If we go on like this the housing debt will be as nothing to the health debt in 10 years time.

Many of us start our lives with debt, usually on property, but this declines as we grow older. If we go on like we are in Health, the housing debt will be as nothing to the 4 UK Health Services debt in 10 years time.. The chancellor is rightly worried about debt, and the future looks bleak…(UK’s borrowing binge is worrying the Bank of England – Larry Elliott in the Guardian 27th March 2017) £50m for Hywel Dda board equates to approximately £156 per head today, and possibly £10,000 per head in 10 years. Expect more and more de-commissioning / covert rationing.

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Ministers refuse to bail out the Welsh Health Boards (Hywel Dda is the worst) – BBC News 28th March 2017

The boards are forecast to over spend by £146m this year.

In one case – Abertawe Bro Morgannwg University Health Board (ABMU) – the financial outlook is said to be “extremely challenging”.

The health board, which covers Swansea and Bridgend, said it was attempting to cut agency staff costs.

As well as ABMU there are overspends at Betsi Cadwaladr in north Wales, Cardiff and Vale board and Hywel Dda in mid and west Wales.

Betsi Cadwaladr’s deficit is now forecast to be £30m, Hywel Dda £49.9m, ABMU £35m and Cardiff and Vale £31m for the 2016-17 financial year.

The health boards will not face a bill to repay the money, but they will be expected to balance their books in the next financial year.

A spokesman for the Betsi Cadwaladr University Health Board said: “We have worked hard throughout the year, and worked closely with Welsh Government, to address our challenges, and we will continue to do so going forward.”

Stephen Foster, of Hywel Dda University Health Board, said: “This is not the financial situation that we would want to find ourselves in and we are putting together significant plans to turn it around.”

Analysis by BBC Wales political editor Nick Servini

These figures show a dramatic deterioration in the finances of four out of Wales’ seven health boards.

They have also prompted a hard-hitting response from the Welsh Government which, until this point, has been keen to stress how they approach problems together.

The tone resembles the approach of the man in charge of the English NHS, Jeremy Hunt, who has not been afraid of calling out heath trusts he believes are under-performing.

The Welsh Government has called for a significant improvement in the financial performance.

That will be easier said than done in the face of intense pressure on these organisations.

Walesonline and the Western Mail report 27th March 2017: Wales’ Health Secretary refused twice to guarantee that NHS services will not face cuts

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There is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible..

The Guardian has an “anonymous” opinion. I guess those close to the decision making action will know who it is. “The NHS sets leaders up to fail – and then recruits more in the same mould” on 27th March 2017.

NHSreality maintains that there is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible. There are no exit interviews of high turnover Trust Directors, and no feedback to Politicians – probably because they know they don’t want to hear it. Anonymous is one of the many disillusioned …. and a 1p hypothecated tax will change nothing. Lincolnshire will get nowhere with it’s request for suggestions because rationing overtly is excluded… Politicians with only one eye on health (the other in Brexit) will continue to be conned ….

It’s my job to support and develop senior NHS managers. And I’m deeply worried that we’re setting them up to fail – then recruiting more in the same mould.

I’m a former primary care trust director

Most of these leaders were hired to lead foundation trusts at a time when NHS providers were being encouraged to compete with other trusts for business; to invest in new services; to develop their own organisations at the expense of other providers. To make use of the freedoms granted to foundation trusts – including the ability to borrow money at commercial rates – they hired leaders with commercial, transactional and financial skills: hard-edged, competitive businesspeople who could expand their market share.

But then the environment changed. Trusts were – quite rightly – put under greater pressure to improve service quality and patient safety. And demand rose much more quickly than budgets, so the tariffs paid for trust services were cut year after year. Soon, many new services were struggling to repay the investments made in them. In a world of shrinking revenues, those skills in business growth suddenly looked out of place.

Meanwhile, health system leaders began pushing a new agenda – one built around collaboration between organisations, professionals and sectors. To protect healthcare nowadays we need people to work together, rather than to compete: the emphasis is on building services around the patients’ needs, rather than the providers’. The Sustainability and Transformation Plans and the Five Year Forward View create a need for leaders who have emotional intelligence; who are approachable and listen to their staff; who put the public’s needs above those of their trust; who can share power and responsibilities with other organisations. And in that context, the skills and approach of many NHS leaders look hopelessly outdated.

Too often, leaders are remote and isolated. Poor links between ward and board mean that board members often remain unaware of emerging problems. To deliver great care, you need your staff behind you – but we’ve spent years recruiting empire-building business leaders who have no feel for the kind of hands-on, visible leadership required.

; I now work as an executive coach, helping NHS executives to improve their skills. Many of my clients lead trusts whose leadership has been deemed “inadequate” or “requires improvement” by the Care Quality Commission – but few of them are genuinely bad leaders. The problem is that they were hired to do one job, and the requirement is now for something quite different. Yet they’re not being helped to change their approach, and when their trusts run into trouble they are being replaced with people likely to encounter exactly the same set of problems.

We end up with chief executives who find themselves receiving a lot of criticism, and being pushed out – creating huge damage to their careers and reputations. But it’s the system that’s let them down, not them letting down the system. Nobody’s given them the right advice or development or challenge, and the characteristics once seen as assets have become liabilities.

Unfortunately, trusts’ recruitment practices haven’t changed to reflect the need for a new kind of leader – so when these more commercial, transactional managers fail, trusts are too often replacing them with new figures cut from the same cloth. Many trust chairs are still stuck in an empire-building mindset; job descriptions focus on financial and operational experience; and recruiters are often cynical about the softer skills required for staff engagement and partnership working. So the trusts select new managers well-suited to facing the challenges of five years ago, and organisations head off towards a fresh set of failures.

What’s to be done? For a start, trusts need to refresh their recruitment practices – taking their cue from NHS Improvement’s new leadership framework, and shifting away from a narrow focus on technical competences towards a values-based approach. The solution is not simply to swap our existing leaders for a new set. The NHS cannot afford to lose a swath of senior managers. Many of these people could develop the skills we need, we just need to help them to do so. After all, we require doctors and nurses to refresh their skills regularly, revalidating their qualifications; and these days, the disciplines of management and leadership are changing just as fast as medical practice.

It’s hard for senior leaders and managers to reflect, train and change their approach. Most already work 60 hours a week, and seeking new skills is too often seen as a confession of weakness or incompetence. But this is a nettle we must grasp. For many of our senior leaders are ill-suited to the task in hand. If we are to serve the interests of NHS organisations, staff, leaders themselves and, above all, patients, we must reshape our leadership cadre – equipping it to understand and address the vast new financial and organisational challenges facing the NHS.

NHS faces ‘mission impossible’ to meet performance targets and budget savings, new analysis from health think-tank NHS Providers finds

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Record Level of claims Inflation – £1000 each taxpayer per annum: How to solve the indemnity crisis

NHSreality has often opined on the need for “No fault compensation” in the UK health services. Short termism ensures that the politicians take no notice – same as for rationing overtly.

Preeti Shukla for Pulse opines in Pulse 20th march 2017: How to solve the indemnity crisis

Blinded by love for a ‘seven-day NHS’, the Government first needs to tackle the issue of rising indemnity fees.

Here is the scale of crisis we are in. The overall NHS budget for 2015-16 was £116.4 billion. The NHS Litigation Authority (NHSLA) liabilities for current and future liabilities are around £28.6 billion costing £1,030 per English taxpayer.

According to the medical defence organisations (MDOs), inflation rate for clinical negligence claims is running at a record-high of 10%, meaning the size of claims is doubling every seven years. By a large margin, this is higher than inflation rates of any other goods or services in the UK. With very little hope of ceiling, this could make the NHS unsustainable.

The eye watering costs of indemnity premiums making GPs change their work patterns. The results of a survey I undertook, published in Pulse, reveal the gravity of the situation, with one in four OOH GPs reducing shifts because of indemnity costs.

Many believe that the GPs are omnipotent bunch of professionals who can triage, manage long-term conditions, reduce inpatient workload by keeping patients out of hospitals, and thus reduce the spiraling costs of the NHS. However, no consideration is given to how they will accommodate if the GPs can’t work to their wanted capacity because of indemnity. OOH services are worst hit and one in ten areas reported that on several occasions in 2016, they had to close OOH centres or run shifts without a GP as there was none available.

How can we address this issue?

The NHSE 2015-16 winter indemnity scheme added 15,000 extra OOH shifts and the scheme was continued in 2016-17. What NHS England seems to have forgotten is that the system now must cope with a winter that never seems to end. My assumption is that the withdrawal of winter indemnity scheme this coming year will lead to a catastrophic collapse of OOH services. Take for example, £100 million allocated for GP triage in A&E – a more practical and effective use of this money would be by reimbursing GPs for indemnity fee hikes for all OOH shifts. This sort of intervention will encourage more GPs to take the shifts and address the workforce crisis and patient demands simultaneously.

A toxic culture to promote litigation that exists is leading to a higher volume of claims like never seen before. The Personal Injuries Act 1948 advocates calculating compensation on the basis of private rather than NHS care and need to be repealed. This law is outdated now as we have the NHS that provides a world class service, so there is no imminent need for private care. MDOs should be allowed to buy local authority and NHS care packages rather than high cost private care packages.

Our secretary of state keeps talking about a ‘no blame culture’ but we need action, and not just empty words. We need efforts from the Government to protect the NHS and NHS employees from litigation as is done for vaccines in the Vaccine Damage Payment Scheme; and more so because doctors, nurses, hospitals and GP surgeries are all regulated by various regulatory bodies like the GMC, NMC and CQC hence any complaints about issues on performance and delivery are already being thoroughly scrutinised and appropriately addressed. Legislation in Germany and Denmark promotes sanction-free reporting of errors and provides indispensable protection for the healthcare professionals, thus enabling a better learning in safe environment.

This does not mean we reject the policies of compensation for negligence for the affected patients. However, there could be a direct system as it prevails for vaccine damages. Over the last decade, the payout made by the NHS has trebled to more than £1.3 billion a year, out of which more than £299 million constitutes legal fees. However, since 2001 only 3.2% claims had damages proved by the court of law. The rest were settled out of court. Could we have used this money for making our NHS safer and more efficient? Of course it could.

Capping of legal costs for small claims need to be done sooner rather than later. Currently there’s a consultation about a cap on legal costs for all such cases up to £25,000. In some incidents, the cost of legal fees has been significantly more than the compensation pay out, and this is completely ludicrous and unacceptable. A new revised law needs to be implemented urgently.

We need a ‘strong political will’ to bring in these reforms, not ‘sticking plasters’. We all (healthcare workforce, patient groups and the media) need to come together to solve this issue.

Dr Preeti Shukla is a GP in Blackburn and member of the GPC’s sessional GPs subcommittee

Has the penny dropped? No repeal for ‘Obamacare’ _ a humiliating defeat for Trump

Update 27th March 2017: The Republican Waterloo by David Frum of Atlantic opines: Conservatives once warned that Obamacare would produce the Democratic Waterloo. Their inability to accept the principle of universal coverage has, instead, led to their own defeat.

Seven years and three days ago, the House of Representatives grumblingly voted to approve the Senate’s version of the Affordable Care Act. Democrats in the House were displeased by many of the changes introduced by Senate Democrats. But in the interval after Senate passage, the Republicans had gained a 41st seat in the Senate. Any further tinkering with the law could trigger a Republican filibuster. Rather than lose the whole thing, the House swallowed hard and accepted a bill that liberals regarded as a giveaway to insurance companies and other interest groups. The finished law proceeded to President Obama for signature on March 23, 2010.

A few minutes after the House vote, I wrote a short blog post for the website I edited in those days. The site had been founded early in 2009 to argue for a more modern and more moderate form of Republicanism……

…It seemed to me that Obama’s adoption of ideas developed at the Heritage Foundation in the early 1990s—and then enacted into state law in Massachusetts by Governor Mitt Romney—offered the best near-term hope to control the federal health-care spending that would otherwise devour the defense budget and force taxes upward. I suggested that universal coverage was a worthy goal, and one that would hugely relieve the anxieties of working-class and middle-class Americans who had suffered so much in the Great Recession. And I predicted that the Democrats remembered the catastrophe that befell them in 1994 when they promised health-care reform and failed to deliver. They had the votes this time to pass something. They surely would do so—and so the practical question facing Republicans was whether it would not be better to negotiate to shape that “something” in ways that would be less expensive, less regulatory, and less redistributive….

…So, when the Democrats indeed did pass the law without Republican input, just as I’d warned they would, a fury overcame me. Eighteen months of being called a “sellout” will do that to a man, I suppose. I opened my computer and in less than half an hour pounded out the blogpost that would function, more or less, as my suicide note in the organized conservative world.

The post was called “Waterloo.” (The title played off a promise by then-senator and now Heritage Foundation president Jim DeMint that the Affordable Care Act would become Obama’s Waterloo, a career-finishing defeat.)

Even more provocatively to Republicans already fixed on a promise to repeal the Obamacare abomination, I urged: “No illusions please: This bill will not be repealed.”…

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

Mark P Cussen for Investopedia in 2011 reports that over 60% of American bankruptcies are due to health costs…. Insolvency is handled differently in different countries.. In Canada it is usually die to occupational hazards, or financial mismanagement. In Australia and other countries with universal coverage they are rarely due to health costs. The UK health services may be losing us all money, but it does not yet affect individuals’ finances…. We can save our services if we pragmatically accept that there are some things we cannot afford and others that we should pay for individually. It can still be universal but only if standards are high and waiting lists short enough to ensure that even the richer citizens choose to use it. This may mean some form of adverse selection through charges related to means, but these charges need to be less than what it would cost for private care, or cover. The penny may have dropped in the US.

ERICA WERNER and ALAN FRAM from The Washington post, the Hamilton Spectator and all the 50 state newspapers, reported  March: No repeal for ‘Obamacare’ – a humiliating defeat for Trump. This was reported in Florida (where they want it to expand) and Michigan, in Alaska and even Texas, where the threat to repeal was acknowledged as based on a lie.

This is the rejection of the Trump plan to abolish the Affordable Care Act (ACA) (Obamacare). This decision alone, which confirms the value of the votes of 70 million citizens already covered (and rising annually) by the ACA. The republicans were rightly concerned that they would not be elected next time. The value of socialised medicine, the only way to cover a country, and one of the fundamental duties of government, was thus confirmed.

These figures are from several years ago and the trend has continued.

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The weakness of the ACA is due to the influence of big business, pharma and insurance industries. They have asked for the continuation of the current plans. This means that the self-employed without cover, the elderly, the sick and the poor and unemployed remain (see Hawaii News – Big Island Now), and they are exactly the highest risk and demand patients. The moral hazard is too big, and the solution is universal coverage. Big pharma and insurers need to be given due notice – and ignored.

The benefits of a large mutual apply to all insurance. Streets or housing estates would be cheaper for motor than individuals. The same is true of health… and smaller mutual such as Wales and N Ireland should take note.

The wording of the article is below:

WASHINGTON — In a humiliating failure, U.S. President Donald Trump and Republican leaders pulled their bill to repeal “Obamacare” off the House floor Friday when it became clear it would fail badly — after seven years of nonstop railing against the law. Democrats said Americans can “breathe a sigh of relief.” Trump said the current law was imploding “and soon will explode.”

Thwarted by two factions of fellow Republicans, from the centre and far right, House Speaker Paul Ryan said president Barack Obama’s health care law, the Republican Party’s No. 1 target in the new Trump administration, will remain in place “for the foreseeable future.”

It was a stunning defeat for the new president after he had demanded House Republicans delay no longer and vote on the legislation Friday, pass or fail.

His gamble failed. Instead Trump, who campaigned as a master deal-maker and claimed that he alone could fix the nation’s health care system, saw his ultimatum rejected by Republican lawmakers who made clear they answer to their own voters, not to the president.

He “never said repeal and replace it in 64 days,” a dejected but still combative Trump said at the White House, though he repeatedly shouted during the presidential campaign that it was going down on Day 1 of his term.

The bill was withdrawn just minutes before the House vote was to occur, and lawmaker said there were no plans to revisit the issue. Republicans will try to move ahead on other agenda items, including overhauling the tax code, though the failure on the health bill can only make whatever comes next immeasurably harder.

Trump pinned the blame on Democrats.

“With no Democrat support we couldn’t quite get there,” he told reporters in the Oval Office. “We learned about loyalty, we learned a lot about the vote-getting process.”

The Obama law was approved in 2010 with no Republican votes.

Despite reports of backbiting from administration officials toward Ryan, Trump said: “I like Speaker Ryan. … I think Paul really worked hard.”

For his part, Ryan told reporters: “We came really close today but we came up short. … This is a disappointing day for us.” He said the president has “really been fantastic.”

But when asked how Republicans could face voters after their failure to make good on years of promises, Ryan quietly said: “It’s a really good question. I wish I had a better answer for you.”

Last fall, Republicans used the issue to gain and keep control of the White House, Senate and House. During the previous years, they had cast dozens of votes to repeal Obama’s law in full or in part, but when they finally got the chance to pass a repeal version that actually had a chance to become law, they couldn’t deliver.

Democrats could hardly contain their satisfaction.

“Today is a great day for our country, what happened on the floor is a victory for the American people,” said House Minority Leader Nancy Pelosi, who as speaker herself helped Obama pass the Affordable Care Act in the first place. “Let’s just for a moment breathe a sigh of relief for the American people.”

The outcome leaves both Ryan and Trump weakened politically.

For the president, this piles a big early congressional defeat onto the continuing inquiries into his presidential campaign’s Russia connections and his unfounded wiretapping allegations against Obama.

Ryan was not able to corral the House Freedom Caucus, the restive band of conservatives that ousted the previous speaker. Those Republicans wanted the bill to go much further, while some GOP moderates felt it went too far.

Instead of picking up support as Friday wore on, the bill went the other direction, with several key lawmakers coming out in opposition. Rep. Rodney Frelinghuysen of New Jersey, chair of a major committee, Appropriations, said the bill would raise costs unacceptably on his constituents.

The defections raised the possibility that the bill would not only lose on the floor, but lose big.

The GOP bill would have eliminated the Obama statute’s unpopular fines on people who do not obtain coverage and would also have removed the often-generous subsidies for those who purchase insurance.

Republican tax credits would have been based on age, not income like Obama’s, and the tax boosts Obama imposed on higher-earning people and health care companies would have been repealed. The bill would have ended Obama’s Medicaid expansion and trimmed future federal financing for the federal-state program, letting states impose work requirements on some of the 70 million beneficiaries.

The nonpartisan Congressional Budget Office said the Republican bill would have resulted in 24 million additional uninsured people in a decade and lead to higher out-of-pocket medical costs for many lower-income and people just shy of age 65 when they would become eligible for Medicare. The bill would have blocked federal payments for a year to Planned Parenthood.

Republicans had never built a constituency for the legislation, and in the end the nearly uniform opposition from hospitals, doctors, nurses, the AARP, consumer groups and others weighed heavily with many members. On the other side, conservative groups including the Koch outfit argued the legislation did not go far enough in uprooting Obamacare.

Ryan made his announcement to lawmakers at a very brief meeting, he was greeted by a standing ovation in recognition of the support he still enjoys from many lawmakers.

When the gathering broke up, Rep. Greg Walden of Oregon, chair of the Energy and Commerce Committee that helped write the bill, told reporters: “”We gave it our best shot. That’s it. It’s done. D-O-N-E done. This bill is dead.”

The Associated Press

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We need tiered rationing according to means… Drugs costing 8p a day could be  hit by ‘devastating’ NHS rationing plan.. What a good idea. 

Many countries are considering ways to prevent the expensive new patented drugs coming to market quickly. Every year delayed saves money, and the closer to loss of patent the greater the saving. There is a dissonance here. Individuals, their physicians, and of course drug companies, want all the drugs possible, but governments are concerned with populations and their investment should not be in new treatments for rare conditions they cannot afford.. Overt rationing on cost alone would be honest, but would create a health divide amongst individuals: something government has a duty to avoid? We already know that the gini coefficient (wealth inequality) enumerates the wealth divide: do we need another coefficient for the health divide? It is becoming evident that we need tiered rationing according to means.. But the 8p suggestion will never happen because of the politicians. Any one who endorses it will lose their seat..

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John Crowley in the Observer 3rd Jan 2017 reports: The US Has Slowed the Pace of Drug Approval and It’s Costing Lives – Rare Disease Day Offers Great Chance to Revisit Promise of Orphan Drug Act

More than 30,000,000 Americans live with any one of over 7,000 rare and often devastating genetic diseases. This week, in observance of the 10th Anniversary of Rare Disease Day, millions of people around the world will meet with policymakers, hold events and use social media to raise awareness about the impact rare genetic diseases have on people’s live. The slogan for this year’s campaign is “with research, possibilities are limitless.”…..

Laura Donelly in the Telegraph 15th March 2017 reports: Drugs costing 8p a day could be  hit by ‘devastating’ NHS rationing plan  

Drugs costing just eight pence a day could be denied to NHS patients under “devastating” new rationing plans, charities have warned.

Under the plans, health officials will be able to delay introducing life-extending treatments for up to three years, after they have been found to be effective.

The cap is likely to affect one in five new treatments, with cheap drugs which could help large numbers of patients affected, as well as high cost drugs.

Ben Hirschier of Reuters reports 15th March 2015: New UK drug cost rules leave companies fuming

British drugmakers on Wednesday accused Theresa May’s Conservative government of breaking a manifesto commitment to improve access to new medicines, following approval of new cost rules that take effect on April 1.

The angry response from both Big Pharma and biotech firms comes despite a concession by government in the latest version of the scheme, which increases the cost threshold for certain drugs for rare diseases from the previously planned level.

Some charities, including the Alzheimer’s Society, also expressed concern that the measures could mean delays for people with serious conditions in getting new treatments.

The row comes at a sensitive time for the government, which is about to trigger proceedings to leave the European Union but wants to encourage investment by strategic industries, including the high-tech pharmaceuticals sector.

Drug companies are already concerned that Brexit could make Britain a less attractive market, especially if the country ends up outside the current EU-wide system for drug licensing.

The National Institute for Health and Care Excellence (NICE), which determines the cost-effectiveness of new drugs, and NHS England say their new procedures will fast-track the availability of drugs that offer exceptional value.

But drug industry executives believe few, if any, new medicines will actually benefit from this provision and the overall impact of the changes will be outweighed by newly introduced budget curbs.

“Today’s proposals from NICE/NHS England break the Conservative Party’s 2015 manifesto promise to speed up the introduction of cost-effective medicines into the NHS,” said Mike Thompson, CEO of the Association of the British Pharmaceutical Industry.

The new system means that new drugs costing the National Health Service (NHS) more than 20 million pounds ($24 million) a year will no longer be automatically funded, even if they are cost-effective. Instead, companies will have to enter negotiations to justify their use and work out funding.

Alzheimer’s Society CEO Jeremy Hughes said any new drug to help all 850,000 people with dementia in Britain would have to cost just 23.50 pounds a year to fit the threshold.

Similar limitations will apply to drugs for very rare diseases that cost more than 300,000 pounds for each year of high quality life delivered.

Previously, the proposed a cap for rare diseases had been 100,000 pounds but NICE CEO Andrew Dillon said the authorities had revised the plan after listening to feedback.

Even at the higher level, drugmakers argue the introduction of cost caps for medicines treating a handful of patients would be damaging and could threaten the flow of new medicines.

Significantly, the new rules apply only to England, leaving a different system in place for Scotland.

“They will build a Hadrian’s Wall for English patients who will no longer be able to access innovative new treatments that will continue to be available in Scotland,” said Steve Bates, CEO of the BioIndustry Association.

(Reporting by Ben Hirschler; Editing by Ruth Pitchford)

NHSreality wants scapegoats – and suggests the successive ministers of health (for England). Allyson Pollock might agree..

Tell Wales it isn’t working. Inequality is increasing…. better to “aspire to excellence”.

Inequality revisited.


A general practitioner is trying to follow the dentists into private practice – clients will initially be the retired rich, but eventually many more of us.

A general practitioner is trying to follow the dentists into private practice. NHSreality has warned that this was likely, and that when patients demand a choice from their ambulance – (private or public A&E?) that will herald the end of Aneurin Bevan’s dream. The perverse incentives in private care need to be exposed.. but even if we get an honest debate I think rationing by price and access may be acceptable in Bournemouth, but not away from the retired rich, and the tooth fairies… It will be interesting to see if Dorset tries to stop/discipline this Dr… watch this space. If it is allowed it will spread…

Laura Bennett reported in the Sun 14th Feb 2017: WANT TO SEE A DOC? THAT’LL BE £145 – GP warns general practice ‘on brink of collapse’ as he launches private service in NHS surgery – Patients can cough up to see a doc or pay £40 for a phone chat – Dr Tim Alder ( Poole Road Medical Practice – Bournemouth ) has launched a new private service at his NHS surgery so patients can pay to skip the four-week wait for an appointment

AN NHS GP surgery has told patients they can skip waiting lists to see their doctor – if they cough up £145.

The surgery has launched a private service – operated by exactly the same NHS doctors – to run alongside its NHS services.

But patients have to fork out £40 for a 10-minute phone consultation, £80 for a 20 minute face-to-face appointment and £145 for a 40-minute consultation.

Dr Tim Alder warned general practice was on “the brink of collapse” and “heading for privatisation” as he decided to launch the controversial Dorset Private GP Service at Poole Road Medical Centre in Bournemouth, Dorset.
NHS patients at the surgery have to wait four weeks for a seven-minute appointment with one of the practice’s four doctors if they are not eligible for its same-day walk-in service.
But critics have slated the move as a “kick in the teeth” for the NHS and patients, claiming it creates a two-tier health system and goes against the principle of reducing inequalities in healthcare.

Dr Alder said increasing demand, a recruitment crisis and lack of funding as well as private provider Virgin Care taking over practices across the country meant the new service was the only way to safeguard the surgery’s future.

He said: “The Government is not trying to save general practice and now it is on the brink of collapse. But when it’s gone, they’ll realise how good we have been at blocking access to the hospitals. By then, it will be too late.
“We have to try something different now to make ourselves stronger in anticipation NHS primary care will be even worse.
“The worry is that Virgin Care, who are already buying up practices, are going to come in and would then just take us over.
“I suppose we’d rather be in charge of our own destiny.”

A humanitarian crisis – and the goodwill of staff has disappeared. When will the public ask for private A&E?

Many A&Es are failing now. As delays, standards, and staffing gets worse, more and more demand will come for private A&E and ambulances.

The risks of private care… overstated?

When will private hospitals begin to offer alternative A&E option?” NHS worse in Wales”. Close the doors!

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Rationing by deliberate delay – how does this fit with the “core values”?

An announcement which may apply to England only (not the other three Regions?) is pre-released in The Guardian 15th March 2017. Delays in approval of proprietary products (value based pricing), until as near to patent expiry as possible, is just one method of rationing by delay, but it should be called what it is, and politicians should be quizzed by the media on their “core values”:

NHS patients could face wait to access life-saving drugs  – New rules mean health bosses in England can delay rollout of expensive treatments after approval by Nice

Patients could face delays accessing drugs on the NHS after health bosses agreed that the most expensive treatments can be stalled.

Even when a drug has been approved by the National Institute for Health and Care Excellence (Nice) – which already has strict rules on affordability – bosses at NHS England can now slow down its delivery to patients.

The move applies to any drugs that are expected to cost £20m or more in any of the first three years of their rollout across the NHS.

This could apply to cheaper drugs that will be used by hundreds of thousands of people or very expensive drugs used by a small number of people. Drugs used to treat a range of conditions, including diabetes or cancer, could be affected.

Under the move, NHS England can ask Nice to extend the amount of time the NHS has to bring the drug in for all patients – in some cases for three years. At present, the NHS has 90 days to make Nice-approved drugs available…..

…Other changes agreed by the Nice board include the introduction of a new fast-track option for treatments which cost less than £10,000 per year of good quality of life to patients.

The upper end of Nice’s standard threshold range is £20-30,000 per year. The new fast-tracking will mean cheaper treatments go through the appraisal process in six months rather than nine.


Rationed – Start of cheaper technique for breast cancer is delayed in UK despite adoption elsewhere. GP commissioners should be demanding intra-operative radiotherapy.

More money needed… lets pour a little more into the holed bucket – and reduce the quality of care by rationing new treatments

Fast-track plan cuts wait for newest drugs by years… will cost more in an unrationed service

Increasing the “Heath divide”? – Dementia victims to have drugs rationed. The “affordability test” is reasonable and sets a precedent at the high cost end..

Value Based Pricing: Drug prices guaranteed to bring headaches