Chief executive of NHS Confederation rejects health secretary's claim that changes to GP contract in 2004 are to blame
There is no link between the crisis in hospital A&E departments and GPs opting out of out-of-hours care, a leading NHS figure has said – in a direct challenge to the health secretary, Jeremy Hunt.
Mike Farrar, the chief executive of the NHS Confederation, the body representing organisations commissioning and providing health services, questioned Hunt's assertion that Labour was to blame for a public loss of confidence in alternatives to casualty by agreeing a new contract with family doctors in 2004.
As the political row deepened over overcrowded A&E departments – one that will get worse as ministers consider a number of closure plans – Farrar said: "We do not see a correlation between the changes to the 2004 GP contract and the NHS 4-hour waiting standard for A&E departments."
Hunt has been keen to differentiate between blaming Labour and GPs themselves, but for days he has been citing the GP contract changes as a main cause of the problem. On Tuesday, he told MPs they had had "devastating impact and that pressures on A&E services were "direct consequences of the disastrous changes".
The minister also said that last year's GP patients' survey showed "only 58% of patients know how to contact their local out-of-hours service, and said that 20% of patients find it difficult to contact their out-of-hours service, that 37% of patients feel that the service is too slow - problems that we are trying to address."
But Farrar said: "In fact, for the vast majority of the last decade, A&E waiting time standards have been improving. It is in recent years where the pressures have started to bite, and there have not been any discernible structural changes to out-of-hours GP contracts during that time.
"It is clearly evident that there are rising pressures on the whole system. We agree there is a need to improve the co-ordination of out-of-hours care, and see how it can help take the pressures off A&E," said Farrar.
"We believe real and lasting improvements to out-of-hours care are possible, but only if we put a greater level of investment in to primary, community and social care."James Meikle
Health secretary seeks to deflect blame over crisis in A&E by accusing Labour of failing to pay tribute to NHS staff
Poor Jeremy Hunt. The health secretary always resembles a young man taking part in a school debating contest who fantasises that he is a really important government minister, running a crucial department. Then he wakes up and realises that he is! It must be terrifying.
On Tuesday he was dragged to the chamber to talk about the crisis in A&E. His figures showed that the situation was getting better. Doctors' figures, used by Labour, suggested it was getting worse. All of which reminds us – you can never, ever believe any statistics about the NHS. They are all massaged as thoroughly as a Japanese Kobe bull the day before it's slaughtered.
Mr Hunt, with his piping voice and eager expression, decided to blame Labour. There was a surprise! It was all their fault for making it easy for GPs to avoid out-of-hours work. And to be fair there is some truth in this.
The former Labour health secretary Patricia Hewitt saw her job as giving the medical profession everything it asked for, and then some. For GPs, she filled a dumper-truck with money, pulled the unload lever, and told the doctors to say when.
On the other hand, the coalition has had three years to do something. And the NHS Direct 111 service, which puts you in touch with people who have a smidgeon of medical knowledge – "neither confident nor competent" in Frank Dobson's words – and who, I'm told, sound as if they would be happier offering you cut-price double glazing. For that reason, their default position is to say something on the lines of: "Oh, I dunno, why don't you just go to A&E?" Where the patient will be lucky to wait for less than four hours.
Andy Burnham, the Labour spokesman, was in a fine froth. "We asked him to get a grip, and his only response was to tour the TV studios blaming it on the 2004 GPs' contract!
"Cut the spin and get a grip!" he added, thoughtfully.
Mr Hunt said the 111 service had had teething problems. Labour MPs jeered happily at that. You could argue that, in the same way, someone who's been smashed in the mouth with a baseball bat also had problems with his teeth.
The secretary of state produced a sort of logical Möbius strip, turned in on itself. After listening to the Labour party complaining for the best part of an hour about the collapse in after-hours care, he announced: "The party opposite have their heads in the sand about the lack of patient confidence in after-hours care.
"We are going to sort out that problem, and if they don't want us to, they will just have to watch while we do it!"
Or perhaps his inspiration was the artist MC Escher: all those people trudging endlessly uphill, never descending, never arriving.
Oh, and Mr Hunt pulled the old trick of accusing the opposition of failing to pay tribute to the marvellous work done by NHS staff. This is the last refuge of the cornered school debater, and it was used lavishly by Labour when they were in power.
No, Mr Hunt, no one doubts their hard work or their commitment. It's you and your government they blame.Simon Hoggart
By demanding Ofsted-style inspections for GPs, Hunt is passing the blame for disastrous coalition policies on to family doctors
I invite Jeremy Hunt, the health secretary, to visit my surgery. He might learn something. We like to think we offer a very personal, family-orientated service, where I rarely have a patient in front of me I haven't met on many occasions. And yes, Mr Hunt, I do know their names and also those of their partners and children, and often grandchildren. Even where they last went on holiday, let alone personal medical problems and details. Anyone who wants an appointment that day gets one.
What is really annoying are the constant attacks on primary care by the very people who are responsible for the mess we are in, such as Hunt and his predecessors.
Apparently, family doctors are to face Ofsted-style inspections, overseen by a new chief inspector of general practice, to secure "safe and responsive care".
In a speech he's due to make to the King's Fund health thinktank on Thursday, the content of which is reported in newspapers today, Hunt tries to blame the stripping away of the 24-hour responsibility from general practice in 2004. Six years later the NHS wasn't even an election issue, and had the highest satisfaction ratings ever. I don't remember calls for a reversal of policy then. Three years of this coalition government and the NHS is in the news every day. Hunt has to blame someone and deflect from what his policies are doing, so why not blame the workers?
Politicians have a cheek when they don't even understand the very important concept of continuity of care. If they did, why have policies that have resulted in it becoming impossible? Groups such as the elderly and young need that continuity of seeing the same doctor. So why is it government policy to let private companies buy and run GP surgeries on the cheap, using locums who are rarely seen again? Why did they introduce the NHS 111 service before it was ready? It frequently gets the patient's surgery, address and other details wrong, let alone their name. Why was NHS Direct, which had its faults but was certainly better than what we have now, abolished? Why is work formerly done by hospitals being dumped on GPs when they are already at breaking point? Even Hunt recognises this, otherwise why does he describe us as "mini A&Es" ?
My patients have almost given up seeking advice and getting care out-of-hours because of the mess the politicians have made of the service. They feel they have nowhere to go except A&E and apparently that's the GPs' fault.
I doubt Hunt won't accept my invitation, as it won't fit with his ideology. Privatisation is breaking the NHS into millions of little fragments, so chickens are coming home to roost.Paul Hobday
Sir David Nicholson, who came under intense pressure after Francis report, tells 'surprised' Jeremy Hunt he plans to retire
Sir David Nicholson, the NHS chief executive caught up in the Stafford hospital scandal, has announced that he will step down from his post next March.
Nicholson came under intense political pressure after publication of the Francis report, which looked at scandalous lack of care at the hospital for four years from 2005. He was briefly head of the local strategic health authority when the first of the serious concerns about Mid Staffs began to emerge.
Campaigners – led by Julie Bailey and Cure the NHS – whose family members died "unnecessarily" at Stafford hospital called for him to go and the Daily Mail branded him as "the man with no shame" for staying in post.
Despite the pressure – some applied by Conservative cabinet ministers – Nicholson retained the support of Downing Street. The veteran of the NHS told a "surprised" Jeremy Hunt of his decision at noon and staff at NHS England were told this afternoon of his retirement. A successor will be found over the next 11 months.
Nicholson was appointed NHS chief executive in 2007. In the coalition's new NHS, he controlled more than £95bn of health spending. Sources say his announcement gives the chair of the NHS – Prof Malcolm Grant – time to plan an orderly succession.
In a letter to Grant, Nicholson said: "I have only ever had one ambition and that is to improve the quality of care for patients. I still passionately believe in what NHS England intends to do. My hope is that by being clear about my intentions now this will give you and the board the opportunity to attract candidates of the very highest calibre so they can appoint someone who will be able to see this essential work through to its completion."
A former student communist, Nicholson wore the badge of "Stalinist" lightly. He was brought in by Labour's health secretary Patricia Hewitt when the NHS was struggling to keep its finances in order. New Labour had originally wanted a US healthcare boss to step in, but Nicholson got the top job. Surprised to be in post, he proved remarkably effective.
Under his leadership NHS spending was reined in while waiting times were brought down. He also successfully brought in a programme to tackle hospital infections. His encyclopedic knowledge of the NHS meant new health secretaries always relied heavily on his advice. When the coalition talks were under way, Nicholson occupied the health secretary's seat at the Department of Health, joking: "We are real masters now."
But Nicholson was faithful to his political bosses. Even when Andrew Lansley, the previous health secretary, and he did not see eye to eye over the coalition's big bang reforms of the NHS, Nicholson continued to text support to the beleaguered cabinet minister.
However, in the new structure of the NHS, it was not ministers but newly empowered civil servants who became media targets in the aftermath of the Francis report. The 57-year-old issued a full apology to "patients, relatives and carers [who] found themselves in the position where they not only had terrible things happen to them but the very organisation they looked to for support let them down in the most devastating of ways" – but this did little to assuage the anger felt.
However, Nicholson's supporters say his decision to step down is personal – he has just become a father again. "I think we will see a liberated man … which will be interesting," said one
The health secretary, Jeremy Hunt, said: "Under Sir David Nicholson's leadership, NHS waiting times have fallen, infection rates reduced, and mixed-sex accommodation is at an all-time low. His job has often been incredibly complex and very difficult, and yet he has always had a reputation for staying calm, and maintaining a relentless focus on what makes a difference on the NHS frontline. I am also grateful to him for overseeing the successful setting up of NHS England and giving us an orderly period in which to select his successor."Randeep Ramesh
Hospitals face rising threat of mortality as shortage of beds poses substantial risk to vulnerable patients, warns expert
• Jeremy Hunt admits pressure is mounting on A&E services
Overcrowding in hospital A&E departments in England could lead to more deaths and serious illness, MPs have been warned.
Mike Clancy, president of the College of Emergency Medicine, said there were not enough beds as more patients, many of them elderly, arrived for treatment after midnight. "If you were to look at the numbers of people multiplied by the length of time they are spending in emergency departments, that is what is increasing substantially," he told the Commons health select committee.
"You should know that is dangerous. There is mortality and morbidity associated with overcrowding, we know that …We have to get rid of that overcrowding because it is a substantial risk."
Clancy's warning comes a week after his organisation said up to 30% of patients attending A&E should go elsewhere and advocated more GP surgeries being set up at hospitals to help keep them out of casualty.
He told MPs on Tuesday many departments had dropped the NHS's four-hour target to deal with patients because of the pressure. The number of A&E patients who waited between four and 12 hours increased by 34,000, Clancy said.
The target is for hospitals to admit or discharge 95% of A&E patients within four hours. "The deterioration in four-hour performance, which is a process measure and not a quality measure, has reflected the pressure the system is under," he added.
"What has happened is that organisations are now focusing more on how many people waiting up to 12 hours, and have in a sense parked the four-hour target because it is so difficult to manage. That is a reflection of the pressure the system is under."
Patrick Cadigan, registrar of the Royal College of Physicians, said: "One of the big challenges here is out-of-hours care. And the problem is that A&E is the recognisable brand, and that's where patients will go because they know they will see someone who is expert, often within four hours, and they will receive treatment.
"Patients will go where the lights are on, and in many of these alternatives the lights are not on after five o'clock in the evening and at weekends. And we have to face up to the fact that the services, other than the A&E department, are often run on a nine to five elective basis."
Later in the Commons, the health secretary, Jeremy Hunt, again blamed Labour for the crisis, claiming the change in GP contracts in 2004, which allowed family doctors to opt out of out-of-hours care, had played a major part in causing it. He also cited Cadigan's remarks.
Hunt, who acknowledged problems with the 111 NHS advice service and said more needed to be done to give confidence in alternatives to A&E, said: "Last year's GP patient survey said that only 58% of patients know how to contact their local out-of-hours service, and said that 20% of patients find it difficult to contact their out-of-hours service, that 37% of patients feel that the service is too slow – problems that we are trying to address."
During heated exchanges, he told his Labour counterpart, Andy Burnham: "Perhaps you should visit some A&E departments, talk to some A&E consultants, talk to some doctors, talk to some nurses, because they will say to you that those changes to GPs' contracts, which you are saying have nothing to do with the pressures on A&E, have had a huge and devastating impact."James Meikle
Now is the moment to fight for safeguards within the health service to protect individuals with disabilities when they are ill
I feel the most joyous time in anyone's life is when their child is born. Then, for some parents, their joy turns to heartbreak and sorrow when they discover that their child has some kind of disability.
They will not know, then, the path that they will tread with this child. It is a path of worry, torment and heartbreak. You fight constantly with services for the appropriate equipment, such as chairlifts, chairs, beds and hoists, and for the continuation of schooling after the age of 25. They will try to take these things away. At the school my daughter Tina attended, they did not succeed. There, mothers all fought hard to ensure that their children could continue to have an education. I had a fight to get Tina in the pilot school scheme because we lived out of the area. But we fought. And we won.
This is what a life is like for a parent with a child with a disability. You are fighting all the time, in addition to caring for your children. I had two children with disabilities. Now I only have one.
Tina died in Basildon hospital in 2009 from aspiration pneumonia. Today, the NHS ombudsman says in a report that mistakes by an out-of-hours GP service and a hospital contributed to her death.
When Tina became ill and was examined by doctors, I could sense them thinking: "Is there any point in trying to save this child's life?" They see it not as a life, but as existence. They are wrong.
This child is loved by all the people with whom he or she comes into contact; family and friends. This child is a human being. A human being who just happens to be born with a disability.
Sometimes, the parents of disabled children will despair. They will feel that they can't continue with the life that they are leading. But then you'll see your child, and the guilt is enormous. This child is completely dependent upon you, and you love them.
It is an outrage when doctors and nurses choose not to use all their professional intelligence to attempt to make my child, or any child in a similar position, well.
Helping such children should give medical staff warmth in their hearts, because the relief and the gratitude that parents feel in being able to take their child home will show all over their faces. If this is not achievable, then at least they will have done their best; parents in this situation recognise this too. But not in our case. Tina was let down by an out-of-hours doctor at the surgery and also the hospital.
Doctors should learn a lesson from these unnecessary deaths. They should treat every patient with the same care, compassion, dignity and respect. And they should treat the parents in the same way.
Please try to imagine how we must be feeling following the loss of our daughter, and support us in this fight with the government to put in place a safeguard for individuals with disabilities. This would ensure that, when they become ill and need treatment from medical staff, that their families can be assured that they will receive the best treatment possible for their condition.Christine Papalabropoulos
NHS lost track of bird flu drug shelf-life dates because of poor record-keeping, National Audit Office finds
Taxpayers lost £74m when 6.5m doses of an anti-flu drug were written off as being past their shelf life because of poor record-keeping by the health service, the government's independent auditors have found.
The government also spent £424m stockpiling 40m units of Tamiflu between 2006-07 and 2012-13, despite question marks over the effectiveness of the drug, a National Audit Office memo says.
The drug had been stockpiled to fight possible flu pandemics. But reports suggest that Tamiflu has not always been effective, because viruses have developed resistance to the drug in some cases.
Margaret Hodge MP, chair of the public accounts committee, said she was shocked by the amount of money spent on the drug, and by the failure to keep proper records of when and where it had been bought, particularly in the light of disagreement among experts over its ability to reduce complications.
"There is simply no excuse for this waste," she said. "It is important that the National Institute for Health and Care Excellence (Nice) and the Medicines and Healthcare products Regulatory Agency (MHRA) assure themselves that they have all clinical trials information. It is essential, not only for the public purse but for public safety, that the Department of Health carefully examine how it stockpiles medicines in the future."
Tamiflu was licensed in the EU in 2002. There is general consensus that the drug can reduce the duration of influenza symptoms, and in some circumstances can prevent it, the report reads. However, there is less consensus about the extent to which it can reduce complications, hospital stays and death rates.
In 2006, as reports of bird flu caused great concern around the world, the health department bought Tamiflu for 25% of the population, under the guidance of the World Health Organisation. Stockpiling grew, auditors found, so that by 2009 there was enough of the drug to cover 80% of the population.
Between 2009-10 and then 2012-13, 10m units of the drug were written off because they had reached the end of their shelf life, the report states. According to the Department of Health's accounts, 6.5m doses had to be destroyed because of poor record-keeping by the NHS during the 2009-10 swine flu pandemic.Rajeev Syal
Compared with normal care, telehealth can achieve better and faster health outcomes, better adherence to medication, and increased productivity
The debate around remote care frequently stalls on the matter of expensive or complicated equipment, but often people have all the technology they need sitting in their pockets. While some healthcare providers use text alerts to remind patients about appointments or about submitting data, little use is made of responsive telehealth – the sending and receiving of linked information.
Developed by the NHS as a simple telehealth application, Florence (or Flo for short) allows clinicians to engage patients with their own healthcare. This achieves faster health outcomes, better adherence to medication or other treatments, and increased productivity compared with normal care. Harnessing this SMS technology has yielded much better engagement between clinician and patient, too.
The process begins with a clinician signing a patient up to the programme, after which the patient may begin receiving regular information or prompting messages to remind them to take their medication, for example. However, the communication is two-way. The patient can send in readings – for example, blood pressure, weight or oxygen saturation – to a website that is monitored by a clinician at agreed intervals, say weekly.
A patient can get bored if they are inundated by patronising telehealth messages. Flo sends messages only when needed and uses humour in transmitting information and encouragement about lifestyle changes. The interaction requires the patient to be involved as they measure their vital signs or describe their condition. The regular feedback from their overseeing clinician by text reassures them that they're progressing well. If their condition isn't improving as expected, they can see their clinician and revise their management plan.
This approach complements that taken by the 3millionlives initiative, which aims to increase the uptake of telehealth and telecare at scale over the next five years, to improve the lives of at least 3 million people. Flo is being used in general practice, acute hospital, community and mental health settings, as well as by social care professionals. A typical general practice might have 100 or so patients using the system for various clinical applications such as asthma, hypertension, smoking cessation and weight management.
When patients or carers are asked what they like about Flo, they describe feeling more confident about their condition, having a "friend", feeling more supported in improving their health, and feeling that the NHS cares about them. But the benefits go beyond these more emotional responses, and the speed with which treatment can be delivered has been as important for patients.
Take, for example, a patient who uses Flo for chronic lung disease to monitor their everyday wellbeing receives prompt messages based on an agreed clinical management plan to guide them to start rescue medication. They start standby antibiotics and steroids when they transmit messages that indicate that they are deteriorating from an infection – several days earlier than if they had waited to see their GP.
Effective telehealth relies on the clinical plan agreed between the patient and their clinician. It is that dual management plan that specifies the purpose of using telehealth, describes what it hopes to achieve and tells the patient what to do if things go wrong – for instance, if there is a jump in blood pressure. This planning stage also must take into account other dimensions of each patient's ill health or circumstances, such as another condition, adverse lifestyle habits or occupation.
Are there risks with using this type of telehealth? As the equipment is viewed as an aid in clinical management rather than a standalone feature, there shouldn't be. If the transmission of information and interactive messaging is done alongside an agreed clinical management plan or lifestyle, then remote care should enhance the quality of a patient's care.
What is crucial is that the purpose and design of any telehealth approach complements usual clinical care and does not replace it.
Dr Ruth Chambers OBE is GP clinical director for practice development and performance at Stoke-on-Trent CCG. She will be presenting at the Patient Safety Congress on 21-22 May in Birmingham, which is sponsored by the Health Foundation
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.
Tina Papalabropoulos died of aspiration pneumonia. As a report into her death is published, her mother speaks out about negligent care, the struggle for recognition, and her unwitting role in Tina's deathJosh StraussRichard SprengerMustafa Khalili
Mother and charity claim doctors provided inadequate care because of attitudes based on woman's disabilities
A catalogue of mistakes by an out-of-hours GP service and a hospital contributed to the death of a young woman with physical and learning disabilities, the NHS ombudsman says on Tuesday in a highly critical report that has led to fresh claims of prejudicial attitudes leading to poor care for such vulnerable patients.
The report, by NHS ombudsman Dame Julie Mellor, finds that Tina Papalabropoulos, 23, died in Basildon hospital in Essex of aspiration pneumonia in 2009 after a series of blunders by two NHS organisations.
Hospital staff let her drink, worsening her life-threatening illness, and even though fluids were leaking through her lungs.
Other failings included the refusal of an out-of-hours GP to visit Papalabropoulos when her parents requested a visit because their daughter's condition was worsening, and crucial delays in diagnosing and properly treating her condition at the hospital.
Christine Papalabropoulos, the dead woman's mother, and the charity Mencap both claimed that doctors provided such grossly inadequate care to her because of attitudes based on her disabilities. She had learning disabilities, epilepsy, a form of dwarfism called Russell-Silver syndrome and severe curvature of her spine.
"When your child becomes ill and you need professional help from doctors, you and your child are looked at and you can see their mind working: 'Is there any point in trying to save this child's life?' You can see that they think 'this child has an existence and not a life'," said Christine Papalabropoulos. "Wrong! This child is loved by all the people, family and friends that they come into contact with. This child is a human being. They just happen to be born with a disability."
Beverley Dawkins, Mencap's policy manager, described Papalabropoulos's death as "an avoidable tragedy". She said: "Her family and Mencap believe that the failings that led to her losing her life at 23 were because doctors held the view that Tina's life was not worth saving, due to her disability."
The hospital trust issued a brief statement welcoming the ombudsman's report but without any apology to the family or regret over the death. It simply said that since Papalabropoulos died in 2009 "the hospital has made significant improvements to the care and treatment we provide our patients with learning disabilities".
In 2010 it appointed a dedicated nurse adviser specialising in learning disabilities to work with patients, their families and carers, and trust staff, it added.
Mencap says it has identified about 100 cases in which patients with learning disabilities have died after receiving poor care and estimates 1,200 such patients a year die because of neglect by the NHS. It is "deeply concerned" about three other deaths at Basildon hospital.
Dr Dan Poulter, the health minister, said it was "unacceptable" that anyone with learning disabilities received what he called the "substandard care" detailed by the ombudsman and said ministers were determined to improve the quality of care for such patients, to stop them dying avoidably early.
Papalabropoulos fell ill with a cough on 21 January 2009. A doctor from the family's GP surgery visited, said she had an acute lower respiratory tract infection and advised her parents to ensure she kept taking antibiotics which had been prescribed the day before.
Three days later, in the early hours of the morning, Tina's mother became so concerned by her daughter's condition that she rang South East Essex Doctors Service (Seeds), the local out-of-hours GP service. "She asked for an urgent home visit, but the Seeds doctor declined to visit her. Instead the Seeds doctor said that he would send a message to the [GP] practice requesting a home visit the next morning. However, because the next day was a Saturday, the practice would not be open," the ombudsman's report found.
Mellor castigates the unnamed GP for not taking appropriate action to assess and treat the patient. As a result he "did not take reasonable decisions" and "his care fell so far below the applicable standard that this was service failure". She found "no evidence that [the patient's] rights under disability discrimination law were properly considered by the Seeds doctor."
The ombudsman made four findings of "service failure" against Basildon hospital, part of Basildon and Thurrock University Hospitals NHS foundation trust. It was guilty of "a prolonged delay before [Paplabropoulos] received the treatment that her condition called for".
Doctors should have given her intravenous antibiotics through a drip and intravenous fluids but did not do so, Mellor found. "They allowed [her] to carry on drinking, despite the risk of aspiration (that she might breathe in the fluids) and they tried to give her oral antibiotics, which her records show she was refusing to take." Staff also failed to transfer her to a high-dependency unit.
The report also criticises the hospital for doctors not giving Tina's parents the full picture during discussions with them, not implementing a care plan which should have guaranteed her better care, as they had dealt with her since she was young, and staff did not discharge their responsibilities under disability discrimination law.Denis Campbell
Ratings published every year will take into account safety, effectiveness and patient experience at GP practices
England's 34,000 family doctors will face Ofsted-style inspections overseen by a new chief inspector of general practice to secure "safe and responsive care", the health secretary, Jeremy Hunt, is to announce.
In March, Hunt welcomed findings of a government-commissioned review which proposed a fresh scrutiny regime and warned that there was "a clear gap in the provision of clearly presented, comprehensive and trusted information on the quality of care". Last year it was estimated that 10% of all GP practices posed a "significant risk" to patients – and would require physical inspections.
In a set of plans designed to underline the health secretary's pro-pensioner credentials, the health secretary will also say on Tuesday that every vulnerable elderly person will have a "named" NHS worker responsible for organising their heath and care needs. Keeping track of the myriad of care organisations and NHS appointments is a distressing experience and Hunt says older patients want to know who is responsible for their care.
A designated worker would help integrate health and social care as well as keeping the elderly out of hospital A&E wards, he says.
The ratings are likely to be run by the health watchdog the CQC, with which GP practices in England must register from 1 April, but overseen by a new chief inspector. Under an Ofsted-style plan the ratings, which will be published annually, would take into account safety, effectiveness and crucially patient experience. It is understood that this system will be in place before 2015.
The health secretary's intervention comes as a leading thinktank calls for a fresh debate over whether wealthy pensioners should receive universal benefits at a time when public funding for essential social care is drying up. The King's Fund warns that the government's attempts to cap social care costs for the elderly "won't solve the social care funding challenge".
It says that since 1980 the number of council residential care beds has dropped from 140,000 to just over 20,000 in 2012. At the same time there has been a dramatic increase in private care home places from 80,000 to 240,000. With NHS long-stay beds also cut by more than half to a little more than 15,000 this means social care for elderly people is largely "privatised".
How to pay for care, the King's Fund argues, is now an urgent public policy concern. Local authorities' spending will have fallen by £2.68bn by March 2014 – a cut of 20% over the current spending review period. The fund calls for a single budget for health and social care to respond to growing demands.
Liz Kendall, Labour's social care spokeswoman, has repeatedly said the government's reforms are being undone by a wave of cuts. "The government is in complete denial about the scale of the crisis that is now engulfing social care. We need a far bigger and bolder response to tackle this crisis and ensure a decent and fair system for the future," she said.
"The King's Fund is right to call for a single strategic budget for the NHS and social care – this is exactly what Labour has been calling for. We need a genuinely integrated care system which helps older people stay healthy and living independently in their own homes for as long as possible and which supports families to care for their loved ones."
Controversially the fund outlines radical solutions for making up the shortfall. The thinktank says a flat-rate charge of £20,000 on estates worth more than £40,000 could raise £4.8bn. Alternatively only giving winter fuel payment and free TV licences to those on pension credit raises £1.4bn.
"With just 9% of the total devoted to essential care needs … [this spending has] been subject to ever more draconian rationing, compared with the large sums of public money disbursed through universal benefits – such as winter fuel allowances, free TV licences and public transport – to all regardless of their needs, income or wealth," warns the fund.
On Monday night a Department of Health spokesperson said: "We recognise that the last spending review provided local government with a challenging settlement. But we prioritised adult social care by providing extra funding for local authorities to help maintain services. In order to make wider improvements to care and support, we need to fundamentally change the way that the system works, not just put in more money."Randeep Ramesh
It is the first duty of governments to protect the health and wellbeing of citizens. It is a priority objective of the EU, enshrined in legislation. Surveys show it is top of people's concerns. So when we read that Nordic politicians are not surprised by the work of David Stuckler and Sanjay Basu (Austerity kills, G2, 16 May), because they have begun to act already with success, our question must be why the dominant political choice across Britain and Europe is to disregard this, and impose austerity measures however much they hurt and destroy lives.
We rage and rush to act when a small number of people are hurt in a specific incident, or by a single disease. Yet millions of people in every country in Europe, as studies commissioned by the EU and WHO will reveal when published, are being almost silently condemned to early, preventable deaths or painful lives, because of economic decisions.
It does not have to be this way. There are well evidenced, cost-effective, proportionate, affordable, immediate and long-term alternative measures available for all political and social systems, left, right or centre. Stuckler recently presented his findings to a WHO Europe intergovernmental conference in Oslo on sustainable health systems in the context of the financial crisis. As he confirms, it is not too late to act, and it is a matter of political choice. These facts, and the relevant work of other British experts such as Professors Marmot, McKee and Wilkinson, should be on the desk of every prime and finance minister, every editor, every company director, every civil servant and every community leader across the country and internationally.
Wellbeing is the business of not only leaders in public, private and voluntary sectors, but also all of us, and the benefits of simple actions can be massive in political, economic and human terms.
Let's look at it from a patient's perspective. In the 90s we introduced targets (the carrot being increased resources to sooth staff reservations) and to some degree they worked.
However, the public received mixed messages – wait four hours in an emergency department or 48 hours to be seen by a GP. We also started talking about choice and, hey presto, patients started voting with their feet.
Problem is, we don't want the public to have choice about urgent care. We designed lots of pathways for different illnesses and injuries that could be dealt with at lots of different destinations. These included minor injury units, pharmacists, walk-in centres, polyclinics and urgent care centres. Additionally, we had NHS Direct and now the 111 service. Unfortunately people don't always want to follow your nicely designed pathway. Safe and efficient emergency departments have become victims of their own success – the better they perform, the more patients arrive.
On top of this, financial incentives are skewed. I once had a very odd discussion with a senior finance manager. We had been directed by the PCT to try and reduce minor injury attendances at our emergency department and so we were looking at our resources to try and redirect these patients. The man from finance was not too keen on these reductions as these were the "easy wins" – the tariff was relatively high for the little work or resource that was necessary for managing these cases. I can see why the CEM has recommended that GP surgeries be set up in hospitals – patients seem to want a single point of entry into the system. If that means an emergency department, then we may need to provide the necessary resources, however politically challenging that may be. I hope Sir Bruce Keogh's review of urgent care finally comes up with an evidenced based solution that both staff and the general public have faith and confidence in.
• Thousands of us marched in London on Saturday to protest at the cuts, closures and privatisation of our hospitals. Campaigns like ours that are fighting the sell-off of buildings, beds and jobs, and others trying to maintain full functioning accident and emergency provision, engage their communities and hospital workforce to oppose the cuts. Such events are covered by local and national media.
What is not so widely publicised is the dreadful crisis in mental health provision. Mental health has suffered the brunt of NHS cuts recently. In the Camden and Islington area alone 100 beds have been closed, hospitals and wards have gone. And now there are no spare mental health beds within the M25 area. This crisis in mainstream and mental health is taking place at a time of increasing health need. Suicides rise and health deteriorates as this government makes cuts to council and other welfare spending and strangles our NHS.
Chair, Defend the Whittington Hospital Coalition