I reconsidered signing off in September and the irregular entries and their observers have encouraged me to continue. Oct 2nd and I am going to try to enter something at least weekly.
Slowly, reluctantly and painfully the public and politicians are being forced to face the reality of their different Regional Health Services. Don’t forget to consider avoiding Hospital in August. If you are on the waiting list for a cold procedure. If invited to attend, you might like to reconsider and delay for a month or so, depending on the urgency. The RHS, and the NHS before it, have done really well for 65 years. Life expectancy is vastly better than it was (better than the USA), our perinatal mortality is good, and patients are empowered with information if they want it. Depending on where they live, they may have the opportunity to make use of that information and behave autonomously. But standards of delivery, and of training are falling.. and border issues expose the risks of regionalisation (In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear – Aneurin Bevan). The privatisation of the NHS holds many risks and most of the profession fear we are in for a period of decline in both finance and standards… This is not absolute and with overt rationing (such as co-payments for GP attendance, bringing back prescription charges, encouraging autonomy by excluding low cost high volume services, removing regional barriers and lack of choice, etc.) we should get by. and preserve the “Crown Jewels”.
My own experience of the Health Service has been a good one (on the whole) and I have recorded it as a summary document: My own family and the NHS.
BBC Wales reports: 25 July 2013 NHS neglect: Calls for inquiry after woman’s death
By India Pollock BBC News
Is the penny dropping in Wales yet? The hospital here are probably all “Mid-Staffs”, but the comparative data is unavailable.
BBC News 16 July 2013 Keogh review: Hospital death rates
Fourteen NHS trusts in England have been investigated as part of a review into higher-than-expected hospital death rates.
BBC News 25 July 2013 Coroner’s court overhaul begins in England and Wales
Perhaps the Coroners will be able to insist that we have comparable information, at least on deaths, across the Regional Health Services.
19 April 2013 GlaxoSmithKline accused of market ‘abuse’
Robert Peston, Business Editor, reports for BBC 16th & 24th July:
The Telegraph reports (Malcolm Moore 25th July): GSK: caught up in a Chinese puzzle
Accusations of corruption against GlaxoSmithKline in China have led to a state-backed campaign against the company. Is it being used as a scapegoat for wider abuses?
Drug companies are getting more open. They have (a)greed, led by Glaxo, to publish all research whether positive or negative for a product. What they have also done is replace government in most forms of research, which is now market led. The market gives money and profit to the elderly in the G8 countries, so that is where the bulk of research is aimed: at what are called “lifestyle drugs”. China is a different market, expanding and aging rapidly, and I expect there is some jealousy in the Chinese that none of their companies has the know how to compete with Glaxo’s selling techniques….. Which it seems may have been utilising the Chinese cultural lack of clarity and endemic bribes..
The Times Chris Smyth 25th July reports: Mystery over sudden rise in national death rates
“Thousands of elderly people have died unexpectedly during the past year, driving a rise in overall death rates that is baffling public health chiefs, a leaked government report has revealed.
About 600 more people died every week this year than the weekly average for the past five years which is about 10,000 deaths.”……
The Times Leader 26th July reports: Looming Crisis. The problems in A&E are a harbinger of a struggle to come for the NHS
The Telegraph reports and asks a question 24th July:
Mats Persson is Director of Open Europe, an independent think-tank with offices in London and Brussels campaigning for EU reform. He asks “Should the EU really be involved in how the NHS is run?”
The European working time directive, the lack of controls over language as an issue for good communication between staff and patients…. All are affected by Euro rules….
The Telegraph’s Nick Collins 24th July reports: Britain’s A&E departments are facing a serious crisis next winter because the pressure they are under is not being treated with “sufficient urgency”, MPs have warned.
“Emergency units are expected to face unprecedented demand next winter but MPs on the Health Committee accused the NHS of “flying blind” to the problem it faces.
Ministers and NHS managers have failed to plan for the potential surge in demand and must act now to prevent disaster later this year, the committee claimed following an inquiry into emergency services and care……”
The political system dictates that politicians’ time horizons are less than a term in office, and it takes 10 years minimum to train a doctor… The media meanwhile, expects even shorter returns and scapegoats the current administration for mistakes and omissions made by preceding governments.. Only a Proportional Representation (P.R.) system can address these issues, and as he media become less prominent and powerful (and diverse) under P.R. they will fight against it.
I retired in 2012. I am capable of work, but the working conditions for doctors have changed so much, and the shape of the job has changed so much, that I am not sure I would do it again. Certainly there are now two types of GP. Firstly those who cover OOH, or locum in many practices and are acquainted with many computer systems, and are able to treat emergencies well. There is another type of GP, who in response to the GP contract has become a “chronic disease” expert. He works at his desk at a computer most of his day. He spends 1-2 hours processing letters and information gathering, he spends 6 hours consulting in Surgery, and he has 1-2 hours of visits, and 1 hour administration and management. He may be a Trainer and supervise several juniors as well. No wonder they both often opt to go Part Time. Both types of GPs have to maintain their skills and write up a demanding “portfolio” of their learning “on line”. The second type of GP is also being de-skilled in emergency medicine.
Since the new contract, GP has become much more attractive to female doctors. If GPs are “obliged” to do weekends and Out of Hours (OOH) then this trend may reverse.
The NHS was formed to address “fear”. The public does not fear chronic diseases, but it does fear emergencies and being seen by an incompetent or being treated in a demoralized, unsafe and uncaring system. GPs need to be complete doctors again, and do be emergency doctors if “In place of fear” is to be reality. If this means GP is less attractive to females, so be it.
But whatever happens, we still have unlimited demand, limited resources, and no disincentive to make a claim. Who will be the first politician to address rationing overtly?
HE WILL BE THE HERO OF NHSreality.
By Sophie Borland 24 July 2013 in The Daily Mail reports: Bed-blockers are taking up two wards in each hospital: Nearly 5,000 patients cannot be discharged because of lack of home care
25 July 2013 BBC News reports: Stafford nurses struck off over waiting times
This is what happens when staff listen too much to management and put managerial needs above those of the patients. It is the “line managers” who should be in the dock, and they will have instructions from their Board!
25 July 2013 BBC Wales reports: Betsi Cadwaladr health board accepts mismanagement report
BBC News 17 July 2013 Barts Health NHS Trust calls in finance help squad By Karl Mercer Political Correspondent BBC London – even the largest Trust is in difficulties. Just wait – they will have board resignations soon)
BBC News 27 September 2012 NHS could get worse from 2013, say finance chiefs
“Next year could be the turning point for the NHS in England when finances unravel and the quality of care starts to get worse, finance chiefs say.
The King’s Fund research, based on its own analysis and interviews with 45 finance directors, found that standards were currently being upheld.
But it warned from 2013 that would get more difficult and care could suffer…”
A reminder from Wales on Line on 21st May: Health minister accused of dodging questions over West Wales NHS overhaul
Are we any closer now? Why not delay a decision until after the next election, and the one after … and the next…?
Chris Smyth Health Correspondent from the Times reports July 27 2013
Hundreds of staff at the Care Quality Commission say they have been bullied by bosses at the troubled NHS regulator, an internal report has found.
Chris Smyth Health Correspondent The Times July 27 2013 Wales’s biggest hospital has been branded “dangerous” after a visit by the Royal College of Surgeons
26 July 2013 BBC Wales reports University Hospital of Wales ‘addressing’ danger claims
26 July 2013 BBC Wales reports: MP calls for inquiry over Cardiff hospital report
An MP (Anne Clewydd) has called for an inquiry after surgeons said patients had died waiting for heart surgery at the University Hospital of Wales (UHW) in Cardiff.
Lindsay McIntosh Scottish Political Correspondent reports in The Times July 26 2013:
Health inspectors have ordered Scottish hospitals to make almost 100 improvements to their care of the elderly after finding a raft of shortcomings that included staff not treating patients respectfully and failing to assess them for dementia and malnutrition.
The Times Chris Smyth Health Correspondent reports on July 24 2013:
Plans to ease pressure on bursting accident and emergency units are inadequate and confused, and the entire system will become unsustainable without radical change, according to an influential group of MPs. (The blind leading the blind? In the kingdom of the blind the one eyed man is king – eyed man is king. Desiderius Erasmus)
Chris Smyth Health Correspondent July 27 2013 reports: Review finds culture of fear and blame at NHS watchdog
Hundreds of staff at the Care Quality Commission say they have been bullied by bosses at the troubled NHS regulator, an internal report has found.
Chris Smyth Health Correspondent reports in The Times July 26 2013:
A majority of GPs now back charging patients for appointments to reduce the burden on the NHS, a poll suggests.
Asking patients to pay to see a doctor would overturn one of the founding principles of the health service, but 51 per cent of family doctors now say it is necessary, according to a survey for the weekly medical magazine Pulse. Only 36 per cent of the 440 GPs polled said that they opposed charging an appointment fee of between £5 and £25.
The Independent 25th July 2013 reports:
Doctors say that patient demand has become unmanageable
The ideal of an NHS free at the point of need was dealt a serious blow today, as a survey of family doctors revealed unprecedented levels of support for charging patients for routine appointments.
For the first time in recent memory, more than half of GPs believe patients should pay fees to see their doctor. The majority of those in favour said that charges should be between £5 and £25 per appointment.
GPs Back Charging Patients To See Doctor – Huffington Post 26th July reports
Published: Fri, July 26, 2013: the Express reports: Doctors want you to pay £150 for an appointment
FAMILY doctors want to charge patients up to £150 just to make an appointment.
A new survey has discovered a majority of GPs are in favour of a deposit system for appointments
The philosophy is being re-examined, not by Politicians or the Media but by Doctors. The demand side is being addressed by this suggestion, which has been successful in New Zealand…. A disincentive to make a claim (charging) can be refunded when the patient is on benefits: they get the money back a month later, but they still appreciate the real time value of the appointment. IS the NHS still to be “free at the point of access…”? What about the other “mantras”? Cradle to grave? (when most Hospices are run as charities) Without reference to means? Comprehensive?
And how about the border issues where patients are gaming: the right to “free prescriptions” in Wales, and to “Choice” in England? What about rurality issues and travelling costs, when patients in the periphery are denied the choice to go to excellent units even if they are prepared to wait longer? Is the “commissioning” of healthcare by GPS causing conflict in those GPs involved when the first duty of a Doctor is to “put their patient at the centre of their concern”? What will happen if one region uses disincentives and another refuses? How will we deal with the border problems? The thought that the media may still call it an “NHS” seems ironic…
If I get the chance to interview more politicians I will ask them whether they feel the Health Service if “founded on a rock” or on “shifting sands”?
Chris Smyth Health Correspondent reports in The Times July 26 2013:
The first nurses have been struck off as a result of the patient neglect scandal at Stafford Hospital which has shaken the NHS.
Sharon Turner was found to have said she didn’t give a “flying f***” about patients, falsified A&E waiting time records and threatened to make a colleague’s life hell to drive him out of the hospital. She called Asian doctors “suicide bombers” and “Osama’s mate”.
Tracey White, who still works at the hospital, called an elderly patient a “naughty little monkey” and told another who had arrived in A&E after an abortion she would have to wait “if you can do that to your baby”. She also changed A&E data to make it look as if waiting time targets had been met.
Camilla Cavendish in The Times Dec 7th 2012
Good News Chris Smith Health Correspondent reports for The Times July 26 2013:
A common blood pressure drug appears to slow and even reverse mental decline, a study suggests.
Dementia patients taking ACE inhibitors declined slower than those not taking them, while people starting a fresh course of the drugs saw a slight improvement in their brain function, a study found.
BBC News 26th July reports: ‘Dangerous’ Cardiff hospital report prompts MP’s inquiry call
Even a population in the South Wales corridor of 2 million is not enough for a quality cardiac surgery unit.
BBC News 27 July 2013 reports: Mentally ill people ‘hit hard by recession’
The economic recession across Europe has had a profound impact on people with mental health problems, research from King’s College London suggests.
Between 2006 and 2010, the rate of unemployment for those with mental health problems rose twice as much as for other people – from 12.7% to 18.2%.
Because mental illness does not get the sustained coverage in the media it is often hit hardest by the administration as it is seen as a soft target without much public sympathy. Expect more…
24 July 2013 Fergus Walsh for the BBC comments: Putting a price on life – meningitis B vaccine refused
Bacterial meningitis is perhaps the most feared of all childhood infections in Britain. It can kill or disable within hours of symptoms emerging.
So it may seem bizarre, even illogical, that the body that advises the government on immunisation should not recommend the introduction of a vaccine against the most common cause of the disease.
The Joint Committee on Vaccination and Immunisation (JCVI) has decided that a vaccine against meningitis B (MenB) is simply not cost-effective.
The decision makers are agents of the population. Your GP is your agent for care provision both inside and outside (privately) of your Regional Health Service.
Will he recommend you have this vaccination despite it not being available free? Is it worth buying it privately? I rather doubt it because herd immunity is what usually matters and in an epidemic the vaccine may be of no avail – but then it might be. We don’t have the evidence as yet, and if you choose to buy it you potentially become part of the evidence – and also of the “inverse care law”….
I have made a separate concurrent post on the risk of being ill in August.
25 July 2013 NHS neglect: Calls for inquiry after woman’s death By India Pollock BBC Wales News
The Sunday Times Sarah-Kate Templeton reports 27th July : If only he’d been born in the daytime
Lack of 24-hour consultant cover was one of the failings before the death of a baby
“EVERY large NHS maternity unit has a potentially unsafe level of consultant cover, new figures from the Royal College of Obstetricians and Gynaecologists (RCOG) reveal.
Since 2010, having a consultant obstetrician on the labour wards 24 hours a day has been recommended for the 57 maternity units across the country that handle more than 5,000 births a year.
However, not one has reached that staffing level, with the majority providing cover for only between 60 and 98 hours a week.
The Royal College of Midwives (RCM) has complained of a “demise of postnatal care”, with midwives who should be caring for mothers and newborn babies being used to prop up overstreched labour wards. ….”
NHS helpline sends ambulances to tackle coughs and sneezes reports Hannah Summers and Jon Ungoed-Thomas The Sunday Times 28 July 2013
“OVERWHELMED call-centre staff on the government’s new NHS 111 helpline are sending ambulances to deal with hangovers, coughs, colds and cat scratches.
It is claimed some centres are in such disarray that callers face delays to speak to a clinician and ambulances are sent out for minor ailments. One manager told an undercover reporter the non-emergency service was “unsafe” at weekends.…”
- Senior doctors described the scheme as ‘very worrying’
- They fear it could repeat the failures of the Liverpool Care Pathway
- Critics say paramedics could prevent patients getting life-saving treatment
and in similar vein 2 days earlier Jenny Hope reports:
- 2,000 procedures cancelled in three months at University Hospital of Wales
- Hospital confirm 15 patients have died while waiting for heart surgery
- Children given hearing aids to save time and money of grommets surgery
- Report also found failures in cleaning and sterilisation of theatre equipment
What on earth will the Welsh population and it’s media feel when they realise that their District General Hospitals are much worse than Cardiff….?
- Poll finds 51 per cent of doctors in favour of introducing charges
- But some fear fees will discourage sick people from seeking treatment
In The Telegraph a contrast is made by Graeme Archer 26th July: The human touch? Forget the NHS, try the Royal Mail
Two state-owned services offer completely different experiences
Charles Moore in The Telegraph 19th July comments: If the NHS embodies our social conscience, we’re in big trouble
“The health service is held up as saintly, and that has disabled attempts to reform it.”
Do you want a new job? Apply below for the poisoned chalice:
The Telegraph 24th July reports: Global search for new NHS boss
The outgoing NHS England boss could be replaced with someone from outside the UK with no experience of the health service, officials have said.
Sir David Nicholson, who has become embroiled in the Mid Staffs care scandal, will step down next year as chief executive of NHS England.
“The organisation’s chair, Sir Malcolm Grant, said he was beginning a ”genuinely open and global search” for a suitable candidate.
He told the Health Service Journal (HSJ) that all of NHS England’s current national directors had ruled themselves out of replacing embattled boss Sir David Nicholson.
Sir David, whose basic salary is £211,000, admitted that ”becoming the story” after the publication of the public inquiry into the care scandal at Mid Staffordshire NHS Foundation Trust contributed to his decision to retire.…”
No way this job can be done without rationing. Just a question of whether the new incumbent persists with covert or overt rationing, depending on his political masters.
Good News: BBC News 29 July 2013. Testicular cancer survival rates ‘soaring’ in UK
By James Gallagher Health and science reporter, BBC News’
Alice Philipson in The Telegraph 29th July reports: Almost all testicular cancer patients now recover.
Almost all patients with testicular cancer recover from the disease, according to new figures from Cancer Research UK.
Survival rates for the disease have risen by almost a third since the 1970s and more than 96 per cent of men who contract the cancer today are now cured.
James Gallagher Health and science reporter, BBC News reports: 29 July 2013 NHS Direct wants to end 111 phone service contracts
I invite the management to do an interview for me..
A reduction in bed numbers and an increase in hospital admissions has led to boarding becoming more common
Moving patients between wards results in them staying in hospital longer and increases the risk of infections spreading, researchers have warned.
One of the risks that can happen to a patient is to be farmed out to a non-specialist ward following a specialist procedure. The potential for complications in the recovery is not recognised as easily in the “barded out” ward. This would never happen in a private hospital, as they don’t have to deal with the emergency admissions that make such a move necessary in the first place.
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4696 (Published 25 July 2013)
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4675 (Published 22 July 2013)
Policy without evidence. I am unaware of any evidence that health checks work on populations…
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4671 (Published 22 July 2013
BMJ reports: The birth and death of the Liverpool care pathway
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4669 (Published 24 July 2013)
I can do no better than quote from the author: “The decision to phase out the pathway shows how sensationalist journalism can dictate health policy and gives implicit credence to some of the more outlandish claims”.
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4609 (Published 18 July 2013) Tell this to the locals in the outer shires and they wont believe it. The “inconvenient truth” is that the voice of the media is given to those who prefer local low standards to higher centralised services.
29 July 2013 BBC News reports:
NHS Direct wants to end 111 phone service contracts By James Gallagher Health and science reporter, BBC News
30 July 2013 BBC News reports: Nurses ‘ration care due to time pressures’
The Times Chris Smyth reports: NHS Direct pulls out of troubled NHS 111 phoneline
“The future of the troubled NHS 111 service was thrown into doubt yesterday when its largest provider pulled out of all its contracts.
NHS Direct said it could no longer afford to carry on with the urgent care line after finding calls took more than twice as long as predicted.
No alternatives have been found for the areas where NHS Direct runs the service, but a spokeswoman said 111 calls would still be answered during the “planned withdrawal”. ….“
The Times Leader 30th July: Problem Direct
Withdrawal of a major supplier of the NHS 111 phoneline results from a failure in the contract negotiations
“From the moment pilot schemes were conducted it was obvious that there would be serious problems. It is not necessary to endorse the BMA’s call for an independent inquiry to agree that at some stage it would be nice to know why warnings were ignored and why the Department of Health decided to proceed even once flaws became apparent.
Yet there are two tasks that are more urgent. The first is to save the 111 line from collapse. It might be easier to revisit the contracts than to find others to step in. It is hard to see why alternative suppliers would not rapidly come up against the problems that drove out NHS Direct.
The second urgent task is to repair the broken contracting system in the NHS. Much of the reform programme depends on the ability to get complicated contracts right. The Department of Health must ensure that its system works, accepting the problems of 111 as evidence that at the moment it does not.
This is important for one other reason, quite outside the immediate problem. The Government has engaged in an ambitious reform programme across the public sector that depends heavily for its success upon competence. If it is going to retain confidence in its radical benefits reform it needs to show it can get a relatively simple thing like a phone line working…”
The article misses the point about cost v quality and the obsession with ousting of GPs from contracts. Could this all have a political imperative – to remove power from the professionals? And what happens when power cuts mean mobile phones cannot be charged? Wales can look benignly on at the “competitive tendering” fiasco…
Throughout the country GPs had bid for these services. They had “experience” and a good track record. They lost the contract on “cost” and not on “quality”, and now is evident the stupidity and short termism of the competitive tendering process….
The Times Laura Pitel reports 30th July 2013: Taxpayers’ £35,000 funds website to identify — waste
“Ministers have spent £35,000 of taxpayers’ money building a website — to help the public identify ways of saving taxpayers’ money.
The Government Interrogating Spending Tool, ( GIST), is described as “a powerful new online tool that gives taxpayers an unprecedented view of how their money is spent”. The data is already available in spreadsheet format but ministers believe it is too complicated for many people to understand.
The website reveals that every taxpayer in the UK on average pays £173 a month towards hospitals and health care and £224 on welfare and pensions.
The data shows that each person spends £16 a month on transport and highways, £61 on the armed forces and defence ministry and £80 on education. It also reveals that in the last three months £1.88p was spent by each person on the HS2 high-speed railway.…”
30th July Chris Smythe in The Times – Patient satisfaction survey branded a waste of £150m
“Patient groups have condemned one of the Prime Minister’s key health initiatives as a £150 million waste of money that made it impossible to compare hospitals.
First results of the Government’s “friends and family test” appeared to highlight 36 NHS wards where most patients say care is so bad that they would not want friends or relatives treated there.
Yet in only 11 of these wards did the number of patients responding reach double figures. In seven of them, one solitary patient completed the survey…”
Whether the Health Services try to bring in disincentives (co-payments) or rules (rationing), or not, there will be new perverse incentives (P.I.s) that follow every change. It should be the politicians’ and the administrators’ responsibility to analyse, publicise and discuss these in advance, and expose the potential for distortion, and to judge whether the changes will make the P.I.s worse or better overall. Whether trends in gagging and whistleblowing reverse or not will depend on the drivers and the incentives to change. This website offers any Health Service staff an opportunity to do an audio interview and send me their file for uploading. Any further postings will depend on this happening… Why not get a friend to interview you, and you could return the favour? Templates are on this site….
As nothing is likely to happen for some years, my suggestion for turnaround is to make each hospital an independent entity, both financially and administratively. The new “ownership” would allow redundancies and restructuring, and although local hardship would follow where access to tertiary centres became more difficult, at least we would have financial probity. Restructuring and new systems for universally applicable methods of access and rationing would follow.
Two interesting articles. One on finding a chief who can find a solution for The NHS curing all ills, and the other on Failing hospitals. What I believe is recorded in a previous post. Our Health Services are rightly something we can be proud of, and this can continue if we address the real issues and our politicians have the courage to act on rationing.
The Nuffield Trust has an informative Timeline for the NHS.
Human History becomes more and more like a race between education and disaster. H G Wells. The Outline of History 1920.