Monthly Archives: June 2013

Health Minister Mark Drakeford warns boards on spending

BBC  News reported 25th March:

Health Minister Mark Drakeford has not ruled out the possibility some Welsh boards could fail to balance the books by the end of the financial year.

But Mark Drakeford, who took on the role earlier this month, said he was confident the Welsh NHS “as a whole” would “live within its means”.

If boards do overspend he said he would expect detailed explanations.

So it’s not surprising when resignations follow..

Betsi Cadwaladr chairman and chief executive to step down after damning report

and of course there are s many more.

If you wish to see the detail ad how the Chancellor has relatively protected the NHS study the graphic below.

Basic CMYK

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Weekly News third edition: Brand Denial, death, bribery and corruption.

Week Three summary UK Health news. The volume is larger each week as the edifice falls.. It reminds me of the game “Jenga” – and implosive fall is the end – when will we see this?..

The Telegraph reports 21st June 2013: Hunt: NHS must pay ‘fair prices’ for medicines

accusations that drug companies secretly colluded with pharmacists to overcharge the NHS millions of pounds are “very serious allegations” and vows to get to the bottom of them.

Jeremy Hunt calls for ‘serious consequences’ if CQC ‘cover-up’ allegations are proven

Former executives responsible for a cover-up at the health watchdog could be stripped of their pensions, Health Secretary Jeremy Hunt suggested today.

The Times Philippe Naughton and Chris Smyth report 21st June 2013:

NHS cover-up officials could lose pensions, says Hunt

Former officials responsible for an “utterly shocking” cover-up at the country’s health watchdog could be stripped of their pensions in punishment, Jeremy Hunt, the Health Secretary, suggested today.

The Care Quality Commission yesterday named the executives who were in the room when it was decided to bury a report critical of the watchdog’s failure to act over the University Hospitals of Morecambe Bay Trust, where mothers and babies died.

They included Cynthia Bower, who was CQC chief executive at the time, and her deputy Jill Finney, who ordered a subordinate to “delete” the report. Also present was the CQC media manager Anna Jefferson, who is still at the Commission.

Ms Bower and Ms Jefferson have denied being involved in a cover-up.

Doing the round of broadcast studios this morning, Mr Hunt said that the CQC must follow “due process” in determining what sanctions can be imposed, but said he would back the regulator “absolutely to the hilt” if it chose to take action against individuals, including those who may have left the organisation.

He told BBC Radio 4’s Today programme: “These are very, very serious allegations and they should have very, very serious consequences if they are proved.

“I know the CQC are looking into disciplinary procedures and what can be done, what sanctions are available, whether you can have forfeiture of pensions, all those things.

BBC News reports Diabetes: Excess deaths well down, study indicates

By Adam Brimelow Health Correspondent, BBC News 21st June 2013:

The extra risk of dying for people with diabetes has fallen sharply since the mid 1990s, research suggests

It found in 2009 people with diabetes were 1.5 times more likely to die than those without it in a given period – down from two times as likely in 1996.

Stroke drug can ‘boost quality of life’

By Caroline Parkinson Health editor, BBC News website 21st June 2013

Patients given a clot-busting drug within six hours of a stroke are more likely to have a good quality of life 18 months afterwards, an international study suggests.

However, the review of more than 3,000 patients found the drug – alteplase – offered no improvement in survival rates.

The drug is increasingly being used in specialist stroke units in the UK.

21st June 2013 – Flawed NHS care ‘leads to 12,000 kidney deaths a year’

& NHS error rate a silent scandal, says Jeremy Hunt

The NHS must tackle the “silent scandal” of errors which meant 3,000 patients died needlessly last year, Health Secretary Jeremy Hunt has said.

In a speech in London, he suggested the UK had become “so numbed to the inevitability of patient harm that we accept the unacceptable”.

He also said the NHS had 326 “never events” – so unacceptable that they should never happen – in 12 months.

Doctor’s legitimate expectation of UK registration

Regina (Patel) v General Medical Council

Before Lord Dyson, Master of the Rolls, Lord Justice Lloyd and Lord Justice Lloyd Jones

Judgment March 27, 2013

A British resident who had undertaken a long course of study by distance learning at an overseas university relying on e-mail assurances from the defendant, a professional medical body with responsibility for registering doctors, that he would be entitled to register his medical qualification once awarded after completing all the clinical requirements, had a legitimate expectation of registration. The defendant body was not entitled to defeat that expectation by refusing him registration because the criteria for accepting overseas qualifications had since changed.

Speaking out cost NHS whistleblower his job. Laura Donelly in The Telgraph 22nd June 2013

Roger Davidson lost his job as head of media and public affairs for the Care Quality Commission just before the 2010 general election — after telling how a quarter of NHS trusts had failed to meet basic hygiene standards.

He was forced to sign a gagging order when he left and was told that the CQC was “railing against” his action to “highlight issues”.

It had previously stopped telling the public how to find reports on infections in their local hospitals to limit publicity damaging to the NHS, he said.

Claire Newell, Holly Watt and Ben Bryant in The Telegraph report:

Pharmaceutical scandal: firms boast of profits on drugs that cost ‘pennies’

Drug company executives have been secretly recorded boasting that they are selling regulated prescription drugs that cost “pennies” for hundreds of pounds because NHS price controls are so weak, The Telegraph discloses today.

Anthony Wells of YouGov reports in The Sunday Times 23rd June:

Pollwatch: six in ten people don’t trust the NHS

Hospital staff ignored Savile sex attacks reports James Gillespie in The Sunday Times 23rd June 2013:

The NHS could face even greater criticism than the BBC over Jimmy Savile when “damning evidence” is revealed in the reports into his predatory sex attacks at hospitals, according to one of the lawyers representing his victims.

Liz Dux, of Slater & Gordon, said the offences on NHS property were just as bad as those committed on the BBC premises and in some cases much worse.

Further, Dux said, the number of people in the NHS who knew of Savile’s behaviour was greater — and yet they took no action. She said one victim had been assaulted while lying on a hospital trolley going to have an x-ray, and another was passing in a wheelchair when she was attacked.

Camilla Cavendish in The Sunday Times 23rd June 2013 reports:

Deaths, incompetence, cover-ups: this was the NHS’s Hillsborough

…..Now, of course, we know that what went wrong at the Mid Staffordshire and Morecambe Bay NHS trusts was even worse than incompetence: it was incompetence compounded by deceit.

Morecambe Bay is the NHS’s Hillsborough. It changes everything. It shows that the NHS chief executive Sir David Nicholson was quite wrong to claim that the tragedies at Mid Staffordshire were “singular” — unique to Stafford Hospital. It seems more likely that there is systemic failure in many hospitals. And the report into Morecambe Bay suggests an alarming collusion between the NHS and other institutions…..

The Sunday Times leader published on 22rnd June says: Loving the NHS to death

“….The assumption is that Morecambe Bay and Mid Staffordshire are rarities but that may be because we are blinded by our love for the NHS.

We love the NHS, it seems, despite a creaking A & E service and GPs unavailable at evenings and weekends. And despite the fact that whistleblowers are demeaned or threatened with dismissal, as was the case with Kay Sheldon, a board member of the Care Quality Commission, the body that tried to cover up the appalling failings at Morecambe Bay.

Our love for the NHS is doing serious damage. Reform, the think tank, says in a new report that most of the things the government wanted to achieve, including shifting care from hospitals, a smaller and more flexible workforce, better integration of primary, secondary and community care, and greater choice for patients, are stuck at first base. Politicians are scared of meddling with this apparently much-loved institution. And as long as they are, its failings will keep on mounting.”

Luke Abbott reports on a poem read out at the RCN conference by Molly Case, a second year nurse at Grenwich.

Molly Case’s NHS speech: A shining example

Anecdotal evidence that there is still some pride remaining..

Breastfeeding figures fall as NHS budget is cut

Daniel Boffley of the Sunday Guardian reports:

Lack of support for new mothers in England leads to first drop in breastfeeding for nearly a decade, say midwives

Could this be interpreted as “deserts based rationing”?

Laura Donelly in The Daily Telgraph 9th may reports:

Hundreds of patients have operations on wrong body part

Hundreds of patients have suffered from major medical blunders such as an operation on the wrong part of the body, or a medical instrument left inside them after surgery, an investigation has found.

Jeremy Hunt: NHS errors mean eight patients die a day

Health secretary attacks lapses in safety at hospitals and clinics in light of CQC, Mid Staffs and Morecambe Bay scandals

Denis Campbell, health correspondent The guardian, Friday 21 June 2013

Katherine Murphy in The Observer 23rd June reports:

Government has let a culture of poor health care flourish

“There are individuals who should be held to account for failings in the NHS, but ultimately MPs must take responsibility

There is good news. The overwhelming majority of care in our hospitals is outstanding. The NHS may appear to be in crisis, but it is most certainly not in peril. The bad news is that if action is not taken soon, then it may be too late. Everybody knows what the problems are: there are pockets within which a culture of poor care is allowed to flourish; a system of regulation proved unfit for purpose; and a complaints procedure that all too often views the complaint as a problem to manage, rather than an opportunity from which to learn.

That was the most disappointing thing about health secretary Jeremy Hunt’s speech on patient safety on Friday. The measures he set out are worthy ones, but they aren’t the huge changes that are so desperately needed. The blueprint for true change was set out by Robert Francis‘s report .

Put the patient first every time. Reform the ineffectual complaints procedure. Ensure sound overall leadership. Enforce a duty of candour. Regulate healthcare assistants. That’s what the secretary of state and his department, should be committed to; that’s what the speech should have announced.”

I am afraid that it really is the politicians who should take the blame, over the last 20 years they have destroyed an honourable culture and institution – by their instructions to management and their denial of the need to ration. They have also regionalised health care which will lead to disintegration.

Andy Burnham denies NHS cover-up

South Wales Guardian reports 22rd June 2013

Former health secretary Andy Burnham has insisted he was “actively” working to identify problems at hospitals during his time in office after being accused of putting pressure on a regulator to tone down criticisms.

The senior Labour MP faced questions about whether he influenced the Care Quality Commission (CQC) at the time it gave Morecambe Bay NHS Trust a clean bill of health despite a series of deaths of mothers and babies at Furness General Hospital.

Tory MP Mr David Morris said “ …there were “serious questions for Labour to answer” particularly in relation to Mr Burnham’s time in office and the “crucial pre-election season” in 2010.”

Can the NHS be paperless by 2018?

All the tools to meet the paperless challenge are available; what’s needed now is the hiring of fresh-thinking people to instigate the change

Orlando Agrippa in Guardian Professional, Wednesday 19 June 2013

The NHS needs a culture change

The health service’s response to the Francis inquiry should be to engage and empower both staff and patients

Mike Farrarr Guardian Professional Wednesday 5 June 2013

How modern life is making us ANGRY: Waiting to see the doctor, traffic jams and crowded buses make us see red mist Nicola Rowe in The Daily Mail 21st June 2013 reports

NHS Core Principals

  • that it meet the      needs of everyone
  • that it be free at      the point of delivery
  • that it be based on      clinical need, not ability to pay

NHS constitution

NHS History A guide to the NHS by Geoffrey Rivett

Philosophy on the NHS

The Telegraph reports 9th Jan 2011 (with video): Andrew Lansley announces ‘new philosophy’ on health

The Government has said a patient-centred NHS is a “step closer to reality” as it published its plans for a radical overhaul of the health service.

The Mail on Sunday DR ROBERT LEFEVER 7th Sept 2012 reports

The philosophy of the NHS is wrong and Jeremy Hunt should look to American Paul Ryan for a dose of reality

….“My Ryan says that “Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government. Every time a tax cut is proposed, the guardians of the new medical-welfare state will argue that tax cuts would come at the expense of health care.”

He is absolutely right.

If the state takes over ultimate health care responsibility from the individual, there are inevitable consequences:

Individuals come to think that they have rights, and hence can demand a service without at the same time having to recognize that the service is inevitably the product of the life and work and integrity of someone else.

Any thinker who allows himself or herself to be the property of someone else ceases to think. Doctors who allow themselves to become mere units in state provision of health care, rather than people who are responsible for their own philosophical and mental integrity, are not worth asking the time of day let alone their opinions on clinical or personal problems.

People often assume that the state will care for the less fortunate. When presented with evidence that it does not do so, they complain that it should – but do not feel obliged to take any positive helpful action themselves.

Thus the state is the cause of the Inverse Care Law, whereby those most in need of help are least likely to get it. The state creates a cruel, arid, uncaring society that smothers individual compassion and human charity. …”

Britain must put health before political philosophy

Blindly defending the NHS does not make you noble, good, or compassionate. We must stop prioritising political dreams over people’s health

John Phelan 22nd Jan 2013 in The Commentator (on line site)

“It is sometimes said that the NHS is the closest thing the increasingly secular British have to a religion. And, like a religion, when questioned its defenders react with accusations of evil and heresy. When Daniel Hannan criticised the NHS in 2009 then Health Secretary Andy Burnham branded him “unpatriotic”.

The dogged defenders of the NHS are wedded to the idea upon which it was founded – the provision of healthcare to all, free at the point of use. In their love of this egalitarian idea they forget that the NHS exists to take care of people’s health, not to advance a political philosophy.

And so, when evaluating a healthcare system, what matters is not the political philosophy but how effectively it cares for your health. The NHS is just a tool, no more, no less, to be employed towards the actual goal of health care. The NHS is useful only so long as it achieves that goal more efficiently than an alternative system. It makes no more sense to get emotionally attached to the NHS then it does to get emotionally attached to a spanner.

Perhaps the revelations from the Alexandra Hospital in Redditch, of patients left screaming in pain, wallowing in their own faeces, starving to death, and receiving cruel treatment from nurses, will finally force the dogged defenders to wake up, grow up, stop relying on unthinking emotion, and critically evaluate our 64-year-old health care system….”

The Telegraph reports By Laura Donnelly, Health Correspondent,, and Josie Ensor 22nd June 2012

Victims of neglect at the Alexandra Hospital

The families of 38 victims of poor treatment at the Alexandra Hospital waited years for an apology after their loved ones were left to suffer appalling neglect. Here we tell their stories.

Patients starve and die of thirst on hospital wards

Forty-three hospital patients starved to death last year and 111 died of thirst while being treated on wards, new figures disclose today.

Laura Donelly 6th October 2012 in The Telegraph

Brand denial: the NHS has failed by Yorker on 7 December 2012

Admittedly it could have been many people, but this time it was a comedian with a background in psychiatry in denial about Britain’s disastrous NHS

NHS chief ‘offered bribe to hush up death of my baby’: Father’s shock at scandal-hit boss’s £3,000 cash deal
The Mail on Sunday Steven Adams and Martyn Halle 22 June 2013

24 June 2013 Tesco-style NHS plan ‘ridiculous’

By Nick Triggle Health correspondent

“Is it possible that the system that is operated by dentists and pharmacists could be applied to visits to the GP, too?”

The Times letters in reply:

Sir, As Nick Gamble says (letter, June 25), there already is a means-tested top-up contribution scheme operating within the NHS. Dentists and pharmacists have been running one on behalf of the government for years. It could be easily implemented by GPs also. After all, NHS treatment from a GP is not, at present, “free at point of delivery”, if it involves a visit to a pharmacy.

Dr Jeremy Ludford
Salisbury

Sir, Robert Leach (letter, June 26), when listing the advantages of a “Tesco NHS”, neglected to mention home visiting when needed.

Alan Porter
Camberley, Surrey

Sir, Robert Leach wants the NHS to be like his local Tesco. Perhaps he would be kind enough to advise us how he manages to get his groceries without paying?

Dr Ronald Watson (retired GP)
Slinfold, W Sussex

Doctors hit out at ‘folly’ of a 24/7 health service

Chris Smyth Health Correspondent  June 24 2013

Former CQC ops chief ‘sacked for raising concerns’

Philippe Naughton  in The Times  June 24 2013

A former director of operations at the Care Quality Commission claimed today that he was sacked after raising serious concerns about the way the watchdog was run.

David Johnstone said he was escorted from the premises then hit with a gagging order after putting together a plan to introduce fundamental changes in the organisation.

Doctors call for NHS to impose top-up fees.

Senior doctors will declare today that the NHS can no longer provide everything the public wants and patients may have to accept paying for some services themselves.

Melanie Hall in The Telegraph 24th June 2013

The Times By Michelle Roberts 25th June 2013

Breast cancer: Women at risk offered tamoxifen on NHS

Whistleblowers ‘must be protected’ RCN on BBC news

NHS ‘bean counters’ condemned in Scotland

Bean-counting NHS managers are accused of treating patients as widgets Dominic Lipinski/PA

Michael Glackin The Times June 25 2013

The leader of Scotland’s doctors has launched a blistering attack on bean-counting managers in the NHS who treat patients as widgets.

NHS chief Sir David Nicholson attacks media for lack of balance

Chris Smyth Health Correspondent June 26 2013

The controversial head of the NHS has accused the media of a “lack of balance” in reporting on the health service.

Sir David Nicholson, who is to retire next year after persistent criticism of his role in the Mid Staffs scandal, said the public needed to find a “better way” of talking about the NHS that included both good and bad points.

His intervention came after doctors at the British Medical Association launched a stinging attack on the “institutionalised dishonesty” of the management of the NHS.

The doctors’ union voted for a compulsory registration system for managers so that bosses could be struck off for failure.

Dr Peter Holden, of the BMA’s GP committee, told the annual conference in Edinburgh that managers worked “without any instinctive, institutional, corporate code of professional ethics and behaviour backed up by a formal professional disciplinary and registration regime.

“Pour into that mix bullying senior colleagues commercial imperative, political vanity, pay related to financial performance and then flavour it with local control of consultant contracts, gagging clauses and operate in a culture of secrecy and covert bullying.

“The result is the perfect toxic professional working environment for this explosive mixture to generate disasters such as Mid Staffordshire which did so much harm to patients. Not even in Communist China did they have managers overruling doctors in the operation of hospitals and health services.”

Sir David, the most senior manager in the English NHS, has said decided to retire after he “became the story” in the face of criticism by newspapers and families of people who died in Stafford Hospital.

He was briefly in charge of the health authority that was meant to supervise Mid Staffs and has been accused of presiding over a culture of bullying in the NHS. A no confidence motion in Sir David due to be debated by the BMA was dropped for lack of time.

Yesterday he posted a blog on the NHS England website saying he felt moved to add to public debate for the first time in 36 years in the health service.

He wrote: “The thing that characterises the views and comments for me is the lack of balance. For example, this time last year, in the wake of the Olympic Opening Ceremony, there was an outpouring of praise for the NHS. It was almost as if support for it had become close to being a religion. Read the newspapers over the last few weeks and it appears the NHS has become one of the worst health care systems in the world.”

He added: “Over the last few years hospital mortality has fallen significantly. At the same time the NHS has continued to fall short in the care of some of our patients, indeed for a small minority it actually causes them harm. Both of these statements are true, and if you chose to ignore either than we are in trouble.”

He asked if NHS leaders were “up to it” in the face of greater scrutiny from patients and the public.

I was ‘hung out to dry’ claims former CQC head Fariha Karim in The Times June 26 2013

The former head of the Care Quality Commission has said that she has been “hung out to dry” after she was accused of being involved in an alleged cover-up over the deaths of several babies and mothers.

Doctors spurn call for longer NHS hours. Jill Sherman, Roland Watson and Michael Savage in The Times June 26 2013

Millions of employees will lose automatic pay rises (Times Business)

George Osborne will announce the first steps towards performance-related pay across the public sector today as he scraps automatic salary rises linked with time served.

Teachers, council staff, nurses and most civil servants at present get a pay increase every year owing to time served — even during a pay freeze — costing the taxpayer £2 billion a year. This has made it impossible for Mr Osborne to contain the £160 billion public sector wage bill, despite a two-year freeze for most workers. The NHS, which employs 1.2 million people, typically had to pay its staff 2-5 per cent in pay increases. In March Mr Osborne announced a 1 per cent pay cap for a further two years in the hope of saving £1 billion, but the savings would be higher without progression pay

The NHS must treat patients, not statistics Rachel Sylvester in The Times 25th June 2013

Core Service – The Times leader 25th June

The BMA has a history of opposing change in the NHS. It must work with politicians to protect the service by changing it

NHS scandals: Dr Dan Poulter is wrong to compare Morecambe Bay with Mid Staffs – The Telegraph 25th June

It is not in the patients’ interests for politicians to heap scorn on doctors and nurses, writes John Woodcock MP.

Good News: HPV testing could cut cervical cancers by a third, finds study

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3888 (Published 14 June 2013)

Boys should be given cancer vaccine as well as girls: Telegraph 2009

And why has this not come about? Are we about to make the same mistake as we did for Rubella which was only given to girls for years, until US figures proved their whole population approach was correct.

Chancellor ‘raids’ NHS to find £1bn to improve pensioners’ social care Chris Smyth Health Correspondent  June 27 2013

An extra £1 billion of the health budget is to be diverted to social care, in what hospitals denounced as a raid on the NHS. George Osborne announced a doubling of the money siphoned from the NHS to help older people to stay healthy, saying that it would “end the scandal of elderly people trapped in hospital because they can’t get a social care bed”.

Doctors refuse to introduce health tourism checks Chris Smyth Health Correspondent , June 27 2013

Doctors have refused to enforce the Government’s planned crackdown on health tourism, saying it would mean asking to see the papers of anyone who “talks funny”. The British Medical Association (BMA) also rebuked Jeremy Hunt for having aired his views on abortion.

Why not incentivise GPs and all staff with a share of the profit if we are able to charge overseas tourists? See entry on Appendicitis in Morocco

Chaplaincy services cut in 40% of English NHS hospital trusts

By Alex Strangwayes-Booth Religious Affairs Reporter, BBC News27th June BBC News

Belfast Trust have ‘real problem’ finding experienced doctors

By Marie-Louise Connolly BBC Northern Ireland health correspondent

But in Southern Ireland there are far too many applicants for GP training places and many of them apply to England, Scotland and Wales, and are very good too. What a sad reflection on manpower planning. There are so many youngsters good enough to do medicine who are denied a place.

27 June 2013 Doctors admit problems with Liverpool pathway for dying By Nick Triggle Health correspondent

Figures show 20 per cent rise in number of cancer cases Chris Smyth Health Correspondent June 27 2013

The overall number of cancer cases has risen by almost 20 per cent, figures from the Office for National Statistics show. In 2011, 274,382 people were told that they had cancer, up from 232,999 in 2002.

First three-parent baby could be British if IVF ban is lifted

Rachel Kean: “It’s amazing to be given hope”

Hannah Devlin in The Times reports June 28 2013:

Britain is poised to become the first country to allow babies to be born with three biological parents under plans announced today.

The historic proposal would lift a ban on IVF treatments that can eliminate incurable genetic diseases by swapping less than 1 per cent of a mother’s DNA with that from a healthy female donor.

Trust disintegration, and a disintegration of Trust

The increasing list of resignations suggests my predictions when I started this site are coming about. N Wales executives had little choice and were going to be punished either way, but the financial imperative is first in the WG and they would be good candidates for audio interview – if only they are willing….

27 June 2013 Cardiff and Vale health board jobs at risk in staff shake-up

Cornwall hospital trust chairman resigns after two days 27 June 2013

Why are doctors so angry?  Doctors speaking during the debate were angry.

Led by consultant radiologist Jacky Davis, who said the NHS in England had been “wrecked” by the “vandals in Westminster”, speaker after speaker was critical of what was happening.

Traditionally the chair of the BMA, who at the end of debates gives their view on the issue, takes a more moderate line. But not this time. Dr Mark Porter said doctors should show no mercy

Chief executive resigns at Midlands trust 9 January, 2013 By Julia McWatt

Betsi Cadwaladr University Health Board chairman Professor Merfyn Jones resigns after damning report on board

27 Jun 2013 06:00 Auditor report warns breakdown of working relationships may contribute to “gap between the ward and the board By David Williamson

The chairman of Betsi Cadwaladr University Health Board has resigned after a damning report into the board’s ability to identify problems with quality and safety of patient care. … “The report expressed “very real concern” that the health board’s current service model is neither clinically nor financially sustainable.”

NHS trusts chief faces resign calls 22nd June 2013 in National News

A senior NHS official faced calls to resign over his links to a scandal-hit hospital trust where mothers and babies died.

Mike Farrar, who heads the body representing NHS trusts, was in charge of North West Strategic Health Authority (NWSHA) at the time of the failings at Morecambe Bay. The Parliamentary and Health Service Ombudsman (PHSO) confirmed it was investigating complaints against the NWSHA.

Trusts ‘used schemes to avoid VAT’ – Alexi Mostrous in The Times June 28 2013

Dozens of NHS trusts in England are under investigation by Revenue & Customs over their alleged use of schemes to avoid millions of pounds in VAT.

Up to 30 trusts used one scheme that allowed them legally to avoid VAT when employing locum or part-time doctors, according to an investigation by ITV news

Camilla Cavendish in The Sunday Times 23rd June 2013 reports:

Deaths, incompetence, cover-ups: this was the NHS’s Hillsborough

…..Now, of course, we know that what went wrong at the Mid Staffordshire and Morecambe Bay NHS trusts was even worse than incompetence: it was incompetence compounded by deceit.

Morecambe Bay is the NHS’s Hillsborough. It changes everything. It shows that the NHS chief executive Sir David Nicholson was quite wrong to claim that the tragedies at Mid Staffordshire were “singular” — unique to Stafford Hospital. It seems more likely that there is systemic failure in many hospitals. And the report into Morecambe Bay suggests an alarming collusion between the NHS and other institutions…..

The Sunday Times leader published on 22rnd June says:

Loving the NHS to death

“….The assumption is that Morecambe Bay and Mid Staffordshire are rarities but that may be because we are blinded by our love for the NHS.

We love the NHS, it seems, despite a creaking A & E service and GPs unavailable at evenings and weekends. And despite the fact that whistleblowers are demeaned or threatened with dismissal, as was the case with Kay Sheldon, a board member of the Care Quality Commission, the body that tried to cover up the appalling failings at Morecambe Bay.

Our love for the NHS is doing serious damage. Reform, the think tank, says in a new report that most of the things the government wanted to achieve, including shifting care from hospitals, a smaller and more flexible workforce, better integration of primary, secondary and community care, and greater choice for patients, are stuck at first base. Politicians are scared of meddling with this apparently much-loved institution. And as long as they are, its failings will keep on mounting.”

Philosophy at last…

NHS Core Principals

  • that it meet the      needs of everyone
  • that it be free at      the point of delivery
  • that it be based on      clinical need, not ability to pay

NHS constitution

NHS History A guide to the NHS by Geoffrey Rivett

Philosophy on the NHS

The Telegraph reports 9th Jan 2011 (with video): Andrew Lansley announces ‘new philosophy’ on health

The Government has said a patient-centred NHS is a “step closer to reality” as it published its plans for a radical overhaul of the health service.

The Mail on Sunday DR ROBERT LEFEVER 7th Sept 2012 reports

The philosophy of the NHS is wrong and Jeremy Hunt should look to American Paul Ryan for a dose of reality

Well lets hear it – autonomy or paternalism? Choice or no choice? Aspiration or lowest common denominator medicine? Approved methods and choices of rationing?

God News: Surgeon data: ‘Historic’ move for NHS

By Nick Triggle Health correspondent, BBC News reports 28th June 2013:

The first wave of new performance data for individual surgeons in England is being published in what is being hailed as a historic moment for the NHS.

Vascular surgeons have become the first of a new group of nine specialities to publish the information, including death rates.

It will appear on the NHS Choices website later. The other groups will follow in the coming weeks. (Only six have opted out)…..

Wales has f course not come on board, and comparators with rest of UK may not be welcomed… but they are inevitable and so I expect Wales will reluctantly adopt and agree to be led by England on this issue. The reason the WG may not like the information is that their electorate gets no choice outside of their own Trust. Commissioning is at a much lower and less competitive level, and allows rationing by localization and reduction of transport and contractual costs. But  – What is the good of information if you cannot exercise choice? As this information becomes more available, some people and usually those who can afford it, will vote with their feet, and use private means or gaming to go where they wish, thus increasing inequalities.

Good News: UK government backs three-person IVF

James Gallagher Health and science reporter, BBC News 28th June reports:

The UK looks set to become the first country to allow the creation of babies using DNA from three people, after the government backed the IVF (In Vitro Fertilization) technique.

It will produce draft regulations later this year and the procedure could be offered within two years.

Experts say three-person IVF could eliminate debilitating and potentially fatal mitochondrial diseases that are passed on from mother to child.

Expensive but of great benefit to both future generations and future costs… Will all the Regional Health Services allow concurrent equitable commissioning of this service…? Or will some poorer Health Boards have to ration it out?

Border Issues – When we will need border controls? Bevan’s “frontier” issues..

Cross-Border Health Care (England and Wales) from Theyworkforyou – Keeping tabs on UK Parliaments and Assemblies and Hansard 25th June 2013

“The basic problem can be simply stated. There are more than 20,000 NHS patients who are resident in England, yet registered with a Welsh general practitioner. Of these, some 3,500 are resident in my county of Herefordshire. Many of these people, like my constituents in the village of Welsh Newton—a Welsh name, but an English village—have no choice but to register with a Welsh GP because no English practice covers their location.

These people live in England, but they are being denied access to hospital services in England. That is grossly unfair, especially as for many, if not all, of them Hereford hospital is the closest and the best place to be treated. The situation also has the damaging knock-on effect of depriving Hereford hospital of revenue from patients who are being treated in Wales. The result is a double whammy: the patients cannot receive the health care that they want and need, and Hereford hospital, already undermined by the deeply iniquitous NHS funding formula, must suffer an unexpected additional financial burden. This burden is already becoming evident. Outpatient treatments for patients living in England but registered with a Welsh GP fell by 10% to 11% in March, April and May this year compared with the same period in 2012, and the hospital expects them to fall further in the months to come.” Jesse Norman (Hereford and South Herefordshire, Conservative)

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This problem goes back to the start of the WG – see this from 2008.ien wee choi

Wales now has more NHS patients than people as English flock over the border for free prescriptions By LUKE SALKELD 16 April 2008

And from the Daily mail in 2008:

“…and Hereford hospital, already undermined by the deeply iniquitous NHS funding formula, must suffer an unexpected additional financial burden. This burden is already becoming evident. Outpatient treatments for patients living in England but registered with a Welsh GP fell by 10% to 11% in March, April and May this year compared with the same period in 2012, and the hospital expects them to fall further in the months to come.”

Jesse Norman (Hereford and South Herefordshire, Conservative)

These two entries show that the public “swings both ways” to take advantage of whatever benefits are better in one region or another. Free prescriptions in Wales, lower waiting lists and choice in England (and probably better morbidity and mortality but are denied proper comparisons).

Can Welsh stronghold ensure continuance of free health care?

Julian Tudor Hart asks whether we can defend the NHS in Wales from increasing commercialisation outside our borders April 26th, 2013 From Clickonwales

Monmouth AM’s fury over NHS ‘Berlin Wall’ on Wales and England border

Nick Ramsay in the South Wales Echo 2nd Jan 2013

Mr Ramsay said he is receiving an increasing number of complaints from patients who are experiencing problems with accessing health services in English hospitals.

So the different Health Regions created a bureaucracy around border issues. They had to because of the politics which Aneurin Bevan had warned about in 1948:

The following statement was issued by the Bath, Gloucestershire, Swindon and Wiltshire Area Team, NHS England: (18th June 2013)

The cross border protocol was agreed in March and implemented in April 2013. Anthony Kealy, Head of Partnerships for NHS England, met with Ministers to discuss issues raised by Mark Harper MP about the cross border protocol and specific issues in the Forest of Dean. Ministers asked us to work with Wales to address this specific issue.

There was a videoconference on 11 June 2013 between NHS England, NHS Gloucestershire Clinical Commissioning Group (CCG) and colleagues from the Welsh Government and the Aneurin Bevan Local Health Board. The meeting focussed on English residents registered with a GP whose branch surgery is situated in England but is part of a Welsh practice.

Patients in Wales face cross-border specialist ops wait

By Owain Clarke BBC Wales health correspondent

Hospitals in England providing specialist care for Welsh patients have been told to delay some operations.

BBC Wales can reveal that health managers in Wales have threatened not to pay English trusts if they treat patients too quickly.

As part of a drive to save money, hospitals have been told to delay some operations, including heart surgery, until the end of March.

Update from Healthwatch Gloucestershire on cross border patient issues for Wales and Gloucestershire

England/Wales Cross Border Frequently Asked Questions

Wherever you live in the United Kingdom, generally you can use the NHS.

(Is this true for anything other than emergencies – is there still an NHS?)

However, the NHS is organised differently in each of the four countries – Wales, England Scotland and Northern   Ireland.

To make it easier for people living near the England-Wales border to understand how they can use local services, the Governments and NHS bodies on either side of the border have made some simple agreements, including a ‘cross border protocol’. This sets out ways to allow patients to see a GP over the border. Through the GP you are able to get other services in a fair and predictable way.

NHS in Wales ‘cynically takes money from English taxpayers’ 12 Mar 2013 00:01

A senior Conservative MP in a border constituency has attacked the NHS in Wales for not allowing patients to be treated in England.

A senior Conservative MP in a border constituency has attacked the NHS in Wales for not allowing patients to be treated in England.

Forest of Dean MP Mark Harper said English patients registered with a Welsh GP now faced longer waiting times and poorer quality services if they were barred from being treated in England.

He accused the Welsh Government of a “cynical move” to take cash from “English taxpayers” to maintain “under-utilised facilities”.

Conservative health minister demands action over health provision on the Wales-England border 26 Jun 2013 14:14

Anna Soubry warned ‘injustice’ between the English and Welsh health services must be tackles, in a debate about the 20,000 people living in England who are registered with a Welsh GP

Tensions over health provision along the Wales-England border have spilled over with a UK Government minister warning “injustice” must be eradicated.

During a debate focused on the welfare of the 20,000 people who live in England but are registered with a Welsh GP, Conservative health minister Anna Soubry demanded action.

Stating that people in Wales “unfortunately do not get some of the excellent access to services that we enjoy in England,” she said the interests of border communities must be addressed.

She said: “While it might not affect a huge number of people, it is a very important issue for them and they feel that there is an injustice. It behoves all of us to ensure that we eradicate any injustice.”

Jesse Norman, the Conservative MP for Hereford and South Herefordshire, led the charge, saying: “The basic problem can be simply stated. There are more than 20,000 NHS patients who are resident in England, yet registered with a Welsh general practitioner.

“Of these, some 3,500 are resident in my county of Herefordshire. Many of these people, like my constituents in the village of Welsh Newton – a Welsh name, but an English village – have no choice but to register with a Welsh GP because no English practice covers their location.”

He continued: “These people live in England, but they are being denied access to hospital services in England. That is grossly unfair, especially as for many, if not all, of them Hereford hospital is the closest and the best place to be treated.

“The situation also has the damaging knock-on effect of depriving Hereford hospital of revenue from patients who are being treated in Wales. The result is a double whammy: the patients cannot receive the health care that they want and need, and Hereford hospital, already undermined by the deeply iniquitous NHS funding formula, must suffer an unexpected additional financial burden.

“This burden is already becoming evident. Outpatient treatments for patients living in England but registered with a Welsh GP fell by 10% to 11% in March, April and May this year compared with the same period in 2012, and the hospital expects them to fall further in the months to come.”

Attacking the quality of Welsh services, Mr Norman said: “The fact that the Welsh Assembly Government Minister for Health and Social Services does not believe that choice is the basis of the health system in Wales means that my constituents do not have the choice of health care, hospitals or consultants that is their proper legal right. Secondly, the Welsh NHS’s performance in meeting its own waiting time targets continues to deteriorate.

“In England the waiting time target is 18 weeks, but in Wales it is 26 weeks, and that is regularly missed. Some patients are not even treated within 36 weeks.

“For example, some 4% of patients are not treated within 36 weeks at Cardiff and Vale hospital, according to recent Welsh Government statistics for April this year.”

Ms Soubry said: “I am very concerned that despite an English border patient’s right to register with a GP practice on either side of the border, that is not always possible in practice. I recognise that, in rural communities, patients often do not feel a choice is available, given that the most accessible practice is a Welsh one.

“I also recognise that many people are registered with a local GP in England but the main practice is over the border in Wales. Those people may not want to change their GP practice.

“We could understand why they might, because in Wales people unfortunately do not get some of the excellent access to services that we enjoy in England. I am very concerned about this.

“I am told by NHS England that it has asked its legal advisers to review their earlier advice on the protocol signed between it and the Welsh Government with reference to the specific concerns that ministers – that is, me – and the Welsh Secretary have raised.”

The Welsh Government has been invited to comment.

Cross Border Information for the NHS in Wales  24 May 2013

Direction and guidance for people in Wales looking for information on all cross border services for the NHS in Wales.

Working on the border between England and Wales

23 March 2013

The report of a second major conference looking at cross border care for people living on the border between England and Wales has just been published.

Priorities and plans for health services are devolved issues. The Department of Health is responsible in England and the Welsh Government is responsible in Wales.

And finally, the English/Welsh system of deliberate inequality may fall foul of European Law:

EU Directive on cross-border healthcare