NHS waiting list

1. Campbell(2018), a health policy editor judging by the NHS report

observed that the number of patients waiting for an operation on
the NHS has reached 4.3 million, the highest total for 10 years, official
figures show.Growing numbers are having to wait more than the
supposed maximum of 18 weeks for planned non-urgent surgery such
as a cataract removal or hip or knee replacement.
2. A freedom of information request to NHS Trusts, carried out by the
Express, revealed that the number of patients dying while on a waiting
list rose from 18,876 in 2012/13 to 29,553 in 2017/18.

3. As at July 2018, Matthew-kings a health correspondent for the

independent revealed that the number of patients in England who have
been forced to wait six months or longer for NHS treatment has risen
by nearly 70,000 in the space of a year

4. If the system was privatized in such a way that individual investors

expanded the number of operating providers and facilities while the
populating using the services remained the same, wait times would
generally decrease. More ‘slots’ available for use means a more quickly
cleared backlog, which causes wait times to fall. This outcome is highly
unlikely, since it would be very doubtful that even a top notch privatized
service could operate in the black this way in a culture that is used to
free-at-the-point of care service.If the system was privatized in such a
way as to use the price system to ‘curate’ its usage, wait times would
likely fall because a number of people would IN EFFECT be excluded
from the system. This is one (open) secret to the relatively shorter wait
times in the United States. If users of the NHS service had to become
very highly sensitive to the potential costs of interacting with the system
the way (some) Americans do, wait times would fall because if you keep
the same number of providers and facilities as before, but effectively
lower the population using the system, you get the same effect as the
other privatization method: fewer people in means you clear the backlog
faster, and wait times fall.
B. End of life care

1. NHS care of people dying in hospital is much better care since the
Liverpool Care Pathway was axed, but too many are still not receiving
proper palliative care in their final hours, a new report has found.

Those who die overnight or at the weekend may be denied the right care
because only 11% of hospital trusts in England provide specialist palliative
services around the clock, according to a detailed audit of end-of-life care.

It found that “a broad front of improvements in nearly all aspects of care of

the dying in hospitals” occurred between 2013, when the controversial LCP
was scrapped, and 2015. Its findings are based on an analysis of the care of
9,302 patients who died in hospital in England in May 2015.

Dr Adrian Tookman, a clinical director at the charity Marie Curie, which

co-funded the research with NHS England, said that “there has been a real
effort to improve care of the dying in hospital over recent years.”

For example, staff had discussed the patient’s impending death with their
relatives in 95% of cases. And in 54% of cases people close to the patient
had had the chance to say what help and support they needed, almost
double the 25% who had that opportunity when the audit was first
undertaken in 2013.

However, Tookman added: “We can’t ignore the fact that the vast majority
of dying people and those close to them still have limited or no access to
specialist palliative care support when they need it in hospital. This is not
right, not good enough.”

“Care of the dying has no respect for time. Round-the-clock availability of

specialist palliative care in hospitals should be the norm. When this care is
missing, people suffer, and this suffering can live long in the memory of
those they leave behind.”
C. Shortage of medication
1. Ash Soni, president of the Royal Pharmaceutical Society, gave the example of anti-
inflammatory naproxen, which he said was “completely out of stock” and could only be
purchased at a cost of £6.49 a box - a £2 hike on the price last agreed by the NHS,
reports the BBC.The Independent notes that a “similar spike in 2017” saw the number of
concessions reach a high of 91 and ultimately cost the NHS an extra £315m.As the current
crisis grows, some pharmacists are sending patients back to their GPs to “ask for a different
medicine or dosage”, while others are “giving patients some of their prescription and sending
them away with an IOU note for the rest”, adds the BBC.Other medicines on the list include
the 40mg dosage of furosemide, used to treat high blood pressure and other cardiovascular
problems, which is the 23rd most commonly prescribed drug in England.There are also
supply problems for the 20mg and 40mg doses of fluoxetine, used to treat depression, and
the 20mg and 40mg doses of propranolol, a common beta-blocker used to treatment of
anxiety.
Topiramate, an anticonvulsant that helps control seizures brought on by epilepsy, has been
granted a price concession in both its 50mg and 100mg forms, as has the 1mg, 2mg, 3mg
and 4mg doses of antipsychotic drug risperidone. Gareth Jones of the National Pharmacy
Association told the BBC that uncertainty over Brexit appears to be a “significant factor” in the
shortages. He advised that patients should “order medicines in advance” to “give the
pharmacist more time to deal with it”.

2. Our annual customer survey* revealed that UL Medicines customers are

spending (on average) 38% of their working week sourcing as a result of drug
shortages, with some respondents spending as much as 50%(UL medicine)

3. Lack of medication availability causing death is the most severe consequence of drug
shortages and mortality was reported in 18 studies(Phuong et al, 2018)

4. We found that drug shortages were predominantly reported to have adverse economic,
clinical and humanistic outcomes to patients. Patients were more commonly reported to have
increased out of pocket costs, rates of drug errors, adverse events, mortality, and complaints
during times of shortage.(Phuong et al, 2018)

5. One trust in England reported a shortfall of more than 300 different drugs, according to the
trade association NHS Providers (Powell, 2019)

6. 95% of hospital pharmacists are currently experiencing problems with medicines

shortages. • 89% of hospital pharmacists report that medicines shortages are a
weekly, sometimes daily, occurrence. • 86% of hospital pharmacists agreed, or
strongly agreed, that medicines shortages in their hospital are having a negative
impact on patient care.( 2018 EAHP Survey on Medicines Shortages)

7. 85% antimicrobial agents 42% preventative medicines 60% of UK hospital

pharmacists are affected by shortages on a daily basis 29% of UK hospital
pharmacists are affected by shortages on a weekly basis 6% of UK hospital
pharmacists are affected by shortages on a monthly basis 29% anaesthetic agents 33%
 cardiovascular medicines 42% emergency medicines( 2018 EAHP Survey on
Medicines Shortages)

D. Cost of NHS

Taxes may have to rise to historically high levels in order to protect the future
of the NHS, according to a new study from the Institute for Fiscal Studies (IFS).
The population is getting bigger and older, and expectations are rising along with the costs of
meeting them. Our analysis suggests that UK spending on healthcare will have to rise by an
average 3.3% a year over the next 15 years just to maintain NHS provision at current levels,
and by at least 4% a year if services are to be improved. Social care funding will need to
increase by 3.9% a year to meet the needs of an ageing population and an increasing
number of younger adults living with disabilities.

Providing healthcare is now far and away the biggest thing the government does. It accounts for
more than 7 per cent of national income and nearly a fifth of all public spending. And it’s hard to
see how those numbers are going to do anything other than get even bigger. The number of
people over the age of 65 is going to grow by more than four million over the next 15 years, and
the number over 85 by well over a million. The number of people of working age will grow much
more slowly. At the same time the prevalence of chronic health conditions is rising, as is the cost
of drugs. We will have to increase the pay of doctors and nurses at least in line with pay increases
across the economy

Despite these increases, public budgets for health and social care are coming under increasing pressure.
Following large increases for both the NHS and social care during the 2000s, the years since 2009–10 have
seen much slower growth in funding for the NHS and, in the case of social care, budget cuts. Between
1996–97 and 2009–10, public spending on health increased by 6.0% per year over and above economy-
wide inflation. Similarly, funding for adult social care rose by 5.7% per year between 2001–02 and 2009–
10. Since 2009–10, health spending has increased by only 1.4% per year, while adult social care funding
has fallen by an annual average of 1.5%. Despite the fact that, taking the whole period since 1996–97,
spending growth, at 4.3% a year, has been above the long-term average of 3.7% a year, this recent
slowdown in funding growth has been reflected in problems experienced by the NHS and local authorities.
Performance along a number of measures – including various waiting times, delayed transfers of care
between hospitals and social care providers, satisfaction with the NHS and provider deficits – has got
worse in recent years, which has led to recent calls for funding increases. In addition to these short-run
pressures, the health and social care system faces a series of longer-term, and potentially more serious,
challenges. Demographic pressures in the form of a growing and ageing population are only one part of
this. Rising expectations, changing population health, and a range of cost pressures from wages and new
technologies will all create substantial pressure on the public finances.

Two thinktanks – the Institute for Fiscal Studies and the Health Foundation –
have said there can be no alternative to higher taxation if there are to be even
modest improvements to care over the next 15 years, adding that demands on the
health service will continue to rise.