Hi all. I'm going to start a generic thread posting articles and links I find on UK healthcare. Feel free to add. I'd like to centralize the information on the boards, to maximize the impact on everyone's research and decisions. =)
Hit squads to tackle NHS deficit
John Carvel, social affairs editor
Friday December 02 2005
The health secretary Patricia Hewitt yesterday ordered budgetary hit squads into the 50 highest overspending health authorities and trusts in England to halt an escalating financial crisis that threatens the stability of the NHS.
In response to an application from the Guardian under the Freedom of Information Act, she released confidential returns forecasting a collective overspend of £623m by the end of the financial year. A quarter of all the country's trusts are forecasting deficits that total £948m.
The figure shocked health ministers, who thought record increases in the NHS budget should have provided plenty of slack in the system.
The Treasury had been assured by the Department of Health that it had NHS funding under control after overspending by £219m last year.
The department said the hit squads - to be known as "turnaround teams" - would be selected on Monday after a lightning tendering exercise over the weekend involving City accountancy firms.
They will be instructed to cut spending to reduce the deficit to £200m by March without endangering patient safety. But quick and easy savings may be hard to make as trusts are already engaged in economies including ward closures, lengthening waiting times, recruitment freezes and the reduced use of agency nurses.
Within the last few days Norfolk, Suffolk and Cambridgeshire health authority stopped East Suffolk primary care trust negotiating with unions to defer paying March salaries until April.
The trust said it would not be able to afford payment in the final month of the financial year, but was instructed to find alternative savings.
Cuts in the most cash-strapped trusts will come at the worst possible time of year as Britain heads into a winter that is forecast to be colder than usual.
Health department figures show that a quarter of trusts are forecasting deficits totalling £948m in 2005/6. Surpluses in other parts of the NHS are expected to be £325m, leaving a net deficit of £623m.
A spokesman said 37 organisations were responsible for two-thirds of the gross deficit. They included: Surrey and Sussex Healthcare Trust (£41.2m); St George's Healthcare Trust, Tooting (£34.5m); Hillingdon primary care trust (£25.7m) and Hampshire and Isle of Wight health authority (£24.1m).
Figures supplied to the Guardian suggested the plight of some trusts may be worse than the department realises. For example Mid Yorkshire Hospitals has forecast a deficit of £14.7m, but health department officials said they were unaware that it is also receiving £19.9m in support from West Yorkshire health authority.
Sir Nigel Crisp, the NHS chief executive, told the Commons health committee that the department was publishing mid-year forecasts for the first time "as a result of an FoI application".
Analysis and publication of the information gained through FoI was pre-empted by the department's decision to make revised mid-year returns generally available.
A spokeswoman said its timing was dictated by the need to provide information to the select committee.
Sir Nigel handed over a dossier at the end of a three-hour session without giving MPs the opportunity to question him on it. He said: "Any actions that the NHS takes to reduce deficits should not lower the quality of care provided to NHS patients."
Ms Hewitt said the £623m forecast deficit was equivalent to less than 1% of the NHS budget, worth £76bn this year.
The shadow health secretary Andrew Lansley said: "NHS finances are spiralling out of control. Patients will bear the brunt of this financial mismanagement as frontline services are cut to balance the books."
Steve Webb, the Liberal Democrat health spokesman, predicted "drastic and swingeing cuts," adding: "The rollercoaster of NHS trust finances makes it impossible for hospital bosses to plan effectively."
John Appleby, chief economist at the independent King's Fund health research institute, said: "The Guardian is to be congratulated for persuading the health secretary to publish these figures. This transparency should now become routine." The British Medical Association welcomed the release of the figures but warned against "bully boy tactics" among the teams working with struggling organisations.
Health professionals believe gender bias limits women's progression in NHS
Liverpool, UK - 1 July 2005: The NHS suffers from an institutional gender bias that favours the progression of men over women according to health professionals.
New research at the University of Liverpool found that men occupy the most authoritative and influential positions in the NHS, with women believing they must assume a more aggressive male ‘career personality' to achieve success. Those taking part in the study said ‘old boy networks' are still evident in terms of selection processes for senior positions.
The research, conducted by Dr Jan Bogg and her team from the University's Department of Clinical Psychology, focused on equality and diversity issues within the NHS Allied Health Professions including those related to gender, ethnic minority backgrounds, disability and sexual orientation.
Dr Bogg said: "Women's traditional role as caregiver on the domestic front often leads to part-time working patterns and this is one reason for their lack of progression. There is a strong perception that NHS managers do not view part-time workers for career advancement in the same way as full-time staff.
"Those taking part in the study believed there was a further in-built bias in the system meaning women and those from ethnic minorities have to work harder to achieve success. Almost twice as many men as women hold senior positions in the NHS yet 80% of NHS staff are women."
The NHS is the largest employer in Western Europe, employing 1.2M people. It is also the largest employer of ethnic minority staff in the UK.
Of the 1,600 health professionals who took part in the study, 75% agreed that the NHS was working hard to promote equality and diversity but 64% believed that those from ethnic minorities were not well represented at senior levels in their organisation.
The use of positive discrimination to redress this imbalance was perceived as an unfair recruitment strategy by the majority of participants who were mainly of White British origin.
Disability and sexual orientation was also perceived as a barrier to career progression - 87% of disabled respondents felt their disability limited their chances of promotion.
Dr Bogg added: "It is clear the NHS is striving to improve working lives and to enhance the recruitment and retention of health professionals. Change is happening in the NHS but the perceptions of those who work there indicate that more needs to be done to address institutionalised practices and challenge stereotypical beliefs."
The research, funded by the European Social Fund, was presented at a University of Liverpool conference entitled ‘Breaking Barriers In The Workplace' on Thursday, 30 June. Keynote speakers will include Surinder Sharma, Director of Equality and Human Rights in the NHS.
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UK Demand for Overseas Doctors Severely Affecting Sub-Saharan Africa
Almost half of the recent 16000 staff expansion of the NHS came from the recruitment of health professionals trained outside the UK and Europe, states an article in this week's issue of The Lancet.
John Eastwood (St George's, University of London, UK) and colleagues note that, while the serious consequences of ‘brain-drain' are becoming increasingly recognised, the fact that the UK's demand for health professionals has affected the English-speaking countries of sub-Saharan Africa the most, has not been appreciated.
The health systems of developing countries have been badly damaged by the emigration of their doctors and nurses to developed countries. The UK has played a particularly prominent part in the process, with 31% of its practising doctors having trained outside the UK. The UK's chronic need to recruit doctors, nurses, and other health professionals from overseas is also increasing in comparison with other European countries of similar size. In France and Germany the proportion of practising doctors who are trained overseas is only around 5%.
The authors believe that the UK, as a major beneficiary of health professionals from sub-Saharan Africa, has a responsibility to take the lead in tackling the problem. They suggest a number of practical steps to slow the migration of health professionals from developing countries. These include significant increases in the training of both doctors and nurses in the UK, and a range of practical measures to assist the African countries most severely affected by loss of health professionals to the UK.
Dr Eastwood comments: "The demand from UK employers for more staff to run their hospitals appears to be a significant cause of the drain of health professionals from Englishspeaking sub-Saharan Africa. We certainly need to train more doctors and nurses in the UK. Also, in 2005, there are special opportunities for the UK to take the lead in focusing the attention of the G8 on the wider problems of health professional migration from poor to rich countries. We suggest that one basic measure would be an agreement in consultation with WHO to establish a basis, in developed countries, for minimum annual numbers of health professionals in training. This would help to reduce developed country reliance on the investment in training made by developing countries." (Quote by e-mail; does not appear in published paper)
In an accompanying Editorial The Lancet comments: "Every rich country can afford and should aim to train as many health-care workers as it needs. To poach and rely on highly skilled foreign workers from poor countries in the public sector is akin to the crime of theft."
Dr JB Eastwood, Department of Cellular and Molecular Medicine, St George's, University of London, UK. T) 020 8725 5067, email [email protected]
Rising workloads and a loss of professional autonomy will lead more doctors to quit their careers, according to research published today.
A survey of 2,000 trainee doctors found that most believed increasingly unrealistic government targets and public expectations were undermining the ethos of the medical profession.
The poll, by the Royal College of Physicians (RCP) and the British Medical Association (BMA), found that 80% of those surveyed felt that a decline in the values that underpin a doctor's relationship with their patients, such as integrity, honesty and humility, would mean many more doctors leaving the profession.
Many trainee doctors and medical students believe these values have been put at risk by changes to working patterns, training, limited financial resources, and patient and political expectations.
The respondents said patients were led to expect certain levels of service, but funding shortages meant this could not always be delivered in the way doctors would like. This left doctors frustrated at the frontline when dealing with patient disappointment which was often due to factors beyond their control.
The trainee doctors also said changes in working patterns, such as different shift systems, meant that doctors are rarely able to see a patient from the start to finish of their treatment.
More than four-fifths (83%) believed that in the last five years there has been an increase in clinicians' responsibilities and a decrease in their autonomy.
The survey found that junior doctors and medical students valued medical professionalism and its qualities, such as altruism and humility, which are defined by responsibility towards patients.
Dr Declan Chard, chairman of the RCP trainees committee, said: "Junior doctors and medical students believe that professionalism is not optional but an essential part of being a doctor - it is at the core of our relationship with patients.
"Sadly many trainees believe that medical professionalism is being challenged to a degree that they may consider leaving medicine. Ultimately this will have a negative effect on patient care.
"If the NHS hopes to retain its doctors and fully support them in their work, it should more overtly value medical professionalism."
The survey results come ahead of a report on medical professionalism due to be published by the RCP next week.