHS with rising, indeed record, patient satisfaction. Under the Tories it suffered a record fall, and then stabilised a little. We await the most recent year’s data (evidence & evidence)
95.   The number of Clinical Negligence Claims made against the NHS has risen 80% since March 31st 2010 & the value of pay-outs has risen £397m (evidence, evidence & evidence)
96.   At a time when more is being asked of the CQC it was naïve to cut their staff numbers by 18%, since 2010 (evidence & evidence)
97.   It is difficult to make any strong conclusions about Never Events because the definition of a never event changed, and the method of collecting and reporting the data has also changed. What we can say is that there is no sign of them falling. NHS ‘Never Events’ rose from 57 (2009), to 139 (2010), to 294 (2011) (evidence). There were 329 never events in 2012-13 (evidence). There were 338 never events in the NHS during 2013/14 (evidence). There have been 197 never events in the 8 months of this year so far (evidence)
98.   There has been a 73% increase in written complaints against the NHS in 4 years. 101k complaints occurred in 2009-10, and this rose to 178k by 2013-14 (evidence & evidence)
99.   All of the main Private Health Firms have had reported shortcomings from CQC inspections on at least 1 of the NHS premises that they gained control of under this Tory government. This can be confirmed by using the CQC search bar and typing in the firms name and then checking the CQC reports for the NHS premises for which they are responsible (start here)

100.            Tory Privatisation has failed to deliver safer and more cost efficient healthcare. Several private health firms have walked away from NHS Contracts because they do not provide them with the profits they had hoped. The very same Private Health firms have then been allowed to rebid for more NHS contracts (evidence, evidence). Some firms have also been found to have overcharged the NHS (evidence). Contracts were also ended in cases where the private care was so bad it was endangering the health of patients (evidence & evidence)