The sensible voice of the small number of the profession still engaged with the political decision making has come up with overt rationing of some low cost high volume services. This of course has no chance with the politicians or the media.. but it says it all in two motions. In Wales NHSreality would add “Reintroduce prescription charges. Give GPs the right to prescribe privately when this will save the patient money”.
Grassroots GPs have instructed the GPC to launch a ‘national debate’ with Government and health bosses on what care the NHS should stop funding.
The policy was devised at the annual LMCs Conference, where delegates argued GPs are getting the blame for ‘postcode lottery’ rationing decisions that are preventing patients from accessing treatments.
Delegates voted in favour of a motion proposing the GPC ‘engages the country in debate on what should be rationed’ – despite counter-arguments that the new policy would ‘play into the Government’s hands’, and warnings from GPC that it would detract from work on other more GP-specific concerns.
Proposing the motion, Dr Brian McGregor from North Yorkshire LMC said: ‘GPs are left holding the baby and having to have that discussion with the patient – yes, we can do something for this but I can’t because the CCG won’t let me, you don’t tick the boxes…
‘What we need is for GPC to take a lead on this, get politicians and management involved and actually bring in some guidelines that don’t give us a postcode lottery, that actually give quality of care to everybody and make it clear for everyone that this is the system, this what you need to do and this is where you get your care from.’
But, arguing against the motion, Dr Annie Farrell from Liverpool LMC said passing it meant ‘playing right into the current Government’s hands’.
She said: ‘This Government is doing much more than just not discussing this, it is actively promoting untruths or “alternative facts” about funding for and availability of care for patients within the NHS.
‘Rather than playing into their hands and doing the Tories’ dirty work for them and colluding with the Government in rationing care, the GPC should be aggressively challenging this misinformation… and promoting the model of a properly funded NHS through taxation which is a viable option if there is a will in the country to do it.’
Speaking on behalf of the GPC, Scottish GPC chair Dr Alan McDevitt also urged conference delegates not to pass the motion.
He said: ‘You keep telling us at GPC our job is to represent GPs and we should spend our time, money and effort represent you.
‘The effort to do this to engage the whole nation in a discussion of [wider NHS rationing] could consume all our energies for years to come.
‘We would also be seen as having a vested interest in that.’
But despite the plea, LMC delegates voted to pass the motion.
Later on in the debate, grassroot GPs also set out GPC policy to push for negotiators to ensure GPs are no longer required to write prescriptions for over-the-counter medicines and foods.
Although Dr Shaba Nabi from Avon LMC said this also counted as ‘a form of rationing’ she added: ‘We need it, GPs in deprived areas are drowning in demand.
‘Patients are not coming to see us because they want clinical expertise but because they want a free prescription, because they believe they are entitled to.’
Dr David Wrigley, BMC council deputy chair and GPC member, warned this would be ‘catnip’ to the Government, as ‘GPs making the decision to restrict medicines or services, or introduce co-payments, is just what they want to hear’.
Dr Wrigley said: ‘This will be the thin end of a very large wedge.
‘More medicines will be deemed unsuitable for the NHS to pay for.’
But indicating support for the motion, GPC prescribing lead Dr Andrew Green said that as it did not suggest GPs could not prescribe items where necessary it did not amount to rationing.
He said: ‘It is about protecting GPs from doing work they don’t have to do.’
The motions in full
‘That conference believes NHS rationing is happening, and politicians will not discuss this due to the implications; conference demands that GPC shows some genuine leadership and engages the country in debate on what should be rationed.’
‘That conference demands that NHS prescriptions are no longer required for the NHS provision of:
i) OTC medications
ii) Food products’
Don’t kid yourself. You could get mentally ill. This is why so many GPs and consultants are looking to go part time. The result is less continuity of care, and especially in GP land, lack of the doctor patient relationship which stopped complaints and led to understanding. I used to look after mild anorexics myself, and there is evidence that they do worse in the hands of the “experts”, but then of course only the worst get to the experts. Now a new NICE guideline means they will all go into the mental health system.. Without continuity of care perhaps this is just as well.
With increased stress, litigation, complaints and expectations, all doctors know they are at risk of burnout or mental illness. It is so sad that with no votes in it, no large party is really interested in mental health.
40 % of primary care is mental health, and yet GPs do not all get mental health training.
Police are investigating the deaths of “up to 20 patients” at a mental health facility in Essex.
Last week an inquest ruled that the authorities had failed to protect Richard Wade, 30, who died in May 2015 after staff at the Linden Centre in Chelmsford failed to confiscate the item he used to hang himself when he was admitted.
Matthew Leahy, 20, died at the centre on November 15, 2012. The inquest into his death concluded there had been “multiple failures”.
The court heard that observation slots were missed, the ward was short staffed and no care plan was put in place for Mr Leahy after he was sectioned on November 7.
The two men were among seven inpatients known to have died at the centre since 2001, all of whom had attached a ligature to fixtures or furniture. Mr Leahy’s mother, Melanie, said that Essex police had told her they were “still investigating my son’s death but are also looking at . . . up to 20 patients, who all died by the same means”.
A Care Quality Commission report in 2016 on the Essex Partnership Trust, which runs the Linden Centre, found improvement was required at the trust and said that there were too many places where patients could hang themselves.
It warned: “Over the past five years, CQC inspectors, along with Mental Health Act reviewers, have inspected this trust several times. Each time we have identified problems that the trust needed to address; for example regarding safety at both the Linden Centre and the Lakes locations. Each time the trust had given assurances and then has not done so.”
Ms Leahy welcomed the fresh investigation and said: “I have worked tirelessly to collect evidence going back to 2001, which proves the trust knew about the ligature points on the ward.
“As proved by the Care Quality Commission inspection in 2015, the wards were not up to the standard required to ensure patient safety.
“The trust had been advised to change things after other patient deaths.”
One nurse, who left the trust in mid-2016 after a decade, speaking anonymously to the BBC, said that ligature points had been identified “many years before” Mr Leahy’s death but had not been resolved.
“If you asked too many questions you were deemed as a troublemaker and things made difficult for you,” he said.
A spokesman for Essex police said that the force was “conducting initial inquiries into a number of deaths which have occurred at the Linden Centre since 2000”.
He added: “This work follows further allegations surrounding the death of Matthew Leahy at the facility in Chelmsford on November 15, 2012.
“We would not put specific links to specific deaths, the research phase will look at the circumstances of a number and then identify those that may have a link due to the circumstances of how the individuals died.”
A spokesman for the Essex trust said the serious incidents were of “great concern” and the trust was “improving systems to ensure that investigations are carried out rigorously. The trust will co-operate with any police inquiries.”
You cannot take your house with you to the hereafter. We are all going to die and pay taxes … Sure, whilst you are alive there should be an incentive to save, but there is also a duty of self-care. The balance between the states encouragement of autonomy and paternalism is the struggle between left and right wing philosophies. It is true that social care is heavily rationed and means tested – overtly. Health is no different: it is just rationed covertly. The dissonance needs debate, and pragmatic leadership, and this is something our media will not allow.. NHSreality believes we will have to ration overtly in both Health and Social Care. There is, by the way, an incentive for individuals with the determination, means and ability to say exactly when their lives should end, saving costs and unhappiness in their family…. (About time too – Doctors ponder ending ban on assisted dying ) Using this “right” may increase the social divide..
Richard Humphries opines in the Guardian 22nd May 2017: We have to address the faultline between social care and the NHS – One is heavily rationed and means-tested, the other free at the point of use and tax-funded. And when assets are involved, the issue becomes politically toxic
In his first speech to the Labour party conference as prime minister in 1997, Tony Blair declared that he did not want his children to be brought up in a country “where the only way pensioners can get long-term care is by selling their home”. Twenty years later this remains a politically toxic issue – even though many people with care needs might wish they had a home to sell. The events of the past few days illustrate why the bold promises of successive governments to reform the way social care is funded have come to so little.
The Dilnot commission’s proposed cap on the lifetime costs of care was accepted by the coalition government in 2011 – albeit with the cap set at £72,000 rather than the £35,000 to £50,000 range proposed by Dilnot. It even made it on to the statute book as part of the Care Act 2014, and was generally welcomed as providing protection from the “catastrophic” costs faced by the one in 10 who need care costing at least £100,000. Implementing the cap was a Conservative manifesto pledge in the 2015 election but, barely 10 weeks later, the government announced this would be postponed until 2020 as the circumstances were “too difficult”.
While the cap was a notable absentee from last week’s Conservative manifesto, proposals that did make it included the replacement of the current means-testing thresholds with a new single limit that would allow people to retain £100,000 of their savings and assets – but, more controversially, it proposed to include the value of property in working out how much people should pay towards care at home, as is currently the case for residential care.
Following the criticism that greeted these proposals, Theresa May today promised that, if re-elected, her government will publish a green paper with proposals for an “upper limit” on now much people should pay. This about-turn reflects the difficulties faced by all governments in addressing the hard choices and trade-offs involved in resolving this thorny issue. But while the reinstatement of the pledge to introduce a cap is welcome and could help to achieve a fairer balance in how costs are shared between the individual and the state, its impact will depend on the level at which it is set: the higher the cap, the fewer people will benefit; the lower the cap, the more it will cost the taxpayer. The detail in the proposals will require carefully scrutiny.
But reforming means-testing alone does not address the deeper challenges facing the social care system. Many thousands of older and disabled people have not been able to acquire property, savings or pension pots, and instead are wholly dependent on local authority-funded care budgets that have been cut by £5.5bn over the last six years. The Conservative manifesto is silent on how much they would invest in the local authority system over and above the additional £2bn announced in the spring budget. The proposal to means-test winter fuel payments for pensioners will bring more money into the system, although it is unlikely to be enough to bridge a looming £2.1bn funding gap in 2019/20.
Nor do the proposals address the deeper inequities in entitlements between the NHS and social care. Although all three main parties are committed to further integration of health and social care, none of their proposals will remove the historical faultline between the NHS – free at point of use and funded through taxation – and social care – which is heavily rationed and means-tested. As the Barker commission concluded, this is neither sustainable or equitable: develop cancer or heart disease but not dementia, and your house and savings will be intact.
The Conservatives are right to say that reforming social care is not just about money. Big changes are also needed in the way services are delivered to offer better outcomes for people and to tackle the mounting workforce problems facing the sector. However, none of the manifestos offer any new or imaginative thinking that address the scale of these challenges. A green paper early in the term of a new government would be an opportunity to put that right.
One letter in the Times 23rd May explains the dissonance in ideology: (all are here: Letters on Social Care funding )
Sir, It seems to me that there are three types of fairness involved in paying for health and social care. First, it should not matter whether the illness requires health care or social care. Second, it should not matter where the care takes place. Third, payment should be by pooled risk paid for on a progressive basis. I would be happy to pay on this basis, and it would probably cost me tens of thousands of pounds. It is confiscatory and vindictive to require payment of almost unlimited amounts, or nothing, purely based on whether one gets ill or not. If Libby Purves is happy for her house to fund her social care, why doesn’t she propose the same system for the NHS? Life is unfair but there’s no need to introduce unfairness deliberately.
Brookmans Park, Herts
Mrs May and the conservatives won some brownie points from NHSreality today. Her acknowledging that there is not enough money, and that we don’t have a plan to provide enough for social care is refreshing. The responses of the Liberals and Labour are pathetic tickertape: word bunting for short term points with a shallow media. What she proposes is fair, and a similar form of overt rationing should arise from a subsequent debate on health.
Mean arguments over subtle changes of direction demean the politicians… They should be discussing social care philosophy and ideology…. At last one political leader is leading by discussing the unpalatable need to ration, and provide. Mrs May has not yet suggested a “mutual” but that may eventually come from a responsible opposition. I hope it’s the Liberals who agree to tell the “hard truths”… but Mr Fallon’s response was unworthy..
….the insertion of a pledge for “an absolute limit” left the bulk of the policy unchanged.
Under the Conservatives’ plans, property would be counted towards the means-test for domiciliary as well as residential care, but the figure for costs to be capped rises from £23,500 to £100,000.
Initially there was no further limit to liability, meaning that wealthier families risked having to spend a greater proportion of their assets to care costs. After intense pressure Mrs May has now pledged to introduce a cap — with the precise figure to be set after the election.
A cap was the central recommendation of the 2011 Dilnot Report into care funding and was due for introduction at a level of £72,000 in 2020…..
Polly Toynbee has it right when she says: Labour’s failure on the NHS is prolonging this health crisis (Feb 2017) and LIbby Purves continues to make sense today in the Times: Why I’m happy for my house to fund my care – The affluent middle classes live in disgustingly overvalued moneyboxes. It’s high time this wealth was put to better use
…The idea is to admit that, whether you stay put or move to a care home, it will now be considered that your means-tested wealth includes your house. Only the last £100,000 of the total gets protected for your heirs. Nobody, and no surviving partner, would have to sell that house in their lifetime. But after death the state would do so, to repay the cost of publicly provided care. The protected £100,000 inheritance is four times as much as under present rules, but the clinching difference is that now the house’s value will be counted as if it were cash.
It’s a bold move, and though tweaks and explanations are needed, a necessary one. Those shouting “dementia tax” — often panicking Conservative candidates — are closing their eyes to two things. One is the reality of an ageing population. The other is that the present low, underpaid standard of home care simply will not do. Nor can I sympathise with dementia charities which, unforgivably, in their propaganda try to set sufferers against one another by complaining that if you were in hospital with cancer your care is free on the NHS, but if you are at home with dementia needing social care you have to contribute……
In Case you did not get the message Dennis Campbell reports the truth which government stooges would suppress: NHS trusts overspend by £770m despite bailout funding – Trusts fail to limit overspending to £580m but make inroads into previous year’s £2.45bn figure…
…“There was a significant improvement in NHS trusts’ finances last year. That was [from] a combination of taking out £750m from the cost of agency staffing and delivering almost another £1bn in efficiency gains,” said Hopson.
New research by his own organisation has found that trusts ended 2016-17 with a combined deficit of £700m-£750m. “That figure would be bigger than that without the £1.8bn sustainability and transformation fund money. That money has clearly been very helpful, too,” Hopson said.
But Sally Gainsbury, a senior policy analyst at the Nuffield Trust health thinktank, said: “The £770m is a very poor measure of how much the NHS is actually overspending by. In reality, the NHS overspent by significantly more than the £770m that HSJ reports because the £770m only comes after a whole series of one-off accountancy adjustments, such as deferring payment of bills from last year into this year and changing the valuation of property [owned by the trust]….
“And there is also the £1.8bn emergency bailout funding from the Treasury. Without it, NHS overspending would probably be in the region of £2.5bn.”
However, Gainsbury added, the NHS’s real deficit at the end of 2015-16 was about £3.7bn, once bailouts were included, so trusts did genuinely improve their finances by £1.2bn during last year.
“The underlying NHS overspend, whatever it turns out to be once NHS Improvement publish their figures, is more a measure of underfunding than of NHS profligacy,” she said.
HSJ’s figures are based on figures contained in board reports for 217 of the 236 trusts and trusts’ responses to its direct requests for information.
Siva Anandaciva, the chief analyst at the King’s Fund health thinktank, said trusts ending the year £770m in the red was an “impressive” performance, given how demanding last winter had been.
But, he added: “Set against the original ambition for lst year’s deficit and given the heavy reliance on sustainabaility and transformation fudning and other financial support, the NHS provider sector clearly remains some way from a balanced financial footing.
“Most worrying is the amount of one-off actions that have been used to improve the 2016-17 position. Delaying payments to suppliers, deferring capital spending and selling land do not address the underlying financial problems facing the NHS each year.”
NHS trusts would only regain control of their finances when “the fundamental imbalance between funding and rising demand is rectified”, he added.
NHS finance experts say that none of the three major political parties’ manifesto pledges of extra money for the NHS during the next parliament will be enough to let it maintain quality of care, meet treatment waiting time targets, improve cancer and mental health services and transform the way it looks after patients.
Key bodies, such as the National Audit Office and the Commons health select committee, have claimed in recent months that the NHS’s finances are unsustainable and need to be put on a stable footing.
There are certain entry requirements to be a midwife. Normally this would be five GCSEs at grade C or above – typically including English language or literature and a science subject – and either two or three A-levels or equivalent. (Health Careers) Midwives can be scapegoated as they are easy to find fault with when there is a disaster, but it is the management, training and the funding which is often really to blame. Deliberately rationing by undercapacity and underinvestment is similar to the way politicians have treated GPs and other parts of the system. It is politicians, not midwives, who should be investigated by the police… In the stampede to downsize staffing we might be asked to deliver our own next..
Cathy Warwick and in 2015: warned in the Telegraph on 7th Feb 2017: The challenges facing midwifery are immense. No wonder we have a crisis on our hands Britain’s older midwives are a ticking timebomb that needs defusing – fast
A new report has found that Britain’s ageing midwives are struggling to cope with a rise in births among women over 40. Royal College of Midwives chief Cathy Warwick explains why mums deserve so much better
In numbers | Problems in childbirth
The number of maternity claims lodged in England in 2015. A new Rapid Resolution and Redress scheme will investigate complaints and aim to cut settlement time
The amount spent last year by the NHS on resolving legal disputes after mistakes by maternity staff.
4.5 per 1,000 births
The stillbirth rate in England and Wales – one of the worst records in the developed world
37 per cent
The proportion of maternity services deemed “inadequate” or requiring improvement by a Care Quality Commission report
The amount pledged towards a pilot aimed at creating new ideas for improving maternity care
Babies are dying and being put at risk of major brain injury because it is “commonplace” for British midwives to qualify without training in use of basic equipment, a senior coroner has warned.
The regulator for midwives has been told to reform the sylllabus for all trainees after a string of deaths of newborns following monitoring failures.
Hospital trusts have been advised to stop recruiting newly qualified midwives until they can prove they can perform foetal heart monitoring.
And every university has been asked to include such training in all midwifery degrees – instead of relying on midwives to go on “E-learning” courses after they qualify.
The action follows a steep rise in compensation claims against the NHS for catastrophic blunders in childbirth.
The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures.
The recommendations have emerged following an inquest into the death of baby Billy Willson, who was three days old when he died, after being starved of oxygen at birth.
Even though his mother was identified as a high risk pregancy, midwives failed to spot an abnormality, instead administering drugs which caused the baby to suffer stress and oxygen deprivation.
A newly qualified midwife on her first night shift at Pinderfields Hospital, West Yorkshire, failed to recognise “pathological” signs on the monitor, continuing to increase the dose of drugs which should have been stopped.
The baby was rescuscitated at birth but survived just three days in intensive care, before his death in November 2013.
In evidence to the inquest, the midwife said she had not received appropriate instruction or training in how to interpret monitor readings, during her Midwifery Course at Bradford University and had not finished an “E-learning” programme on the subject.
An expert witness told the inquest that it was “commonplace” for student midwives to qualify without undergoing the essential training.
West Yorkshire coroner David Hinchcliff has now asked Nursing and Midwifery Council (NMC) to take a series of urgent steps to prevent future deaths.
In a second report he warned that “many” inquests have revealed that midwives and doctors lack “core skills” to intepret the monitors.
The regulator – which has been repeatedly criticised for slow action over a series of maternity scandals – was given a deadline to draw up a plan of action by last week.
Last night the NMC said it had responded to the coroner, and begun “a wholesale review” of the standards student midwives need to reach to become qualified.
spokesman said this would consider the concerns raised about the consistency of training in interpretation of foetal heart monitoring.
In February, the same coroner raised concerns after the death of a baby boy, Maxim Karpovich, in similar circumstances, in March 2015.
He has also written to the heads of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists callling for action, after midwives and a junior doctor at Leeds General Infirmary failed to detect abormal readings.
Last night Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, said she shared the coroner’s concerns.
She said: “We have undertaken a full review of our guidance, training programmes and other resources, and are committed to working in collaboration with the Royal College of Midwives to help improve team working in maternity units across the UK.”
Allegations of similar blunders are at the heart of an investigation into the deaths of 15 babies and three mothers at Shrewsbury and Telford NHS trust.
Failures to properly check babies’ heart rates are a factor in at least five of the deaths, prompting the local coroner to write to the trust.
Mothers said their children had died because midwives “couldn’t be bothered” to fulfil basic monitoring tasks, or to act on warnings that babies were in danger.
The concerns come as the NHS attempts to encourage more women to opt for midwife-led care, instead of on traditional labour wards staffed by doctors. Since 2004/5, the value of claims against NHS maternity units for brain damage and cerebral palsy has risen from £354m to £990m, official figures show.
The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16.
In total, almost 1,100 maternity claims were lodged, official figures show.
The most expensive involve cases of brain damage and cerebral palsy, where round-the-clock support is often required for life.
BBC News rightly reports some good news. The shaming of the health services by the case of Ashya King is recorded in the posts below. Ironic that Wales has the first UK Proton Beam therapy, but I suspect a lot of political machinations were done to get an edge over England… It has taken 27 years since the first Proton Beam therapy in 1990…
UK to get first proton therapy centre after Ashya King’s plight raised awareness of vital cancer treatment – The Telegraph 20th May 2017
Patrick Hill in the Mirror today: You’re still failing him: Parents say brain cancer survivor Ashya King is being refused vital treatment by the NHS – Plight of boy, 8, hit the headlines when his mum Naghmeh and dad Brett took him from a hospital without consent to get pioneering treatment abroad
In 2014 Joan Smith gave a balanced account of the case for the Independent: Ashya King: This story isn’t quite what it seems – The five-year-old isn’t dying – but nor is he getting the urgent treatment he needs, despite Jeremy Hunt’s extraordinary offer
It feels from the party manifestos that there is an agreement that the state needs to do more, especially to reduce inequalities. The conservatives wish to use capital assets for domestic/home based care in the same way as assets are used for Nursing Homes now. ( Down to £23,000 ) NHSreality sees nothing wrong with this approach – it has the virtue of being honest and open rationing. Methods of saving for a demented old age do not appeal – after all most of us pretend we are going to live for ever, and if we go, hope we die suddenly. A mutual fund for elderly care can only work if it is universal….
All parties in this election share a belief in big government. If that becomes blind faith, it will be bad news for the economy and public finances
Modern British history is often carved into periods of consensus. The postwar consensus venerated the state. For 30 years no party seriously challenged Clement Attlee’s nationalisations, universal welfare or the heavy regulation and union power established by a war economy. Then came the Thatcherite consensus, and it venerated the market. Privatisation, low tax and deregulation were, in time, accepted even by Labour. The manifestos released this week were in some ways as different as any set in decades. Yet there were whispers of a new consensus, too. All parties emphasise the role of the state. They should be careful not to forget what is good in Mrs Thatcher’s legacy.
Nobody expected a swashbuckling treatise on the virtues of economic liberalism from Jeremy Corbyn. His manifesto was true to form. Proposals for new taxes on income, profit and financial transactions were accompanied by promises of public ownership for Royal Mail, the railways and water, along with the higher spending on public services. The Liberal Democrat manifesto was less economically radical, but not much more economically liberal, its hefty spending promises financed by a mixture of tax rises and borrowing.
If the parties are converging on a new consensus, however, it also warrants scrutiny. The Times supported Mr Cameron’s programme of austerity not only because it was needed to sustain market confidence, but also because too unwieldy a state apparatus chokes the private sector and wastes money. Public spending as a proportion of GDP has fallen in the past seven years, and Britain is now at near full employment. That should be celebrated.
Yet public debt is still high and rising. Cost pressures in the NHS and welfare budgets will put more pressure on the exchequer in the coming years. Despite this no major manifesto has dared question the principle of an NHS free at the point of use. The main parties in this election have defined fiscal prudence as the ability to finance a big state. Any bigger than the present one is too big.