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Consulting professionals and managers about the NHS.

This site aims to bring out the truth about the state of the NHS. We reveal the views of current and retired NHS professionals, doctors, nurses and managers in particular. This has never happened in a public domain before. We also report stories of interest in order to provide a context. Find out more..


IVF: NHS couples ‘face social rationing’ as providers struggle to fund it

NHSreality if actually “for” rationing, but we could afford all the infertility treatment that could be demanded if we rationed high volume and cheap services: perhaps those costing less that 2 pints of beer and a packet of 20 cigarettes? Figures for the other 4 health services in the UK are of course not available for comparison. They are certainly worse in Wales, but like most important issues after devolution, we cannot compare.

See the source image

BBC News reported 20th July: IVF: NHS couples ‘face social rationing’

The parents of the world’s first IVF baby – born 40 years ago next week – would not have got the procedure on the NHS in most of England today because of “social rationing”, a charity has said.

NHS IVF is unavailable to couples in many areas if either of them has children from a previous relationship…… Figures collated by campaign group Fertility Fairness show IVF provision at all 208 clinical commissioning groups (CCGs) across England.

They show eight out of 10 CCGs do not enable access to IVF if one of the couple has children from a previous relationship……Her father already had children from a previous relationship, which would render the treatment unavailable to the couple in many areas today, Fertility Network UK said.

Data chart

Aileen Feeney, chief executive of the charity, said: “If Louise Brown’s parents wanted to try NHS IVF today, they would be turned down by the vast majority of England’s clinical commissioning groups on social rationing grounds: although Mrs Brown was clinically infertile, Mr Brown had a child from a previous relationship.

ITV News reporter Lorna Shaddick reports 23rd July 2018: IVF treatment being rationed as providers struggle to fund it

Couples in the UK seeking fertility treatment are finding that their access varies dramatically, depending on where they live.

This week marks 40 years since the birth of the first test tube baby, Louise Brown, but if rules then had been what they are today, she may not have been born.

Couples in the UK face what campaigners call “social rationing” of fertility treatment on the NHS, meaning its availability to would-be parents varies dramatically depending on where they live.

It is up to each local NHS provider – the Clinical Commissioning Group – to decide which treatments to fund.

The charity Fertility Network UK says if Louise Brown’s parents were seeking IVF on the NHS today, they would be turned down by over 80% of England’s clinical commissioning groups, because her father already had a child from a previous relationship, one of many rules that make it more difficult for couples to get IVF.

The National Institute for Health and Care Excellence (NICE) guidelines say women under 40 who have been trying for more than two years to get pregnant should have access to three full cycles of IVF on the NHS – but crucially those are not binding.

IVF postcode lottery
Image: The availability of IVF depends on where people live

Campaign group Fertility Fairness says the number of CCGs in England meeting those guidelines has gone down, from 24% in 2013 to 12% in 2017, and only four offer what Fertility Network UK calls the “gold standard” of three full IVF cycles, even for couples who have children from previous relationships.

Aileen Feeney, the chief executive of Fertility Network UK, said: “We believe that there should be fair access.

“NICE guidelines are there because financially and medically they are the best way to achieve the outcome that you want.

“So, therefore, we believe that everywhere in the UK should be offering those in line with the NICE guidelines, so three full cycles of IVF.”

Emma Edey and her husband Lee say they are victims of these geographical differences.

Both have health problems that doctors agree would make natural conception difficult, but they live in north east Essex, one of seven areas in England where all NHS IVF treatment has been removed or suspended – and they cannot afford to pay for private treatment.

When Mrs Edey appealed to her local CCG last year, saying that her bowel disease means she is in “exceptional circumstances”, she was refused.

She said: “They’ve just completely taken away everything – all of both of our dreams.

“We just want to be given the opportunity to have what all our friends have got, to be able to celebrate Christmases and stuff like a family, as families do.

“And it doesn’t seem fair that my friends a few miles down the road can have it but I can’t.”

The cost of IVF varies but one cycle at a private clinic can come to more than £5,000.

NHS clinical commissioners told Sky News: “Unfortunately the NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.

“As a result there are some tough choices that have to be made, which we appreciate can be difficult for some patients.”

After more than two years of letters and phone calls to her MP, CCG and local hospital, Mrs Edey was told last month that her subsequent appeal has been upheld, and she can receive treatment.

But she says she’ll keep fighting for others in the same situation.

“I won’t stop,” she said.

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GPs could be forced to switch IT systems under new NHS Digital contract

The UK governments have not got a good record on the introduction of IT – anywhere. There is a tendency to go for too much, too quickly, and at too much cost. Some 20 years ago I proposed that all the GPs in West Wales used the same system. The knock on effects and health gains would have been immense. But I was thwarted, and we have not progressed. Out of Hours records are derisory, slow and unreliable. Information gained in one area (A&E for example) is  not shared electronically with another (GPs). NHSreality would have more faith if progress was in selected areas like the Isle of Wight, or Cornwall, or Pembrokeshire, before risking a national roll out. This could be good news… It would be better to use smaller groups, health board areas etc. 

Carolyn Wickware reports for Pulse 16th August 2018: GP practices may have to switch systems as NHS Digital embarks on a re-tendering process for patient record IT providers.

NHS Digital will launch a tender for a new panel of system providers in January, with the intention to have the new framework in place next summer.

But, in order to secure a spot on the panel, providers will need to show they can provide record systems for ‘multi-disciplinary settings’, and NHS Digital said this ‘may or may not’ be the systems currently used by practices.

Under the current GP Systems of Choice framework, which expires at the end of this year, practices can choose to use TPP SystmOne, EMIS Web, InPS Vision or Microtest Evolution.

GP leaders warned that attempts to overhaul GP IT systems ‘will be a huge undertaking’ and urged NHS Digital to ‘carefully consider the potential impact on practices’.

The current framework, which has been extended several times, has been in place since 2007.

All providers can bid to remain on the updated framework, however NHS Digital said they could lose their spot if they failed or refused to meet ‘new requirements’.

NHS Digital said the new Digital Care Services framework, worth £450m, aims to support ‘integrated care organisations’.

According to the prior information notice for the tender process, providers on the framework will be expected to provide ‘patient record systems for multi-disciplinary settings’, which ‘may or may not be general practice (GP) systems as currently accessed within the UK market’.

Martin Warden, NHS Digital’s director of digital transformation in general practice, said: ‘This is a step-change towards ensuring the continued relevance and resilience of primary care IT systems to meet evolving NHS needs.

‘The new framework will improve access to GP data for patients and the NHS, as well as enabling digitised workflows in and between care settings to support better patient care.’

He added that it will also ‘provide local organisations and other buyers with more choice through an online catalogue service’.

Dr Farah Jameel, BMA GP Committee executive team IT lead, said: ‘Any attempt to completely overhaul GP IT systems will be a huge undertaking, and those responsible must carefully consider the potential impact on practices and patients.

‘GPs and their teams must be fully consulted on these plans to ensure that they are rolled out with minimal disruption and the best interests of patients and practices as a priority.’

Requirements for NHS Digital’s new IT systems framework

  • Patient record systems for multi-disciplinary settings, which ‘may or may not be GP systems as currently accessed within the UK market’
  • GP systems ‘designed around the operation of a traditional general practice’
  • Digital services ‘integrating into the clinical desktop, such as document management, clinical decision support [and] e-Consultation’
  • Digital support services ‘supporting integrated service delivery’
  • Patient facing services including ‘appointment or practice communication apps’.

Source: NHS Digital

IT – the solution and a problem… Every patient deserves an examination. GPs must not be robots..

Do you have a right to forbid your notes to be filed electronically? We don’t know..

Bringing back fear, and suffering. A return to 19th century inequalities.. How quickly politicians destroyed what was the best safety net in the world?

The potential risk for blackmail – think about your medical records when you are young. Are you ambitious to be famous?

The Hacking reveals a collusion of anonymity for responsibility for rationing…


Successive increases in the health budgets in Wales have not helped….. Brexit will make it worse… We all seem agreed, so why not change direction?

Pouring more money into a bottomless well, or a holed bucket is what is occurring in Welsh health. There are seven Welsh Health Boards, in various states of economic degradation. There is no NHS, and so the Welsh Health Service has its own financial budget (Including NHS funding rules), its own litigation fund, its own waiting lists, and its own complication and death rates. These will eventually be compared with the other regions in the UK, and the WHO will report to show the differences after and since devolution. Wales is unsustainable as a devolved health service if the residents expect to have the same standards as England (why not, they pay the same taxes?) In addition, Wales is the region which voted most for Brexit, but according to the “Brexitometer” at the Pembrokeshire County Show the farming community are certainly thinking again. (This picture taken well before end of the show)

ITV news explored the Brexit outcomes for Wales: How will Brexit affect the Welsh NHS? | Wales – ITV News The third question askes if people think that Brexit will be good for the NHS. We all seem agreed, so why not change direction?

Meanwhile, the area of the UK with the greatest recruitment problems, has also got the greatest (pro rata) litigation problems. The money set aside for litigation in N Wales is extraordinary. This is part of a national concern, as staff shortages bite, and standards fall: Concern at ‘spiralling’ health complaints to ombudsman (BBC News today)

On 8th December 2015 David Deans in Walesonline reported on an increase of £278m to make a budget for 2016 of £7.1 billion. 

This was confirmed by the National Health (funding) Executive. But assessed at £260m

It is hard to get up-to-date information and the “NHS expenditure programme budgets” from the Welsh Government (WG) website does not help. Neither does the WG budgets website. (A work in progress!!) Neither is help offered by the WG beta website (again in development).

There are however, historic documents for download (.pdf) showing the change in expenditure year on year. (This is of course historic information, and not the budget)

Although prescriptions are free, Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Wales is already subsidised by England but The real cost of the English taxpayer subsidising NHS Wales – is twice the official figure

Outside of the cities, Cardiff and Swansea, there are really poor areas, and The agony of Damocles swaord hangs over West Wales..

Projected Litigation funding in N Wales is £90m, and the BBC 9 days ago said ” NHS Wales negligence bill alarming”,

Where recruitment is poor, morale is low and staff sickness, already the worst in the world for any organisation, is desperate. Jez Hemming in the Daily Post 6 days ago: What’s been making North Wales health staff so sick?

Shane Brennan reports 16th August on “super sized morgues” and  on the epidemic of obesity leading to higher death rates, as predicted by NHSreality.

This is not a surprise to GPs or NHSreality as Number of GPs in Wales hits lowest level in a decade

Cutting our hospitals could make sense, but there are many threats in doing this. The rules for Yorkshire do not apply in rural Wales. The fourth option for West Wales? Do we want “soft lies and gentle indifference”, until we realise the safety net is failing for us personally?

We are already subsidised by £1,500 per head, and now we have a running deficit: A bigger and bigger deficit in West Wales…… Now at £600 per head……

In Wales they really can waste money: £68m unveiled for health and care hubs

Cancer statistics broken down across Wales. What a pity we in Wales cannot compare to the rest of the UK, and EU.

Stroke patients in Wales ‘could die’ because thrombectomy not available Acute shortage in NHS of specialist doctors who undertake life-saving treatment means hospitals cannot provide it

Rationing by waiting, and insufficient staff. Wales is worst…

Wales is an unsustainable state: another good reason not to leave the EU. Graphics in support…

In Wales, as in many rural areas GPonline Nick Bostock reports: How small GP practices are being pushed towards extinction






Local Media may better expose the covert post code rationing which is present throughout the country

Local media may do what national media seems incapable of. Exposing the covert post code rationing which is present throughout the country, in all 4 different UK systems. Its only when you lottery number comes up, and you get ill, that you discover what may not be available for you. In psychiatric medicine this may be psychotherapy, in gynaecology it may be IVF, and in cancer treatment it may be proton beam therapy or a PET scan investigation.

Stuart Minting in Richmondshire Today 8th August 2018 in Yorkshire reports:  New Health Secretary to be pressed on state of North Yorkshire’s NHS services

The bleak financial outlook facing the NHS in North Yorkshire and concerns for patients’ services is set to be laid before the new Secretary of State for Health and Social Care.

The county’s health watchdog said it would press Matt Hancock for an immediate answer to questions as both his predecessor, Jeremy Hunt, and Prime Minister Theresa May had failed to respond to appeals for action.

Councillor Jim Clark, chairman of North Yorkshire’s Scrutiny of Health Committee, said he would write to Mr Hancock calling for urgent action as documents had revealed the deficit facing the clinical commissioning’ groups (CCGs) that control NHS funding was continuing to rise this year.

The committee has previously highlighted how groups commissioning NHS services in the county have for many years been unable to keep within their spending limits.

Despite concerted drives to cut spending, Hambleton, Richmondshire and Whitby, Harrogate, Vale of York and Scarborough and Ryedale CCGs racked up a £46m deficit last year and are expected to go £30m into the red this year.

The CCGs have been reported to the Health Secretary for acting unlawfully by exceeding last year’s budgets, while the committee has raised concerns over the “chronic shortage of NHS staff”.

In addition, the Hambleton group will have to draw up a financial recovery plan and notify health chiefs should it wish to make any senior appointments after being placed in special measures.

Cllr Clark said while the threat of longer waiting lists, more rationing of services and hospital bed closures loomed for North Yorkshire residents, the Government did not appear to have understood the urgent nature of the situation.

He said Mr Hancock would be pressed to get stringent financial controls put in place by NHS England to oversee any additional money given to address the deficit.

Cllr Clark said while it appeared while the CCGs were set to cut their costs by more collaborative working, it remained unclear if any extra Government funding would be used effectively and efficiently and if taxpayers would get value for money.

The retired accountant said: “I have had no response from the Prime Minister, but four out of five of our CCGs are still acting unlawfully and this has got to be addressed. They are building up a considerable deficit again this year.

“The NHS are spending more and more money on management consultations, but the problem is that they can’t recruit medical consultants.

“Hopefully, the new Secretary of State for Health and Social Care might get the seriousness of the situation.”

Nathan Hide in Leeds Live on line reports 7th July 2018: Revealed: Leeds patients denied necessary treatments

“There is something that would cure me, but I can’t have it unless I can afford it”

The Yorkshire Post 21st July reported on the rationing of IVF services.

and calls for “greater funding of IVF treatments”.


The perverse incentive to have a long waiting list… Rationing of health services in this way is immoral. It is a two tier system sponsored by the state.

Rationing of health services in this way is immoral. It is a two tier system sponsored by the state.

Hospitals are evidently charging for private operations that by-pass their waiting lists. According to the Mail this involves 2/3 of Hospitals in England (presumably).

Patients are being allowed to jump growing NHS queues by paying up to £15,000 for a hip replacement.

Hospitals are encouraging people to self-fund procedures that are either heavily rationed or have very long waiting times.

A Daily Mail investigation uncovered how two-thirds of hospitals allow patients to pay out of their pockets for hip and knee replacements and cataract surgery. It follows revelations that patients are having to wait for up to a year for surgery on the NHS.

Many hospitals offer all-inclusive packages that work out significantly cheaper than charging separate fees for the operating theatre time, the consultant and occupying a hospital bed.

Similarly patients wanting cataract surgery are charged a maximum of £5,125 at Derby Teaching Hospitals. The NHS typically pays just £800 for the procedure, though it involves a less advanced lens.

In return, patients are treated almost immediately

And last week the BMJ said 1,700 patients had been refused hip and knee operations even though their doctors had pleaded their cases.

But campaigners said it was ‘deeply worrying’ that patients were having to choose between finding the money themselves or enduring very long waits.

Caroline Abrahams, charity director at Age UK said: ‘It is deeply worrying that we’re apparently sleepwalking towards a situation in which if you want a routine operation such as a hip or knee replacement you either have to pay privately or wait a long time on the NHS. What about the many older people who cannot possibly afford to pay thousands and who are left in pain and distress for months on NHS waiting lists?’

Labour’s health spokesman Jonathan Ashworth MP said years of cuts have meant we have been left with ‘a two-tier NHS with quick surgery for those with cash while the majority are forced to wait longer and longer in pain’.

Rationing of health services in this way is immoral. It is a two tier system sponsored by the state.


Government (in England) plans to stockpile drugs and blood over Brexit!! Normally the prerogative of panicking individuals but now it seems to be endorsed by a panicking government.

Stockpiling is normally the prerogative of panicking individuals but now it seems to be endorsed by a panicking government.

The Independent 25th July: Government admits plan to stockpile medicines and blood in case UK leaves EU with no deal

‘Some of the medicines most difficult to provide in a no-deal scenario, where there is difficult access through ports, will need to be flown in’

The government is making plans to stockpile vital blood products and medicines in case of a no-deal Brexit, the new health secretary has said.

Matthew Hancock admitted he had already met with industry leaders to discuss building up NHS reserves of vaccinations and other medical supplies if Britain crashes out of the European Union without a deal.

His comments came after Dominic Raab, the new Brexit secretary, finally confirmed preparations were being made to stockpile food, as ministers ramp up planning in case the negotiations fail.

heresa May told MPs last week that consumers and companies will be sent technical notices over the summer to help them prepare for a no-deal Brexit, amid pressure from Eurosceptics to strengthen Britain’s hand in talks by gearing up to walk away.

However the warnings provoked Brexiteer fury, with one Tory Eurosceptic accusing the health secretary of “weaponising the no-deal preparations” amid efforts to win support for the prime minister’s Brexit vision.

Mr Hancock told the Commons health committee: “We are seeking to avoid a no-deal Brexit, I am confident that it can be avoided. But any responsible government needs to prepare for a range of outcomes, including the unlikely scenario of no deal.

“Since I have arrived in the department, I’ve asked this work to accelerate and I’ve met with industry leaders to discuss it.

“We are working right across government to ensure that the health sector and the industry are prepared and that people’s health will be safeguarded in the event of a no-deal Brexit.

“This includes the chain of medical supplies, vaccines, medical devices, clinical consumables, blood products. And I have asked the department to work up options for stockpiling by industry.

“We are working with industry for the potential need for stockpiling in the event of a no-deal Brexit.”

He admitted there was a “cost implication”, adding: “We are also focusing on the importance of a continuous supply of medicines that have a short shelf life – so some of the medicines most difficult to provide in a no-deal scenario where there is difficult access through ports will need to be flown in.”

Shadow health minister Justin Madders blamed the government’s “chaotic handling” of Brexit for the news and demanded urgent reassurances for patients that they would not be left without treatment.

“This is the terrifying reality of this Government’s failure to prioritise the NHS in the Brexit negotiations,” he said.

“NHS patients and their families need urgent reassurances from ministers about how they’re going to avoid this doomsday scenario.”

Sarah Wollaston, chair of the health committee, called for more clarity about the government’s plans.

The Tory MP told Newsnight: “It’s not just about stockpiling here, there are some products that can’t be stockpiled.

“Around 700,000 diagnostic tests every year in the NHS require medical radio-isotopes but these have very short shelf-lives, they can’t be stockpiled and they aren’t manufactured here.”

Niall Dickson, co-chair of the Brexit Health Alliance, a group of NHS, industry and public health groups, said the government was right to plan for the worst but it needed to inform the health service over the scale of the challenge.

He said: “We may be able to accept delays for some goods crossing borders, but that is simply not acceptable for medicines and other materials on which patients rely every day.

“Whatever happens in the negotiations, there is an absolute requirement on all those in office to make sure that patients continue to receive the medicines and the treatment they need.”

The Independent has launched its #FinalSay campaign to demand that voters are given a voice on the final Brexit deal.

Sign our petition here

What is the real effect of closing A&E departments? Would patients prefer access and local services to a longer life expectancy?

When I am given the information (on survival), given the option, I will surely travel. a posting from 2017 might apply to me, who has information  and choice, but it does not apply to everyone. We might not need to close all these A&Es if we had more doctors, and more competition for places in hospitals. Research based on an industrial area with good motorway links does not necessarily apply to rural underpopulated areas. Life expectancy here (Wales and the North East) may well be less – we await the WHO’s next report on the 4 UK health systems.

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But the latest paper, reported in the Times August 14th “Closing A&Es ‘doesn’t cause more deaths’”,  opining on research  which comes from Sheffield University

What is the real effect of closing A&E departments? Would patients prefer access and local services to a longer life expectancy?

Downgrading emergency departments does not lead to a spike in deaths despite patients having to travel further, a new study suggests.

However, it may heap pressure on local ambulance services.

The closure of emergency departments is an area of concern among local communities but there has been little research into the impact on care. Units can be downgraded, for instance from a 24-hour consultant-led unit to a minor injuries or urgent care one, or closed.

Researchers at Sheffield University evaluated five emergency units — Newark, Rochdale, Hartlepool, Bishop Auckland and Hemel Hempstead — that were downgraded between 2009 and 2011 and found no overall increase in the number of deaths.

“This suggests that any negative effects caused by increased journey time to the ED [emergency department] can be offset by other factors; for example, if other new services are introduced and care becomes more effective than it used to be, or if the care received at the now-nearest hospital is more effective than that provided at the hospital where the ED closed,” they wrote.

However, there was an impact on other emergency care providers, according to the study, published by the National Institute for Health Research. The authors found an increase in the number of incidents dealt with by ambulance services and in the time taken to get to hospital.

In four of the five areas studied, the emergency department was replaced with an urgent care facility.

The study’s co-author, Jon Nicholl of the School of Health and Related Research, said that downgrading emergency departments did not necessarily improve outcomes.

“We didn’t find the better outcomes for patients that planners hoped to see from closing these small departments either. This means it isn’t clear that the disruption and anxiety that can be caused by closing emergency departments is worthwhile,” he said.

Rationing Health Care – is it time to set out more clearly what is NOT funded by the NHS?” Does the Nuffield Trust need to write a new report?

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