Why not implement no-fault compensation? Because it needs a longer term perspective and a PR system to get it through.

Frances Gibb reports in The Times 23rd June 2017: Medical negligence payouts ‘unaffordable’

Reforms to curb the soaring costs of medical negligence, which could see taxpayers paying out £2.6 billion a year by 2022, must go ahead, a report has urged.
The NHS spent £1.5 billion on clinical negligence claims last year, enough to train more than 6,500 doctors, the Medical Protection Society said. The not-for-profit organisation , which supports 300,000 healthcare professionals worldwide, is calling for a package of legal reforms that would strike a balance between compensation that is reasonable but also affordable.
Its proposals include a cap on future care costs which would be paid on a tariff to be agreed by an expert working party. It also wants to use national average weekly earnings to calculate damages awarded, to avoid unfairness between high and low-income earners.

and the comments are good as well. In Wales the amount set aside for future litigation/compensation is more than one year’s budget. Why not implement no-fault compensation scheme? Because it needs a longer term perspective and a PR system to get it through. Apologies would then be like confetti..

Image result for confetti cartoonand that’s not to mention apologies from our masters re both contract and staffing levels:

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Scotland (and I hope Wales will follow) has announced legislation to protect doctors if and when they apologise. Doctors in Scotland get legal protection when apologising, explains MDU

Doctors in Scotland are being given legal protection when apologising to patients, the Medical Defence Union (MDU), explained today.

The Apologies (Scotland) Act 2016, the relevant part of which comes into force on 19 June 2017, makes it clear that an apology (outside of legal proceedings) is not an admission of liability. In the new Act, an apology is defined as:

‘…any statement made by or on behalf of a person which indicates that the person is sorry about, or regrets, an act, omission or outcome and includes any part of the statement which contains an undertaking to look at the circumstances giving rise to the act, omission or outcome with a view to preventing a recurrence.’

Mr Jerard Ross, MDU medico-legal adviser, said:

‘Saying sorry to a patient when something has gone wrong is the right thing to do and is an ethical duty for doctors. The Apologies (Scotland) Act provides further reassurance to doctors that apologising is not an admission of legal liability. In the MDU’s experience, a sincere and frank apology and explanation can help restore a patient’s confidence in their doctor following an error and help to rebuild trust. This is important for a patient’s future healthcare and can help to avoid a complaint or litigation.’

Doctors have a professional duty of candour, set out in the General Medical Council’s Good medical practice which states: ‘You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress you should put matters right (if that is possible), offer an apology, explaining fully and promptly what has happened and the likely short-term and long-term effects.’

A legal duty of candour was also introduced for health and social care providers in Scotland under The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 although it has yet to be brought into force by enabling legislation. It will mean that doctors and other health and social care staff in Scotland will have to inform patients and their families when a patient has, in the reasonable opinion of an uninvolved registered health professional, died or been unintentionally or unexpectedly mentally or physically harmed as a result of their care or treatment.

Although the Apologies Act does not apply to the legal duty of candour, the Health Act itself makes it clear that ‘an apology or other step taken in accordance with the Duty of Candour…does not of itself amount to admission of negligence or breach of a statutory duty’.

The GMC has published ethical guidance on the professional duty of candour which explains in more detail what constitutes an effective apology for healthcare professionals. This includes advice that apologies should not be formulaic and that the most appropriate team member, usually the lead clinician, should consider offering a personalised apology, rather than a general expression of regret.

In Wales the amount set aside for future litigation/compensation is more than one year’s budget.

David Williamson for Walesonline 30th Dec 2016 : More than £600m allocated to pay for clinical negligence and personal injury claims against the Welsh NHS in the future

In the last financial year £74.6m was paid out and £682m has been set aside for future payments

NHS faces ‘compensation time bomb’ as clinical negligence …  GP online25 Jul 2016

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BBC News28 Nov 2016


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Leimyoscarcoma treatment options unfair…. in west Wales where choice is anathema.

I do not mind if something/some service is denied to everyone in the UK paying into the same mutual. What I do not like to hear is when someone in my town and post code is denied a treatment which is available in London. The National Sarcoma centre is at the Marsden, and there is a National Sarcoma Service. Unfortunately, unbeknown to the citizens and taxpayers of Pembrokeshire, until they suffer from sarcoma, is that this service is not available to them. This is what NHSreality calls COVERT rationing because one is not aware of it in advance. Net result is that money is raised, and this one patient gets “private” care. What about all the others in Wales? Local exclusion would be all very well for high volume low cost treatments, (this is not allowed) but is patently unjust for low volume high cost treatments. (allowed under the current “rules of the game”) Will the trust respond by saying they feel this is reasonable rationing? No way. They will use the words exclusion, restriction or prioritisation to justify their position. As a trust in special measures ( bankrupt and getting worse) it is not surprising they wish to save money… and the treatment may be poor value for money but this shows how unfair the situation is for those in West Wales, and it is repeated across many specialities and treatments.

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BBC News reports today 23rd June 2017: Haverfordwest mum’s ‘roadblocks’ to SIRT cancer treatment

NHS Wales has been accused of “not being set up to deal with” certain types of cancer.

Anca Falconer, 36, from Pembrokeshire, was diagnosed with Leiomyosarcoma (LMS), a type of soft tissue sarcoma, just days after giving birth in 2010.

Her request for specialist treatment in England was refused.

The Welsh Health Specialised Services Committee said the success of Selective Internal Radiation Therapy (SIRT) “has not currently been established.”

Mrs Falconer, who lives in Haverfordwest, initially underwent extensive surgery and chemotherapy for her rare liver cancer, but it returned.

Her first request to the committee was rejected in 2013 on funding grounds, and her cancer consultant refused to submit another application, describing the efforts as being “futile”, and she was told she would have to find the money herself.

Fundraising efforts allowed her to receive the first round of SIRT, which involves injecting radioactive microbeads into the liver, at a cost of £10,000.

Mrs Falconer, who had been bedbound for about three months, said she felt transformed after the treatment.

“Within days I was able to stand up again. I can play with Mary and take her to school,” she said. “I had lost hope before.”

The second round of treatment costs £20,000 and is due by late August.

Mrs Falconer’s husband, Richard, 51, said NHS Wales was “not set up to deal with soft tissue sarcomas” with many of the specialist centres in England.

He added that he thought experts in Wales had “given up on his wife” four years ago and that she had received “nothing more than palliative care” and “roadblocks to all curative options that should have been on the table”.

Dr Sian Lewis, medical director for the Welsh Health Specialised Services Committee, said the “clinical effectiveness” of SIRT for the treatment of liver cancer “has not currently been established”.

She said it is only available to a limited number of patients in NHS England as part of a programme to assess its effectiveness.

The Welsh Government said NHS Wales will make a decision regarding the routine commissioning of SIRT when the results of the evaluation become available next year.

False hopes

Abertawe Bro Morgannwg University Health Board, which provided chemotherapy to Mrs Falconer, said if previous funding requests have been declined by the committee any subsequent submission has to contain “new clinical evidence”.

A statement from the health board said, while it could not comment on Mrs Falconer’s case, its “clinicians fully appreciate the distressing situation its patients are in”.

“It’s because of this they would never consider falsely getting a patient’s hopes up by resubmitting an already declined request when there is no new clinical evidence available.”

Hywel Dda University Health Board has also been asked to comment.

September 2016 – Mark Smith for Walesonline: Three Welsh health boards have been placed under additional Welsh Government scrutiny

Cardiff and Vale, ABMU and Hywel Dda are just one level short of ‘special measures’

Adrian O’Dowd in the BMJ 15th June 2017: Trusts boost ratings by engaging staff and including clinicians in management

Adrian Dowd in the BMJ 23rd June 2017 : The only way is up: the “special measures” trust that got back on its feet

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Mums, you have a 1:200 risk of stillbirth – what can you do about it?

Sorting out the figures from the office of National Statistics is not easy. Comparisons between the 4 different jurisdictions are not obvious. Different countries produce figures in different years and the speciality is changing rapidly. Concentration of specialist services has been shown to work, provided transport links are good. Even remote areas of Canada and Australia can have good figures given the right infrastructure. The latest (2013) BBC report from Wales indicates there is a lot to be done in our poorest region. (Stillbirth rate ‘unacceptably high’ in Wales say AMs) The rates for the different Welsh regions are summarised and available in real time, and show that Cardiff and Vale trust is worse than Hywel Dda. 15 babies a year die daily (The SANDS charity) in the UK. It is time to address this, and locally led midwifery units at a distance from specialist centres may not help. Deprivation and smoking go together…

So what can you do about it? Mums can stop smoking, stop alcohol, stop drugs, reduce weight if obese, eat a better diet, keep active and fit, go to antenatal classes, and meet other mums for support. Moving to a richer area would not affect an individual’s risk, but if moving meant the specialist services for a high risk pregnancy were closer this might be well worth considering… The governments job is to treat populations and the illiberal success of the anti-smoking lobby is a major gain. Going privately may increase your chances of intervention (perverse incentives) and figures for private outcomes are not available from the UK. Australian results suggest worse outcomes.. Its an option not only to make the baby on holiday, but to have it away from home..

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There is good news in the latest statistics, but the BBC announced yesterday that there was only one country worse in the EU and that was Malta. There is much to be done.. The Times leader on Stillbirths – by Janet Scott of SANDS.

Chris Smyth reports in the Times 21st June 2017: Better care during birth could have prevented hundreds of baby deaths

Three quarters of babies who die or are brain damaged during birth could have been saved with better care, a study has concluded.
Hundreds die each year because mistakes are repeated and hospitals must improve heart-rate monitoring and staff communication, the report by the Royal College of Obstetricians and Gynaecologists said…. almost one in 200 babies is born dead…

and on June 22nd: Stillbirth rates decline for the first time in a decade

Stillbirth rates have started to fall for the first time in a decade, according to figures that underline the importance of pressing hospitals to take action.

In 2015 about 250 babies survived who would have died two years earlier, figures that recorded an 8 per cent drop in stillbirth rates suggest. Experts said that the fall would have to speed up to meet a target to halve stillbirths by 2030.

There are also still big variations, with death rates a third higher in the worst-performing areas than in the best-performing.

The Royal College of Obstetricians and Gynaecologists (RCOG) said yesterday that three quarters of babies who died or were brain damaged at birth could have been saved had they received better care.

It was the latest in a series of reports and safety initiatives underscoring repeated errors in maternity units that have appeared since The Times highlighted complacency in the NHS over stillbirths in 2012. The latest figures suggest that such messages are starting to filter through, with stillbirth rates falling from 4.2 per 1,000 births in 2013 to 3.87 in 2015, according to the most authoritative academic study…

…Overall in the UK the number of stillbirths fell to 3,032 in 2015 from 3,252 the year before, but deaths before and soon after birth still vary around the country, from 5 to 6.5 per 1,000…. Disappointingly, the findings show only a small reduction in neonatal death rates.”

…Deaths within the first week of life were 1.74 per 1,000 in 2015, compared with 1.84 two years before….

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Infant Mortality and Stillbirth in the UK – Parliament UK (2014) .pdf

Infant death rate ‘lowest ever’ recorded – BBC News (best in the affluent areas, and some areas saw worse results).

It does  not help when a charity (Kicks Count) is reported in the South Wales Argus 20th June:  Baby heartbeat detectors should be banned, says pregnancy charity when they really mean for unqualified patients.

In Scotland the Herald on 15th June reported the main reason for improvement: Smoking rate in UK second lowest in Europe after 25 per cent fall …

The long term results of rationing midwives and doctors in training…

“Reducing the ratio (of maternity staff in Surrey) to balance the books is the worst of all decisions.”

Stillbirths in all different UK systems are still too high

50,000 short – not £millions but staff…. 

and now we need more despite Brexit: (Chris Smyth June 22nd – NHS in talks to recruit Indian nurses to deal with staff crisis).

Michael Safi in the Guardian 2014: Babies born in private hospitals ‘more likely’ to have health problems – The Study, which looked at 700,000 ‘low-risk’ births in NSW, suggests higher rates of medical intervention could be the cause

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The Times leader on Stillbirths – by Janet Scott of SANDS.




Read all about it: media coverage of NHS rationing. John Major: The NHS is about as safe with Tory Brexiteers as a hamster is with a phython..

Anna Charles of the The Kings fund policy research unit has published a paper on 16th February 2017: Read all about it: media coverage of NHS rationing

NHSreality has been trying to tell citizens that covert rationing is going to get worse, standards are going to fall, and since Brexit there will be national staff shortages. Many Health Services are delivered by private contract, or by charities. Budget cuts mean these suffer more than the “core” of long term health employees…. The Civil Unrest in London as a result of the poor fire safety rules for high rises will be nothing compared to the unrest as the average citizen realises their safety net has been holed – by neglect and denial.

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Tom Bulger on 20th June in the Liverpool Echo reports: Health boss slams Tory cuts as more than 20 city charities lose NHS cash

The Northampton Telegraph reports 21st June: Corby survey finds majority of people are unaware of planned NHS changes


Michael Buchanon for BBC News reports today: Ninth avoidable baby death at NHS trust

and BBC News reports (presumably with Michaels help): Reducing baby deaths and brain injuries during childbirth – shamed by an infant death rate which in Europe is only better than Malta, and worse than all other countries in Europe.

Katie Forster in the Independent 21st June reports: NHS leak reveals ‘shocking restrictions’ on care in London hospitals as part of secret cuts programme

Secret cost-cutting plans described as a “death knell” for the NHS will result in longer waiting times, rationing of care, job losses and ward closures at hospitals in London, a new leak has revealed.

Details of the proposals, part of a national savings drive designed to cap NHS spending, have been called “shocking restrictions on care quality and access for patients” by politicians.

North Central London is one of 14 regions across the country in which senior NHS managers have been told to make “difficult choices” to curb overspending.

A document leaked to The Guardian sets out how care at 10 hospital trusts in Camden, Islington, Haringey, Barnet and Enfield – including the Royal Free and Great Ormond Street children’s hospital – could be cut back.

These include job losses to reduce “admin costs”, increasing waiting times past the current 18-week limit, and the closure or downgrading of services, likely to put smaller hospitals such as North Middlesex Hospital in Enfield at risk, reported the newspaper.

The document is said to outline plans to plug a £183.1 deficit at the London trusts – singled out by health bodies NHS England and NHS Improvement as one of the most severe in the country.

But Jonathan Ashworth, Labour’s shadow health secretary, said the proposals, known as the “capped expenditure process”, would result in “a postcode lottery where healthcare varies depending on where you live”.

He said Theresa May’s “weak and unstable” Government has “huge questions to answer about this new NHS ‘capped expenditure process’”, which is “in reality a Tory NHS ‘hit-list’ drawn up in secrecy during the election campaign.”.

“It’s an absolute scandal that, whilst Parliament and the public were concentrating on the election campaign, this was being rushed through in secret, ready for immediate approval by ministers in the expectation of a Tory victory at the general election,” said Mr Ashworth.
“Now we learn detailed proposals for North London involve shocking restrictions on care quality and access for patients.”
Other ideas under consideration as part of the programme, which aims to ensure NHS spending meets budget targets for this year, include limiting the number of operations carried out by non-NHS providers to make sure funding stays within the health service, which could limit patients’ choice of providers.

NHS funding could also be withdrawn for new and recently-approved treatments and those considered “low value” – adding to the list of prescription items such as cough medicine and gluten-free food that patients were made to pay for earlier this year.

Doctors said the “sweeping cuts” would result in patients being denied treatment and increasing wait times that are already unacceptable. This is “far from safe and will only lead to poorer care in the future,” said Dr Mark Porter, Council Chair of the British Medical Association (BMA).

“The government must step up and finally act in the best interests of the NHS and its patients, rather than continuing to starve the health service of resource and patients of care,“ he said.

Louise Irvine, a GP who stood against Jeremy Hunt in his South West Surrey constituency at the general election, coming second with 20 per cent of the vote, previously told The Independent the “truly shocking” scale of the proposed cuts and closures represent a “death knell” for the founding values of the NHS.

Campaign group Keep Our NHS Public said there were “no surprises” in the revelations, but “plenty of horrors”.

“Their twisted plans – hatched largely in secret – are set to hurt people all over London, Jeremy Corbyn’s constituents included. How long are people going to put up with this double dose of secrecy and cuts? Is this what they voted for?”

The North and Central London consortium of NHS bodies said: “Health organisations across North London are working with NHS England and NHS Improvement to ensure we deliver safe and effective patient care within budget. This process is underway but has not reached any conclusions to date.”

John Major: The NHS is about as safe with Tory Brexiteers as a hamster is with a phython

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There is no nothing National about abortions if you live in N Ireland..

The Times’ Law reports 19th June:  Court rejects appeal over free NHS abortions in Northern Ireland. 

This case will be decided in the European Court of Human Rights and if the word National is to apply at all the women of N Ireland will win out. If we have left the EU and the decision is taken away from this court by Brexit, we are shamed. The judges may have been divided here in the UK but NHSreality expects a clear decision from Europe.

The Supreme Court has rejected an appeal for women from Northern Ireland to have abortions paid for by the NHS.

The Supreme Court has rejected an appeal for women from Northern Ireland to have abortions paid for by the NHS.
The justices announced the decision by a vote of three to two in London today.
At the centre of the case are a woman and her mother, who cannot be named for legal reasons, who travelled from Northern Ireland to Manchester only to be told that she would have to pay hundreds of pounds because she was excluded from free abortion services.
They lost their original action in the High Court in London in May 2014, when the judge concluded that the health secretary was entitled to adopt a residence-based system, and lost an appeal in 2015.

Announcing the Supreme Court’s decision, Lord Wilson said that the judges had been “sharply divided” about the outcome.

The majority concluded that the health secretary was entitled to reach the decision he did.
He said that it was not for the court to “address the ethical considerations which underlie the difference” in the law regarding abortion in Northern Ireland and England.
Lord Wilson added: “But the fact is that the law in Northern Ireland puts most women in unwanted pregnancy there in a deeply unenviable position.”
Lawyers for the mother and daughter said that women and girls from Northern Ireland were being treated as “second-class citizens”.
The women, referred to as A and B, said in a statement after the hearing: “We are really encouraged that two of the judges found in our favour and all of the judges were sympathetic to A’s situation.
“We have come this far and fought hard because the issues are so important for women in Northern Ireland. For this reason, we will do all that we can to take the fight further. We have instructed our legal team to file an application with the European Court of Human Rights in Strasbourg, to protect the human rights of the many other women who make the lonely journey to England every week because they are denied access to basic healthcare services in their own country.”
Angela Jackman, a partner at the law firm Simpson Millar, who has represented the two women, said: “All five of the judges concluded that my clients were discriminated against (on the basis of their status as UK citizens, present in England and usually resident in Northern Ireland). Whilst a slim majority decided the discrimination was justified, I am heartened that Lady Hale and Lord Kerr, the two most senior judges on the case, gave strong dissenting judgments and would have allowed the appeal in full.
“This provides A and B with a firm basis for taking their case forward to the European Court of Human Rights.”

May 23rd: People ‘should have their say on abortion’

May 14th: Abortion for health reasons backed by 75% 

April 24th : Detractors proved wrong with mix of calm and fury Ellen Coyne

Nobody predicted this. When the citizens’ assembly was announced to widespread disdain from both the pro-choice and the anti-abortion campaign groups last year, the notion that it would recommend full legal access to abortion in Ireland was beyond comprehension for those on both sides.

May 24th: Politicians are out of touch with the public on abortion

Support for abortion has become a mark of orthodoxy among the political elite. But politicians, especially in Scotland, are seriously out of touch with the general public on this matter, as a new opinion poll has revealed this week. With abortion devolved to the Scottish parliament since last year, MSPs now have power to address this issue.

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The second eleven – The British political class is not up to the job

In the Economist June 10th, and talking about Brussels and Brexit negotiations, the writer Bagehot argues that career politicians do not have the experience for the job. This also applies to the Health Services in the UK. The dishonest language, denial, lack of leadership and low quality debate that threaten the health services apply to Europe. The lies on the bus… The politicians push commissioning onto GPs, rationing onto NICE, and try to pretend that they provide “Everything for everyone for ever“, but without ever saying what cannot be provided.

The second eleven – The British political class is not up to the job

IT HAS been impossible to watch the general election without being haunted by a single question-cum-exclamation: surely Britain can do better than this? The best performer in the campaign, Jeremy Corbyn, the Labour leader, is a 68-year-old crypto-communist who has never run anything except his own mouth. Theresa May, the Tory leader, tried to make the election all about herself and then demonstrated that there wasn’t much of a self to make it about. As for Tim Farron, the Liberal Democrats’ leader, he looked more like a schoolboy playing the part of a politician in an end-of-term play than a potential prime minister.

Complaining about the quality of your leaders is an ancient tradition: Gladstone’s older contemporaries no doubt moaned that he wasn’t a patch on Pitt the Elder. George Osborne, a former Tory chancellor, has had an enjoyable election skewering Mrs May from the editor’s chair at the Evening Standard, a London newspaper. But only four years ago that same organ was skewering Mr Osborne for his “omnishambles” Budget. And Britain’s leadership problems pale compared with those of America, where Donald Trump crashes from one disaster to another.

Yet sometimes decline really is decline. Both Mrs May and Mr Corbyn want to extend the already considerable powers of the government, Mr Corbyn massively so. And both promise to lead Britain out of the European Union, a fiendishly complicated operation. Unfortunately, both candidates have demonstrated that they are the flawed captains of flawed teams. Mrs May broke the first rule of politics: don’t kick your most faithful voters in the teeth for no reason. Mr Corbyn has stood out in part because his team is so mediocre. Diane Abbott, his shadow home secretary, stepped down the day before the election citing ill health, after a succession of disastrous interviews.

In 1922 Winston Churchill dubbed Bonar Law’s coalition government the “second eleven” because so many top players, including Lloyd George, refused to serve in it. Today both major parties are fielding their second elevens—Labour because of the rise of the far-left and the Tories because of Brexit. On the left, three-quarters of Labour MPs have concluded that Mr Corbyn is not fit to run their party, either personally or politically, scuppering their chances of a front-bench position. On the right, Brexit has hollowed out the party. Several prominent Remainers (including David Cameron and Mr Osborne) have retired, while several leading Leavers (such as Boris Johnson and Michael Gove) are seriously weakened. The Conservative Party chose Mrs May because she hadn’t expressed any strong opinions about the most important question of her time.

There are also deeper reasons. For most of the 20th century British politics has enjoyed an embarrassment of riches. Britain’s competing elites directed their most gifted offspring towards Parliament. The landed aristocracy sent Churchill and the Cecil clan. The business crowd offered Harold Macmillan and the Chamberlain dynasty. The trade unions put forward Ernest Bevin, Nye Bevan and James Callaghan. And the meritocratic elite sent intellectuals galore—so many, in fact, that the 1964-66 Labour cabinet contained seven people with first-class degrees from Oxbridge. (Mr Corbyn left school with two grade “E”s at A-level.)

There was plenty of dross among the gold, of course: Tory knights of the shires who didn’t care about much except badger culling and Labour trade-unionists who were only there for the beer. But the gold shone brightly. And it was well distributed between the major parties, with the Tories mobilising the forces of property and Labour the workers and intellectuals. Today it is as if Britain’s various elites have all decided, at exactly the same time, to stop sending their best people to Parliament.

It is harder to sell landed aristocrats to the people than it used to be. The trade unions are shadows of their former selves. But there is one big reason. Over the past 30 years politics has become a profession. Yesterday’s tribunes of the people, or at least of the people’s leading interest groups, have been replaced by professionals who make their livelihood out of politics. The trouble is, it turns out that politics is not a very attractive profession.

A sticky wicket

Most people crave two types of rewards: material (money and security) and psychological (esteem and fulfilment). Politicians don’t get much of any of this. They have seen their salaries fall relative to the sort of jobs that their university contemporaries go into, such as banking, consultancy and the law. They endure horrendous workloads: constituencies to nurse, speeches to make and, if they are ministers, huge departments to run. They live with the possibility of having the rug pulled from under their feet by electoral misfortune or personal scandal. And the public treats them with a mixture of suspicion and contempt. The proportion of Britons telling pollsters that they almost never trust the government has risen from one in ten in 1986 to one in three today. The biggest reward for putting up with all this is nebulous: the sense that you are part of the whirl while history is being made.

There are a few things that can be done to slow the decline. One is to give more respect to age and experience in selecting MPs. Parliament is over-stuffed with young former aides. Selection committees need to pay more attention to candidates who have already succeeded in other professions. A second is to broaden the talent pool. Margaret Thatcher used the House of Lords to bring in business people such as David Young. Gordon Brown did the same to try to create an administration of “all the talents”. The devolution of power to the cities may also provide another road to the top. If Britain embraces these and other ideas the electorate might face a more inspiring choice at the next election. But it is too late to do anything about the current mess: whoever wins the election, Britain will go into bat against Brussels with one of the weakest teams it has fielded in decades.

The comments and suggestions of “qualification” to be a politician by MBA are interesting.


Its the “philosophy” sillies – and I am talking to you politicians.

Ron Lilley on NHSmanagers.net and in his e-mail blog to 5000 people rightly points out some of the problems with regard to the disintegrating, formerly National, health services. He points out that a lack of leadership (read “honesty”) leaves us with no idea about how the health service will run next year, let alone in 25 years’ time. Reading his blog he alludes to, but does not mention rationing, making him equally culpable for dishonesty… The workforce is not enough, and is too female biased. Even the spin on Wales recruiting more GP trainees (By bribery) is not reality. We need twice as many in Wales alone to cover the next generation. This can never seem to be said…. and many doctors are working a 3-4 day week but doing well over 40 hours. The reporting is shallow..  How many MPs have Private Medical Insurance (PMI) and why? Its the “philosophy” sillies – and I am talking to you politicians. 

Reasonable rationing is derided, and when reversed because of politics this is celebrated. Laura Donelly in the Telegraph: ‘Monumental’ NHS U-turn

Deserts based rationing is unofficial and facilitated by “privatisation”, especially for the obese.

Despite a “primary care led” Health service, the staffing needs of A&E, so badly planned, trump this as we are in meltdown. In such a situation prevention should rightly be abandoned, and emergency treatment becomes essential. So GPs all need A&E training, (as well as Paeds, Psych, O&G etc….. this is not the case as Deaneries’ decisions are not taken by GPs but Consultants.

Roy Lilley opines: (http://www.nhsmanagers.net/)

The call is for a national debate about the future of healthcare.  The debate, if there is to be one, is as much philosophical as it is practical.

Thus far we have struggled to survive by cutting, patching and repairing.  It is inconceivable we can survive another year of the same.

The way forward is beset with difficult choices as much about how we behave as it is about how the institutions that provide our care, behave.

Setting aside issues of the ‘money’, there are four questions; let’s call them the ‘retains’, that spring to mind.

1.  Will we retain our present willingness to share our risks?

The potential is for middle-class families, presented with options to clunky access to primary care, to elect to pay subscriptions for Apps such as Babylon or Go-Doc and start to undermine the solidarity of the NHS.

The NHS only works because it is ‘our’ NHS, we agree to syndicate the costs and risks of our illnesses, disease, accidents and maternity.

We may be lucky, pay our dues and only have rare occasions to call-in a dividend of care.  On the other hand, disaster may strike and put us on a long and painful road to recovery.

We may not share your pain but we do agree to share the cost.

Employers, frustrated at the thought of losing the skills of key staff to prolonged absence through illness, are already sparking a rejuvenation in the private insured care market, in the hope of circumventing waiting lists, now north of 300,000.

If support is fragmented the NHS fails.

2.  Will we retain power and influence at the centre or are we prepared to give it away in devolution and independence?

How the NHS is organised is important.  We have seen what happens when the NHS is broken up.  The disastrous Lansley reforms gave us a disaggregated, fragmented leadership model and a confusing array of over 200 commissioners; most of them inexperienced, too small to be effective and too costly to run, to be viable.

Devolution may be a seductive alternative to government from Westminister but sharing budgets means sharing risks.  However, we have also seen, from the better CCGs, fragmentation can bring decisions closer to populations.  In the worst, macho CCG management is already set on giving away the NHS, to third parties, to run for ten or even fifteen years.

Do we want to give the NHS away?  How much do we want to break it up?

3.   Will we retain the tendency to ‘accumulate’ healthcare data or will we make a determined effort to ‘use’ personal information for the wider public health.

Do we overcome the reservations we have about sharing data?  The Caldecott conclusions do not bring us closer to solutions for front-line staff trying to work across boundaries.

The extent to which we agree to our data being pooled is the extent to which public health bodies will be able to forecast and plan for a healthier nation.  Thus far, overriding concerns about privacy have slowed progress.

4.  Will we retain our resistance to interference in our lifestyles or will we surrender some choices in the interests of good health and wider societal gains, seeing it as a civic duty.

Perhaps governments have done all the easy stuff with public health; adult literacy, childhood immunisation and clean water.  The future lies in the extent to which governments are prepared to interfere in the lives of ordinary people.

Are we prepared to accept the law interfering in our lifestyle choices?  Banning foods, penalising anti-social life-styles that lead to costs for the NHS.  Refuse treatments to the obese and smokers is one thing but in the interests of equity, do we refuse treatment to a person with a self-inflicted injury sustained in a recreational game of squash.

The four ‘retains’… Public health, data, holding-on or letting-go, sharing our risks.  Perhaps the cornerstones of modern healthcare upon which we either agree and build for the future, or we run the risk of being spectators as, through lack of clarity, vision and determination, we watch it fall apart.

I judge there is an appetite for change if only we knew what it looked like?

How can you paint me a picture of the NHS in 2025 when you can’t sketch what it will look like next year.

Have a good weekend.


 Chris Smyth in the Times 16th June 2017: Young doctors go part-time to avoid long hours

A shortage of family doctors has been exacerbated by millennials’ reluctance to work long hours, the NHS training chief says.
More part-time young doctors means that the NHS now has the equivalent of 10 per cent fewer doctors, said Ian Cumming, chief executive of Health Education England, which supports the delivery of healthcare in England. Ministers have had to downgrade their estimate of the number of full-time equivalent doctors, he said……

Also on the same day: NHS secures deal with pharma for breast cancer drug Kadcyla

Kat Lay reports: GPs reluctant to refer fat men to clubs such as Slimming World

Laura Donelly: ‘Monumental’ NHS U-turn on breast cancer drug…

Neil Roberts for GPonline reports 14th June: Exclusive: Hospitals could need more than 200 GPs to staff NHS A&E plans

Owain Clarke for BBC news 13th June 2017 reports: GP recruitment: More junior doctors choosing Wales

Gender bias. The one sex change on the NHS that nobody has been talking about