Spats‘r’us
The Socialist Heath Association is a bit hurt by the Labour conference’s rejection of its resolution to re-establish the NHS as a public service. There was, says the SHA, “an unprecedented over-ruling of the Conference Arrangements Committee” and the ejection of SHA Secretary Harry Stratton, who was one of the SHA’s two delegates. Surprising that we have not heard more of this.
Source: admin@sochealth.co.uk
Too much medicine?
The British Medical Journal has published an analysis of the data on survival in people with symptom-free metastases of lung cancer. Surgical removal or destruction (ablation) are favoured by some oncologists. Either procedure seems common sense, but the evidence supporting them is thin, whilst the evidence of harm caused is more robust. The opportunity to run a scientific trial was recently missed. The BMJ article concluded there was too much medicine, and that patients need to be informed of uncertainty of benefit and risks of harm.
Source: Fergus Macbeth and colleagues, Removal or ablation of asymptomatic lung metastases should be reconsidered. BMJ 2032;383 e073043
Babylon down, eMed up
The NHS’s largest General Practice which lost money on every one of its consultations, is no longer struggling financially, according to its new owners. US company eMed bought GP at Hand – which serves 100,000 NHS patients – along with the rest of Babylon’s UK business in September 2033. An anonymous commentator in the Health Service Journal provided the context for GP at Hand’s recovery.
Since 1998 consultant and hospital doctor numbers have tripled. For comparison, GP numbers rose for a few years then declined to just below 1998 levels. Since 1998 GP consultation numbers have roughly doubled (difficult to assess due to poor data in 1998) whereas hospital outpatient, A and E and inpatient numbers have been roughly flat.
There are currently 6 hospital doctors for every GP. Hospital doctors spend approximately 50% of their paid time patient-facing. GPs spend 100% of their time patient-facing and do everything else in their own time. Stick GPs on the consultant contract (which many would want) and our individual workload would halve, as would our productivity. Currently GPs see around 360 million patients per year. For comparison A and E sees around 23 million, and outpatients around 30 million.
Real-terms funding for general practice is around 35% down since 2004 despite the increased numbers of consultations. Currently general practice receives 7.2% of the NHS budget, compared to 2005 when it was 11.2%. Mental Health and Community Services also receives around 7.2% each. Everything else goes to the hospitals, around 79%. For hospitals the real-terms funding has significantly increased but there have been no obvious or meaningful productivity gains.
General practice is the only profession …. where newly-qualified practitioners immediately go less than full time because the job is so difficult it is impossible to work full-time.
In the past few years we have seen a number of private entries into NHS general practice - by and large for the reasons above they have quickly left, usually with their fingers burned.
Nothing has changed in a year. I don't know [the new boss of GP at Hand}, but unless his background is in running general practice (not commissioning it, or watching it from secondary care) he won't be able to deliver no matter how smart and hard-working and nice he is.
Secondary care managers always assume general practice is easy to run, but it doesn't run in linear ways like hospital clinics and in-patient stays. It is more complicated than that.
Which means that if I were an investor, I would stay clear.
Source: Comment on Mimi Launder GP at Hand ‘financial turbulence’ is history, says new owner Health Services Journal 16 November 2023
Sickness absence
The latest data from the Health & Safety Executive demonstrates the huge economic cost of ill-health in the workplace amid soaring economic inactivity due to chronic illness and NHS waiting lists, and could force employers’ hands towards offering a greater provision of private healthcare options according to leading independent consultancy Broadstone.
The statistics reveal that 677,000 new cases of work-related ill health are reported every year and it is estimated by HSE that in 2021/22, new cases of work-related ill health cost Britain around £13.1 billion.
Of the 677,000 annual cases of work-related ill-health, 323,000 (48%) result in seven days absence or longer with an average of 17 days taken off work. These longer cases account for the lion’s share of social and economic costs – episodes of ill-health resulting in seven days or more off work account for nearly 97% of total costs despite representing just under half of incidences.
The average cost per case of ill-health stands at an average of £19,300 which rises to £39,400 for absences of seven or more days. Around 14,200 workers never return to the labour market as a result of their work-related ill-health.
Source: Broadstone@templebaradvisory.com
Treasury versus Trusts
Another enlightening analysis from the Nuffield Trust. Here is a taster. The commanding heights of the British state resent the failure of health and care to deliver commitments on savings, reform, waiting times and financial control – often without much introspection on what this says about the realism of the commitments. On their side, health and care leaders often lobby for cash by appealing to special narratives and the priorities of politicians to show that their need for more is different this time.
Source: Mark Dayan NHS trust: why Whitehall’s increasingly divided view on health and care matters Nuffield Trust 16/11/23
Productivity problem?
The hiring of several thousand staff in the financially troubled health system of Greater Manchester has been called ‘not readily explainable’ and seems well beyond the increases reported by similar NHS areas. Around 1,000 more doctors and almost 5,000 more nurses are being employed than the system’s activity levels would suggest. A Turn Around director has been appointed.
Source: Lawrence Dunhill Headcount rise of 4,000 ‘not readily explainable’ by troubled ICS Health Service Journal 15 November 2023
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/