Tag Archive: Government


Hospitals ‘fiddling’ A&E waiting times

Filed Under: Healthcare News, The NHS and Healthcare by Kirsty — Leave a comment
August 14, 2010

Hospitals are fiddling a four-hour A&E wait target by using other wards as dumping grounds, the Conservatives say. Data from 114 NHS trusts in England found many patients faced long waits in assessment units which did not count towards the waiting time. Over a fifth of units reported keeping patients longer than the recommended 24 hours with the average wait being 17. Doctors agreed the system was being abused in places, but the government said the research was “misleading”.

The Conservatives asked hospitals to provide data on their use of these wards under the Freedom of Information Act.We expect assessment units to be used to improve patient care, not as a ‘holding area’ or to avoid breaching the A&E four-hour standard. The units are commonly known as emergency assessment or clinical decision units. They effectively act as a half-way house between A&E and hospital to allow patients to continue to be monitored before a decision is taken to continue treating them or discharge them.

Many are mixed-sex and do not have proper beds, leaving patients to rest on trolleys. Shadow health secretary Andrew Lansley said: “Labour complacently claim that they have abolished long waits for patients being admitted to hospitals, but these figures show that all they have really done is fiddle the figures.

It is not the first time the way the target is being met has been criticised. Both the British Medical Association and academics at London’s City University have raised concerns over the last few years about the use of assessment units. John Heyworth, from the College of Emergency Medicine, said the four-hour target, introduced in 2004, was not working as well as people believed it was. “There is a continuing amount of gaming going on,” he said. “We know these areas are being used frequently purely to admit patients to meet the target and quite often they are not properly equipped or staffed.” He adds doctors would like to see more flexibility in the target to allow them to continue monitoring patients for longer than four hours when appropriate.

Nigel Edwards, policy director of the NHS Confederation, which represents hospital trusts, said it was likely patients were being moved to provide more time for tests, as the four-hour target did not give medical staff “very much leeway”.

Health minister Gillian Merron pointed out before Labour came to power patients were facing long waits. She said the Tory figures were “misleading” as some of the units were observational wards which had been designed and equipped to care for patients for a while. But she added: “We expect assessment units to be used to improve patient care, not as a ‘holding area’ or to avoid breaching the A&E four-hour standard.”

It would seem that the NHS is under so much pressure to change to many things at once, no wonder they are overstretched due to the sheer number of people they have to see when they have a mountain of paperwork to complete. So we shouldn’t blame them for attempting to modify procedure so that they appear to conform to the standards set by the government as they are aware that they risk funding being reduced if they don’t conform.

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Stakeholders

Filed Under: Businesses by Kirsty — Leave a comment
April 15, 2010

The definition of a stakeholder is people or groups who have legitimate interest in activities of businesses and other organisations in their society.
The stakeholder concept is important for 2 main reasons. Firstly it emphasises the fact that stakeholder groups have differing interests. Secondly it highlights the relationship between businesses and their external environment.
There are 4 points that also need to be kept in mind when thinking about stakeholders:

• All businesses have internal stakeholders. They also have external stakeholders these are usually either strongly linked or affected by the business.
• A pretty obvious fact considering that stakeholders are human beings is that they can have differing interests which may conflict
• Culture, structure and control systems within a business will determine how conflicts, or trade-offs, are resolved, and in practice the interests of one stakeholder group often have a dominant position.
• Some stakeholder interests are protected by law, but not all. The interests of other stakeholders are protected, if at all, only by regulation or management discretion whereas owners and shareholders are protected by property and company law.
All businesses have difficulty balancing the interests of their different stakeholders, mainly when the political reality is that different groups have varying amounts of power. Such as:

• Commercial businesses have structures that recognise the dominance of shareholders. However, the legislative and regulatory environment, over, for example CO2 emissions, is increasingly imposing constraints to protect the interests of the other stakeholder groups.
• Voluntary organisations are typically less tightly structured, and priorities may depend on the power of their management committees or trustees. Employees may exhibit greater dominance than those in the commercial sector.
• Government bodies are answerable to taxpayers and to service users, both of which are represented by elected representatives (politicians); in some instances, the reality is that the dominant stakeholder is the employee.

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Brown’s action on “excessive pay”

Filed Under: Businesses by Kirsty — Leave a comment
February 28, 2010

Gordon Brown has said overpaid public sector workers will be “named and shamed” in efforts to deliver more value for money in public services. Ahead of the pre-Budget report, the PM said “efficiency savings” would help to save £12bn over four years – £3bn more than planned in the Budget. Crime maps and online school reports will be used to cut overheads as Labour tries to halve the Budget deficit.

The Conservatives say the government is not being straight on the cuts needed. The government has delayed its planned comprehensive spending review until after a general election. In the pre-Budget report, Mr Darling is expected to confirm annual borrowing will top £175bn – which the government has promised to halve within four years. In his speech in central London, Mr Brown said ministers had identified £3bn in additional efficiency savings since the Budget in April.

Of that, £1.3bn over four years would be achieved by streamlining central government, he said, indicating that certain programmes would have to be delayed or abandoned. We need to do what households up and down the country do to prioritise the necessities and postpone the things we can do without

Government spending on consultants would be cut by half and communication spending by a quarter – saving £650m – while more Civil Service staff would be relocated from London to “cheaper” premises. Whitehall departments could set up “common spending policies” and share office space, as part of a “third generation of changes in public services”. In its report, Putting The Frontline First, the government points out there are now 4,300 senior civil servants compared with 3,100 in the mid-1990s.

Mr Brown said public sector workers earning an “over-generous” salary would be “named and shamed”, as many had “lost touch” with normality. In future, all new public sector jobs with salaries above £150,000 will have to be approved by the Treasury while the details of civil servants and other public sector managers under direct ministerial control currently earning that amount will be published.

Mr Brown has ordered a review of senior public sector pay by the Senior Salaries Review Body to report by the Spring. He said: “Money which should be spent on health, on schools, on policing and on social services is, in some cases, going on excessive salaries and unjustified bonuses, far beyond the expectation of the majority of workers. This culture of excess must change and will change.” He added that the government would use technological advances to make services more user-friendly and cheaper.

As an example, sending text messages to remind patients about GP appointments could help save up to £600m a year wasted on missed visits. The public needed more “feedback and interaction” when using services, such as crime maps and giving parents online details of children’s progress at school, he added. Mr Brown promised to bring more such details on to the internet by next year. “The proposals we are setting out in this plan – which is just one element of our efforts to reduce the deficit – will go further than we have ever gone before in streamlining central government,” Mr Brown said.

“We have already promised savings of £35bn a year by 2011 on top of the £26.5bn a year already delivered through the Gershon [spending] review. “But by identifying new ways of working – and being prepared to make the tough choices – we can deliver in excess of another £12bn in efficiency savings over the next four years.
“This includes £3bn of new efficiency savings identified since the Budget – of which over £1.3bn will come from streamlining central government.”

The proposals were laid out in Parliament by Liam Byrne, Chief Secretary to the Treasury, who said that saving money should be “everybody’s business”. Chancellor Alistair Darling told BBC One’s Andrew Marr show that public spending would be “a lot tighter than it was in the past” as a result.

He said parts of the troubled £12bn NHS IT system would be delayed as it “isn’t essential to the front line” – a move Health Secretary Andy Burnham told MPs on Monday would save £600m “over the lifetime of the programme”. Mr Darling said the full details of spending cuts would not be revealed until “the first half of next year at some point”.

Meanwhile, as part of plans to tackle the deficit in public finances, the Treasury is working on a possible windfall tax on what it sees as the exceptional profits of banks or the excessive bonuses of bankers.
But the Conservatives say the government is still not revealing the full extent of cuts needed to tackle Britain’s debts.

They say they would protect NHS and international development spending but the rest of Whitehall would face “very difficult choices” if the Tories won power. The party has also called for a moratorium on all government computer projects, claiming Labour has spent £100bn on IT since 1997 and that contracts worth another £70bn are due to be renewed or commissioned in the next two years.

Shadow Treasury minister Philip Hammond told MPs: “Since 2000 they’ve poured billions of pounds of taxpayers’ money into indifferent public services, borrowing and spending like it’s Monopoly money.”
He called Labour’s savings plans a “mish-mash of announcements and stolen clothes, in the dying months of their rule”.

Liberal Democrat Treasury spokesman Vince Cable said: “If the government knew there was inefficiency, why hasn’t the government already dealt with it?” We have now reached the point where the investment gap which we inherited…in 1997 has been fixed.

He added that more had to be done to improve the level of independence local government has from Whitehall, in an effort to increase accountability. Jonathan Baume, general secretary of the First Division Association, which represents senior civil servants, called the government’s proposals on public sector workers “irresponsible”. He added that “this announcement looks more like crude electioneering than a sober assessment of the implications for central government of the fiscal crisis”.

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Banks need to wake up

Filed Under: Uncategorized by Kirsty — Leave a comment
February 16, 2010

A government minister has told bankers “to come back into the real world” after Royal Bank of Scotland directors threatened to resign over bonuses. City Minister Lord Myners said it was unrealistic that bankers should expect to be paid million pound bonuses.

RBS reportedly wants to pay a total of £1.5bn in bonuses to investment banking staff, and the board has threatened to quit if the government blocks the move. The Treasury said it would intervene if it was in the interest of taxpayers.

Meanwhile, Barclays is planning on increasing the non-variable element of staff pay at Barclays Capital, its investment bank, the BBC’s business editor Robert Peston says. The Government is caught between a rock and a hard place. Many voters cannot understand why taxpayer supported banks should pay their staff any extra bonuses.

In January the Chancellor will have to approve the bonus pot at RBS. Any increase could generate a backlash against the government. But the City doesn’t like what’s seen as interference in the boardroom. Looks like this will run and run. Barclays maintains that by pushing up salaries, it is only doing what G20 governments have asked it to do, by shifting the weight of pay from the variable portion – ie bonuses – to fixed.

Lord Myners has estimated that at least 5,000 bankers in the UK will earn more than £1m this year. He told the BBC that the median wage in the UK was just over £20,000 a year, and yet some bankers expected as a matter of course to receive bonuses, in addition to their salaries, of millions of pounds.

He also said banks needed to be mindful of the fact that much of the profit they were now making was due to “the benign conditions” created by the government pumping billions of pounds into the economy to stimulate demand. RBS directors say it is their legal duty to act in the interests of shareholders, and that if they do not pay competitive bonuses, top talent will leave the bank.

This would have an adverse impact on profitability, and therefore the bank’s ability to repay the taxpayer, they argue. Business Secretary Lord Mandelson said: “I understand the point that RBS directors are expressing – they say they have to remain competitive in the market in recruiting senior executives, and this is why it’s important that all the banks are equally restrained, and RBS is not singled out.”

The Conservatives said the government was sending out mixed messages. Shadow financial secretary Mark Hoban said: “The government’s policy on bonuses is a muddle. The city minister claims he will veto big bonuses only to be superseded by the business secretary calling for banks merely to show restraint.

“We have been clear – no significant cash bonuses should be paid out this year and that money should go towards increasing lending to the families and businesses who propped up the banks in the first place.”
Liberal Democrat Treasury spokesman Vince Cable said the government should “call the bluff” of the RBS directors and accept their resignations. “The government has to impose itself and must not be pushed around,” he told the BBC. One banking analyst went a step further, suggesting the directors should be sacked. “Their job is very simple – to fulfil the requirements of the shareholders. If we tell them to paint everything blue, everything has to be blue,” said Ralph Silva at SRN. “They should not be going up against shareholders. I think we should fire them [before they resign].”

But he also argued that the government would be making a mistake if it told the bank not to pay bonuses. The best bankers who brought in the most profit would leave, he said, and for this reason he thought the bonuses would be paid. But others took a more sympathetic line with the RBS directors. Stephen Regan at the Cranfield School of Management said that shareholders could not call the shots and only had the power to call an extraordinary general meeting, at which they could vote on whether to oust the board.

“Ownership is with the shareholders, but control of the business is with the directors,” he said. The government owns 70% of RBS after bailing out the bank during the height of the financial crisis, a stake that is set to rise to 84% following the Treasury’s recent pledge to inject billions more into the bank.

Last month, Chancellor Alistair Darling announced that the Treasury, as the major shareholder in the bank, would have the “right to consent” to how much RBS pays in bonuses and how they are paid. RBS is said to want to pay £2bn in bonuses across the group for its performance in 2009, with £1.5bn going to its investment banking division, which is expected to make £6bn in profits this year.

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America attacks the NHS

Filed Under: Healthcare News by Kirsty — Leave a comment
August 15, 2009

Daniel Hannan, a Tory MEP (Member of European Parliament) who criticised the NHS on American TV was accused of being “unpatriotic” by Andy Burnham, who is the Health Secretary. He claimed that the NHS is unfair and outdated and should be scrapped. Hannan made a series of appearances on American television over several weeks, and was quoted as describing the NHS as “60 year mistake” and he “wouldn’t wish it on anyone”. This rather brutal attack on the NHS came about following Obama’s proposal to introduce a similar system in America. Mr Hannan has repeatedly stressed that the views he expressed on U.S TV were his own and not those of the party but that Roger Helmer, a fellow Tory MEP who reports claim he said on BBC Radio 4′s PM programme: “I think Dan has done us a service by raising these issues which need to be looked at”. Burnham said: “What has happened within the last 48 hours is what Cameron has feared most because it lays bare the Tories’ deep ambivalence towards the NHS.”

Daniel Hannan claims that: “If 80% of Americans are getting better health care than we are in the UK then we ought to ask why, and we ought to ask how are we going to deliver equally good results.” For those who are not particularly familiar with the current health care system in America see The Difference between USA healthcare and the NHS

Tory leader David Cameron, vows to protect health from spending cuts that have been predicted for 2011 if he comes to power, he reiterates his commitment to the NHS and has made it clear that he does not share Hannan’s views and has distanced himself from Hannan. Cameron claims:”We are the party of the NHS, we back it, we are going to expand it, we have ring-fenced it and said that it will get more money under a Conservative government, and it is our number one mission to improve it.” He goes on to say: “He (Hannan) does have some quite eccentric views about some things, and political parties always include some people who don’t toe the party line on one issue or another issue.”

There are some who feel that Daniel Hannan should be disciplined for his comments about the NHS. Mr Hannan’s words have been seized on by Labour and the Liberal Democrats who have questioned the party’s commitment to the NHS. His critics state that Hannan’s words were an “insult” to the 1.4m NHS workers and “he should not be voicing those views in the foreign media in my view”. John Prescott has recorded a message accusing Mr Hannan of “misrepresentation of the NHS here in Britain”. Even the Prime Minister has publicly joined those who support the NHS by joining the welovetheNHS Twitter campaign, that was set up defend the health service from US attacks.

It would seem that Hannan’s comment has stirred alot of unrest within the British public and alot of people are pledging their support to the NHS. One of those is the physicist Professor Stephen Hawking, who claims that he would not be alive without it: “I have received a large amount of high-quality treatment without which I would not have survived.” Hawking, who has Lou Gehrig’s disease, was in Washington to be awarded the America’s highest civilian honour, the Presidential Medal of Freedom. An American newspaper subsequently used Prof Hawking as an example of the deficiencies of the NHS. “People such as scientist Stephen Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless,” it claimed.

As with any big institution there will be a few that oppose it but for the vast majority of people the NHS does work and saves millions of lives. For those that don’t like the NHS the UK also has the option of private healthcare so if you don’t want to use the NHS go private. Simple.

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Private Transplants to be banned

Filed Under: Healthcare News, The NHS and Healthcare by Kirsty — Leave a comment
August 2, 2009

The government is planning to ban all private transplants of organs from dead donors in the UK. The ban comes as a result of media reports of patients from countries such as Greece and Italy paying to get on waiting lists for organs from British people, so due to the fact that organs are scarce the general consensus is that to ensure NHS patients don’t miss out no one should be allowed to pay for transplants. At present the ban is only been approved in England but is expected to come into place across the rest of the UK by October.

An enquiry carried out revealed that over 700 transplants, most of which were liver transplants, had been carried out on non-UK patients over the past 10 years. Of the 700 transplants 631 of those transplants used organs from dead donors and, of those, 314 were from outside the EU. It is worth pointing out that the enquiry uncovered no evidence of wrongdoing with regards to the allocation of the organs but came to the conclusion that no one should be able to pay for such operations. According EU law, some patients can receive treatment in other countries, if approved by their healthcare system, which then foots the bill, however the NHS should be more cautious when assessing patients’ eligibility as it is possible that some patients are receiving treatment when they should be refused. Some say that the NHS should work with other EU countries to help develop their own transplant scheme.

The ban only applies to transplants from dead donors private transplants can still be carried out using organs from living donors. Critics of the ban claim that the only reason people pay for transplants is the NHS takes so long that you will probably be dead before you get it. They also point out that it is illegal to sell your organs so why should hospitals be allowed to sell organs to the highest bidder, especially when there are not enough organs available for citizens of the UK. The organs should be allocated on the basis of who is in the greatest need instead of who can afford to pay.

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Swine Flu unstoppable?

Filed Under: Healthcare News by Kirsty — Leave a comment
July 20, 2009

Top health officials for the UN have started a forum in Mexico on combating swine flu by saying the spread of the virus is now unstoppable. Current statistics show over 100 countries reporting cases of the virus, Dr Chan from the WHO claims; “….once a fully fit pandemic virus emerges, its further international spread is unstoppable.”

The UK is predicting more than 100,000 new cases of H1N1 a day in the UK alone by the end of the summer.
Whilst Mexico swine flu cases have decreased. In South America the peak of the flu season is approaching, as a result some areas have declared a public health emergency. However it is worth mentioning that in the 2 months since the outbreak of swine flu it has only killed approximately 300 people worldwide which when you put it into context isn’t really that many, obviously it is a tragedy for those who knew these people. In the UK the latest figures show only 26 people have died from the virus, which is minimal when regular flu claims the lives of around 6,000 people a year.

In the UK Health Secretary,Andy Burnham has come under fire from the Liberal Democrats who claim fighting within government departments led to the hotline which offers information on the virus and what to do to avoid catching it and what to do if you suspect that you have the virus being launched six months late. Although this claim is flawed as the outbreak of the virus was only announced 2 months ago. It was hoped that the hotline would take the pressure off frontline NHS staff and enable them to deal with other illnesses

Before everyone starts to panic the WHO says most cases of H1N1 (swine flu) are mild, with recovery within a week and often without any medical treatment. The exceptions, she said, were pregnant women and people with underlying health problems, who were at higher risk from complications from the virus and should be monitored if they fall ill.

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80 Hour weeks scrapped for Junior Doctors

Filed Under: Healthcare News by Kirsty — Leave a comment
June 26, 2009

Health Secretary Andy Burnham announced that the days of NHS junior doctors working 80 hour weeks have gone for good and that the “overwhelming majority” of junior doctor rotas will comply with the European working time directive by 1 August.

Due to the fact that the NHS is seriously understaffed it means that junior hospital doctors are working an 80-hour week often unsupervised. It is believed that scrapping this system will be a long-awaited boost to their morale. One reason that the system was reviewed was because of the number of reports of serious, potentially fatal, mistakes or near-misses, made while coping alone and exhausted on a ward late at night and their consultant bosses were tucked up in bed.

This is made worse when junior doctors complain to their consultants about the excruciatingly long hours, the clerical work, the endless list of minor tasks are still told: ‘We did it, so can you.’ Do consultants not realise that things are changing all the time? The number of staff has decreased due to the economic climate meaning that jobs have been cut and the amount of paperwork has increased due to various policies put in place by those higher up the ladder, some are a result of Government policy and others are a result of media coverage of errors in practice.

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Plan to give patients to get their own NHS budgets

Filed Under: Healthcare News, The NHS and Healthcare by Kirsty — Leave a comment
January 17, 2009

Personal budgets have been used in social care since the mid 1990s and ministers claim that they can encourage patients to get more from the NHS. Evidence shows that personal budgets have allowed people in social care to be more imaginative and use funds more “carefully” than the system did. It is said that the personal budget programme employed in social care includes direct cash payments to the individual as well as budgets that a patient can put in the hands of a social care professional.

Those who support the idea of patients having their own personal budget have said that there is no reason why this should not happen in health, although it will need to be carefully introduced.

There are those who claim that the system who say that the system can be misused if you are simply giving patients money however the information on this scheme states that where direct payments are handed over to individuals the way they are used is carefully monitored and people receive help from professionals about what services are available. The chief executive of the NHS Confederation, which represents managers, states: “There is a growing body of evidence to suggest health outcomes are improved when the patient is directly involved in making decisions about their treatment and the way in which care is delivered by NHS staff.” Despite this there are a number of obstacles to overcome before the scheme can be launched nationally.

There are lots of questions from those who have their doubts about this new system such as, should patients be allowed to spend their personal budgets on non cost-effective treatments? or should individuals be allowed to top-up their care? Should patients be allowed to invest personal budgets to be spent at a later date? Dr Hamish Meldrum, who is the chairman of the British Medical Association, said the policy appeared to “further establish the idea of healthcare as a commodity”, which would not be in patients’ “best interests”.

Those who support the idea of patients managing their own budget claim that “Personal health budgets could revolutionise the way in which care is delivered, but they are not without risks.”

Niall Dickson states: “Getting the initial payment level right will be important as will deciding what restrictions to place on the kind of treatment a patient is allowed to purchase with tax payers’ money, and from whom.”

Ministers imagine that it will be of particular interest to those with long-term conditions such as diabetes and people using mental health services, for example, a person with diabetes may choose to use their budget to get treatment from a community clinic rather than being referred to a hospital specialist. Launching the Bill, Health Secretary Alan Johnson said: “People rightly have high expectations of the care the NHS offers, and they want more control over their own health – which is why this Bill will give more power to patients and drive up the quality of care.” Andrew Lansley adds: “Personal budgets have been at pilot stage since 2005. If Labour had stuck to their promises to deliver them then patients would already be benefiting”.

It would seem that the majority of people are dubious of this new scheme as it seems that they are worried about several factors:

  • It is essentially privatising the NHS
  • Some people may get a higher budget than others
  • Some people may use their budget to jump through the waiting lists for procedures

Without a detailed plan of how the scheme will actually work it is impossible to know whether the scheme will actually work basically I’m not sure if the scheme is good or bad. Although the evidence would suggest that there is the potential for the scheme to work I think it may cause some people to lose out or be unable to get the treatment they need.

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VAT and the change explained

Filed Under: Uncategorized by Kirsty — Leave a comment
December 22, 2008

VAT is value added tax; basically pretty much every item you purchase has VAT added to the cost price of the item. For example a chocolate bar costs the shopkeeper 49p for the consumer the cost of the same bar of chocolate is 52p at the old rate of VAT. Before 1st December 2008 the rate 0f VAT was 17.5%; the current rate is 15%.

The reason for the decrease in the VAT rate was an attempt to resolve the country’s economic crisis by encouraging people to start spending again although I should point out that it is temporary and the reduction will apply only for a short time which given the changes listed below will ultimately mean even greater expense for the companies. Unfortunately when the government decided to introduce this reduction they forgot to consider the sheer cost involved in amending the prices of every item. Not only do you have to ammend the prices on the actual item but you also have to reprogramme the software used to
process the sale (tills or software on online sales), another problem is that the brochures for next year have already been printed thus with the reduction they are now useless therefore it increases the cost to the company. It also generates a further problem because retailers have 1 of 2 options either they can pass the saving on to their customers and make a loss themselves as the wholesale price does not change, alternatively they can basically pocket the difference unfortunately there is no way to prove who is doing what.

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