Tag Archives: after

Call for tighter checks on private hospitals used by NHS after MRSA case

Theresa May has been urged to tighten checks on private hospitals used by the NHS after a Labour MP raised the case of a young patient with an open wound who contracted MRSA on a private mental health ward.

Louise Haigh, a Labour frontbencher, called for the NHS to thoroughly investigate the quality of care before it commissions beds and treatment from private providers.

She cited the case in her of a “young women with MRSA with open wounds” on a child and adolescent mental health ward at Cygnet hospital Sheffield, which a report by a healthcare watchdog rated as inadequate in terms of safety.

“NHS England commissions child and adolescent mental health beds at a private hospital in my constituency, which recently received a damning Care Quality Commission report,” she said.

“Does the prime minister share my concern that a shortage of mental health beds risks the NHS placing vulnerable young people in unsafe environments, and will she consider giving NHS England the responsibility for, and the resources to investigate, the quality of care before it commissions?”

In response, May promised to ask Jeremy Hunt, the health secretary, to investigate, while highlighting a “a number of steps to improve mental health” provision in the NHS, including an increase in funding.

But Haigh said she wanted to see more action to make sure private beds paid for by the NHS are safe.

“Clearly the NHS should not be commissioning beds for children and young people unless they are confident they are safe places for them to be treated,” she said.

“This horrifying example suggests that a shortage of beds in the NHS and by private providers is forcing the NHS to place vulnerable young people in situations that are dangerous.

“I want to see NHS England have the responsibility and the resources to ensure that all places are safe and provide decent quality care before they are commissioned.”

Cygnet Health Care, which runs the hospital in Sheffield, said it had proactively notified the Care Quality Commission about cases of MRSA.

A spokesperson for the hospital said: “Our absolute priority is the health and wellbeing of the young people we support. Prior to the CQC’s inspection, we had notified the regulator about two instances of infection relating to patients.

“During the inspection, we further advised inspectors that a member of staff had also tested positive, and had been temporarily removed from the hospital as part of our infection control measures.

“Following the inspection we thoroughly reviewed our infection control protocol, and carried out additional staff training to ensure all measures are followed appropriately.”

Call for tighter checks on private hospitals used by NHS after MRSA case

Theresa May has been urged to tighten checks on private hospitals used by the NHS after a Labour MP raised the case of a young patient with an open wound who contracted MRSA on a private mental health ward.

Louise Haigh, a Labour frontbencher, called for the NHS to thoroughly investigate the quality of care before it commissions beds and treatment from private providers.

She cited the case in her of a “young women with MRSA with open wounds” on a child and adolescent mental health ward at Cygnet hospital Sheffield, which a report by a healthcare watchdog rated as inadequate in terms of safety.

“NHS England commissions child and adolescent mental health beds at a private hospital in my constituency, which recently received a damning Care Quality Commission report,” she said.

“Does the prime minister share my concern that a shortage of mental health beds risks the NHS placing vulnerable young people in unsafe environments, and will she consider giving NHS England the responsibility for, and the resources to investigate, the quality of care before it commissions?”

In response, May promised to ask Jeremy Hunt, the health secretary, to investigate, while highlighting a “a number of steps to improve mental health” provision in the NHS, including an increase in funding.

But Haigh said she wanted to see more action to make sure private beds paid for by the NHS are safe.

“Clearly the NHS should not be commissioning beds for children and young people unless they are confident they are safe places for them to be treated,” she said.

“This horrifying example suggests that a shortage of beds in the NHS and by private providers is forcing the NHS to place vulnerable young people in situations that are dangerous.

“I want to see NHS England have the responsibility and the resources to ensure that all places are safe and provide decent quality care before they are commissioned.”

Cygnet Health Care, which runs the hospital in Sheffield, said it had proactively notified the Care Quality Commission about cases of MRSA.

A spokesperson for the hospital said: “Our absolute priority is the health and wellbeing of the young people we support. Prior to the CQC’s inspection, we had notified the regulator about two instances of infection relating to patients.

“During the inspection, we further advised inspectors that a member of staff had also tested positive, and had been temporarily removed from the hospital as part of our infection control measures.

“Following the inspection we thoroughly reviewed our infection control protocol, and carried out additional staff training to ensure all measures are followed appropriately.”

Rise in children seeking mental health support after terror attacks

The number of children and young people seeking help from mental health services has spiked in the wake of recent terrorist attacks in England, according to the Royal College of Psychiatrists (RCP).

Hospitals across the Manchester region have seen an estimated 10% increase in children seeking help since a bomb ripped through the Manchester Arena on 22 May, killing 22 people, according to the RCP. Mental health experts in Greater Manchester hospitals received hundreds more patients from June to July compared with previous months.

Dr Louise Theodosiou, a consultant child and adolescent psychiatrist at Royal Manchester children’s hospital and a member of the RCP, described the increase as significant and said the terror attack had a “profound impact on the way the children view their city”.

Just a small fraction of those treated had been at the concert; the majority of patients had felt increased anxiety after watching the events on the news. Anxiety and insomnia were the most common complaints, with children worrying about going out or being on public transport after the attacks.

Theodosiou warned the number affected could be significantly greater, with people also seeking support through school or voluntary services and many others yet to come forward for help.

A similar trend has been noticed in London. Dr Jon Goldin, the vice-chair of the child and adolescent psychiatry faculty at RCP, said there had also been anecdotal evidence of “a rise in children seeking mental health services after recent terror attacks”.

“Maybe the rise hasn’t been as much as Manchester [...] but some of those with a predisposition to anxiety have had it heightened by these recent events,” he said.

The increase could be linked to young people’s consumption of media, with children able to access disturbing footage on their smartphones, according to experts. It could also be a positive sign that efforts to reduce the stigma around mental health were having an impact.

Dr Rachel Langley, a clinical psychologist from Southampton children’s hospital’s sleepdisorder service, said: “Technology has a huge amount to answer for in fuelling a rise in children’s sleep problems. It gives young people access to what is going on in the world and also … the blue light of the screens affects melatonin release.”

She added: “There was a 10-year-old boy I saw recently who has anxiety-related insomnia and he has a specific concern about his dad, who works in London, getting caught up in a terror attack.”

In Manchester more young people are expected to seek help in the coming months and years. Theodosiou said: “It has unmasked vulnerabilities that were not there before. It’s fair to say that of the hundreds of children affected only a small fraction would have witnessed the events.”

She added: “If you think of the bomb as being like an influenza epidemic, those most affected by that will be ones with underlying respiratory problems [...] and in the same way the group most affected by the terror attack in the city have been those who are vulnerable to mental health at the beginning.”

Peter Sweeney, another psychiatrist from Royal Manchester children’s hospital, said services needed to plan ahead to manage post-traumatic stress disorder that could hit families and young people.

“We needed to do lots of work for the survivors initially … they got a high level of support at the start. Our concern now is more about young people who may be experiencing anxiety but are not presenting to us, so those who were at the concert but not seriously injured or those who were not at the concert but affected,” he said.

The message to children should be that these attacks should not alter behaviour and that people should get on with their normal lives, said Goldin. “Children should get that message as well as adults. If you have anxious parents saying ‘don’t go to London etc’ then that doesn’t give the most helpful message.

“One message to get across is that it’s important not to feel that, when a child is anxious about a terror attack, they should be taken straight to children’s mental health services. Usually family and a normal support network can really help them. When things are more enduring, for example several weeks after a traumatic experience a child is still struggling with sleep or their mood etc, then you would want CAMHS [child and adolescent mental health services] to get involved.”

  • In the UK, the Samaritans can be contacted on 116 123, and Childline on 0800 1111. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

Rise in children seeking mental health support after terror attacks

The number of children and young people seeking help from mental health services has spiked in the wake of recent terrorist attacks in England, according to the Royal College of Psychiatrists (RCP).

Hospitals across the Manchester region have seen an estimated 10% increase in children seeking help since a bomb ripped through the Manchester Arena on 22 May, killing 22 people, according to the RCP. Mental health experts in Greater Manchester hospitals received hundreds more patients from June to July compared with previous months.

Dr Louise Theodosiou, a consultant child and adolescent psychiatrist at Royal Manchester children’s hospital and a member of the RCP, described the increase as significant and said the terror attack had a “profound impact on the way the children view their city”.

Just a small fraction of those treated had been at the concert; the majority of patients had felt increased anxiety after watching the events on the news. Anxiety and insomnia were the most common complaints, with children worrying about going out or being on public transport after the attacks.

Theodosiou warned the number affected could be significantly greater, with people also seeking support through school or voluntary services and many others yet to come forward for help.

A similar trend has been noticed in London. Dr Jon Goldin, the vice-chair of the child and adolescent psychiatry faculty at RCP, said there had also been anecdotal evidence of “a rise in children seeking mental health services after recent terror attacks”.

“Maybe the rise hasn’t been as much as Manchester [...] but some of those with a predisposition to anxiety have had it heightened by these recent events,” he said.

The increase could be linked to young people’s consumption of media, with children able to access disturbing footage on their smartphones, according to experts. It could also be a positive sign that efforts to reduce the stigma around mental health were having an impact.

Dr Rachel Langley, a clinical psychologist from Southampton children’s hospital’s sleepdisorder service, said: “Technology has a huge amount to answer for in fuelling a rise in children’s sleep problems. It gives young people access to what is going on in the world and also … the blue light of the screens affects melatonin release.”

She added: “There was a 10-year-old boy I saw recently who has anxiety-related insomnia and he has a specific concern about his dad, who works in London, getting caught up in a terror attack.”

In Manchester more young people are expected to seek help in the coming months and years. Theodosiou said: “It has unmasked vulnerabilities that were not there before. It’s fair to say that of the hundreds of children affected only a small fraction would have witnessed the events.”

She added: “If you think of the bomb as being like an influenza epidemic, those most affected by that will be ones with underlying respiratory problems [...] and in the same way the group most affected by the terror attack in the city have been those who are vulnerable to mental health at the beginning.”

Peter Sweeney, another psychiatrist from Royal Manchester children’s hospital, said services needed to plan ahead to manage post-traumatic stress disorder that could hit families and young people.

“We needed to do lots of work for the survivors initially … they got a high level of support at the start. Our concern now is more about young people who may be experiencing anxiety but are not presenting to us, so those who were at the concert but not seriously injured or those who were not at the concert but affected,” he said.

The message to children should be that these attacks should not alter behaviour and that people should get on with their normal lives, said Goldin. “Children should get that message as well as adults. If you have anxious parents saying ‘don’t go to London etc’ then that doesn’t give the most helpful message.

“One message to get across is that it’s important not to feel that, when a child is anxious about a terror attack, they should be taken straight to children’s mental health services. Usually family and a normal support network can really help them. When things are more enduring, for example several weeks after a traumatic experience a child is still struggling with sleep or their mood etc, then you would want CAMHS [child and adolescent mental health services] to get involved.”

  • In the UK, the Samaritans can be contacted on 116 123, and Childline on 0800 1111. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

El Salvador teen rape victim sentenced to 30 years in prison after stillbirth

A teenage rape victim in El Salvador has been sentenced to 30 years in prison for murder after having a stillbirth, the latest in a long line of failures of justice against pregnant women in the Central American country.

Evelyn Beatriz Hernandez Cruz, 19, from a small rural community in Cuscatlán, eastern El Salvador, was convicted on the grounds that failing to seek antenatal care amounted to murder.

Hernandez, a high school student, gave birth into the toilet in April 2016 after falling ill with acute back and stomach pain.

Hernandez, who at the time was 18, was in her third trimester, but hadn’t realised that she was pregnant. She had been repeatedly raped by a gang member over several months as part of a forced sexual relationship.

El Salvador: ‘I had a miscarriage. The judge accused me of murder’

Medical experts were unable to ascertain whether the foetus died in utero or in the moments after delivery.

The female judge accepted the prosecutor’s claims that Hernandez failed to seek antenatal care because she did not want the baby, and threw him into the toilet intending to kill him.

In sentencing, the judge went further and suggested that Hernandez could not have acted alone and that her mother may also be criminally responsible.

According to Morena Herrera, executive director of the Citizens’ Group for the Decriminalisation of Abortion, the verdict was based on prejudices held by the prosecutor and judge.

“The judgment sentencing Evelyn to 30 years in prison shows how in El Salvador justice is applied without direct proof, without sufficient evidence that clarifies what a woman has done,” Herrera said.

El Salvador – one of five countries where abortion is illegal in all circumstances – has imprisoned dozens of mainly poor young women for murder after they suffered obstetric complications.

Abortion was criminalised in El Salvador 20 years ago, after legislators from across the political spectrum voted to strip women of their reproductive rights without any public debate or medical consultation about the consequences. The 1997 reform was passed after a shadowy campaign by a small group of powerful anti-choice groups linked to the Catholic church.

Hopes had been raised that the ban would be relaxed amid a groundswell of public and medical support for a parliamentary bill proposing to allow abortion in cases of rape or human trafficking; when the foetus is unviable; or to protect the pregnant woman’s health or life.

But four months after the parliamentary hearings ended, the bill remains in the hands of the legislative committee. The nine cross-party deputies have yet to decide whether the bill should be sent to the legislative assembly for a vote.

Hernandez insists that she only realised she had given birth after the fact, when her mother took her to hospital with severe abdominal pain.

Hernandez was arrested after police found the deceased foetus in the toilet. She spent a week handcuffed to a hospital bed while being treated for severe anaemia and a urinary tract infection, and has been detained ever since.

Her lawyer condemned Wednesday’s decision as unjust and unlawful.

“The judge’s verdict doesn’t reflect the evidence presented in court. It’s a decision based on morality, not the law or justice,” said Dennis Munoz.

Lawyers will appeal the verdict, but Hernandez faces a long road to justice.

In 2014 the Citizens’ Group launched a campaign to seek clemency for 17 women wrongly jailed for murder who had exhausted all other legal appeals. Three of the women known as Las 17 have so far been freed; another will be released next year after her sentence was reduced from 30 to 15 years. At least five other women including Hernandez have since been jailed.

Half of junior doctors having accidents or near misses after night shifts

More than half of trainee hospital doctors have had an accident or near miss on their way home after a night shift due to sleep deprivation, according to new evidence about fatigue among NHS staff.

Doctors have described swerving across motorways, crashing into other vehicles, being stopped by police and hitting a kerb, verge or roundabout as a result of falling asleep at the wheel on their journey home.

In all, 1,229 (57%) of 2,155 trainee anaesthetists questioned had been involved in an accident, or come close to having one, while driving, motorcycling, cycling or walking home after working all night.

“I have fallen asleep at traffic lights. I once hallucinated on the motorway,” one doctor said. Another said: “Previously experienced microsleep/nodding off on the M5. Foot came off the gas pedal and the car slowly drifted into middle lane. Woke up when driver in van came up alongside me and honked continuously.”

Some suffered injuries ranging from minor bumps and scrapes to more serious harm, but others had written off their car and some incidents put others at risk, too. Almost all doctors admitted that the incidents were their fault, though caused by exhaustion.

Another respondent recounted how: “I’ve fallen asleep and drifted towards a lorry in the other lane of a dual carriageway. I’ve fallen asleep and hit a car coming the other way with our wing mirrors on a village road near home. I’ve also pulled out of a junction when someone was coming as I was so dopey after a night [shift].”

More than eight out of 10 (84%) of respondents said that they had felt too tired to drive home after a night shift. About 90% use caffeine-based drinks in order to stay awake on a night shift.

Seven out of 10 (72%) said that work-related fatigue had negatively affected their physical health, while almost as many said it had damaged their psychological wellbeing (69%) or personal relationships (66%). Over half (53%) of the trainee anaesthetists said fatigue had impaired their ability to do their job.

The findings, published in the medical journal Anaesthesia, have prompted calls for the NHS to do more to ensure that doctors on duty overnight can get some sleep during their shift or sleep in the hospital before heading home afterwards.

“These are very worrying findings. Junior doctors are putting their lives at risk due to fatigue resulting from their shift work and the lack of rest facilities at their hospitals both during and after shifts,” said Dr Laura McClelland, a co-author of the survey.

Extreme tiredness among doctors could also lead to them making mistakes when they are working at night, McClelland warned.

“It may lead people to believe that they are able to drive when they aren’t or to misjudge a clinical situation. We’re required to make judgements about everything from the clinical presentation of a patient to the drug doses we use and also the appropriate course of the clinical care. Fatigue can lead to anything going wrong in any of those processes,” she said.


Junior doctors are putting their lives at risk due to fatigue resulting from shift work and the lack of rest facilities

Dr Laura McClelland

A typical junior doctor’s night shift lasts for 12 and a half hours. But 17% of medics said they never managed a sleep of at least 30 minutes during that time.

“That 17% figure is a worry as it highlights that people on a night shift, who aren’t physiologically designed to be awake all night, aren’t having the opportunity to have the rest breaks required so that they can function optimally and safely, so they can give patients the best possible care and drive safely during their journey,” said Dr Jon Holland, another co-author.

At least three junior doctors have died in car crashes on their way home after nightshifts since 2013, added Holland. They include trainee anaesthetist Ronak Patel, 33. He died when he crashed his car into a lorry on his way home from the third of three successive night shifts at the Norfolk and Norwich hospital in Norwich. The inquest into his death heard that he had been singing to try to keep himself awake during the journey.

Many respondents said they had no opportunity to have a short sleep mid-shift because they were too busy or there were too few other doctors on duty to allow them to do that. A third (34%) did not have rest facilities available in their hospital to have a nap in mid-shift.

The Association of Anaesthetists of Great Britain and Ireland, which endorsed the study’s conclusions, believes that the loss of rooms in hospitals in which doctors could sleep during or after a night shift has led to increased fatigue among medics.

A Department of Health spokeswoman said: “We know how hard our junior doctors work to provide world-leading care and it is absolutely vital they get proper support. And that’s why their new contract has much stricter safeguards in mandating rest days after consecutive night shifts and reducing the maximum hours worked in any one week.”

Half of junior doctors having accidents or near misses after night shifts

More than half of trainee hospital doctors have had an accident or near miss on their way home after a night shift due to sleep deprivation, according to new evidence about fatigue among NHS staff.

Doctors have described swerving across motorways, crashing into other vehicles, being stopped by police and hitting a kerb, verge or roundabout as a result of falling asleep at the wheel on their journey home.

In all, 1,229 (57%) of 2,155 trainee anaesthetists questioned had been involved in an accident, or come close to having one, while driving, motorcycling, cycling or walking home after working all night.

“I have fallen asleep at traffic lights. I once hallucinated on the motorway,” one doctor said. Another said: “Previously experienced microsleep/nodding off on the M5. Foot came off the gas pedal and the car slowly drifted into middle lane. Woke up when driver in van came up alongside me and honked continuously.”

Some suffered injuries ranging from minor bumps and scrapes to more serious harm, but others had written off their car and some incidents put others at risk, too. Almost all doctors admitted that the incidents were their fault, though caused by exhaustion.

Another respondent recounted how: “I’ve fallen asleep and drifted towards a lorry in the other lane of a dual carriageway. I’ve fallen asleep and hit a car coming the other way with our wing mirrors on a village road near home. I’ve also pulled out of a junction when someone was coming as I was so dopey after a night [shift].”

More than eight out of 10 (84%) of respondents said that they had felt too tired to drive home after a night shift. About 90% use caffeine-based drinks in order to stay awake on a night shift.

Seven out of 10 (72%) said that work-related fatigue had negatively affected their physical health, while almost as many said it had damaged their psychological wellbeing (69%) or personal relationships (66%). Over half (53%) of the trainee anaesthetists said fatigue had impaired their ability to do their job.

The findings, published in the medical journal Anaesthesia, have prompted calls for the NHS to do more to ensure that doctors on duty overnight can get some sleep during their shift or sleep in the hospital before heading home afterwards.

“These are very worrying findings. Junior doctors are putting their lives at risk due to fatigue resulting from their shift work and the lack of rest facilities at their hospitals both during and after shifts,” said Dr Laura McClelland, a co-author of the survey.

Extreme tiredness among doctors could also lead to them making mistakes when they are working at night, McClelland warned.

“It may lead people to believe that they are able to drive when they aren’t or to misjudge a clinical situation. We’re required to make judgements about everything from the clinical presentation of a patient to the drug doses we use and also the appropriate course of the clinical care. Fatigue can lead to anything going wrong in any of those processes,” she said.


Junior doctors are putting their lives at risk due to fatigue resulting from shift work and the lack of rest facilities

Dr Laura McClelland

A typical junior doctor’s night shift lasts for 12 and a half hours. But 17% of medics said they never managed a sleep of at least 30 minutes during that time.

“That 17% figure is a worry as it highlights that people on a night shift, who aren’t physiologically designed to be awake all night, aren’t having the opportunity to have the rest breaks required so that they can function optimally and safely, so they can give patients the best possible care and drive safely during their journey,” said Dr John Holland, another co-author.

At least three junior doctors have died in car crashes on their way home after nightshifts since 2013, added Holland. They include trainee anaesthetist Ronak Patel, 33. He died when he crashed his car into a lorry on his way home from the third of three successive night shifts at the Norfolk and Norwich hospital in Norwich. The inquest into his death heard that he had been singing to try to keep himself awake during the journey.

Many respondents said they had no opportunity to have a short sleep mid-shift because they were too busy or there were too few other doctors on duty to allow them to do that. A third (34%) did not have rest facilities available in their hospital to have a nap in mid-shift.

The Association of Anaesthetists of Great Britain and Ireland, which commissioned the study, believes that the loss of rooms in hospitals in which doctors could sleep during or after a night shift has led to increased fatigue among medics.

A Department of Health spokeswoman said: “We know how hard our junior doctors work to provide world-leading care and it is absolutely vital they get proper support. And that’s why their new contract has much stricter safeguards in mandating rest days after consecutive night shifts and reducing the maximum hours worked in any one week.”

NHS chiefs soften ‘brutal’ cost-cutting plan after huge backlash

NHS bosses have been forced to backtrack on controversial plans to impose “brutal” cost-cutting measures that involved delaying operations, denying patients treatment and closing hospital wards.

NHS Improvement (NHSI), the service’s financial regulator, has watered down proposals it drew up alongside NHS England after doctors, health charities and senior NHS staff in the 14 affected areas of England reacted with anger, amazement and warnings that patients would suffer.

The Guardian last week reported how leaked NHS documents showed that hospitals serving five north London boroughs were being pressed to ration care and make patients wait longer for operations as part of a plan to save £183.1m within nine months. And we disclosed that plans to cut the number of endoscopies – vital diagnostic tests – in Cheshire by 25% prompted fears this could lead to cancer patients being diagnosed later and dying sooner.

The backlash against the cuts envisaged under the “capped expenditure process” has prompted NHSI to write to hospital trusts in the 14 areas to clarify the initiative in a bid to lessen the hostility it has triggered. It has imposed the CEP on the 14 areas because they are due to record massive deficits this year, though they blame NHS underfunding for their problems.

In his letter Jim Mackey, NHSI’s chief executive, has told hospital bosses that the final version of plans to make greater savings this year than planned “must safeguard patient safety and quality”.

In addition, “providers need to ensure that CEP plans are consistent with constitutional rights for RTT [referral to treatment] and patient choice”. That appears to rule out plans, previously being discussed in some of the 14 areas, to make patients wait longer for a non-urgent operation than the maximum 18 weeks under the NHS constitution and also to deny them their right to be treated at the NHS’s expense in a private hospital if they chose to do so.

Trust bosses privately criticised NHSI and NHSE’s plans as “brutal”, “unrealistic” and “impossible to deliver”, given the pressures their hospitals are under from rising demand. NHSI has also almost halved the amount of savings it hopes the 14 areas will deliver through the CEP from £470m to £250m, according to NHS sources and the Health Service Journal.

Chris Hopson, chief executive of NHS Providers, which represents most NHS trusts in England, said: “We are pleased the approach has changed. The trusts involved were very concerned – not just in terms of the level and speed of savings required, but also the lack of proper debate and transparency in the process. We set out those concerns to NHS England and NHS Improvement. It’s clear they have listened. “However, let’s not forget that the underlying problem – the gap between what the NHS is being asked to deliver and the funding available – remains.”

Jonathan Ashworth, Labour’s shadow health secretary, said: “The capped expenditure process is in total chaos. The government are refusing to answer questions about it and Jeremy Hunt is trying to shirk responsibility for this scheme, which will see hundreds of millions of pounds cut from health budgets.”

Ashworth condemned the “scandalous lack of transparency around the whole affair”. The Department of Health, NHS England and NHSI have shrouded the CEP in secrecy and refused to answer questions posed by the Guardian, in breach of their duty to be open, honest and transparent.

Philip Dunne, the health minister, this week refused to answer a series of detailed parliamentary questions tabled by Ashworth. Instead he simply defended the thrust of the CEP and stated that: “It is unfair if a small number of areas in effect take more than their fair share of that [NHS] budget [for 2017-18] at the expense of other people’s hospital services, general practitioner care and mental health clinics elsewhere in the country”. The government’s mandate to the NHS for 2017-18 requires all 44 sustainability and transformation areas to stick to their budgets, he added.

But Ashworth said: “We still do not know who is charged with drawing up each local plan, who chose which local areas would have to make extra cuts, or when confirmation of the plans will be published. Jeremy Hunt needs to make clear whether and when he signed off this hit-list of NHS cuts which will devastating outcomes for people all across the country.”

Imelda Redmond, national director of the patient watchdog Healthwatch England, criticised the secrecy around the CEP.

She said: “It’s clear the health service faces deeply challenging times but the solutions don’t lie in closed rooms, rather in honest conversations with patients, carers and communities. The last thing we need is a chain of kneejerk reactions driving poor decisions that don’t make sense to people.

“Where difficult choices do have to be made, people need clear information explaining the rationale and outlining how the NHS will track the impact to ensure no one is left without the care they need.”

Mackey’s letter also makes clear that from now on NHS trusts should also consult the public and “ensure that patients and staff are engaged throughout the planning and implementation stages of CEP”, especially if plans ultimately involve the downgrading or closure of A&E or maternity units.

NHS chiefs soften ‘brutal’ cost-cutting plan after huge backlash

NHS bosses have been forced to backtrack on controversial plans to impose “brutal” cost-cutting measures that involved delaying operations, denying patients treatment and closing hospital wards.

NHS Improvement (NHSI), the service’s financial regulator, has watered down proposals it drew up alongside NHS England after doctors, health charities and senior NHS staff in the 14 affected areas of England reacted with anger, amazement and warnings that patients would suffer.

The Guardian last week reported how leaked NHS documents showed that hospitals serving five north London boroughs were being pressed to ration care and make patients wait longer for operations as part of a plan to save £183.1m within nine months. And we disclosed that plans to cut the number of endoscopies – vital diagnostic tests – in Cheshire by 25% prompted fears this could lead to cancer patients being diagnosed later and dying sooner.

The backlash against the cuts envisaged under the “capped expenditure process” has prompted NHSI to write to hospital trusts in the 14 areas to clarify the initiative in a bid to lessen the hostility it has triggered. It has imposed the CEP on the 14 areas because they are due to record massive deficits this year, though they blame NHS underfunding for their problems.

In his letter Jim Mackey, NHSI’s chief executive, has told hospital bosses that the final version of plans to make greater savings this year than planned “must safeguard patient safety and quality”.

In addition, “providers need to ensure that CEP plans are consistent with constitutional rights for RTT [referral to treatment] and patient choice”. That appears to rule out plans, previously being discussed in some of the 14 areas, to make patients wait longer for a non-urgent operation than the maximum 18 weeks under the NHS constitution and also to deny them their right to be treated at the NHS’s expense in a private hospital if they chose to do so.

Trust bosses privately criticised NHSI and NHSE’s plans as “brutal”, “unrealistic” and “impossible to deliver”, given the pressures their hospitals are under from rising demand. NHSI has also almost halved the amount of savings it hopes the 14 areas will deliver through the CEP from £470m to £250m, according to NHS sources and the Health Service Journal.

Chris Hopson, chief executive of NHS Providers, which represents most NHS trusts in England, said: “We are pleased the approach has changed. The trusts involved were very concerned – not just in terms of the level and speed of savings required, but also the lack of proper debate and transparency in the process. We set out those concerns to NHS England and NHS Improvement. It’s clear they have listened. “However, let’s not forget that the underlying problem – the gap between what the NHS is being asked to deliver and the funding available – remains.”

Jonathan Ashworth, Labour’s shadow health secretary, said: “The capped expenditure process is in total chaos. The government are refusing to answer questions about it and Jeremy Hunt is trying to shirk responsibility for this scheme, which will see hundreds of millions of pounds cut from health budgets.”

Ashworth condemned the “scandalous lack of transparency around the whole affair”. The Department of Health, NHS England and NHSI have shrouded the CEP in secrecy and refused to answer questions posed by the Guardian, in breach of their duty to be open, honest and transparent.

Philip Dunne, the health minister, this week refused to answer a series of detailed parliamentary questions tabled by Ashworth. Instead he simply defended the thrust of the CEP and stated that: “It is unfair if a small number of areas in effect take more than their fair share of that [NHS] budget [for 2017-18] at the expense of other people’s hospital services, general practitioner care and mental health clinics elsewhere in the country”. The government’s mandate to the NHS for 2017-18 requires all 44 sustainability and transformation areas to stick to their budgets, he added.

But Ashworth said: “We still do not know who is charged with drawing up each local plan, who chose which local areas would have to make extra cuts, or when confirmation of the plans will be published. Jeremy Hunt needs to make clear whether and when he signed off this hit-list of NHS cuts which will devastating outcomes for people all across the country.”

Imelda Redmond, national director of the patient watchdog Healthwatch England, criticised the secrecy around the CEP.

She said: “It’s clear the health service faces deeply challenging times but the solutions don’t lie in closed rooms, rather in honest conversations with patients, carers and communities. The last thing we need is a chain of kneejerk reactions driving poor decisions that don’t make sense to people.

“Where difficult choices do have to be made, people need clear information explaining the rationale and outlining how the NHS will track the impact to ensure no one is left without the care they need.”

Mackey’s letter also makes clear that from now on NHS trusts should also consult the public and “ensure that patients and staff are engaged throughout the planning and implementation stages of CEP”, especially if plans ultimately involve the downgrading or closure of A&E or maternity units.

Why you might need a stiff drink after Brexit and the general election

British politics can feel like one long hangover. Following the Brexit binge, the snap election was like the hair of the dog.

Although the chemistry behind that particular old wives’ tale is sound, the neurobiology is more complicated. Hangovers are caused by the effects of various toxins as they make their way down the metabolic pathways. It’s the by-products which can cause as many problems as the original shot.

Some of the nastiest effects come from methanol, which often arises from the distilling process. As it is processed, it breaks down into formaldehyde and formic acid, a venom used by some ants which isn’t great to have in your body.

The principle of the hair of the dog is that taking more ethanol on board (that sneaky breakfast Bloody Mary) slows the metabolism of methanol and so more of it gets excreted harmlessly. If less formic acid is produced, this could reduce the feeling of being stung by a million ants from the inside. Sadly there is only limited evidence to recommend this approach. As with elections, further research is needed before we can be sure it is having the desired effect.

Dr Daniel Glaser is director of Science Gallery at King’s College London