The Treasury's suggestion that Papworth hospital should be relocated and joined with the loss-making Peterborough and Stamford NHS Foundation Trust is deeply disturbing and clearly based on financial aspirations rather than sound medical considerations (Report, 15 February). When I was appointed consultant cardiothoracic surgeon to Papworth 42 years ago, I was told by the regional medical officer that we'd be moved to the Addenbrooke's site within four years. Events conspired against this. However, after my retirement I served as a non-executive on the Papworth board and, following lengthy discussions with Addenbrooke's, it was unanimously agreed that we should move to its site in Cambridge. There we would have our own building and retain our own management and identity as a separate trust, but would share some expensive services that would be used by both hospitals.
Our reason for wanting to remain independent was because of our success. We had excellent management and, being a single-specialty hospital, were able to focus efficiently on treating patients with heart and lung disease without being subjected to the demands and pressures of being part of a large general hospital. We were in agreement that both hospitals would benefit from the proximity of our respective clinical services and, for Papworth, the presence of world-class research-based organisations and the medical school on the same campus were added attractions. This still has to be the best option for the patients of East Anglia and for those who attend our supra-regional services from further afield. It is intolerable that this should be put at risk by this late intervention from the Treasury.
• The real iniquity associated with the Papworth hospital PFI bid is not with Mr Osborne's decision to reject it but the rush to PFI by successive governments, saddling the country with massive debt. The NHS is a publicly funded body, bound by statute to provide healthcare free at the point of delivery from taxpayer's money. Implicit within this must be the provision of hospitals and facilities for the delivery of that care. Instead of wasting vast amounts of money on foreign expeditions, our politicians should be prioritising care for our own population first. This should include the building of modern hospitals for the delivery of state-of-the art healthcare for our people.
Papworth has been at the forefront of cardiothoracic surgery and medicine for half a century and is recognised around the world as a top institution. It is a jewel in the NHS crown and yet visitors from other countries are appalled at the facilities within which this work has to be carried out. To cause years of delay in its rebuilding on the Cambridge University hospitals campus (one of the largest and most advanced in the world), its rightful site in the 21st century, demonstrates nothing if not political blindness to the importance of the scientific developments in medicine.
For a mere £150m, the UK would be delivered of a fine state-of-the-art facility that patients and staff deserve. There can be little doubt that the populace, whose taxes should be used appropriately, would support such a move. After all, if a new cardiothoracic institute can be built with 100% government funding at a previously unrecognised site such as Basildon, surely it should be shamed into funding this worthy project. PFI-developed projects cost the taxpayer a factor of three to four times the cost over a 30-year period and, at the end of it, the builders retain control. Millions of pounds are being poured into the pockets of developers , with additional income streams generated for them by the excessive running costs of these institutions that they control.
Consultant cardiothoracic surgeon, Papworth hospital
• I can empathise with Stephen Bridge, the chief executive of Papworth, and his anxiety over its future, but I think he is being naive on at least three counts. First, the quality and levels of medical services and care are determined by the teams of clinicians and support staff, not the location or the name on the door of the hospital. Second, he raises the question of the financial problems facing the Peterborough hospital caused largely by its PFI debt, but in the same breath says Papworth would be raising £80m through that same facility. PFI schemes have been one of the biggest sources of financial problems to beset the NHS in recent years. Third, he argues that location in the Cambridge biomedical campus is vital. Given the facilities of modern communications and the proximity of Peterborough to Cambridge – only 30 miles – it is difficult to accept this as a strong argument.
Having served for 10 years as a patient governor on the councils of both Moorfields and now University College London, I am well aware of the benefits of hospitals being a part of academic health science centres, as I am also of the problems of financing the building of new hospitals and the use of PFI to do so. Moorfields is facing a move to a replacement facility and UCLH used a PFI loan for its Euston Road premises. Stephen Bridge would do well not to confuse "NHS politics" with economic probity.
• It could be amusing, were it no so wretched and destructive, to point out that the possible "shotgun partnership" of Papworth hospital ("at the forefront of medical innovation") with Peterborough and Stamford NHS foundation trust ("the NHS's most loss-making foundation trust") would be a stark example of the fallacy of the second accident, popularly known as a "secundum quid".
Jeremy Hunt has it in his secretary of state's power to nip this in the bud and insist that Papworth should realise its move, 10 years in the planning, to the 310-bed hospital in the Cambridge biomedical campus, next door to Addenbrooke's, where Roy Calne pioneered liver transplantation and much more. In this situation, the Department of Health should stick to its decision to back Papworth's move and tell Hunt to tell the Treasury to get lost. If the Treasury decides against and Hunt gives in, then Papworth will drown and decades of British and global medical transplant care and advance will be matters of history and, yet again, the fallacy of the second accident will have prevailed.
Figures show that girls aged 15 to 19 had one of the highest number of admissions for stress, behind only middle-aged men
There were nearly 300 incidents of girls aged 15 to 19 admitted to NHS hospitals for stress over a 12-month period, figures have revealed, prompting a charity to call for earlier intervention to help children with mental health problems.
The statistics, published by the Health and Social Care Information Centre (HSCIC), showed that girls in the 15-19 age group had one of the highest numbers of hospital admissions for stress in the year to November 2013, behind only middle-aged men.
Sam Challis, information manager at the mental health charity Mind, said: "[This] underlines the concerning scale of severe mental health problems amongst young girls. Hospitalisation in itself should be a last resort when it comes to mental health treatment. It is an indication that a patient has reached crisis point, that they have nowhere else to turn and need urgent help.
"These figures emphasise the very real need for early intervention. Schools and colleges, as well as family and those in a child's wider support network, need to recognise the role they can play. Creating a culture of openness where young people feel able to talk about their mental health is vital, to ensure they get the right support and at the right time. In turn, appropriate services must be accessible, long before hospitalisation becomes a necessity."
The overall number of admissions for stress fell by almost 14% on the previous 12 months, from 5,610 to 4,840, but the number of admissions of girls aged 15 to 19 remained almost static, dropping by one to 295.
HSCIC's chief executive, Alan Perkins, said the figures showed "interesting age and gender patterns for stress cases".
Eight out of 10 admissions for stress across the different age groups were emergency admissions, while one in four of those admitted – 1,230 people – had a history of self-harm.
The HSCIC figures also showed that almost three out of 10 admissions to NHS hospitals for anxiety over the same period were women aged 60 and over. Overall, the number of hospital admissions for anxiety also fell on the previous 12 months, by 2% from 8,930 to 8,720.
HSCIC said the pattern of admissions for anxiety or stress by age and gender was similar to the previous 12 months.
• This article was amended to reflect the fact there were 300 reported incidents of young women being admitted to hospital, and not 300 women, as we reported earlier.Haroon Siddique
Rallying cry is attractive but reinforces beliefs about the health service that are simplistic, naive and probably incorrect
In the often heated debate about the future of the NHS, there is one thing that politicians seem to agree on: both sides are happy to use the slogan "more resources to the frontline". The slogan is not just naive, it damages the service.
The slogan effectively captures the public mood. When a UKIP politician on BBC Question Time claimed that the NHS has two managers for every nurse, he was overestimating the manager count by a factor larger than 20 (see useful analysis of the real numbers here and here).
The slogan reinforces beliefs about the NHS that are simplistic, naive and probably incorrect. But the slogan is so attractive almost nobody looks beyond it.
This wouldn't be a problem if the people running the system didn't share the belief. But the slogan was written into the health bill. Despite the whole thrust of the bill being to free up local NHS organisations from central control to help them decide how to run the system, a centrally imposed target on how much could be spent on management has been built in. This target was derived from the idea that we should move more resources to the frontline, even though the best evidence available at the time suggested the system was undermanaged before the changes.
The second reason the slogan is so dangerous is that it affects how well the services run, damaging their quality and productivity. The slogan discourages us from thinking of a hospital as a system. Instead, people casually accept that all that matters is how many doctors or nurses there are.
It never seems to occur to people that a hospital is a complicated system of interacting people and components that requires a lot of coordination to function at all. There is no point having a doctor in the operating theatre if the anaesthetist hasn't turned up, the theatre hasn't been cleaned, the hospital has run out of AB-ve blood and there is no bed available to receive the patient when the operation is over. The slogan just diverts thought from those complexities, dissuading us from asking how many supporting people we need to enable surgeons to do their work well.
A recent estimate from one doctor suggested that perhaps three hours a day are consumed in paperwork. We might have more staff on the frontline, but we are not spending it in front of patients; instead, we are wasting medical time doing badly designed administrative tasks that should mostly have been automated and computerised. More resources to the frontline is leading to less frontline time with patients.
If we lived in a world where our attention were not distracted by a beguiling political slogan, we might ask more intelligent questions about how the NHS works. A hospital is a complex machine where all the parts must work in harmony. It needs a lot of cogs other than doctors and nurses to function and sometimes it doesn't work well because there isn't enough support of the frontline. Sometimes, investing in better systems and investing in more support staff (and managers) is the way to improve the effectiveness of doctors and nurses. Maybe, for example, better organised A&Es are more pleasant places to work and therefore find it easier to recruit the doctors they need to function well (but this might mean they need to invest in managers or systems first). This isn't just speculation; we have strong evidence that good management dramatically improves the quality and cost effectiveness of what doctors and nurses do.
A more nuanced view of how the NHS actually works might give managers a better sense of their role. They should be making sure the systems and processes make it as easy as possible for the frontline staff to do their work. They should be supporting the front line. We might even choose to invest in more managers or more computers or more support staff because that is the best way to make the whole system work better. But we won't, because we are all befuddled by the slogan: "more resources to the front line".
Dr Stephen Black is a health management expert at PA Consulting Group
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King's Fund report says primary care must restructure to keep the NHS sustainable
GP practices must start working together in federations and delivering far more services in a restructuring of healthcare that is vital to keep the NHS sustainable, the King's Fund urges today in a report that has attracted high-level government interest.
Major changes are needed in how primary care and both hospital and community-based services are funded, delivered and co-ordinated so that the health service can cope with the huge pressures caused by ageing and long-term conditions, the thinktank argues.
Its report on the future of general practice comes less than a year after the coalition's unpopular and far-reaching overhaul of the health service in England. It accepts that it would involve "a radical departure for the NHS" and yet more upheaval, especially for GPs. But it contends that without family doctors hugely expanding their roles – including a controversial resumption of responsibility for out-of-hours care – the NHS will fail to cope with rising demand, years of expected tight budgets and a growing shortage of GPs.
If implemented, the ideas could produce the long-sought integration between health and social care that ministers agree is crucial to long-term sustainability, reverse general practice's diminishing share of the service's £110bn budget and see many services delivered outside hospitals – another big shift that, although widely supported, has not yet happened.
"We argue that GPs should take the lead in developing care out of hospital by taking responsibility not only for their own services but for many other services used by patients in the community", say co-authors Professor Chris Ham, the thinktank's chief executive, and Rachael Addicott, a senior fellow.
Ham says: "There needs to be a radically different model of general practice in the future because of the ageing population and changing burden of disease, especially the fact that more people have more complex needs. And such people are not being well served by the current model of general practice, because what they need is not what their practice can prove. What they need is access to other expertise and staff in the community, such as community nurses, physiotherapists and occupational therapists, and also social care – and sometimes they need access to these services 24/7 rather than during surgery opening hours. At the moment, general practice isn't sustainable."
The key to the report is the suggestion that between four and 25 GP practices join up to become a federation, each of which covers between 25,000 and 100,000 people. They are the bodies that would be the hub of "family care networks" (FCNs). Each would get a population-based budget, but from one of NHS England's local area teams and not from the 211 local clinical commissioning groups (CCGs)created by last year's reorganisation. This raises serious questions over the purpose and viability of CCGs, which were meant to symbolise GPs being put in the driving seat of healthcare.
While patients would remain registered with their own GP, Ham says FCNs would give them access to a much wider range of expertise than any practice can currently provide alone.
"I think that over time CCGs would no longer be needed to commission care as they do today, and would wither on the vine," Ham admits.
In her foreword to the report, Dr Maureen Baker, chair of the Royal College of General Practitioners, points out that it first floated the idea of federations a decade ago and that some already exist, and work successfully. However, Dr Chaand Nagpaul, chair of the British Medical Association's GPs' committee, says general practice does not need another reorganisation: "Instead, we should be focusing on tackling the serious workload and financial challenges facing GP practices, and supporting them … rather than wasting resources rearranging the NHS's already complicated bureaucracy."
GP Michael Dixon, president of NHS Clinical Commissioners, which represents most CCGs, says their local and clinical knowledge will be crucial to support and manage future NHS changes. "I can't see why CCGs would be redundant," he says.Denis Campbell
GP and patient groups hail decision to put launch of care.data back six months to give more patients more time to evaluate opt-outs
NHS England is to delay the introduction of a system to share medical records after medical and patients' groups called for more time to raise awareness of how people can opt out and have confidence in the scheme.
Under the original timetable, patients had until the start of April to opt out of the records-sharing system, which the NHS says will improve research into the outcome of treatments and allow drug and insurance companies to buy "pseudonymised" medical information. Last month, all 26m households in England were sent leaflets about the scheme, setting out the possible benefits and explaining how to decide whether to take part.
In a statement, NHS England said the collection of data from GPs' surgeries would begin in the autumn – it did not give a more precise date – to permit "more time to build understanding of the benefits of using the information, what safeguards are in place, and how people can opt out if they choose to".
During this time NHS England will work with groups including the British Medical Association (BMA), the Royal College of General Practitioners (RCGP) and the consumer body Healthwatch to promote awareness, as well as looking to new means of building confidence in the scheme, formally known as care.data.
In the meanwhile, NHS England would work with a small number of GP practices on a voluntary basis to test the quality of the data collected, the statement added.
Tim Kelsey, national director for patients at NHS England, said it wanted to listen to patients' views. He said: "We have been told very clearly that patients need more time to learn about the benefits of sharing information and their right to object to their information being shared. That is why we are extending the public awareness campaign by an extra six months."
Anna Bradley, chair of Healthwatch England, said: "This is a really positive move by NHS England. They have shown a willingness to listen to what the public have to say about the way their health and care services are run.
"Crucially they have agreed to Healthwatch England's request to see the roll-out of care.data delayed to allow more time to ensure the public are fully informed. Over the coming months the Healthwatch network will continue to play a key role listening to the concerns of local communities, helping to inform them about what's happening and working with NHS England to improve their communications with the public so each of us can make an informed decision."
Professor Nigel Mathers, from the RCGP, said: "We would like to thank NHS England for listening to the concerns of RCGP members and for acting so quickly to announce this pause. The extra time will provide it with the chance to redouble its efforts to inform every patient of their right to opt out, every GP of how the programme will work, and the nation of what robust safeguards will be in place to protect the security of people's data."
The RCGP has sent a letter to NHS England arguing that the delay should be used to clarify issues such as what data can be disclosed and who will decide this, and for a national campaign that highlights the option to opt out.
Chaand Nagpaul, chair of the BMA's general practitioner's committee, said: "With just weeks to go until the uploading of patient data was scheduled to begin, it was clear from GPs on the ground that patients remain inadequately informed about the implications of care.data.
"While the BMA is supportive of using anonymised data to plan and improve the quality of NHS care for patients, this must only be done with the support and consent of the public, and it is only right that they fully understand what the proposals mean to them and what their rights are if they do not wish their data to be extracted."
The scheme's rollout has been beset by criticisms about the clarity of the information provided to the public. Earlier this month, the information commissioner's office criticised the campaign for failing to adequately explain what data was involved and how patients could avoid their medical records being shared. At the time, Kelsey agreed with some of the critics, saying: "Maybe we haven't been clear enough about the opt-out."Peter WalkerJames Meikle
Take part in our member survey and help raise awareness of the issues and problems in the NHS
The last year has been a tough one for the NHS, with professionals contending with restructuring, a funding freeze and the fallout from the Mid Staffs scandal.
Regular Healthcare Professionals Network contributor Chris Hopson, chief executive of the Foundation Trust Network, described 2013 as the health service's annus horribilis.
We last surveyed our network members last spring as they prepared for the reorganisation – and they said the NHS was not ready for the reforms. More than 1,000 senior NHS staff – in both clinical and management posts – took part in that survey, sharing their concerns about the scale and pace of the overhaul. The survey, conducted following publication of Robert Francis's report on the Mid Staffs scandal, also found that 40% of respondents had serious concerns over issues from waiting lists to staff shortages that could impact on the quality of patient care.
We're launching our latest survey as the health service nears the first anniversary of the reorganisation. We're keen to hear from healthcare professionals about how their job has changed over the last year; whether their role is getting easier; whether those whose work involves contact with patients are spending more or less time with them.
We'd also like to hear about what healthcare professionals think should be top of the agenda for the incoming NHS England chief executive, Simon Stevens, who is due to take up his post in April.
And our survey asks about what measures health service leaders need to implement to ensure the financial sustainability of the NHS.
To share your opinions and experiences, take part in our short survey – there is also the chance to win £100 worth of Guardian books.
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.Clare Horton
You might have thought a £30bn shortfall in NHS finances would have prompted Jeremy Hunt into action. Apparently not
Several recent reports have made two basic facts about the NHS impossible to ignore. One is that on current spending plans, the NHS will run out of money within the next 5 to 6 years. The other is that the Health and Social Care Act 2012 has created a dysfunctional set of structures which mask the government's failure to offer a credible response.
The Nuffield Trust has shown that because of population growth, ageing and cost increases, by 2020-21 the NHS will require some £30bn (25%) more than it is getting now just to maintain services at their present level – yet the government plans to keep NHS spending constant. Either services will be severely reduced or quality will deteriorate drastically or, more likely, both.
The Institute for Fiscal Studies' latest analysis goes even further: it now thinks that keeping NHS spending constant is likely to mean some other government departments facing spending cuts of up to 20%. But that is not going to happen. So unless budget plans are scrapped, NHS spending will have to be cut: services would then not just contract, they would disappear and quality would collapse. As Roy Lilley, an commentator, puts it in his widely read blog for NHS managers, it would mean the "extinction" of state-funded healthcare for all.
Yet the government has so far not proposed a credible policy response. Jeremy Hunt is momentarily protected by the legal fiction that he is no longer responsible for "providing" the NHS. Indeed, just before Christmas, in an extraordinary move, the chairs of both NHS England and the Care Quality Commission publicly criticised him for "meddling".
As a result, there is a policy vacuum, which the private health lobby is eagerly seeking to fill with renewed calls for charging and "top-ups"; in reality, these would do little to close the funding gap, but would mean the end of free and equal care for all. In the meantime, it seems that in official circles it is left to everyone except Hunt to suggest solutions: more "efficiency savings" (Sir David Nicholson); rationalisation, with fewer hospitals offering specialist care (Sir Malcom Grant); more specialist GPs and intermediate care provision (NHS England's Dr Martin McShane); more self-care (NHS clinical commissioners); more telemedicine (the joint government-industry 3millionlives project).
But even taken together, these unproven and sometimes implausible ideas don't match the scale of the funding gap; and meanwhile the "reformed" NHS is bogged down in contradictions that make even good ideas unlikely to work. The Commons health committee favours "reconfiguration" (closing many hospitals and shifting resources to non-hospital and social care) but thinks it can't happen efficiently without decisions made in Westminster and implemented from Whitehall. But in England, key decisions on reconfiguration are being left to 130 cash-starved local councils and 211 clinical commissioning groups which were not designed to implement radical changes and lack the capacity to do so.
As for rationalisation, when two hospitals in Bournemouth and Poole proposed last year a merger to rationalise their services, the Competition Commission prohibited it; and plans to move the world-famous Papworth hospital to the biomedical campus at Cambridge are being blocked by the Treasury, which wants it to shore up Peterborough hospital's PFI-stricken finances by moving there instead. By these standards, government policy on flood prevention is a model of rationality.
Yet the government will eventually be held responsible for what happens to our healthcare. Flooding affecting many thousands of people has finally produced an irresistible demand for a policy response. A major crisis in health care will affect everyone in the country except the very rich. Is it acceptable for the secretary of state for health to have a sign on his desk saying, "the buck stops somewhere else"?Colin Leys
Televisions could be used to give instant access to medical notes and guidance, x-rays or scans, and dietary advice
There is good reason to be awed by NHS ambitions to gather the nation's medical data electronically into a digital Domesday Book, but also cause to pause.
Why isn't more priority being given to making the same information available electronically to patients, who might be said to have a prior claim, for free?
Evidence from a study in the US suggests that those on the receiving end of healthcare welcome having the access, and that clinical outcomes improve.
The Open Notes study involving 105 US doctors and published in 2012 found that 87% of patients allowed to look at their doctor's notes did so at least once. The vast majority, 78%, said it helped them stick to treatment.
Despite concerns from all sides, 99% of patients wanted the project to continue. Significantly, none of the doctors taking part have yet opted out.
Technology is available to give the same sort of access digitally in the UK, and, in the case of hospitals, it is usually right by the bed already.
Nearly everyone in a ward has a television. What they may not know is that the technology delivering Game of Thrones can often do a lot more, such as instant access to medical notes, x-rays or scans, dietary advice and guidance about their condition. If only clinicians could be persuaded to use it.
Their failure to do so is clashing with a public expectation, which is encouraged by health secretary Jeremy Hunt, to see patient notes, both as a matter of democratic decency and to help recovery.
But this is not just about patients. The bedside systems have the potential to save nurses up to 25% of their time, freeing them from administrative work for tasks that often get sidelined.
They help reduce food wastage, estimated to cost the NHS £27m a year, by more accurately matching supply to demand; and they ensure that when beds become free, everyone knows it. In Great Ormond Street children's hospital the systems are even used for school work.
A suspicion is that the main reason why patients still rarely see their notes, offline or online, is cultural. Some hospital managers still think too much access raises too many awkward questions.
Doctors and nurses would start to sanitise their language, goes the argument, fearing repercussions which could jeopardise treatment.
This is a false concern. Bedside systems have filters that allow clinicians access to information for their eyes only. There is no need to fear making frank observations – for example, that a patient has a fabricated illness or is "difficult".
Unfortunately, the public sector in the UK has had an unhappy relationship with software, as a litany of stories about overspending and under delivery testify. Perhaps it just seems safer to use the ones by the beds for entertainment?
As a result, it is almost unsettling when the NHS cheerfully announces a ground-breaking gathering of patient data, and yet can still be inconvenienced by the arguably simpler task of allowing electronic access to the patients themselves.
While not every patient will want data, plenty will. Many are familiar and comfortable with what technology can offer. Why should they be denied it by their own healthcare provider – especially when others are being allowed to buy it?
Jeremy Hunt wrote recently that better data means better care. Better access to data means the same, as the Open Notes study found.
The current under-use of bedside computer systems by most NHS trusts is like owning a smartphone, but only using it to make calls: fine, but rather a waste.
Andrew Clark is a director of hospital computer system developer Lincor Solutions
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My mother, Elizabeth Hoffman, who has died aged 92, was an anaesthetist and an accomplished amateur musician.
Betty was born in Ilford, Essex. Her father, Philip, was an optical engineer who invented the artificial horizon used as a navigational aid for pilots in the second world war. At an early age she determined to become independent of her family.
During the second world war she drove ambulances around London, peering up through the windscreen because she was too short to see out. She also did fire-watching on the roof of Exeter Cathedral, looking out for incendiary bombs. Upon qualifying as a doctor at the Royal Free hospital in London, she took up work at a hospital in Vancouver, Canada, without pay. Travelling home through the Rocky Mountains by rail with no money for food, she was bought a meal by a stranger on the train.
Back in London, Betty returned to the Royal Free, then the only hospital to offer clinical training for women. Walking home late through dark streets, she took care to wear an old coat and flat shoes so that she was able to run if she found herself in danger. As a young woman she had also been a keen swimmer.
Taking a job in Sedgefield, County Durham, she met her future husband, Eugene Hoffman, at a classical music concert. Eugene was a consultant chest surgeon whose research included work on the benefit of seat belts in cars. When the couple married in 1963, Betty was a consultant anaesthetist at Middlesbrough general hospital. When I started learning the violin aged six, Betty took up the cello. She played for many years with her quartet at home in Middlesbrough, was also a member of the Teesside Symphony Orchestra and supported the Teesside Music Society, accommodating visiting artists. She also sang in a madrigal group for many years.
Betty became an expert flower arranger and loved walking and skiing in France or Switzerland, and the planning that this involved. Giving up work in 1983 was a big blow and she felt she had lost her purpose in life, so she became a voracious reader. Eugene died in 1997.
My mother faced the onset of Alzheimer's disease without complaint and took comfort during her last illness in my practising the Bach Brandenburg Concertos by her bedside. She is survived by me, her only daughter.