The NHS will be paid to cut waiting lists – at great cost to patient safety
Imagine the furore if a Conservative government announced a scheme to shrink hospital waiting lists using financial incentives. First, they'd pay cash-strapped hospitals unlimited bonuses to kick patients off the lists. Then, they'd offer GPs cash to stop referring patients to hospital. I'm not sure anyone would hold back from calling it what it was: an overt attempt at using the profit motive to distort safe decision-making.
There is no need to imagine this scenario. A Labour health secretary has decided to go where not even Andrew Lansley, Jeremy Hunt and Sajid Javid dared tread. Earlier this month, the Guardian revealed hospitals in England are being offered unlimited bonus payments to remove people they have decided do not need treatment from their waiting lists. Something like this was in place before, but with a payment cap of 5 per cent of the trust's total waiting list. Now the cap has been lifted. Trusts have been instructed to 'validate' their entire list. They will receive an 'incentive payment' for every patient they remove, with no limit to the amount awarded. Deficits at NHS trusts in England have more than doubled over the past year. Do we really expect hospital bosses not to be tempted to game their figures by taking a scythe to those waiting?
Then, the BBC ran a story headlined: 'Plan for GPs to keep millions out of hospital.' The health minister Karin Smyth said the scheme would 'save time and stop masses of people having to head to hospital for unnecessary appointments'. This would be achieved, apparently, by linking 'GPs and hospital specialists before patients are referred on to waiting lists, so that tests and treatments can be offered in the most convenient place'. The piece cited the examples of earwax, IBS and menopause symptoms – as though hapless GPs routinely refer patients with earwax to specialists (they do not). Only mentioned at the end of the piece was that every time a GP decides not to refer a patient to hospital, they will be paid £20 for doing so.
Is this a patient-safety scandal or simply common sense? Are waiting lists really clogged up with thousands of patients who don't need to be there? In theory, some patients – those whose symptoms have eased, or who have already resorted to paying for private care – could perhaps be taken off lists safely. But experienced GPs do not make referrals lightly. Indeed, part of the art of general practice lies in using one's judgement to decide who really needs to be referred and who can be safely managed in a community setting.
More so, the danger of incentivising a particular behaviour is that providers become so fixated on the goal that they cease to notice, or choose to ignore, harm to patients. The NHS has a long and egregious record of doing precisely this. The Mid Staffordshire scandal, for example, was caused by the trust cutting staff to unsustainable levels to try to meet financial targets. Immeasurable harm to patients followed.
No one can doubt Wes Streeting's zeal to tackle NHS waiting lists, or how vital doing so is after a succession of Conservative governments permitted them to double, from 2.3 million to 4.6 million cases from 2010 to 2019. Are some patients destined to become collateral damage, denied treatment to make the lists 'fall' faster?
The words of Streeting's predecessor on this issue are worth quoting in full. When, in 2018, it was revealed some clinical commissioning groups had started trying to balance their books by offering GPs cash not to refer patients to hospital, Jonathan Ashworth, the then shadow health secretary, was unequivocal: 'The minister should step in and ban this practice immediately. Patients should be referred for treatment on the basis of their medical needs. These cash handouts – which some might even describe as 'bribes' – to block referrals are totally unacceptable and the latest pernicious effect of Tory underfunding of our NHS.'
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With Labour now in power, the tables have turned.
Phil Whitaker will return to Health Matters in the summer
[See also: The nastiness and cowardice of Kneecap]
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North Wales Chronicle
an hour ago
- North Wales Chronicle
Health leader condemns ‘black service, not NHS service' received by mother
Lord Victor Adebowale, chairman of the NHS Confederation, described the death of his 92-year-old mother as 'undignified'. His mother Grace, who worked as an NHS nurse for 45 years, died in January of suspected lung cancer. But her cancer was not detected until after she died. Her case highlights systemic racial disparities in healthcare, Lord Adebowale said. 'I just think there are too many situations where people that look like me and shades of me don't get the service,' he said. In an emotional speech, Lord Adebowale told the NHS ConfedExpo conference in Manchester: 'It was not the dignified death that we would have wanted for her. It wasn't the death she deserved. 'So it makes me clear about the need to address the inequity. I think she got a black service, not an NHS service. 'So I have to address the inequity that still exists within the NHS, in terms of the experiences that people who look like me continue to receive. 'It just hasn't got any better.' He went on: 'It is not acceptable that someone who looks like me, on average waits 20 minutes longer in A&E than white patients. 'To achieve an inclusive, equitable NHS we need an inclusive equitable culture from top to bottom.' Mrs Adebowale emigrated from Nigeria to Scotland in the 1950s. Lord Adebowale, who grew up in Wakefield, said that he did not want to blame anyone, but he said that he wanted to highlight a 'systematic problem'. 'She lived to the age of 92 and you may think, 'well, she had the good old innings', but for a lot of those years she was in some discomfort, and it looks like she died from cancer,' he told reporters. 'It's still the case that if you look like me, you're more likely to discover that you've got cancer in A&E, and that that for me is it's an example of two different services. 'I used the phrase 'black service'… you only have to look at the stats – across all the major disease categories that we talk about, black people have a worse experience and worse outcomes – we've known that for years, I'm not saying anything new. 'My mother is an episodic example of a systematic problem. 'We've got a cancer programme, we've got a cancer we've had targets for diagnostics, and pathways, and yet, people like my mother…' Lord Adebowale, who established the NHS Race and Health Observatory in 2021 to try and tackle inequalities experienced by black and minority ethnic patients in healthcare, went on: 'I just think there are too many, too many situations where people that look like me and shades of me don't get the service. 'What I'm talking about is a systemic problem exampled by what I have experienced a my mum, and I think she represents a lot of other mums out there and lots of other people out there.' Asked about his comments about a 'black service', Lord Adebowale went on: 'Why did I (say) it? Because I'm sick of it not changing like everyone else, and I'm close enough to it to know that it happens. 'I could have stood there and give you a load of stats, and you wouldn't be talking to me. 'And my mum, I think, God bless her, I think she would have wanted me to say it.' He added: 'The disproportionate poor services that too many poor people and too many black people experience, that's what I'm sick of.' He said there was nothing in his mother's medical records to suggest she had cancer, adding: 'She went to A&E in a poor condition. 'My sister described a hospital that was really struggling when she went in, she had to argue for mum to get a room. 'It was a very busy day. There had to be a negotiation to find a space, which you shouldn't have to do, but that's what happens when people are under pressure.' He added: 'We haven't got to the bottom of it, and that's why I'm not blaming anybody, and I don't want to, but I can talk about my experience and my observation of what happened to my mum. 'How does that happen? I know it does happen. People have chronic diseases and people don't know and they die of them – I know it's more likely to happen if you're black, it's also more likely to happen if you're poor. 'It's all part of the same story. I used to own story to illustrate a bigger problem, which is systemic.' On his mother, whose full name was Grace Amoke Owuren Adebowale and who worked in various nursing sectors including mental health, acute care and maternity, he said: 'If you a nurse it is what you are, it's what you're born to do.' Commenting on Lord Adebowale's remarks, Professor Habib Naqvi, chief executive of the NHS Race and Health Observatory, said: 'We extend our sincere condolences, thoughts and support to Lord Victor and the Adebowale family. 'The loss of a beloved family member is extremely difficult. We thank Victor for the candour in sharing his personal testimony. 'The NHS Race and Health Observatory continues to support healthcare organisations in implementing meaningful change for ethnic minority patients, communities, and members of the healthcare workforce.'Kate Seymour, from the charity Macmillan Cancer Support, said: 'Stories like Grace Amoke Owuren Adebowale's highlight the heartbreaking reality for some when it comes to accessing cancer care in this country. 'It is categorically unacceptable that some people with cancer are having worse experiences simply because of who they are or where they live.' An NHS spokesperson said: 'Everyone – no matter their background – should receive the best NHS care possible. 'That's why we are working across the NHS to ensure that happens – from improving access to cancer diagnosis and treatment, to expanding health checks for Black and Asian communities and increasing uptake of blood pressure and cholesterol medication in under-served groups. 'But we know there is much more to do, and tackling health inequalities will form an important part of the upcoming 10 Year Health Plan.'
Belfast Telegraph
an hour ago
- Belfast Telegraph
Health leader condemns ‘black service, not NHS service' received by mother
Lord Victor Adebowale, chairman of the NHS Confederation, described the death of his 92-year-old mother as 'undignified'. His mother Grace, who worked as an NHS nurse for 45 years, died in January of suspected lung cancer. But her cancer was not detected until after she died. Her case highlights systemic racial disparities in healthcare, Lord Adebowale said. 'I just think there are too many situations where people that look like me and shades of me don't get the service,' he said. In an emotional speech, Lord Adebowale told the NHS ConfedExpo conference in Manchester: 'It was not the dignified death that we would have wanted for her. It wasn't the death she deserved. 'So it makes me clear about the need to address the inequity. I think she got a black service, not an NHS service. 'So I have to address the inequity that still exists within the NHS, in terms of the experiences that people who look like me continue to receive. 'It just hasn't got any better.' He went on: 'It is not acceptable that someone who looks like me, on average waits 20 minutes longer in A&E than white patients. 'To achieve an inclusive, equitable NHS we need an inclusive equitable culture from top to bottom.' Mrs Adebowale emigrated from Nigeria to Scotland in the 1950s. Lord Adebowale, who grew up in Wakefield, said that he did not want to blame anyone, but he said that he wanted to highlight a 'systematic problem'. 'She lived to the age of 92 and you may think, 'well, she had the good old innings', but for a lot of those years she was in some discomfort, and it looks like she died from cancer,' he told reporters. 'It's still the case that if you look like me, you're more likely to discover that you've got cancer in A&E, and that that for me is it's an example of two different services. 'I used the phrase 'black service'… you only have to look at the stats – across all the major disease categories that we talk about, black people have a worse experience and worse outcomes – we've known that for years, I'm not saying anything new. 'My mother is an episodic example of a systematic problem. 'We've got a cancer programme, we've got a cancer we've had targets for diagnostics, and pathways, and yet, people like my mother…' Lord Adebowale, who established the NHS Race and Health Observatory in 2021 to try and tackle inequalities experienced by black and minority ethnic patients in healthcare, went on: 'I just think there are too many, too many situations where people that look like me and shades of me don't get the service. 'What I'm talking about is a systemic problem exampled by what I have experienced a my mum, and I think she represents a lot of other mums out there and lots of other people out there.' Asked about his comments about a 'black service', Lord Adebowale went on: 'Why did I (say) it? Because I'm sick of it not changing like everyone else, and I'm close enough to it to know that it happens. 'I could have stood there and give you a load of stats, and you wouldn't be talking to me. 'And my mum, I think, God bless her, I think she would have wanted me to say it.' He added: 'The disproportionate poor services that too many poor people and too many black people experience, that's what I'm sick of.' He said there was nothing in his mother's medical records to suggest she had cancer, adding: 'She went to A&E in a poor condition. 'My sister described a hospital that was really struggling when she went in, she had to argue for mum to get a room. 'It was a very busy day. There had to be a negotiation to find a space, which you shouldn't have to do, but that's what happens when people are under pressure.' He added: 'We haven't got to the bottom of it, and that's why I'm not blaming anybody, and I don't want to, but I can talk about my experience and my observation of what happened to my mum. 'How does that happen? I know it does happen. People have chronic diseases and people don't know and they die of them – I know it's more likely to happen if you're black, it's also more likely to happen if you're poor. 'It's all part of the same story. I used to own story to illustrate a bigger problem, which is systemic.' On his mother, whose full name was Grace Amoke Owuren Adebowale and who worked in various nursing sectors including mental health, acute care and maternity, he said: 'If you a nurse it is what you are, it's what you're born to do.' Commenting on Lord Adebowale's remarks, Professor Habib Naqvi, chief executive of the NHS Race and Health Observatory, said: 'We extend our sincere condolences, thoughts and support to Lord Victor and the Adebowale family. 'The loss of a beloved family member is extremely difficult. We thank Victor for the candour in sharing his personal testimony. 'The NHS Race and Health Observatory continues to support healthcare organisations in implementing meaningful change for ethnic minority patients, communities, and members of the healthcare workforce.'Kate Seymour, from the charity Macmillan Cancer Support, said: 'Stories like Grace Amoke Owuren Adebowale's highlight the heartbreaking reality for some when it comes to accessing cancer care in this country. 'It is categorically unacceptable that some people with cancer are having worse experiences simply because of who they are or where they live.' An NHS spokesperson said: 'Everyone – no matter their background – should receive the best NHS care possible. 'That's why we are working across the NHS to ensure that happens – from improving access to cancer diagnosis and treatment, to expanding health checks for Black and Asian communities and increasing uptake of blood pressure and cholesterol medication in under-served groups. 'But we know there is much more to do, and tackling health inequalities will form an important part of the upcoming 10 Year Health Plan.'
Western Telegraph
an hour ago
- Western Telegraph
Health leader condemns ‘black service, not NHS service' received by mother
Lord Victor Adebowale, chairman of the NHS Confederation, described the death of his 92-year-old mother as 'undignified'. His mother Grace, who worked as an NHS nurse for 45 years, died in January of suspected lung cancer. But her cancer was not detected until after she died. Her case highlights systemic racial disparities in healthcare, Lord Adebowale said. 'I just think there are too many situations where people that look like me and shades of me don't get the service,' he said. In an emotional speech, Lord Adebowale told the NHS ConfedExpo conference in Manchester: 'It was not the dignified death that we would have wanted for her. It wasn't the death she deserved. 'So it makes me clear about the need to address the inequity. I think she got a black service, not an NHS service. 'So I have to address the inequity that still exists within the NHS, in terms of the experiences that people who look like me continue to receive. 'It just hasn't got any better.' Grace Amoke Owuren Adebowale died in January (Family Handout/PA) He went on: 'It is not acceptable that someone who looks like me, on average waits 20 minutes longer in A&E than white patients. 'To achieve an inclusive, equitable NHS we need an inclusive equitable culture from top to bottom.' Mrs Adebowale emigrated from Nigeria to Scotland in the 1950s. Lord Adebowale, who grew up in Wakefield, said that he did not want to blame anyone, but he said that he wanted to highlight a 'systematic problem'. 'She lived to the age of 92 and you may think, 'well, she had the good old innings', but for a lot of those years she was in some discomfort, and it looks like she died from cancer,' he told reporters. 'It's still the case that if you look like me, you're more likely to discover that you've got cancer in A&E, and that that for me is it's an example of two different services. 'I used the phrase 'black service'… you only have to look at the stats – across all the major disease categories that we talk about, black people have a worse experience and worse outcomes – we've known that for years, I'm not saying anything new. 'My mother is an episodic example of a systematic problem. 'We've got a cancer programme, we've got a cancer we've had targets for diagnostics, and pathways, and yet, people like my mother…' Lord Adebowale, who established the NHS Race and Health Observatory in 2021 to try and tackle inequalities experienced by black and minority ethnic patients in healthcare, went on: 'I just think there are too many, too many situations where people that look like me and shades of me don't get the service. 'What I'm talking about is a systemic problem exampled by what I have experienced a my mum, and I think she represents a lot of other mums out there and lots of other people out there.' Asked about his comments about a 'black service', Lord Adebowale went on: 'Why did I (say) it? Because I'm sick of it not changing like everyone else, and I'm close enough to it to know that it happens. 'I could have stood there and give you a load of stats, and you wouldn't be talking to me. 'And my mum, I think, God bless her, I think she would have wanted me to say it.' He added: 'The disproportionate poor services that too many poor people and too many black people experience, that's what I'm sick of.' He said there was nothing in his mother's medical records to suggest she had cancer, adding: 'She went to A&E in a poor condition. 'My sister described a hospital that was really struggling when she went in, she had to argue for mum to get a room. 'It was a very busy day. There had to be a negotiation to find a space, which you shouldn't have to do, but that's what happens when people are under pressure.' He added: 'We haven't got to the bottom of it, and that's why I'm not blaming anybody, and I don't want to, but I can talk about my experience and my observation of what happened to my mum. 'How does that happen? I know it does happen. People have chronic diseases and people don't know and they die of them – I know it's more likely to happen if you're black, it's also more likely to happen if you're poor. 'It's all part of the same story. I used to own story to illustrate a bigger problem, which is systemic.' On his mother, whose full name was Grace Amoke Owuren Adebowale and who worked in various nursing sectors including mental health, acute care and maternity, he said: 'If you a nurse it is what you are, it's what you're born to do.' Commenting on Lord Adebowale's remarks, Professor Habib Naqvi, chief executive of the NHS Race and Health Observatory, said: 'We extend our sincere condolences, thoughts and support to Lord Victor and the Adebowale family. 'The loss of a beloved family member is extremely difficult. We thank Victor for the candour in sharing his personal testimony. 'The NHS Race and Health Observatory continues to support healthcare organisations in implementing meaningful change for ethnic minority patients, communities, and members of the healthcare workforce.' Kate Seymour, from the charity Macmillan Cancer Support, said: 'Stories like Grace Amoke Owuren Adebowale's highlight the heartbreaking reality for some when it comes to accessing cancer care in this country. 'It is categorically unacceptable that some people with cancer are having worse experiences simply because of who they are or where they live.' An NHS spokesperson said: 'Everyone – no matter their background – should receive the best NHS care possible. 'That's why we are working across the NHS to ensure that happens – from improving access to cancer diagnosis and treatment, to expanding health checks for Black and Asian communities and increasing uptake of blood pressure and cholesterol medication in under-served groups. 'But we know there is much more to do, and tackling health inequalities will form an important part of the upcoming 10 Year Health Plan.'
