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  1. NHS funding in chaos as major hospitals rebel

    The NHS funding system in England was in chaos last night after a rebellion by the country's largest hospitals.

    One expert said the policy underlying funding allocations has reached "the end of the line."

    NHS organisations triggered a little known provision in the law by registering their objection to the coming year's finance proposals.

    But NHS England officials denied hints of a revolution last night - telling managers to continue planning on the current proposals.

    The revolt involves the NHS tariff, the system of prices which determines how much hospitals are paid for procedures.

    NHS England has used it to force efficiencies on hospitals by reducing prices each year.

    The system has been particularly controversial in accident & emergency departments where it has been blamed for some of the problems.

    Next year's proposals had already sparked a public rebellion by senior consultants by suggesting that specialist services would only get paid 50% rates for any increase in activity.

    Across the board prices would be cut by 3.8%.

    Some 13% of clinical commissioning groups and 37% of hospitals and providers lodged objections. But because objections came from the largest hospitals, they represented 75% of NHS activity in total.

    The level of objections means that the Competition and Markets Authority will have to decide what happens unless objections are withdrawn - and it is unclear how long this will take.

    A spokesperson for regulator Monitor said: "Amongst the options available are engaging with the sector then re-consulting on revised proposals or referring the method to the Competition and Markets Authority.

    Paul Baumann, chief financial officer of NHS England, threatened reductions in certain supplementary payments while the matter was settled.

    He said: "Since the overall NHS funding totals for 2015/16 are now agreed, any changes to the proposed tariff would in practice just be robbing Peter to pay Paul – meaning less investment in other hospitals, mental health or GP and community services – the exact opposite of what pressures this winter show is now needed.

    "In the meantime, CCGs and providers should assume that the 2015/16 planning round proceeds on the agreed timetable, within the funding and overall efficiency envelope set out in the joint planning guidance issued just before Christmas.”

    But Richard Murray, of think-tank the King's Fund, said the rejection was "very significant," warning that concessions on staff pay would make it even hard to balance the NHS books.

    He said: It signals that the policy of implementing year-on-year reductions in the prices paid to hospitals for their services has reached the end of the line.

    He said: "This is an unprecedented development. It is not clear what the outcome will be but, with just three months to go before the start of the financial year, it will throw financial planning in the NHS into disarray.

    "With signs that it is becoming increasingly difficult to maintain downward pressure on staff pay, it indicates that the two main ways used to reduce NHS costs over the last few years - limiting staff salary increases and reducing payments to hospitals – have now been largely exhausted.

    "With financial problems among hospitals now endemic, waiting times rising and staff morale a significant cause for concern, this once again indicates that the situation facing the NHS is becoming critical."

  2. Hip fracture care booklet launched

    A new booklet about hip fracture care is published today by the National Hip Fracture Database.

    Written in "clear, plain" English, with minimum jargon, the booklet is designed to help patients, families and carers understand what is likely to happen during hospital treatment and after discharge.

    It covers the most commonly asked questions about the essential aspects of hip fracture care, describes what a hip fracture is, and explains why it happens and how it will be treated.

    Mr Rob Wakeman, clinical lead in orthopaedic surgery, said: “Patients who have not had a hip fracture before, and families and carers who have not supported someone through this injury, need the best possible advice on what the process entails and what care patient should receive.

    “By using the booklet to encourage questions about their care, we hope that we will improve understanding of the patient journey. We know what the best care looks like – patients deserve it, and asking questions will encourage hospitals to provide that high quality care.”

    The booklet includes a list of 12 questions that patients should ask the clinical team in charge of their care, such as pain relief, memory problems, the seniority and kinds of doctor that should be involved in care, how soon an operation should take place, and rehabilitation following the operation or procedure.

    It also includes the relevant results from the National Hip Fracture Database annual report for each question.

    The booklets is available to download free of charge from the NHFD website – – and hard copies can also be obtained.

  3. Terminally ill need carers - survey

    Care arrangements are crucial to enable people terminally ill with cancer to stay at home, campaigners say today.

    Macmillan Cancer Support is urging all political parties to commit to including free social care for people in England at the end of life as part of their general election pledges.

    Its plea comes as the charity reveals that people with terminal cancer are more than twice as likely to die in hospital than at home if they have no domestic health or social care in place in the final months of their lives.

    This is despite the fact that most people with cancer want to die at home, says the charity, which also warns that the costs of caring for those people in hospital is placing an unnecessary strain on an already under-pressure NHS.

    Lynda Thomas, chief executive of Macmillan Cancer Support, says: “We are confronted here with a bleak picture of people with cancer who can’t die at home when they want to. The analysis suggests that because many people don’t have social care at home, they ultimately don’t get to choose where they die.

    “This lack of support for people with cancer can create an intolerable stress on family and friends at what is already a distressing time. And this too often results in dying people ending up in hospital against their wishes. Having help at home, even with tasks such as washing and getting dressed, could make a vital difference.

    “Macmillan Cancer Support is calling on all political parties to include free social care for people at the end of life in their general election manifestos.”

    A previous Macmillan survey showed that while 3 in 4 people living with cancer would prefer to die at home, only 30% are able to do so.

    However, today’s analysis of the Office for National Statistic’s 2013 National Survey of Bereaved People (VOICES) in England shows that one in seven (17%) with terminal cancer do not receive any care at home and of those, only 7% died at home, while 75% died in hospital.

    The analysis also reveals that of those who received at least 1 type of care service at home, 44% died at home, compared with 29% in hospital.

    A report by Macmillan in 2014 estimated that £137million was spent on hospital care for 36,400 cancer patients who died in hospital in 2012 but who wanted to die at home.

  4. Stroke risk for mid-life heavy drinkers

    Middle-aged people who have more than two alcoholic drinks a day could face a greater risk of stroke than those with high blood pressure and diabetes, researchers warned last night.

    The finding is the latest to highlight the potential risks of daily drinking. An earlier study linked it to increased risk of liver cirrhosis.

    A Czech study of 11,644 middle-aged Swedish twins found that heavy drinkers – those who had more than 2 alcoholic drinks a day – had about a 34% higher risk of stroke compared to light drinkers.

    Writing in the latest edition of Stroke, the authors, who analysed data over 43 years from the Swedish Twin Registry, revealed that heavy drinkers in their 50s and 60s were likely to have a stroke 5 years earlier in life irrespective of genetic and early-life factors, while they also increased their stroke risk compared to well-known risk factors like high blood pressure and diabetes.

    Although previous studies have shown that alcohol affects stroke risk, this is the first to pinpoint differences with age.

    Pavla Kadlecová, a statistician at St Anne’s University Hospital’s International Clinical Research Centre in the Czech Republic, said the study means that there is now a clearer picture about these risk factors, how they change with age and how the influence of drinking alcohol shifts as we get older.

    Kadlecová and team analysed results from the Swedish Twin Registry of same-sex twins, all of whom were under the age of 60, who answered questionnaires from 1967 to 1970.

    By 2010, the registry yielded 43 years of follow-up, including hospital discharge and cause of death data, which was sorted the data based on stroke, high blood pressure, diabetes and other heart conditions.

    Almost 30% of participants, who had been categorised as light, moderate, heavy or non-drinkers based on the questionnaires, had a stroke. Researchers compared the risk from alcohol and health risks such as high blood pressure, diabetes and smoking.

    Among the identical twin pairs, those who had had a stroke drank more than their siblings who had not had a stroke, which suggested that mid-life drinking raises stroke risks regardless of genetics and early lifestyle.

    “For mid-aged adults, avoiding more than 2 drinks a day could be a way to prevent stroke in later productive age – about 60s,” Kadlecová said.

    Kadlecová P. Alcohol Consumption at Midlife and Risk of Stroke During 43 Years of Follow-Up Cohort and Twin Analyses. Stroke 29 January 2015; doi: 10.1161/STROKEAHA.114.006724


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