Our NHS

A failing hospital has paid at least ten senior managers annual rates of more than £200,000 despite providing unsafe care and suffering from a major shortage of nurses.

An investigation by The Sunday Telegraph can disclose that Medway Foundation trust has hired more than 30 interim managers on six-figure packages over the last few months. The most highly paid are receiving annual rates of up to £540,000 a year.

However, the hospital is about to be branded "inadequate" by regulators – the worst possible rating – while its own reports admit that the trust needs 120 more nurses in order to provide patients with safe care.

The trust was put into special measures last year after an investigation into high death rates found dangerously low staffing levels in Accident & Emergency and in wards caring for the seriously ill.

Since then it has hired an interim chairman on a £200,000 package to work as little as one day a week, and a temporary chief executive on annual rates of £360,000 for a four-day week, as revealed by The Telegraph last week.

This newspaper’s investigation has now revealed that they are just two of dozens of "interim" administrators who have been awarded such packages by the trust, with ten managers receiving pay equivalent to more than £200,000 each a year.

Nurse leaders last night urged the Government to get a grip on the scale of excess in parts of the NHS and said "wildly generous" packages for some administrators were starving frontline services of funds.

Among the highly-paid managers, some of whom are paid via private companies, are a banking specialist who costs the trust more than £45,000 a month, which is equivalent to £540,000 a year.

Robert Griffiths received the package for acting as "treasurer" for the trust, while his assistant James Mitchell, has been paid £25,000 a month.

Both men come from consulting and restructuring firm Red Clover Partnership.

Mr Griffiths’ entry on its website says "his experience, in particular as a restructuring banker, provides him with a unique insight into the different requirements and mindset of all stakeholders in stressed and distressed company negotiations."

It can also be revealed that the trust has now just appointed a temporary finance director Tim Bolot, a barrister and accountant who charged £40,000 a month for previous NHS placements, with funds paid via his company, which specialises in "turnaround programmes".

Interim director of operations Mark Morgan costs the trust around £28,000 a month.

The trust’s chief executive Nigel Beverley, who was hired in February on a £30,000 a month package, left the trust last week, several weeks before his contract as an interim was due to expire, leaving the trust’s medical director to act in the role.

The disclosures come after The Telegraph revealed last week that in February, Christopher Langley, the trust’s chairman, was awarded a package worth £190,000 a year for one or two days’ work a week.

The funds are paid to his private company, and under the deal, he can claim £17,000 in expenses a year, without any proof of how or whether the money was spent – a deal which patients’ groups described as "indefensible".

However, despite the large sums being spent on mangers, latest figures show that the trust is spending almost £1 million a month on agency nurses, while a report to the board says 120 more nurses are needed to provide a "safe establishment."

Figures published earlier this month suggest the worst shortages of nurses and healthcare assistants are occurring at night.

Board papers from this month warn that the trust is currently "being challenged to deliver a clinically safe minimum staffing levels".

Last night nurse leaders said the revelations were an outrageous example of a wider problem in the NHS, with senior managers being given "wildly generous" rewards, while frontline services were desperately overstretched.

Dr Peter Carter, Chief Executive of the Royal College of Nursing urged the Government to "get a grip" on the situation.

He said: "Frontline staff and patients alike will be shocked that interim managers are receiving such wildly generous payments while the trust is in desperate need of more nurses.

"The NHS faces massive financial challenges and what’s been happening at Medway is an outrageous example of a wider problem in the health service."

Katherine Murphy, chief executive of the Patients Association, said: "It’s a disgrace. These are vast sums being spent bringing in all these senior people, yet meanwhile the shortages of staff are risking patient safety and compromising care."

Monitor – which regulates foundation trusts - ordered the appointment of Mr Langley as chairman in February.

It justified his salary by saying the trust "needed the right people in place to make urgent improvements needed for its patients."

A spokesman for Medway Foundation trust said: "Use of interim staff with appropriate skills has been necessary during a period where the trust faces significant challenges. A key priority for the board is to recruit permanent staff for all key roles throughout the organisation."

He said the trust was trying to recruit more nurses, and had held several open days and intended to search abroad for more staff.

A Department of Health spokesman said: "We have been absolutely clear that while executive directors and senior managers, like other staff, deserve to be paid fairly for the important work they undertake, we do not believe in a culture within the NHS where high pay is normal."

• First we let everyone know it's happening. Thousands of us could call people living in the areas where it's being rolled out first, to tell them about Care.data. We could flyer every house, buy local advertising space and do lots of other things.
     
  
• Next, we help people opt out. We could build a website where people can opt out of Care.data easily until NHS England fix the scheme.
  

Urgent: on Friday, MPs will vote on a new law to rein in NHS privatisation. If it passes, it would scrap the worst parts of the Health and Social Care Act - the terrible law which is forcing the steady privatisation and break-up of our health service. [1]

The new law will also keep the NHS out of TTIP - the US-EU trade agreement that threatens to lock privatisation into public services. [2] It’s simple: this new law would be great for our NHS.

Can you sign a petition to your MP asking them to turn up and vote the right way on Friday? MPs aren’t used to being the target of petitions: the last thing they want is hundreds of their constituents banding together. So the bigger this petition is, the more likely your MP is to listen.

Click here to tell your MP to vote to save our NHS on Friday:
https://you.38degrees.org.uk/petitions/vote-to-save-our-nhs-brent-central

Since the Health and Social Care Act passed in 2012, 38 Degrees members have watched in horror as health privatisation has gathered pace. In just one year, over £10bn of NHS funding ended up in the hands of profit-hungry companies. [3] Our health service is under threat. [4]

And now, with the government refusing to keep the NHS out of TTIP, it’s in even more danger. If TTIP goes through, and the NHS stays in the deal, it’ll be open season for private healthcare companies. [5]

It’ll be a hard vote to win. But our NHS is worth fighting for even when the odds are against us. And win or not, politicians need to know that 38 Degrees members haven’t given up or gone away - we’re still here, we still care, and we’ll take every opportunity to get rid of privatisation in our NHS.

So let's send each and every one of our MPs a clear message: we believe in a public NHS that provides decent care for everyone, whenever we need it. We will never sit back while our health service is under threat - and we will take every chance we have to try and save it.

Please click here to sign the petition to your MP now, calling on them to turn up this Friday and vote to save the NHS:
https://you.38degrees.org.uk/petitions/vote-to-save-our-nhs-brent-central



Thanks for being involved,

Susannah, Elizabeth, Rachel, Blanche and the 38 Degrees team


PS: This Friday's vote is on a "Private Members' Bill" - a law proposed by a backbench MP. In this case, it's proposed by a backbench Labour MP called Clive Efford. That means it will be particularly hard to get enough Lib Dem or Conservative MPs to vote for it! But public pressure has persuaded MPs to break ranks with their own party before, so let’s give it a go. Please sign the petition to your MP now:
https://you.38degrees.org.uk/petitions/vote-to-save-our-nhs-brent-central



NOTES
[1] Clive Efford, Labour MP for Eltham, is tabling a Private Member’s Bill for debate in the House of Commons on Friday 21st November. It’s called the National Health Service (Amended Duties and Powers) Bill 2014-15, and it would amend some of the most controversial bits of the Health and Social Care Act 2012.

Every year, a small number of backbench MPs have the opportunity to introduce their own legislation to Parliament. Their attempted laws are called Private Member’s Bills. If Clive Efford’s Private Member’s Bill passes, it would reverse many of the worst changes to our NHS.

Politics.co.uk: Labour backs bill to repeal NHS reforms:
http://www.politics.co.uk/news/2014/06/29/labour-backs-bill-to-repeal-nhs-reforms
You can see the bill’s passage through Parliament here:
http://services.parliament.uk/bills/2014-15/nationalhealthserviceamendeddutiesandpowers.html
[2] International Business Times: TTIP: Labour Vows to Push Bill to Protect NHS from Privatisation:
http://www.ibtimes.co.uk/ttip-labour-vows-push-bill-protect-nhs-privatisation-1473045
[3] NHS for sale?: Private providers reports:
http://www.nhsforsale.info/private-providers/private_providers02.html
NHS for sale?: Contract Alert Report (Apr 2013 -Apr 2014):
http://www.nhsforsale.info/privatisation-list/contract-alert/contract-alert-report-april-april.html
[4] The Telegraph: Care Quality Commission: ‘Four in five NHS hospitals not safe’:
http://www.telegraph.co.uk/health/nhs/11166270/Care-Quality-Commission-Four-in-five-NHS-hospitals-not-safe.html
[5] OurNHS: On TTIP and the NHS, they are trying to bamboozle us: https://www.opendemocracy.net/ournhs/john-hilary/on-ttip-and-nhs-they-are-trying-to-bamboozle-us

Department of Health’s response to The People’s NHS campaign about the Transatlantic Trade and Investment Partnership.

The government believes that the inclusion of health in the TTIP does not threaten the public nature of the NHS, but provides an opportunity for European businesses, including improving access to the US market for the UK’s world-class pharmaceutical and medical devices sectors.

Decisions about the commissioning of NHS care will remain with local GP-led commissioners, who will continue to act solely in the best interests of patients.

The European Commission has explicitly ruled out public services from the scope of any market liberalisation in the TTIP. The agreement will not require participating EU members to open up their national health systems to private providers. Following the most recent round of negotiations, both EU and US negotiators have confirmed this position.

The rules on investment protection for the TTIP will be negotiated carefully to preserve the right of the government to regulate in the public interest, whilst offering international investors access to justice if they feel they have been discriminated against unfairly. This agreement is not new, and the UK has over 90 similar agreements in place.

The European Commission carried out a public consultation on the investor protection provisions earlier this year. The consultation sought stakeholder views on what modern investment provisions should look like in the TTIP.

Breaking news: MPs just voted in favour of the plan to roll back privatisation in the NHS. The law’s through to the next stage in parliament.

241 MPs voted for it and only 18 MPs voted against. It looks like the government told their MPs to boycott the vote. Maybe they realised they couldn't win..?

38 Degrees members brought incredible pressure to bear on today's debate. Big "Save our NHS" petitions were started in every constituency. Hundreds of thousands of messages were sent to MPs by email, Facebook, Twitter and phone. Thousands of us chipped in for full-page newspaper adverts telling MPs we are watching them.

There’s a very long way to go before this plan to kick privatisation out of the NHS becomes a proper law. The government's boycott today was odd and unexpected. Does it mean they've got a trick up their sleeve to block it further down the line?

This week we sent a very powerful message to MPs: our NHS is precious. We're not going to stand by and watch it get privatised or broken up. We want everyone in Britain to have brilliant health care - wherever we live, young or old, rich or poor.

Getting this anti-privatisation, anti-TTIP plan into law remains a long shot. But winning today's vote means we’ve still got a chance. And our NHS is so important - it's worth giving it all we've got.

As Circle Holdings, the first private firm to manage an NHS hospital, looks to leaving its contract, we have a depressing example of how privatisation can go badly wrong.

What a difference (less than) a year makes. In a press release back in February last year, private healthcare company Circle Holdings spun that it had, “transformed services at Hinchingbrooke”. The hospital, it boasted, “is now secure for the future”.

Which would make the news today that it was walking away two years into a 10-year contract to run Hinchingbrooke – the UK’s only privately-run NHS hospital – a shock, were it not for the sheer, abject predictability of it.

The fact that Circle is dumping the contract on financial grounds, citing a lack of funding and pressure on the casualty department, is certainly no surprise to many, not least the National Health Action Party founding member and Save Lewisham Hospital veteran Dr Louise Irvine.

She says: “This is exactly what we warned and predicted would happen and illustrates the folly of private sector involvement in our NHS. When the going gets tough, the private sector gets going - and dumps NHS patients. The privatisation experiment has lamentably failed”.

A further consultant has resigned from the Worcestershire Royal Hospital.

Their reasons for leaving are "continuing uncertainty about the future of Redditch Hospital", according to BBC Midlands Today health correspondent, Michele Paduano.

All five have been offered jobs at Warwick Hospital, the BBC understands.

"I am reliably told that the relationship between management and consultants has completely broken down. They had identified problems in the department and solutions, but weren't listened to," said Paduano.

"I am told that they are very close to their teams and so would not have taken this decision lightly. One said it wasn't because he didn't love his job."

Neil Stote, from the Save the Alex campaign group, said the news was "devastating" and that local people would have grave concerns.

"It shows that something is not right, the failure to retain staff is shocking, something's not right," he said.

"The best outcome for the whole county would be for a [new] trust with a proven track record to take over. To have five consultants leave in one day is a damning verdict of Worcestershire Acute Hospitals Trust".

A spokeswoman from Worcestershire Acute NHS Trust said an urgent transition plan will be put in place and emergency care will continue as normal.

Greater Manchester: The start of something big?

25 February 2015

Greater Manchester is pooling its health and care budgets. Nick Triggle asks whether this could this be a milestone in the drive to join up the two separate systems.

• NHS privatisation: Why the fuss?
  
• Does the (care) cap fit?
  
• The cost of being unhealthy
  
• How hospitals have reached gridlock
  
• Does missing the target matter?
  
• NHS set for a bumpy start to 2015
  
• Is the obsession with NHS targets justified?
  
• Why are hospitals under so much pressure?
  
• Why the care sector is green with envy
  
• NHS strike: A walkout with a difference
  
• Why the NHS is facing a tricky winter
  
• Is there really a crisis among GPs?
  
• Joined-up care: The elephant in the room
  
• The NHS plan: Five things we've learned
  
• Mental health: A start of a long journey?
  
• NHS budget: What we aren't being told
  
• The battle over GP opening
  
• Labour bares its teeth on the NHS
  
• What is the NHS there for?
  
• E-cigarettes: Debate - and confusion - is natural
  
• Failing GPs: A Pandora's Box?
  
• Cancer drugs row: A sign of things to come?
  
• NHS waits: Getting the excuses in early?
  
• The secret to transforming a failing hospital
  
• Failing hospitals: Is the glass half-full or half-empty?
  
• How many nurses short is the NHS?
  
• What can the NHS learn from phones?
  
• Why the NHS must heed the lessons of Savile
  
• GP access: A story that is here to stay
  
• Nursing: Are we facing a trade-off?
  
• Dropping the 'N' in NHS
  
• A&E: Are we asking the right question?
  The NHS and 'cradle to the grave'
  
• Watershed moment for nurse numbers?
  
• Care homes: The known and the unknown
  
• Should we expect more on cancer?
  
• Routine operations: Is a crisis brewing?
  
• So which nation has the best NHS?
  
• Why cigarette packs are the 'silent salesmen'
  
• What's in the new NHS boss's in-tray?
  
• Did the NHS get lucky this winter?
  
• Is water fluoridation the next big thing?
  
• Hospitals feeling the pinch
  
• NHS pay: A Catch-22 situation
  
• A Sliding Doors moment for the NHS?
  
• Care.data: How did it go so wrong?
  
• What is the Francis effect?
  
• Are your medical records in danger?
  
• Are hospitals fiddling the waiting times?
  
• Obesity: Cause for concern?
  
• Will you be lonely this Christmas?
  
• Are we missing a trick on A&E?
  
• 2013: NHS annus horribilis?
  
• Are we being fair to the NHS?
  
• A&E: Straw that broke camel's back
  
• Why cancer costs as much as a mortgage
  
• Let's talk about sex...
  
• Are there enough nurses in the NHS?
  
• The secret is out: not all A&Es are equal
  
• Is it right to pay people to be healthy?
  
• Colchester General: The key questions
  
• What the latest scandal says about the NHS
  
• Will it be a bleak winter for the NHS?
  
• Sifting through the data mountain
  
• Hospices: The forgotten pillar of elderly care?
  
• Elderly care all sorted? Think again...
  
• Are GPs better value than hamsters?
  
• GP opening: A reinvention?
  
• The return of the D-word
  
• Power to the patients
  
• Nurses: The engine of the NHS
  
• A lot to shout about?
  
• Cut crime, boost health
  
• Smoking: Glass half full or empty?
  
• Did Olympics boost health?
  
• Is A&E bailout a drop in ocean?
  
• Yet another NHS review
  
• Healthy life expectancy issues
  
• NHS leadership problem
  
• Five ways NHS is changing
  
• Are more hospitals failing?
  
• Will austerity harm health?
  
• Why are doctors so angry?
  
• Do we need a 24/7 NHS?
  
• The rotten side of the NHS
  
• Is four-hour A&E target key?
  
• Children 'failed on grand scale'
  
• Bad news for healthy lifestyles?
  
• Free leisure services impact
  
• Is the NHS really over-managed?
  
• Is nurse training plan stupid?
  
• Is the NHS really untouchable?
  
• Death rates not exact science
  
• Five ways the NHS is changing
  
• Are the patients the problem?
  
• Mixed reviews for alcohol stance
  
• Reforms row is warning
  
• Ministers walk NHS tightrope
  

This has been the most difficult winter for the NHS for a long time. Wherever you live in the UK, local services have been under strain.

The four-hour target to be seen in A&E has been missed in each nation - and that has had a knock-on effect on other parts of the hospital system.

The BBC has been following how the health service has been doing through its NHS Winter project, which has tracked the performance of each hospital trust since November. Friday marks the last day we will be publishing the detailed breakdown.

The chief executive who resigned as the head of a troubled mental health trust had a new £240,000-a-year job created for her, the BBC has learned.

Katrina Percy faced sustained calls to resign over Southern Health's failure to investigate hundreds of deaths.

The BBC has now discovered her new job did not exist previously and she was the only candidate for it.

Ms Percy faced months of criticism for the way her trust failed to investigate patient deaths.

In June, the trust accepted responsibility for the death of 18-year-old Connor Sparrowhawk, who drowned in a bath at Slade House in Oxford.

Ms Percy resigned last week but went straight into a new role at the trust on the same salary of £240,000 a year, including pension benefits.

Trust Chairman Tim Smart, who has been in his post for four months, said it did not advertise the role but that the work the job entails - giving strategic advice to GPs - "needed to be done", describing Ms Percy as "uniquely qualified".

Dr Maureen Rickman, whose sister died while in Southern Health's care, called the move "completely outrageous".

"She should be axed from Southern Health altogether, end of," she said.

"There shouldn't be a sideways move, that shouldn't be an option at all."

Southern Health said it had addressed the failings highlighted in a series of reports and that patients were now safe.

Mr Smart said: "I can unequivocally look you in the eye and say every member of staff that I have met who works on the front line is putting patient safety and the quality of care first."

The trust is currently being investigated by the Health and Safety Executive over the earlier deaths of patients.

'Very strange'

Mark Aspinall, who resigned as one of the trust's 13 public governors following a critical report by the Care Quality Commission in April, said it seemed "very strange" the new role for Ms Percy had been created.

"The health service is usually very rigorous in terms of recruitment, so the idea that a new role has been created purely to move Katrina sideways seems very surprising.

"The whole board has to look at itself and the policies it has put in place that have led to reports that have slated leadership at the trust, and the failures to investigate the deaths of patients in its care.

"But Katrina should have taken responsibility for this a long time ago."
Former health minister Norman Lamb has already called for Southern Health to reconsider its decision to create the role.

"I don't have a difficulty with someone being well paid for a highly-responsible job, but on the proviso that there is accountability with it and that, if things go wrong, you take responsibility for that and you step down ultimately."

The NHS has come under intense pressure this winter, with record numbers of patients facing long waits in accident and emergency units among other challenges.

We asked some of those who have fallen ill, and the families of others, to share their experiences of winter 2016-17.

• Inside A&E: 'Times are desperate'
  
• 'How the NHS has changed our lives'
  
• Voices from NHS frontline
  
• Video: What happens when a hospital clogs up
  
• Guide: Find out what's for the chop where you live?
  
• Video: Cradle to the grave: What the NHS does for you
  
• Explainer: How each part of the UK compares
  

At least 1,700 patients may have been harmed by a 'colossal' blunder that meant thousands of patient records were left to pile up in a warehouse.

The number at risk is likely to rise as only two thirds of the 700,000 notes found had been checked, officials said.
Cancer test results and child protection notes were among the documents that were missing in England.
The National Audit Office also said there were questions to answer about the handling of the incident.
Its review of the issue looked at the role of the government and the company responsible for the mix-up, which is part-owned by the Department of Health.

The company, NHS Shared Business Services (SBS), was employed in the East Midlands, South West and north-west London to redirect mail for the health service.
It was meant to pass on documents that had either been incorrectly addressed or needed re-routing because the patient had moved to a new GP surgery.
But between 2011 and 2016 a backlog of 709,000 pieces of correspondence piled up in a NHS SBS warehouse.

'Colossal' blunder

The issue came to light in February after the Guardian newspaper reported it.
Now the NAO has reviewed what exactly happened and found:

• The company had become aware of a risk to patients in January 2014, but senior managers had not developed a plan to deal with it or tell the government or NHS England for another two years
  
• A label with "clinical notes" on it had been removed from the room where the files were stored. A manager had apparently said: "You don't want to advertise what's in that room"
  
• In August 2015, a member of staff raised concerns the records were being destroyed
  
• NHS SBS finally told NHS England and Department of Health of the problem in March 2016, but neither Parliament nor the public were told
  
• The episode suggested there had been a conflict of interest between the health secretary's responsibility for the health service as a whole and his department's position as a shareholder in NHS SBS
  
• NHS England said the company had been "obstructive and unhelpful" when it had tried to investigate issue
  

The report by the NAO found the cost of dealing with the incident was likely to be in the region of at least £6.6m.
A spokeswoman for NHS SBS acknowledged there had been "failings".
She added: "We regret this situation and have co-operated fully with the NAO in its investigation."

A Department of Health spokeswoman said it was committed to being transparent over the handling of the issue and was working to make sure this did not happen again.
It said it was given advice not to raise the alarm publicly until it had a better understanding of the problem, concerns about patient safety would always outweigh its role as a shareholder in the company and as yet there had still been no proof of harm to patients.
Individual investigations - overseen by NHS England - are taking place into the 1,788 cases of potential harm identified by GPs who have reviewed the missing notes.
On top of that over 200,000 records have still to be reviewed by GPs in the first place to determine if there was a potential for harm to have happened.
All investigations are expected to be completed by the end of the year.
Dr Richard Vautrey, of the British Medical Association, said the "disastrous" situation should never happen again.
"The handling and transfer of clinical correspondence is a crucial part of how general practice operates, and it's essential that important information reaches GPs as soon as possible so that they can provide the best possible care to their patients."

Liberal Democrat leader Tim Farron described it as "colossal blunder".
And shadow health secretary Jonathan Ashworth said the whole episode was a "scandal" that ministers needed to answer for.
"This is a staggering catalogue of mistakes on this government's watch," he added.

The Observer view on the risk the Tory party poses to the NHS
Observer editorial
The US pharmaceutical industry is desperate to raise the price of its drugs and the hardline Tory right is eager to help it

It is little wonder that the NHS takes centre stage in election campaign after election campaign: it commands an extraordinary level of public support. We are more proud of the NHS than the armed forces or the royal family. Nine in 10 support the founding principles of the NHS: free to all on the basis of need, not ability to pay. And if the NHS is the closest thing the British have to a religion, voters tend to look unfavourably on politicians seen to embody a credible threat to it.

This is why Jeremy Corbyn launched his campaign with a stark warning about the threat of a US trade deal struck by a Conservative government, declaring the NHS is “not for sale ”. The Conservatives promptly hit back; the health secretary, Matt Hancock, called it one of Labour’s “pathetic scare stories ”. Even Donald Trump weighed in, saying: “It’s not for us to have anything to do with your healthcare system… we’re just talking about trade.” It would be politically foolish for any Conservative government to try to unpick the fundamental underpinnings of the NHS; to pave the way for large-scale privatisation, to introduce an insurance-style system or to bring in significant user charges. But Labour is right that the Conservatives pose a more insidious threat, by starving it of the resources it needs, and introducing the means for powerful private-sector suppliers, such as the big pharma companies, to extract more profit at the expense of the taxpayer.

The Conservative record since 2010 speaks for itself. Like every other public service, the NHS has come under severe strain as a result of public spending cuts imposed by Tory chancellors , even as they have doled out generous tax cuts costing billions of pounds a year that have disproportionately benefited more affluent families. This last decade has represented the tightest funding settlement the NHS has received since its founding. Funding has not kept pace with rising demand as a result of an ageing population and advances in medical technology, despite the fact that spending on healthcare is significantly lower than among many of our international competitors.

The verdict of the independent King’s Fund is that the NHS is “clearly under-resourced ”. This is why, winter after winter, the NHS has struggled to meet need. Last winter, it took the unprecedented step of cancelling all non-urgent surgery , against a backdrop of increasing waiting lists, understaffing and bed occupancy rates consistently above the levels that permit safe care . Meanwhile, Conservative ministers have sought to misrepresent the figures: they have consistently claimed that the NHS is getting more money than it actually is .

So the Conservatives have already put the NHS at risk in order to fulfil their objective of cutting back public spending in order to pay for expensive and unnecessary tax cuts. There is no reason to believe they will not do so again. A US trade deal is a cherished objective of the hard Eurosceptic right that now dominates the Conservative party and it poses serious risks to the NHS.

It could open the door to rising NHS drug costs to the tune of billions of pounds a year. The NHS is one of the world’s biggest drugs purchasers and exerts a significant downward pressure on prices. Most pharmaceutical companies take part in a voluntary pricing and access scheme that caps the total price the NHS pays for drugs manufactured under patent. The NHS also has a world-leading system for assessing drugs, not just for safety and effectiveness but value for money. Together, these mechanisms mean pharmaceutical companies wanting to sell to the NHS have to offer their drugs many times cheaper than in the under-regulated American market. The price the NHS pays influences pricing across much of the rest of the world.

The US pharmaceutical industry has thus long had the NHS in its sights and in Trump they have found a sympathetic ear. He has taken aim at “freeloading” foreign countries that regulate drug prices, blaming them for high US prices. The US government’s desire to liberalise access to international drug markets has shaped the trade deals it has struck with other countries and it has stated it is an objective in any trade talks with the UK. As revealed by Channel 4’s Dispatches last week, it has already been the subject of several meetings between US and UK trade negotiators.

The hardline Tory right is desperate for a US trade deal that would align the UK’s regulatory standards more closely to that of the free-market US; it is one of the reasons why it has always wanted to leave the EU. And the US is an economic powerhouse that will expect most of its objectives to be met in such a deal, particularly under an America-first president.

After the economic fallout of a Boris Johnson hard Brexit , the UK would hardly be in a place to make exacting demands. A Johnson government could sign up the UK to measures in an international treaty that would bind the hand of future governments and turn Britain into a true rule-taker from the US. It makes an ultimate irony of the argument advanced by Brexiters that we should leave the EU, an institution over whose laws and rules we have a democratic say, in order to “take back control”.

The ideological right has taken over the Conservative party. It has already shown through its determination to pursue a hard Brexit that it will sacrifice the country’s economic wellbeing in order to get the version of the future it wants. Think it will exclude the NHS? Think again. The old adage has perhaps never been more right. You can’t trust the Tories with the NHS .

Dear Reader
In this edition we learn that arguing that claimants ‘need putting down’ is not enough to get you sacked as a Tory candidate.
We also have a frank admission from the Tribunals Service that they can’t cope with the number of PIP appeals they have to deal with.
There’s the welcome news that the benefits freeze is going to end next year.
And more welcome news that the DWP has not got away with a cynically misleading ad campaign.
We have another PIP training day coming up in the new year.
And, finally, we ask you how important benefits policies are in swaying your vote at the general election.
 
CLAIMANTS “NEED PUTTING DOWN” CANDIDATE STILL STANDING
Every day seems to bring news of another prospective MP who has been forced to stand down because of some appalling comments unearthed in their social media history.
And yet, it seems, that saying that benefits claimants “need putting down” and laughing approvingly at the idea of attacking homeless people with a bat is too minor to require a Tory candidate to be replaced.
Francesca O’Brien, who is standing in the Tory target seat of Gower made the comments five years ago on her Facebook page, after watching ‘Benefits Street’.
She has now retracted the remarks, saying “. . . my use of language was unacceptable and I would like to apologise for any upset I have caused”
Most people would probably consider that this went far beyond simply a poor choice of words.
It is the hate-inciting and violent attitude that stood behind those words that would make most people consider O’Brien utterly unfit for public office.
Sadly, the secretary of state for work and pensions, Therese Coffey, doesn’t agree.
She is happy to still endorse O’Brien as a parliamentary candidate, saying that it should be up to the people of the Gower to decide if they want her to be their MP.
We’ll watch the result on the day with great interest.
 
TRIBUNALS SERVICE OVERWHELMED BY PIP APPEALS
A report by the Tribunals Service admits that they can’t keep pace with the number of PIP appeals.
The ‘Senior President of Tribunals’ Annual Report’ admits that “the rapid rise in appeal numbers has outstripped our ability to recruit and train sufficient numbers of panel members to keep pace”.
Appeal numbers plummeted in 2013, from a high of over half a million, after the DWP introduced its cynical mandatory reconsideration hurdle.
However, numbers are on the rise again, more than doubling from 112,000 in 2014 to 238,000 in 2018.
To try to cope, the Tribunals Service appointed 130 new judges, 225 medically qualified members and 125 disability qualified members last year.
They are also trying other methods to reduce the backlog, including cramming more PIP appeals into each session and trying to resolve more cases before they reach a hearing.
But the one thing that would really cut their workload - the DWP getting more decisions right - is unlikely to happen any time soon.
 
BENEFITS FREEZE TO END NEXT YEAR
The five year long benefits freeze will finally end in April 2020, the government has announced.
However, the rise in benefits rates will be just 1.7% next year.
According to a Resolution Foundation report, the freeze has left claimants 6% worse off than they would have been.
The Foundation says that the real value of basic out-of-work support in 2020 will be lower than it was in 1992, adding that:
“Relative to earnings, unemployment support has fallen to a record low of 14 per cent, down from 27 per cent at the emergence of the Beveridge system”
So, over 70 years on, support is half of what it was when the country was just emerging from a devastating war.
 
DWP GUILTY OF PUBLISHING FALSE CLAIMS
It’s absolutely no surprise to learn that the DWP have been misleading tabloid readers about universal credit on a grand scale, at the taxpayers’ expense.
But what is surprising is that the Advertising Standards Authority (ASA) actually upheld complaints about the deliberately deceptive DWP adverts disguised as news.
Regular readers will know that the DWP paid for an extensive ‘myth busting’ campaign in the Metro newspaper and online earlier this year.
The project provoked a backlash from claimants, who organised the removal and destruction of many thousands of copies of the Metro from train and tube stations.
Now the ASA has ruled that the advertising campaign must not be run again.
They decided that:

• DWP claims that people on UC move more quickly into work could not be proved;
  
• the DWP did not make it clear that UC advances are loans that have to be repaid;
  
• the DWP assertion that claimants could simply arrange for UC to be paid to their landlord was not true;
  
• the DWP obscured the fact that the online adverts were written by them and were not independent news.
  

The DWP, rather than apologising, simply says it is ‘disappointed’ with the decision.
 
DISCOUNT ON PIP TRAINING DAY FOR PROFESSIONALS
Following a very well received PIP training day in Nottingham last week, we are now running the same course in Birmingham in February.
There’s a 20% discount for early booking.
Details are further down in this newsletter.
 
WILL BENEFITS POLICIES DECIDE YOUR VOTE?
Finally, we definitely don’t want Brexit wars to break out on the pages of Benefits and Work.
But we would appreciate your comments below the line about how important a part benefits policies are in deciding who will get your vote.
Are plans for benefits the most important issue for you?
Or just one among many issues of equal importance.
Let us know your thoughts. There’s a link to the article in the News section below.
Good Luck,
Steve Donnison

All 118 units fell below the 95% threshold in November as the NHS posted its worst performance since targets were introduced more than a decade ago.
Alongside the growing waits in A&E, the data showed there were record delays finding beds for the sickest patients.
The numbers on waiting lists for routine care also hit an all-time high.

• 11 charts on why the NHS matters in this election
  
• NHS news under wraps until after polling day
  
• What do promises on the NHS really mean?
  

NHS England medical director Prof Stephen Powis said the NHS was facing a "very tough few months".
He said staff were "pulling out all the stops" but added that increasing demand, particularly among patients with complex illnesses, and a shortage of staff were making it difficult.
Nigel Edwards, of the Nuffield Trust think tank, said the figures were "very worrying" as the coldest months were still to come.
He said: "Returning to Downing Street, Boris Johnson has been met by an immediate reminder of the grim winter his government faces in the English NHS."

Worst ever month for A&E

Overall just 81.4% of A&E patients were seen within four hours last month - that is the worst performance since the target was introduced in 2004.
The figures include those seen in major A&E units, as well as minor-injury units and walk-in centres.

Of the 118 major units, not one managed to treat or admit 95% of patients in four hours - the target threshold.
That has never happened before.
However, for most of this year the figures have not included the performance of 14 trusts that are piloting a new way of recording waits. A few of these are among the traditional top performers.
What is more, A&E units reported they were facing increasing problems finding beds for the sickest patients.
Close to 90,000 patients waited more than four hours for a bed to be found in November - nearly double the number from two years ago and the highest on record.
This is after any wait patients have had in A&E.
More than 1,000 patients waited more than 12 hours.

What about the other targets?

The data, released on Friday, also covers waits for cancer treatment and non-emergency treatment such as knee and hip replacements.
It came out a day later than normal, because the UK Statistics Authority ruled no official figures could be released on polling day.



There were 4.45 million people on waiting lists for non-emergency treatment - the most since records began in 2007.

The number waiting more than 18 weeks is also at its worst level since the target was introduced in 2012.

Just 84.7% of patients were waiting less than 18 weeks at the end of October.
.


The target to start treating cancer patients within 62 days of an urgent referral is also being missed.

It is now more than three years since any of the flagship targets were hit.

British Medical Association leader Dr Chaand Nagpaul said the performance was "shambolic".

"Day one of the new government and another set of stark NHS performance figures," he said.

"They are not inheriting a problem, they created this problem and the responsibility ultimately lies with them to fix it."

Miriam Deakin, of NHS Providers, which represents managers, said hospitals were full and there had been an early spike in flu and the vomiting bug norovirus, which had added to the pressures.

"This potent mix coming up against an already overstretched service will mean tough choices over winter."

Dear Reader,

It’s probably an understatement to say that this wasn’t the election result the majority of our readers wanted.

And when we said last week that we would send out a brief post-election update today, we were hoping to have some optimistic news.

But the chance of seeing an end to the roll out of universal credit, the removal of private sector companies from benefits assessments, an increase in ESA for claimants in the work-related activity group and all the other improvements that parties other than the Tories promised, have now been crushed.

The one consolation, if it can even be called that, is that it is very unlikely we will see any sweeping changes to the benefits system in the next few years.

If the Conservative mantra for the election was ‘Get Brexit done’ the DWP’s mantra for the next few years will be ‘Get universal credit done.’

There is likely to be little enthusiasm for taking on new challenges whilst the incredibly delayed and utterly flawed roll out of universal credit continues to lurch towards its distant goal.

Aside from rolling out UC, we will see the continued attempts of the Tribunals Service to move as many appeals as possible online.

And the Conservative manifesto made it clear that the use of the Human Rights Act and judicial reviews to wrest justice from over-powerful government departments will be made more difficult.

This last move comes as no surprise given the role that the courts played in making the last 12 months grim ones for the DWP.

It began with the news that Amber Rudd, remember her, was having to postpone legislation to transfer millions of legacy benefits claimants onto UC and go ahead with a pilot only, such was the concern that the whole thing was going to be a PR disaster for the Conservatives.

This was followed by the announcement that claimants in receipt of the severe disability premium (SDP) would no longer be moved onto UC by natural migration, due to a court defeat for the DWP the preceding summer.

Still in January, there was the revelation that far from cutting the cost of disability benefits by 20 per cent as the DWP intended, PIP had resulted in an increase in costs of 15 to 20 per cent.

In February the DWP had to widen the scope of its project to check whether claimants who were moved from incapacity benefit to ESA were given the wrong award. It now covered 600,000 claimants.

In April, the Royal College of GPs was amongst those demanding the DWP rewrite its misleading fit note advice to claimants because it was endangering patients health. The DWP bowed to pressure and complied.

May saw the start of a fight back against the DWP’s fake news campaign in support of UC.

It would end with the advertising watchdog finding the DWP guilty of publishing misleading adverts.

September witnessed the demise of Amber Rudd after less than a year in office. Her replacement, Therese Coffey, has yet to make her mark. Judging by how long previous ministers have lasted, she will not have long to do so.

Also in September we had the news that the success rate for both PIP and ESA appeals had risen again to an all-time high of 75%.

In October, the DWP revealed that it had so far paid out over £37 million in to claimants who lost out on the severe disability premium (SDP) when they were migrated from legacy benefits such as ESA and UC.

Still in October, the DWP announced that, following another court case it had lost, it would be checking yet more PIP decisions to see if claimants were entitled to additional payments.

November saw Benefits and Work readers crowdfund a legal bid to end the DWP’s cynical practice of forcing claimants to undergo a mandatory reconsideration before they can appeal a decision. The case should be going ahead soon.

And so, into a new year in which we will hope for further victories for claimants before attempts to nobble the judicial system can be put in place.

Whatever the coming months bring, we plan on still being here to support claimants, as we have done for the last 17 years.

Meanwhile, in this brief period of calm, we would like to wish all our readers a Happy Christmas and a peaceful New Year.

We’ll be back on 15 January.

Good luck,

Steve Donnison and The Office Team
Benefits and Work Publishing Ltd
Company registration No. 5962666

Anonymous wrote:I’d suffered recurrent miscarriages and one day it happened at work, I’d only found out I was pregnant the week before.

I wasn’t allowed to go home as we were already short-staffed.

I went to borrow some scrubs as I had bled through my trousers and was “caught” in the changing room and asked if I was a surgeon.

I said I was a medical doctor but was told off for “stealing scrubs”.

I explained what had happened and couldn’t help but get tearful. I was told that was “no excuse”. I worked the rest of my shift in my trousers.

Dr Louis Lewis wrote:I was first on call for medical admissions, the second on call was off sick, the foundation doctor was understandably taking a while with each patient.
There were 18 to see and counting. I had just watched a lady die in resus. I had been going for eight hours without a break. I got some water from the water cooler and drank it.

I got told not to drink in front of the patients as it gives the impression we’re not working hard enough and to wait until my break like everybody else by one of the senior A&E nurses.

I burst into tears. Said nurse didn’t notice. He was walking by at the time. I soldiered on.

Anonymous wrote:The first time I did CPR as a new doctor was one of the most awful experiences I’ve had. The patient was conscious as the compressions were enough to perfuse her brain. I now know this is rare but it was my first resus.

We couldn’t get her back and had to tell her she was dying. She was young and even the my seniors were affected by it.

Our mess was closed so I had nowhere to go. I stepped into the kitchen to splash some water on my face and was berated by a manager for “stealing”.

I was openly crying at this point. She said maybe I wasn’t tough enough to be a doctor and I should rethink my career. I left medicine not long after that.

Dr Natalie Ashburner wrote:It was the first time I had ever spoken to somebody just minutes before they had gone into a cardiac arrest. I was sat crying in the doctors’ office, shocked and upset, when a nurse entered.

She saw me crying and said, “What’s your problem?” She asked me to hurry up and finish the discharge summaries I was doing for other patients on the ward.

I felt ashamed about that incident for a long time afterwards because, in showing my emotion, I felt that I had not behaved in a way expected of a doctor.

SERCO - A company that has ties to the Conservative party but has been fined on a number of occasions was awarded a contract to provide a track and trace system to deal with the pandemic. The Chief executive is the brother of a ex-minister, and a sitting MP is also a lobbyist for the company. Boris Johnson also attended the same Burlington club as the company boss.

Kitkat wrote:How come SERCO seem to be able to get their noses in so many public troughs?
... even though they have been (at best) useless and (at worst) dangerously incompetent?
And how have they been able to get away with scarfing so much tax-payers' money?

SERCO - A company that has ties to the Conservative party but has been fined on a number of occasions was awarded a contract to provide a track and trace system to deal with the pandemic. The Chief executive is the brother of a ex-minister, and a sitting MP is also a lobbyist for the company. Boris Johnson also attended the same Burlington club as the company boss.

'The NHS will last as long as there are folk left with the faith to fight for it'

  The NHS will last as long as there are folk left with the faith to fight for it." (Nye Bevan, 1948)
"We are those folk, come and join us. "(Defend Enfield NHS, 2022)

1. Approve emergency funding of £20 billion to save lives this winter
   
2. Invest in a fully publicly owned NHS and guarantee free healthcare for future generations
   
3. Pay staff properly: without fair pay, staffing shortages will cost lives.
   

There is no better way to sum up the rationale for the existence of DENHS, HCT, Keep Our NHS Public, Doctors for the NHS, Junior Doctors Alliance, NHS Patient Voice, We Own It, and many others than in the words of Nye Bevan, founder of the NHS in July 1948:
“THE NHS WILL LAST AS LONG AS THERE ARE FOLK LEFT WITH THE FAITH TO FIGHT FOR IT”.
 We are those folk - come and join us!

www,facebook.com/denhs

NHS Care to Fall Below Expected Standards This Winter

As a result of 12 years of deliberate weakening of the NHS, the standards of care are to be formally lowered because it's physically impossible for the badly under-resourced medics to cope.
This is not a winter NHS crisis being experienced in other advanced European nations.
This is a crisis borne of a deliberate reduction in the capacity of our NHS.

Whitty letter in full:

'I worry we're killing people - ambulance dispatcher'

:Left Quotes: "The job is crushingly depressing, stressful and embarrassing," the dispatcher says. "I feel so destroyed. The feeling of saving lives has been taken over by how many can we not kill.
"I never thought I'd leave the NHS - but I'd take a job at Aldi. I'd take a job cleaning.
"The thought of going in and having to manage those calls just fills me with absolute dread. I have seen people leave the ambulance service - they have had enough. We are physically and mentally exhausted."
Most frustrating, the dispatcher says, is the number of crews stuck outside hospital waiting to hand patients over to accident-and-emergency staff.

In the last week of 2022, more than 40% of crews in England had waits of more than 30 minutes - it should take 15.
"I know going in that I will have to dispatch ambulance crews to hospitals to take over from other ambulance crews who have been outside for 12 hours," the dispatcher says.
"It just means we don't have those crews available to respond to calls and it exacerbates our shortness of resources by 10-fold, 100-fold.
"So instead of going out on jobs, the first thing they do is go to the hospitals and free the ambulance staff up to go home. Those staff could have been there the whole shift virtually. This happens every shift at virtually every hospital.

"If the crews are with patients in ambulances, then we send one crew to one ambulance to swap. Effectively, if there's seven ambulances outside, then seven new pairs of crews complete with ambulances are swapping over. They then send the 12-hour old crew back to base to go home.
"It is not how things should be - and because we have so many ambulances stuck at hospital, we are putting patients at risk."

The problems are due to a lack of beds, the dispatcher says.
"Social care is not in place," they say. "I'll give you an example - a lady had a fall and was medically fit for discharge on 21 December but because her care package wasn't in place, she was advised that it was safer if she stayed in hospital.
"That's a bed taken up for the entirety of the Christmas and new-year period by someone who is well enough to leave hospital."
The dispatcher is particularly concerned about category-two calls, which include people who have had strokes and heart attacks. Meant to be reached in 18 minutes on average, they are taking nearly three times as long and in some cases, they say, hours.


"We are now telling them how long they have to wait, when there are long waits," the dispatcher says. "We are asking them if there is anyone who can convey them to [hospital], because time is of the essence. Sometimes, they don't have that - and three hours later, they can be dead.
"In one case, there was a man who had chest pains who drove himself to hospital and had a cardiac arrest in the hospital car park and crashed his car.

"This is not the NHS I know and love and is why we have to take action."
In response, the North West Ambulance Service said the service was under "extreme pressure" and some patients were waiting longer "than we would like".
But it added: "Our staff work hard every day to ensure everyone who needs an ambulance gets one - and we continue to perform better than other parts of the country."
The service said it was working with other parts of the NHS to tackle handover delays and recruiting call handlers and clinicians into the call centres, as well as front-line ambulance crews.
Meanwhile, a spokesman for the Department of Health and Social Care said extra money it was investing this winter, totalling £750m, would help speed up delayed discharges, which in turn would ease the handover problems being seen.
"We recognise the pressures the NHS is facing following the impact of the pandemic and are working tireless to ensure people get the care they need," he added.

The NHS crisis - decades in the making

The NHS is in the middle of its worst winter in a generation, with senior doctors warning that hospitals are facing intolerable pressures that are costing lives.

A&E waits and ambulance delays are at their worst levels on record.
The health service was already under pressure - the result of long-standing problems - but Covid, flu and now strike action by staff have all added to the sense of crisis this winter.
So how did the NHS get to this point?

A squeeze on funding

Advances in medicine over recent decades have meant people are living longer.
That is a success story. But it means the NHS, like every health service in the developed world, is having to cope with an ageing population.


That puts a huge strain on the health service. Half of over-65s have two or more health conditions and are responsible for two-thirds of all hospital admissions.

• Record number of ambulances queue at A&E
  

To help the health service cope with this demand as well as pay for the advances in medicine, the NHS budget has traditionally risen by an average of 4% above inflation each year.
But since 2010, the average annual rate of increase has been half that.



Of course, that is when a Conservative-led government came into power, although it is worth bearing in mind Labour were also signed up to this squeeze following the 2008 financial crash.
Labour - despite previous big increases in funding - were promising less for the health service than the Tories in the 2010 election, while in 2015 there was little between the two parties.
The government points to extra funding for the NHS during this parliament and topped up further in the Autumn Statement but a decade of austerity has come at a cost.

Bed numbers have fallen, while staffing shortages have increased.

The squeeze has driven industrial unrest

Currently around one in 10 NHS posts are vacant, leaving the UK with fewer doctors and nurses than many of its Western European counterparts.


he lack of staff puts even more pressure on those in post.
Talk to paramedics, nurses and doctors and one of the most common refrains is that the job is no longer enjoyable because they cannot provide the level of care they want for their patients.
Alongside pay, this is a driving factor for those ambulance staff and nurses who took strike action last month and look set to do so again in the coming weeks.
In fact, they argue the two issues are interlinked. Pay for NHS staff has been cut over the past decade once inflation is taken into account.

Until that is addressed, the government has little chance of plugging the staff gaps, they believe.

Social care is a big factor

The problems being seen also have their origins in when the NHS was created in the aftermath of World War II.
The decision was taken to split health (run by the NHS) and social care for the elderly (run by councils).
More than 70 years on, and despite some move towards integration, this division still persists.
This is despite successive governments since the late 1990s all promising major reform.
It means we have a health system that is free at the point of need, but a care system that is means-tested and has been squeezed even more than the NHS.
The waiting list for care is rising sharply, while this sector too has a staffing crisis with one in 10 posts also vacant.


Successive governments have failed to reform the social care system - Getty Images

They are two very different systems, despite being two sides of the same coin.
Without care to keep them independent, the frail elderly are more likely to end up in hospital and less likely to be able to get out.
Every day more than half of patients who are ready to leave hospital cannot because of a lack of care in the community. Not all of this is down to social care, but much of it is.
This divide is something that does not exist - certainly not to such an acute extent - in many of the social insurance systems across the world that have been developed much more around the needs of the individual.

Pressure from Covid/flu 'twindemic'

Of course, the NHS, like other health systems, has been battered by the pandemic. Waiting lists have grown and staff have been left exhausted from fighting Covid - the latter is another factor that has driven staff to vote for industrial action.
What is more, the tail end of the pandemic has had a sting. Other infections, and in particular flu, have rebounded after the lockdowns suppressed cases and immunity.
The NHS is now in the grip of its worst flu season for a decade - and this has come as the fifth wave of Covid has reared its head.
And while the most recent data suggests hospitalisations for both may have peaked, experts are urging caution because reporting delays over the festive period may have masked what is happening.



There has been another consequence too - the indirect health impacts. This is something England's Chief Medical Officer Prof Sir Chris Whitty warned about at the start of the pandemic and now appears to be taking off.
The lockdown led to people with chronic conditions not always getting the support they needed - patients with heart problems not getting statins and people with respiratory illness not getting their regular checks for example.
This is thought to be one factor behind the rising demand being seen on the emergency care system, as well as the higher-than-expected number of deaths being seen.
A frailer, sicker population is adding to the pressure when the NHS and its staff are least able to respond.

'Use 999 wisely, public told, as call handlers join ambulance strike'

Summary

• The NHS says people should use services "wisely" and only call 999 in a life-threatening emergency as about 20,000 ambulance workers walk out in England and Wales
  
  
• All category one emergency calls will get an ambulance - but the response to category two calls will vary by region
  
  
• Health leaders have warned the impact will likely be worse than the strike before Christmas because call handlers are walking out this time
  
  
• Steve Barclay, the health secretary, says people should use their "common sense" when it comes to what activities they  do today
  
  
• One paramedic in South Yorkshire told the BBC that emergency care has "effectively collapsed" and he has "given up faith" that ministers want to fix the problem
  
  
• The government says above-inflation pay rises for staff are "unaffordable" and is planning a law to maintain minimum services levels during future strikes
  
  
• But there are signs of compromise - the boss of Unison says it would seriously consider any kind of offer on pay
  

‘I’m not striking but I fully support those who do’

Analysis: How did we get here?

'We couldn't get an ambulance for my husband then he died'

Ambulance bosses have apologised to the family of a man who died after he had a heart attack but no ambulance came.

Martin Clark, 68, started suffering with chest pains at his home in East Sussex on 18 November - before any strike action started in the NHS.
His family rang three times for an ambulance and after waiting 45 minutes drove him in their car to hospital.
When they arrived, the father-of-five went into cardiac arrest and, despite receiving medical attention, died.
His wife, Ann, said while waiting for an ambulance he had been crying out in pain and at one point wrote a note saying: "I don't think I'm going to make it. Love you."
It was excruciating, she said, adding: "He was let down very badly. They should have come."

The case has come to light as NHS England has published figures showing a dramatic deterioration in NHS waiting times amid record demand.



They show in December:

• Average waits of more than 90 minutes to reach emergency calls such as heart attacks - five times longer than the target time
  
• Response times for the highest priority calls, such as cardiac arrests,taking close to 11 minutes - four minutes longer than they should
  
• More than a third of patients in A&E waiting longer than four hours
  
• One in seven patients waiting more than 12 hours for a bed on a ward when they need to be admitted
  

"Pressures on the NHS right now are intolerable - with patients paying the price," said Louise Ansari, national director of the Healthwatch England patient group.

• The NHS crisis - decades in the making
  
• I worry we're killing people - ambulance dispatcher
  

'The NHS is broken'

Ms Clark told the BBC's Breakfast programme she constantly wonders what would have happened had an ambulance arrived quickly.
Her husband had had high blood pressure but had been a "fit man".
"He didn't drink. He didn't smoke. He walked every day. That day, he was out there with a chainsaw, cutting the hedge," she said.

"The NHS is broken. Everybody is scared if they get ill where can they turn. Something needs to change - there's going to be so many deaths because of this. It's terrible."

The ambulance calls

• 16:58 - Ms Clark calls 999
  
  
• 17:30 - A second 999 call makes clear Mr Clark's condition has worsened
  
  
• 17:45 - In a third 999 call, the family say they will drive him to hospital themselves, only to be told by the ambulance service: "We don't recommend you do that"
  
  
• 17:55 and 18:01 - The ambulance service ring the home phone back, after the family have left for the hospital, and leave a voicemail saying it has still not identified an ambulance
  

The South East Ambulance Service said: "We are very sorry we were unable to provide a timely response to Mr Clark. Our thoughts are with his family and we will look into this.
"We are working hard to respond to everyone who needs us as quickly as possible while our services remain under significant pressure."

---

The Healthcare Safety Investigations Branch, which investigates incidents in the NHS, has previously warned about the risk to patients from ambulance delays.
One of the key problems is the long delays crews face at accident and emergency units.
The handover of patients should be done within 15 minutes - but in November, a third of handovers took more than 30 minutes.

By the end of the December, this had risen to more than 40%.
Unions say patient safety is one of the key reasons ambulance staff are striking. Wednesday saw the second walkout of the winter by crews in England and Wales.

'Extreme delays can't be new normal'

Dr Sonya Babu-Narayan, of the British Heart Foundation (BHF), said cases such as the Clarks' were "incredibly distressing".
"The difference between life and death can be a matter of minutes when someone is having a heart attack or stroke," she said.
"Extreme delays to emergency heart and stroke care cannot become a new normal.
"Healthcare staff are doing all they can - but there aren't enough of them and many will be working in difficult conditions without fit-for-purpose facilities.
"There are no easy solutions but there is a way out of this crisis - if the NHS gets the significant investment it needs to address the vast backlog of heart care.
"It's also vital that we get prevention back on track to stop heart attacks and strokes from happening in the first place."
The Department of Health and Social Care said it could not comment on individual cases but recognised the pressures the NHS was facing following the pandemic and was "working tirelessly" to ensure people received the care they needed.
This included an extra £750m being invested this winter to free up hospital beds and unlock some of the delays in the emergency-care system.

A&E GP says critical patient faced 20-hour ambulance wait on non-strike day

A GP working in urgent and emergency care in the North East believes patients ‘can no longer reliably access safe health care’ in England

An A&E doctor has compared conditions in the crisis-hit NHS to “the Third World,” with the family of one unconscious patient having to drive them to hospital after being told an ambulance would take 20 hours to reach them on a non-strike day.
Dr Alison George, a GP working in urgent and emergency care in the North East, said “you can no longer reliably access safe health care” in the UK, but insisted the current state of the health service is nothing to do with striking NHS workers.
Dr George’s comments came as 25,000 ambulance workers across England and Wales took part in a second day of industrial action in a dispute over pay.

NHS national medical director, Professor Sir Stephen Powis has described this winter as “one of the most difficult in the history of the NHS”, with flu cases in hospital up by almost half last week and NHS 111 staff answering a near record number of calls.
Dr George told i: “I know of someone who collapsed upstairs at home. The family were forced to carry the unconscious patient down the stairs and drive them to hospital after being told by 999 call handlers they would have to wait more than 20 hours for an ambulance. The patient is still in a critical condition. And that was not a strike day.
“Another patient I know of had chest pain on Friday and didn’t want to tell anybody because she was worried about what would happen if she rang an ambulance or if she tried to go to A&E.
“You can no longer reliably access safe, timely, high-quality healthcare in this country. It’s nothing to do with the strikes, that is on a day-to-day basis, that is normal for this country.
“It reminds me of the Third World. People are crammed into corridors, are out in driveways trying to get some help, taking treacherous journeys.
“Maybe in the Third World it’ll be in a jeep across difficult terrain. Here, it is people taking their own family who are very poorly in cars.”

Ambulance workers strike in Waterloo amid a dispute with the Government over pay (Photo: Toby Melville/Reuters)

While there were “undoubtedly” going to be problems during today’s strike for those calling 999 “the harsh reality” was that “you can’t normally rely on an ambulance to come and get you on a normal non-strike day”, she added.
Another doctor working in Manchester, who did not wish to be named, told i: “Conditions are currently abysmal – a few years ago a trust would move mountains if there was a four-hour breach. We now routinely have patients waiting upwards of 12 hours to get a bed. These can include really quite sick patients – those with sepsis, blood clots and the like.
“Ambulance strikes have historically led to slightly lower demand on the day followed by surges after as people actively avoid or delay seeking help when they know an ambulance won’t come.”
He added: “Burnout is high amongst colleagues. You have to frame the situation as doing the best you can in conditions outside your control, but increasingly it is hard to feel you have done your best.
“I have done placements in A&E but currently do ad hoc shifts every month. These are becoming more and more intolerable given the conditions – it’s hard to justify a stressful day when you know what is coming in advance.”
Wednesday’s strike has seen Unison call handlers join GMB call handlers and paramedics on the picket line, with NHS leaders fearing Wednesday’s industrial action may be more damaging for the public than the previous walkout on 21 December.
Dr George said that, even before the ambulance workers’ strikes, people were facing challenges in their attempts to access healthcare.
“I think that lots of people are feeling nervous about approaching, or even trying to find out what the best thing is to do in certain situations,” she said.
“I see quite a lot of people who’ve tried the normal route to get healthcare and not been successful. And that’s not criticism of GPs, it’s just the system is overloaded.
“People who have had to call 111, but then had to wait for a very long time. I dread to think what’s happening at 111 today.”
Patients have been advised by the NHS to not call 999 during Wednesday’s strike unless they were facing a “life-threatening emergency”, with Health Secretary Steve Barclay urging people to use “common sense” when taking part in activities during the strike.

But people having a heart attack or a stroke may be unable to detect their symptoms which sometimes don’t fit the textbook pattern, said Dr George, raising the risk of an “extra surge” in A&E patients on Thursday as people refrain from calling 999 during the strike.
“Heart attack, strokes, sepsis, all of those things – the more hours you wait the less likely you are to get the right treatment, which will mean that you are either cured or you have a really good outcome,” she added.
“It’s a really desperate situation, the word crisis is absolutely right. I qualified in 1990. This is going into my 33rd year of working as a doctor. I have never in my life seen anything like this. It really is grim.”
 A Department of Health and Social Care spokesperson said: “We recognise the pressures the NHS is facing following the impact of the pandemic and are working tirelessly to ensure people get the care they need – we recently announced up to £250m of additional funding to provide immediate support to reduce hospital bed occupancy, alleviate pressures on A&E and unlock much-needed ambulance handovers.
“This is on top of the £500m Discharge Fund to speed up the safe discharge of patients who are medically fit to leave hospital, create the equivalent of 7,000 more beds and establish 24/7 data driven system control centres in every local area to manage demand and capacity.
“We have also made significant investment into the ambulance workforce with the number of NHS ambulance staff and support staff increasing by 41.5 per cent since October 2010 and we are boosting the number of 999 and 111 call handlers this winter.”