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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..


Politicians need to speak out for or against deserts based rationing. If they don’t it will occur by post-code and by default.

BBC News : Hertfordshire NHS breath tests for smokers before surgery

The Daily Mail reports in East Herfordshire’s attempt to bring in deserts based rationing for the obese and smokers.

Simon Clark, director of the smokers’ group Forest, said: ‘Forcing smokers to take a breath test is not only heavy-handed, it’s a gross intrusion of …

Politicians need to speak out for or against deserts based rationing. If they don’t it will occur by post-code and by default. Rationing does not happen at present according to the politicians…. Not all obese people are couch potatoes, and some have genuine medical conditions. The Hertfordshire proposal is the thin edge of a very large wedge. If perused ad absurdum, we could end up dealing with alcohol, violent sports and assaults, car accidents and even worse, self harm in a deserts based way. The only way forward is an open discussion, a pragmatic compromise, acceptance of rationing, and a period of “warning” so that those who would suffer can clean up their act. And that’s not to mentioned unplanned pregnancies or STDs…..

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Obese and Smokers could be “punished” by deserts based rationing?

A deserts based approach to bed blocking and obesity? How could we encourage families to take their relatives home?

Which party will embrace any form of deserts based rationing?

Its not news to GPs or the Surgeons: Covert, Post-Coded, deserts based rationing is official policy

Devon Health Board deserts based rationing – and political dishonesty & denial at Cabinet level at PMQs.

Overt (deserts based) rationing? – “NHS to ‘ration’ routine operations for obese people and smokers”.

Care for UK military veterans is ‘flawed’, medical experts say – deserts based rationing endorsed but not implemented?

Couch Potatoes deserve deserts based rationing..

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Relatives of registered organ donors block more than 100 transplants a year

Sometimes rationing occurs by the people – probably through fear and ignorance. This is a major reason for the opt out rather than opt in law on organ donation. Rachel Naylor reports for the BBC: Hundreds of families block organ donation

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The Telegraph reports 19th October: Relatives of registered organ donors block more than 100 transplants a year 

Objections from relatives have stopped more than 100 organ donations from taking place each year, it is reported.

Figures from NHS Blood and Transplant Service (NHSBT) have shown that 505 families have blocked donations from taking place in the last five years – despite the deceased being a registered donor.

The data was obtained by the BBC, with one would-be donor telling the broadcaster she was worried her family may not support her wishes.

The 17-year-old, referred to as Rachel, told BBC Radio 5 Live: “I wasn’t aware when I signed up that your family had to be supportive of your decision. It seems like, well, what’s the point of signing up if it could be overruled anyway?

“It does worry me because, if I died now, my mum does make the main decision. I hope I can trust her to make the right one.”
Laws surrounding organ donation suggest that consent is given by the deceased – but the wishes of relatives are respected.
Similar figures were published in January last year, suggesting relatives blocked transplants in 547 – or one in seven – cases since 2010.
In response, the NHSBT said it would no longer seek a family’s formal consent in order to reduce the number of “overrides”.

The latest figures come weeks after Prime Minister Theresa May announced a shift in “the balance of presumption in favour of organ donations” in England, saying it will give more people a realistic chance of receiving a transplant.

The proposals would see changes to the current system whereby those wishing to donate their organs have to opt in, which requires registration on a scheme run by NHSBT.

A Government consultation on “presumed consent” will look at whether there should be a reversal of the rules in which people would be automatically entered on to the donor register – unless they choose to opt out.

Mrs May told the Conservative Party conference that 500 people died last year because a suitable donor organ was not available.

“Our ability to help people who need transplants is limited by the number of organ donors that come forward,” the Prime Minister said.
“That is why last year 500 people died because a suitable organ was not available. And there are 6,500 on the transplant list today.
“So to address this challenge that affects all communities in our country, we will change that system. Shifting the balance of presumption in favour of organ donation.”

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At a glance | How to become an organ donor

How to register:

Fill in a form at http://www.organdonation.nhs.uk

Or phone 0300 123 23 23

You can also join when:

Registering for a driving licence

Applying for a Boots Advantage Card

Registering at a GP surgery

Registering for a European Health Insurance Card (EHIC)

Private Medical Insurance options… Going to get more popular? Our leaders show us the way.

PMI or Private Medical Insurance is going to get more and more popular in the next few years. There are several choices to be made, especially regarding the company, the excess and whether to go for full cover, family cover or even “group” cover. It is not inconceivable that groups of professionals or trade unions might club together to get a group policy. These are much cheaper than individual cover.

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As the standards fall, and complication rates rise, infections will get more common, and the risk reduction by going private will be the greater. Don’t forget that Private Medicine escapes from complications either by prevention (No shit in this theatre) or by transferring to the UK’s 4 health services when things go wrong.

Private Medicine does take away from health services’ waiting lists, and as such the gain to the 4 health services is much greater than the loss of £250 million annually. However, as the percentage of citizens who choose PMI or just to pay outright increases, there is a more obvious health divide. Those who can afford it have operations at a time they choose, from a consultant and not a junior, and have less complications and get back to full function more quickly. The morbidity of waiting for 160 weeks as in N Ireland cannot be measured, but we know that heart complaints and obesity are likely.

Choosing a high excess means a lower premium, but the reason you take out this option is for disasters. These might include an exclusion from a NICE approved cancer treatment in your particular post code. I have not been able to research helicopter transport options to Tertiary Cardiac Surgical centres. In remote areas of the country citizens are too far from such centres to reach them in time for a stent in the event of a heart attack……

Casualty (A&E) services are degenerating as well as planned care. It may not be long before ambulances ask if you might like to go to a private A&E ….. These are NOT covered by most policies.

40% of what a GP sees has a psychiatric element to it, and 40% of GPs in training do not get psychiatry in their rotations. PMI can be perverse in its application, especially in Mental Illness. In Australia the actuaries have commented: “Insurers offer perverse incentives on mental health claims”. (Banking and Finance in Australia) Mental Illness can be long, and making a claim is laborious. Once claiming successfully there is less incentive to get back to work quickly than there is with physical conditions, according to actuaries.

Whether you decide to pay directly or insure, remember that premiums rise as you get older, and are higher still for those with pre-existing conditions, Even if your cancer is cured and 5 years old, you may well be loaded or even rejected.

NHSreality predicts PMI will get more popular, and that there may be differentially higher rates in regions whose services are worst, as more claims will be made. Our “leaders” will show us the way…

Chris Smyth reports October 20th in the Times: NHS spends £250 million patching up private care

Paul Gallagher for Inews reports: Junior doctors in private hospitals ‘left in charge of up to 96 beds each’

MoneySupermarket offers a comparison website. as do many others.

The big UK players are: AXA PPP,         Aviva,        Western Provident,         BUPA

and of course there is the Benenden low cost option (Mutual) which excludes cancers, and only operates when waiting lists are longer than their policy (always these days)

23rd August 2017: Best private health insurers revealed by Which?

In Dentistry the same players offerings can be compared, as well as Denplan

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Drivers for more PMI: (Our leaders show us the way) Waiting times, Choice, Standards, Risk reduction….

Government officials, former Chairmen and CEOs of Health Trusts, and Politicians all choose PMI. Why? (The Express 18th October 2017: Anger as new NHS watchdog chief REFUSES to give up private …)

As the UK disintegrates there will be competition for professions in shortage. GPs are the gatekeepers and the single reason the system has been “efficient” in the past. Now there are Concerns Cornwall could lose GPs to Devon over pay

NHS problems and Waiting Lists are unacceptable : NHS Health Check: Hunt says NHS problems ‘unacceptable’ reports Nick Triggle for the BBC on 10th February.

NHS Health Check: Which part of the UK is doing the best/ (worst)?

Faye Kirkland and Phillipa Roxby report: NHS Health Check: A&E waits for January ‘worst ever’

Full article The 10 ‘longest’ hospital delays exposed

l article How one GP practice tackled waiting times: 

Jeremy Hunt: We must do better on NHS waiting times

Self-harming up by 70% among young teenage girls. Is social media responsible?

Social Media can be very useful, but without school rules it can be destructive. Without household rules it can be intrusive, and without societal rules it can be dangerous. Young people can become addicted easily, and every family needs to work out it’s own solution to being responsible. Recently I have turned my mobile to silent so that it is innocuous. After all its main use is as a comfort for emergencies.. Just like the health service, without co-payments and social responsibility, mobile phones get abused and overused…

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James Gillespie and John Lawless reported 23rd July 20187: Hundreds of under‑13s treated for self‑harm and then

Nicola Woodcock reports 19th October: Self-harming up by 70% among young teenage girls

The number of girls aged between 13 and 16 who harmed themselves rose by 70 per cent in three years, but the number of boys and older girls remained stable, according to a study of GP records.

Children who harm themselves are nine times more likely to die from causes such as drugs or violence and 17 times more likely to kill themselves.

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The report, by Manchester University and published in the British Medical Journal, used figures from almost 17,000 young patients at one in six GP practices across Britain. Previous research had been based on hospital statistics.

The overall rate of self-harm was 37.4 per 10,000 for girls and 12.3 per 10,000 in boys, but between 2011 and 2014 the proportion in girls aged 13 to 16 rose from 45.9 per 10,000 to 77 per 10,000. The real number could be higher as the study covers only incidents reported to GPs.….

Natasha Devon on October 19th opines: Self-harming is the anguished cry of a generation

Only 15 per cent of people who self-harm ever disclose the truth, according to one expert in the field. Furthermore, statistics usually only take into account classic behaviours such as cutting and those cases severe enough to warrant hospitalisation. While shocking, figures such as those released today on the soaring rates of self-harm in teenage girls can only ever really show us the tip of the iceberg.

There is a tendency to dismiss self-harm as “attention seeking” but it is, in reality, always an attempt to communicate some form of distress. Any psychologist worth their salt will tell you that their aim must not be simply to stop the self-harming behaviours, which are often a necessary coping mechanism, but to identify and deal with the underlying anguish.

On a national level, the government needs to see these dramatic increases in self-harm as representative of a generation of young people trying to communicate their distress. It needs to identify and address the causes.

My suspicion is that it will be reticent to do so, since I was unceremoniously fired as the government’s first ever mental health champion in May last year after speculating that mental illness in young people was being fuelled by changes to the education system, teacher stress levels, child poverty and concerns about future prospects.

Theresa May needs to stop behaving like a campaigner and remember that she is the person with the power and control of the purse strings. While she has talked vaguely about “stigma” and pledged to train school staff to spot the signs of poor mental health in pupils, child and adolescent mental health services (CAMHS) were cut to the tune of £80 million between 2010 and 2016.

Furthermore, an investigation by Luciana Berger, former shadow minister for mental health, revealed that, owing to Jeremy Hunt’s refusal to ringfence £1.4 billion promised to local authorities for mental health services between 2015 and 2020, only half have increased their spending on services in real terms. The average local authority spends only 1 per cent of its total health budget on mental health, despite it now accounting for one in three GP visits.
Charity campaigns, royal interventions and this newspaper’s Time to Mind campaign have managed magnificently to empower people to speak about and seek help for mental health issues, but it will all be for nought if the services they need don’t exist.

Natasha Devon MBE is a mental health campaigner who works with 12 to 21-year-olds

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Check NHS cancer, A&E and operations targets in your area

The BBC has provided a comparative website for cancer care waiting outcomes. Put in your address/post code and find out the reality for you when / if you are unlucky enough to get an unexpected cancer. It’s good news we know what is unavailable…. Only one hospital in England MET IT’S TAGETS IN THE LAST YEAR. (Daily Mail)

The NHS is under unprecedented pressure. Rising numbers of patients need hospital care – whether in an accident and emergency department, for cancer treatment or for planned operations and care, such as knee and hip replacements.

For each there are strict targets local services are expected to meet across the UK. But what are the chances of being seen in time where you live? Use our interactive tracker to find out.


Check NHS cancer, A&E and operations targets in your area

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Measure Cancer Mortality rather than Cancer Survival rates. Invidious differences between UK Health Systems ..

The waiting lists differential in the 4 UK health systems will become evident in mortality and morbidity. Different regions of the UK ration differently, and the results will become evident to a discontented public. We are all in the same tax system, but our life expectancies are different depending on Post Code. Waiting for 3 years for cold surgery will usually increase other risks as well as ones related to the condition.

Northern has never met key NHS cancer target reports Marie-Louise Connolly for the BBC News today 18th October. 

Previously, yesterday BBC reported: NHS surgery waits run into years in Northern Ireland

Walesonline Mark Smith reports 15th September 2017 on Avastin being unavailable in Wales.

Cancer survival rates

Closing in on cancer” (September 16th) followed the reasoning that increased survival rates mean better cures. You did not take the lead-time bias into account. This occurs when a disease is diagnosed early or by screening before it becomes apparent. Early diagnosis and screening mean that the patient lives longer with the disease and the survival rate increases, independently of any potential treatment.

In the case of prostate cancer, more screening and earlier diagnosis take place in America than in Britain and explain much of the different survival rates. Cancer mortality is a better measure for improved treatment because it indicates how many people die from a given cancer.


Check NHS cancer, A&E and operations targets in your area

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They dont really care – they have known about the shortage of Radiologists coming for decades..

With a national shortage and prolonged systemic rationing of places in medicine and radiology, everyone needs to be a radiologist now

Radiologist shortage leaves patient care at risk, warns royal college (BMJ 2017;359:j4683 )

The UK does not have enough radiologists to meet imaging and diagnostic demands in the NHS, the Royal College of Radiologists has warned.

Nearly all radiology departments in the UK (97%) said that they had been unable to meet their diagnostic reporting requirements in 2016 within their radiology staff’s contracted hours, the college’s 2016 census report found.1 “This points to an insufficient number of radiologists to meet the increasing demand for imaging and diagnostic services,” it said.

The census received responses from all 202 radiology department leads in the UK. The workforce crisis comes at a time of well documented shortages in other specialties, including paediatrics,2 obstetrics,3 emergency medicine, rheumatology, psychiatry, and general practice.4

Radiology has the second lowest proportion of trainees to consultants when compared with other hospital based specialties, said the report, with 26 trainees for every 74 consultants, compared with an average in all specialties of 40 trainees for every 60 consultants. “This raises questions about the future replenishment and sustainability of numbers in the consultant workforce,” the report warned.

The census also found that nearly one in 10 UK radiologist posts (8.5%) were vacant during 2016, nearly two thirds of which (61%) were unfilled for a year or more.

Although the proportion of whole time equivalent consultant radiologists in the UK increased by an average rate of 3% a year over the past six years, the workforce has not kept pace with an increase in clinical demand, the report noted.

The workforce shortage was particularly prominent in Scotland, where the consultant workforce grew by 7% from 2010 to 2016 but demand for computed tomography and magnetic resonance imaging scans increased by over 10%.

The census also found that 22% of the consultant radiologist workforce (698 consultants) were predicted to retire in the next five years. The report said that this and the shortage of consultants raised questions about “the sustainability of radiology services in the near future,” adding, “Unless the situation is addressed urgently, there is a clear risk that patient care will be significantly affected.”

The NHS paid nearly £88m (€98.5m; $116m) in 2016 for backlogs of radiology examinations to be reported, the census found—an amount that could have paid for at least 1028 full time radiology consultants.

To cover the backlog, 92% of radiology departments paid radiologists to work overtime, 78% outsourced reporting to independent teleradiology companies, and 52% employed ad hoc locums.

Everyone’s a radiologist now (BMJ 2008;336:1041 )