Week 8 summary: Slowly, reluctantly and painfully: a signing off posting – reconsidered October 2013

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 16^th & 24^th July:

GSK’s Chinese lesson

Why didn’t Glaxo spot the alleged Chinese fraud?

The Telegraph reports (Malcolm Moore 25^th 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 25^th 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 26^th 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 24^th 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 24^th 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

Councillors in Carmarthenshire refused meeting with Mark Drakeford to discuss changes in Hywel Dda Health Board

Are we any closer now? Why not delay a decision until after the next election, and the one after … and the next…?

Review finds culture of fear and blame at NHS watchdog

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.

Gridlocked Cardiff wards are ‘a Welsh Mid Staffs’

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:

Inspectors tell Scots hospitals to improve care of the elderly

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:

NHS ‘flying blind’ over how to solve A&E crisis, say MPs

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:

Half of GPs come out in favour of charging fee for appointments

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 25^th July 2013 reports:

£25 to see your GP: Majority of doctors want to charge patients for routine appointments

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 26^th 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.

In The Huddersfield Daily Examiner 27 Jul 2013: Andrew Jackson: Missed appointments costs you and me time and money

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 Nurses are first to be struck off after Mid Staffs scandal

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.

Flashback: At last, compassion is coming back to the ward

Camilla Cavendish in The Times Dec 7^th 2012

Good News Chris Smith Health Correspondent reports for The Times July 26 2013:

Drug for high blood pressure may offer hope to dementia sufferers

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 27^th 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.…”

The Mail on Sunday Jonathan Petre and Stephen Adams 28^th July dramatise in the paper’s usual way reporting:

Ambulance drivers told NOT to take ‘death list’ patients to hospital: Patients who tell GPs they want to die at home could be denied vital emergency treatment

• 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:

Wales’ biggest hospital is dangerous, with  patients ‘dying regularly’ due to waiting list delays

• 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….?

On 25^th July  Sophie Borland reports: Most GPs want to charge up to £25 for appointments: Doctors want payments to stop patients turning up ‘for no reason’

• 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 26^th July: The human touch? Forget the NHS, try the Royal Mail

Two state-owned services offer completely different experiences

Charles Moore in The Telegraph 19^th 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 24^th 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 29^th 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..

29 July 2013 ‘Boarding’ increases hospital stays and spreads infections, researchers say

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.

16 July, 2013 Crispin Dowler of HSJ reports: Resignations announced at Keogh review trust

The BMJ reports: Future gaps in workforce pose an impending crisis for the NHS, report warns

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4696 (Published 25 July 2013)

BMJ reports: Drive to boost health checks in England is criticised

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 reports: Dependence of high deficit hospitals on bailouts is unsustainable, audit office finds

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 reports: Mortality rates after emergency surgery vary widely between hospitals, study shows

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 30^th 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.…”

29 July 2013 BBCs Nick Triggle Health correspondent

The importance of ‘healthy life expectancy’

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.

 With apologies to Luke Fildes from Punch Cartoons.

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.

National Health Service 1948 – YouTube

Clipped from a short 1948 film by the British government introducing the original aims of the British National Health Service …

National Health Service History

Human History becomes more and more like a race between education and disaster. H G Wells. The Outline of History 1920.

Agents are needed for NHSreality….

The problem of an organisation as large and complex as the Health Service changing for the better is immense. The reversal of gagging and the encouragement of whistleblowing needs to continue, but the pace of change is too slow to save the system from further deterioration.

Meanwhile more and more Trust Board members will resign, and their Exit Interviews will either not happen, or not be made public.

NHSreality needs agents around the country. Please think about whether you would be willing to help… by interviewing people you know in your locality. Retired consultants, GPs, managers nurses and other staff (working or retired) all make good witnesses…. Perhaps Community Health Councils would help in Wales, or perhaps the BMA and the RCN will take it on…

Please contact me on roger@burnspace.co.uk if you are willing to be an “agent”.

Dont be Ill in August & particularly on the 11/12th …. A reminder that nothing much has changed and how hard it is to make the change

The NHS (Jeremy Hunt in The Sunday Times 17th March 2013) is saying that deaths will be treated like airline accidents. If that is the case the NHS needs to consider why all its new pilots are allowed to fly the fleet aircraft for the first time on the same day!

The debate started in Dr Foster and was then reported in The Guardian on 23^rd September 2009: “NHS hospital deaths rise on day junior doctors join wards, study finds”.  Dr Foster’s Independence has possibly been compromised since then (Health Policy Insight – Editors Blog 9th August 2010).

• “The NHS has its very own black Wednesday, when death rates go up by an average of 6%” Sarah Boseley, health editor

There is never a good time to have a heart attack, but the wise person afflicted with clogging arteries might want to be especially careful in future to avoid stress and watch the diet as August rolls around.

The NHS, it is revealed today, has its very own black Wednesday, when death rates go up by an average of 6%; and there is a somewhat disturbing underlying cause – the arrival on the wards of a new intake of junior doctors.

On the first Wednesday in August every year, a freshly qualified set of junior doctors arrives on the wards. Pristine and eager and brilliant they no doubt are, but while they are finding their way around something unexplained and slightly perplexing appears to happen.

Researchers from the Dr Foster unit and the department of acute medicine at Imperial College London say there has been a suspicion for years that more people die on the day the new doctors arrive, but for the first time they have established that it happens – although they say the rise in deaths is very small.

They do not blame the doctors’ inexperience or confusion in the hospital and say it is also possible that only the severest cases are admitted in that week, because of the changeover.

Their study has international implications, the researchers say. “A similar effect has been recorded in the US (known as the ‘July phenomenon’),” they write in their paper, published today in the open-access journal PloS (Public Library of Science) One. But previous studies have looked only at a few hospitals.

The Imperial study is far bigger, scrutinising data from nearly 300,000 patients in 175 hospital trusts between 2000 and 2008. It compared death rates on the first Wednesday in August with the last Wednesday in July. The difference was most marked in medical cases, such as heart attacks and strokes, where there was an 8% increase in deaths; there was no difference in surgical cases.

“We wanted to find out whether mortality rates changed on the first Wednesday in August, when junior doctors take up their new posts,” said senior author Paul Aylin. “What we have found looks like an interesting pattern and we would now like to look at this in more detail to find out what might be causing the increase.

“Our study does not mean that people should avoid going into hospital that week. This is a relatively small difference in mortality rates, and the numbers of excess deaths are very low. It’s too early to say what might be causing it.”

Shree Datta, chair of the British Medical Association’s junior doctor committee, said the study had to be judged alongside others looking at mortality rates before and after junior doctors start their new jobs, but added: “Clearly even a small increase in death rates is of great concern and we need further research to see whether this is a real effect or an anomaly.”

The Scotsman August change-over for NHS doctors puts patients at risk Published on Wednesday 17 August 2011.

Thousands of juniors start jobs in NHS ‘killing season’ The Telegraph 1st August 2012

The MDDUS (Insurance company) in News – June 2012 August change-over “puts patients at risk”.

Daily Mail 28th June 2012 reports: NHS ordered to end the ‘killing season’ when patient death rate jumps as thousands of graduate doctors start work.

BBC News reported: doctor changeover ‘impacts on patient safety’.

Tuesday August 6th is changeover day. This is the day that juniors from Medical School are employed and paid to work for the first time. They have been studying for 5 years and it will be at least another 5 years before they complete their qualification by specialising in General Practice (shortest) or Plastic & Reconstructive Orofacial Surgery (Longest). The Consultants are often on holiday and locums are hard to find. Induction into the Health Service culture in the first day has often been so onerous that the junior is visibly dazed and overawed with the volume of information… Although the risk of adverse events reduces exponentially during this period, August is not the month to be ill. It is also true that patients have more chance of dying at weekends, so it follows that 11/12th August is very high risk.

My wife was once stung by a bee in the first week of August. The locum casualty officer (from another European country) either did not understand or believe me when I rushed her into A&E saying that she had been stung, was known to have anaphylaxis to bee venom, and needed adrenaline. As she went blue in front of us all,  the Doctor spent 5 – 8 minutes trying to put up a drip, and did not give any instruction to the nurses to give adrenaline. Finally the nursing sister said to me, after I had asked over half a dozen times, “Dr Burns shall I give adrenaline to your wife” and I replied “please, thank god!” She woke on the end of the needle, and was better within 15 minutes. Without my presence I rather doubt the treatment needed would have been administered at all…

Week 7 summary: Does the NHS have a leadership problem!

Does the NHS have a leadership problem? Nick Triggle reports in The Times 24^th July 2013:

Clear and accountable leadership is essential for any organisation that wants to be successful.

That is particularly true for something as large as the NHS in England, which has more than 1.3m staff and deals with 1m people every 36 hours.

But the latest report by the Health Select Committee raises an extremely worrying question: who is taking responsibility for what?

It’s even worse than this, as the politicians are not taking responsibility for its failing structure and philosophy. It has to  get worse until this is tackled face-on! In Wales and Scotland its slightly more difficult as the MPs can claim they have no influence on health at all, which is patently untrue when considering philosophy and structure.

The recent Kings Fund Animation reveals how complex the structure is:

and is available direct here.

Other news follows, not necessarily by date..

Norfolk and Norwich Hospital to break rules to cut backlog BBC News 4^th July

Norfolk coroner confirmed as health watchdog chairman

Adam Gretton reports July 17^th In the Evening News

19 July 2013 Cancer health issues warning by charity

Alcohol deaths in young women show ‘worrying rise’1

18 July 2013 Hospital inspections to be more robust, chief inspector says – By Nick Triggle Health correspondent, BBC News

18 July 2013 Francis inquiry into Stafford Hospital cost government £6m

18 July 2013 Full 111 rollout put back to 2014 By Nick Triggle Health correspondent, BBC News

The full rollout of the NHS non-emergency telephone service has been put back to next year, NHS officials say.

The 111 service was due to be in place in April, but five of the 46 services areas are still not live.

19 July 2013 CJD alert at Dublin hospital for up to 20 surgery patients

19 July 2013 Health Ombudsman to investigate more NHS complaints, By Simon Cox BBC Radio 4’s The Report

19 July 2013 Bain Capital buys stake in UK government blood company

17 July 2013 Cancer surgery: Tumour ‘sniffing’ surgical knife designed By James Gallagher BBC News

18 July 2013 Why not… privatise the NHS By Brian Wheeler Politics reporter, BBC News

Nick Triggle: 19 July 2013 Five ways the NHS landscape is changing

The health service in England has been hogging the headlines.

Nick Triggle: 17 July 2013 Failing hospitals: Are there more out there?

17 July 2013 Death rates review: Call for Lincolnshire trust board’s resignation

The entire board of a Lincolnshire NHS trust should resign in the wake of a critical report into high death rates, a Lincolnshire councillor says.

Four Ambulance board members resign – Chelmsford Weekly News 3^rd July 2013

Former hospital governors call on Dudley Group bosses to resign – Stourbridge News 17^th July 2013

22 July 2013 Staffordshire nurses wrongly recorded waiting times

Applying targets to staff provides perverse incentives to record incorrect information.

Good News: 22 July 2013 ‘Big leap’ towards curing blindness in stem cell study

Don’t fall ill at the weekend – Our campaign for a seven-day health service has been given new urgency by the disclosure that some hospitals have one consultant per 100 patients on Sundays

Sarah-Kate Templeton and Jon Ungoed-Thomas in The Sunday Times 21^st July 2013 – Full documentation as PDF here: Joining the fight to curb NHS weekend deaths

Revealed: NHS hospitals with one consultant for 100 patients – Jon Ungoed-Thomas and Sarah-Kate Templeton 21^st July 1013

Private patients ‘dumped on NHS’ – Andrew Clark Deputy Business Editor The Times reports 23^rd July 2013

Health groups in plea over new NHS drugs– The Times Scotland Staff July 23 2013

Fears have been raised that new drugs will only be approved for use by the NHS in Scotland if they help improve life expectancy for patients.

Camilla Cavendish’s reports on the NHS includes

Roll your sleeve up, doc, this jab of patient power will make the NHS better

Hole opens in No 10’s tobacco ‘smokescreen’

The PM scrapped plans for plain cigarette packs despite evidence that they cut smoking

Dipesh Gadher and Jonathan Leake in Sunday Times 21^st July

NHS urged Met to hide scale of Savile abuse – David Leppard

Oh joy, misery molecule found – Jonathan Leake, Science Editor (Good news?)

“SCIENTISTS have found the brain’s most miserable molecule — the protein involved in all our feelings of stress, anxiety and even depression.

They used one of the world’s most powerful x-ray machines to study molecules that jut from the outer surfaces of cells in the brain’s pituitary gland.

Scientists already know that the pituitary plays a crucial role in anxiety and depression by releasing stress chemicals into the blood. What they did not know was how the response was triggered, although a protein named CRF1 was a suspect…”

NHS hospitals with one consultant for 100 patients – Jon Ungoed-Thomas and Sarah-Kate Templeton

Doctors declare CQC not fit for purpose – BMA News 27^th June

and in an Editorial on 13^th July the BMA then comments on the publication of surgeons figures “Publication of these results is a major event in the history of the NHS and the medical profession.” BMJ 2013;347:f4402

Mortality rates after emergency surgery vary widely between hospitals, study shows

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4609 (Published 18 July 2013)

Cite this as: BMJ 2013;347:f4609

Time for a new approach to assessing the quality of hospitals in England

Managing Quality is as important as financial management for Trust Boards.

BMJ 2013; 347:f4421

GPs put the squeeze on access to hospital care

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4432 (Published 10 July 2013)

NHS paid £95m to dismiss managers who were later re-employed

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4471 (Published 10 July 2013)

Cut to the core – BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4469 (Published 10 July 2013) (Full PDF Cut to the Core by Fiona Goodlee, editor BMJ)

“….Jon Ford, head of the BMA’s Health Policy and Economic Research Unit, concludes that the NHS is being required to create efficiency savings equal to a quarter of its budget by 2016, something he believes to be “totally unrealistic” (doi:10.1136/bmj.f4422). It can only be achieved, he says, by slashing pay and staffing levels, which would make the service unviable…..”

The Mutually Agrees Resignation Scheme.

Isle of Wight CEO sent this letter in 2012. Ironic that it is often lack of staff numbers that is the real problem with quality.

Good News from 8^th July by Emma Innes in The Daily Mail

The ‘no-frills’ IVF that costs just £170: Budget treatment uses cheap test tubes but is as good as techniques costing thousands

• Technique could bring IVF within reach of millions more childless      couples
• Could cost less than £200 per cycle, compared to £5,000 in UK clinics      now
• It produces just as many viable embryos as the conventional method
• Technique uses two connected tubes – one generates CO2 to keep acidity      stable in the other, which is where fertilisation takes place

Also reported by Chris Smyth in The Times:

and on 13^th July by Michael Cook in Bioethics:

24 July 2013 A&E crisis plans ‘not good enough’ By Nick Triggle Health correspondent, BBC News

“… The MPs said a combination of staffing problems and a lack of alternatives along with rising attendances were among the main factors for the problems.

Their evidence found just 17% of hospitals had the recommended level of consultant cover, while problems with discharging patients and a lack of beds at times meant the flow of patients through the system was disrupted….”

This is all spin as a result of poor manpower planning and training of insufficient numbers of doctors. The UK has relied on doctors trained at the expense of poorer countries for decades, and there is no sign of a change. It follows that correction will take a decade (at least) as this is the time taken to train a doctor. This is without the realisation and leadership changes needed…. This whole page, my penultimate, is a vindication of the suggestions in NHSreality since I started the site on 1st March. The site follows five months of scandalous failure, institutional corruption and gagging, lack of care and unsustainable structures due to financial pressures… (Nationalise PFIs) Interesting that so many public figures and politicians choose non Regional Health Service care….

What a statement of confidence it would have been for the Duchess to have a normal HS bed, but then confidence in security and confidentiality would not have been possible, even if clinically they were happy!

The next post will be my last routine one on this site. There is enough evidence for overt rationing as a solution – it is all here from the last 5 months.

Barts (England’s largest) Health NHS Trust calls in finance help squad

17 July 2013 BBC News reports:  England’s largest hospital trust is to call in specialists to help it tackle its “biggest ever financial challenge”.

Sources at Barts Health NHS Trust have told BBC London if the trust did nothing it could face being taken over by outside administrators.

The trust had planned to save £77m this financial year but after three months it is already £15m behind its target.

It is already talking about cutting about 1,000 posts.

This is also reported in The Evening Standard (28 deaths) and comment also:

And the Guardian: London NHS hospital trust Barts Health losing £2m a week

It seems Barts Trust are certainly “changing lives”.. And dont forget the political imperative:

14 July 2013 BBC News NHS failings ‘suppressed for electoral reasons’

Even failing NHS trusts “had to deliver good news for the minister”, Prof Jarman said

An independent expert on mortality rates has suggested that ministers have suppressed details of NHS failings to avoid losing votes.

Roger Taylor in The Guardian 9th March 2013 reports: “We love the NHS too much to make it better”. Communal denial is the current paradigm, and it will remain until things get so worse that even the politicians have personal loss and embarrassment and start to speak out. When the largest trust in the country, probably with the best management, comes under such pressure it must be time to change the rules of the game.. Ration Overtly

A Cynic. (n.) An idealist whose rose-colored glasses have been removed, snapped in two and stomped into the ground, immediately improving his vision.  — Rick Bayan

Week Six summary: Hunt on deaths at NHS Hospitals “Failure or mediocrity is so deeply entrenched . . . that (Trusts) have continued to decline..

Week 6 summary

What a devastating week and how important is the Keogh report as a landmark event? It seems the public and the politicians are being bought face to face with the truth. The Health Services Journal reports on several trusts, and the local and national newspapers, either printed or on line, cover the others. We all need to ask our politicians when they will agree to even discuss the pragmatic rationing of services… then the debate can start about how we would like to ration. It is not unacceptable to ration, and it is done openly in all other countries. Ask yourself: “are some goods or services which are so cheap and easily available that everyone should pay for them, and are there some which are so expensive that we cannot afford them?” For those of us who love the Health Service this has been a very painful week.,..

BMJ 13th July: investigation finds GPs being forced to ration access to hospital care (see previous posting)

Liverpool Care Pathway expected to be phased out over ‘worrying standards’

Hollie Clemence July 13 2013 (see previous posting)

Chris Smyth, Health Correspondent July 13 2013

Ministers have been accused of not caring about the deaths of people with learning disabilities in their response to a report finding widespread discrimination in the NHS.

Smokers urged to join organ donor register Hannah Devlin, Science Editor, July 11 2013

Smokers, drinkers and people over 60 are being urged to sign up as organ donors in an effort to meet the increasing demand. (Why not all of us, and the same opt out as Wales? Better access for donors, especially if giving blood as well as organs?)

Good News: New drug gives prostate cancer victims hope Chris Smyth, Health Correspondent, July 11 2013

Men with advanced prostate cancer have been offered fresh hope as a powerful drug that can extend life by a third becomes available in England today.

Natasha Curry for the Nuffield Trust 11th June 2012. Low cost and high quality integrated care: what can we learn from Japan?

“Japan’s long term care insurance system provides an interesting model for us as we grapple with the thorny issue of social care funding”.

Bill Garner reports in The Sussex Argus 12th July 2013: Crawley health boss resigns over patient care fears

“A health boss has resigned over fears doctors could refuse to treat patients in a bid to save money. Dr Jerry Luke stepped down as medical director of Crawley Clinical Commissioning Group (CCG) because he believed cuts will affect patient care.

Hospital chiefs claimed doctors would never restrict treatments for low-level problems because of the cost but admitted to ordering a “rationalisation” of services. Speaking at a national medical conference, Dr Luke said: “CCGs only have one real duty and that is to end the year in budget. “CCGs are not allowed to run out of money. They can run out of services, but they cannot run out of money.

“I fear without the GMC [General Medical Council] telling us time and again that our patients have to come first, before the money, then we are going to be led by some of our colleagues who are quite happy to cut and slash just like the Department of Health wants.

“I personally am not prepared to carry on like this.”

At the meeting of Local Medical Committee, Dr Luke put forward a motion calling on NHS bosses to stop “putting financial targets ahead of clinical priorities”.

Other reasons Dr Luke gave for his resignation were a rise in practice workload and the bureaucracy involved in clinical commissioning.

Bosses at the Crawley CCG claimed cost-cutting would not affect patient care, but admitted Dr Luke had resigned partly in protest at the “rationalisation” of services.

Dr Amit Bhargava, clinical commissioning officer for Crawley CCG, said: “It’s all about living within your means. You can’t have people shopping in Harrods when the local Tesco would do just as well.

“What we have said to our GP colleagues is that a GP should never refuse care to any patient based on costs. But there’s going to be £60 million less in the NHS over the next ten years so there’s got to be a different way of providing services. There’s no other alternative.”

GP Christa Beelsey, chief clinical lead for the Brighton and Hove Clinical Commissioning Group, said: “I am pleased to reassure the public and patients in Brighton and Hove that we have not put any extra measures in place to limit GP referrals for any procedures deemed non-urgent or low clinical priority.”

I have reported the BMA enquiry into rationing, and my view that there will be more and more resignations. (Trust disintegration and a disintegration of trust.)

Waiting in hope for help: One Sussex person a month dying while on transplant list

GPs ‘rationing hospital care’

Nick Collins in The Telegraph 10th July 2013 reports: GPs are rationing patients’ access to hospital care, according to an investigation which found that regional managers are cutting costs by making it harder for patients to qualify for a host of minor procedures.

26 June 2013 Urine-soaked’ patients at Bupa Crawley care home

“Elderly care home residents in Crawley were left soaked to the chest in urine, a health watchdog report has revealed. The Care Quality Commission (CQC) found a series of failings including staff not supporting high dependency patients at Oakhurst Grange. Bupa, which runs the home in Goffs Park Road, said it was now being shut down.”

Jon Ungoed-Thomas and Sarah-Kate Templeton The Sunday Times14 July 2013 report: Scandal of NHS deaths at weekends

Isabel Oakeshott and Jack Grimston The Sunday Times 14 July 2013 report: Care worsens at inquiry hospitals

Two more board members resign from Cornwall NHS trust ITV News 28th June

Eastern Daily Press Wednesday, June 12, 2013: Union’s concern over sudden resignation of NHS trust chief

Sarah-Kate Templeton and Jon Ungoed-Thomas Published: 14 July 2013 report – Why we need a seven-day NHS

A young mother is one of thousands who have died because much of the NHS is shut on Saturdays and Sundays. Today The Sunday Times exposes the scandal and launches a campaign to improve care at weekends.

Interview with the mother of Rebecca Ben-Nejma who died after being denied treatment as no staff were available at the weekend to treat her condition

When Rebecca Ben-Nejma discovered that she was expecting her third child she was overjoyed. A few days later, she developed pains in her abdomen, and sought help at the accident and emergency department of Maidstone Hospital in Kent.

Doctors suspected an ectopic pregnancy, a potentially fatal condition in which the embryo implants outside the womb. But it was a Friday afternoon. The hospital was emptying for the weekend.

Instead of having the scan she urgently needed to confirm the diagnosis, Ben-Nejma was sent home with painkillers and told to come back on Monday morning.

By then it was too late. She collapsed on Sunday morning and died in hospital. She was 28 and left two children.

View the full table of NHS mortality rates

Maidstone and Tunbridge Wells NHS Trust has admitted that if Ben-Nejma had received the care she needed when she arrived at the hospital in December 2010, she would still be alive. Last week the trust settled a compensation claim from her family.

John Kyriacou, of Penningtons Solicitors, London, said: “This is a devastating case for everyone involved. The NHS needs to be as effective during the weekend as it is during the week.”

The avoidable death of Rebecca Ben-Nejma highlights a long-neglected scandal in the NHS: large parts of the medical infrastructure shut at weekends, leaving dangerous gaps in care.

Interactive comparison of the weekday and weekend mortality rates

The scandal has been gradually uncovered — in spite of great resistance and protests from within the service — through the compilation of hospital death rates. These show a clear increase in risk at the weekend.

A report published by NHS England last month said 4,400 lives a year could be saved if mortality rates were the same at weekends as during the week.

Today, The Sunday Times launches a campaign for safe weekend care. Our objectives are: more consultants on duty at weekends, safe levels of all staff, and more diagnostic tests such as scans on Saturdays and Sundays. We also believe GPs should take more responsibility for their patients out of hours.

Readers are invited to join the campaign by following the link in the box on the right-hand page. We hope your support will help to mobilise the government, health authorities and medical profession to improve care at weekends and reduce needless deaths.

Some of the most senior officials in the health service believe the time is right for change. Sir Bruce Keogh, the medical director of NHS England, believes moving to a seven-day week is a necessity.

The British Medical Association (BMA) is resistant to radical change. It claims a fully staffed, seven-day-a-week operation would spread resources too thinly.

However, there is one point on which everyone is agreed: the loss of thousands of lives a year can no longer be ignored.

The West Briton June 28th 2013 reports: Interim Royal Cornwall Hospitals Trust chairman resigns

Tameside Hospital:3 Jul 2013: Chief executive Christine Green quits scandal-hit NHS trust

It is understood the decision was made last week but was only confirmed today after pressure grew on her to leave.

14 July 2013 BBC News NHS failings ‘suppressed for electoral reasons’

Even failing NHS trusts “had to deliver good news for the minister”, Prof Jarman said

An independent expert on mortality rates has suggested that ministers have suppressed details of NHS failings to avoid losing votes.

Shortfall in GPs could rise to 16,000 by 2021

shortfall of more than 8,300 family doctors, the RCGP said

The Times Staff report July 15 2013 “A funding gap between 2013 and 2021 could lead to a shortfall of 16,000 family doctors in England, the Royal College of General Practitioners (RCGP) has said. NHS England reported on Thursday that there would be a £30 billion gap over the next eight years if health services in England continue to deliver care in the way they do now.”

T om Whipple and Francis Elliott in The Times July 15 2013 report:Data on needless hospital deaths may stay secret

Estimates of “excess” deaths resulting from failings in NHS trusts could be left out of a report to be presented this week because they are “too hot to handle”, it was claimed yesterday.

BBC News 14th July 2013 reports: NHS failings ‘suppressed for electoral reasons’

15 July 2013 BBC News Wales reports: Carwyn Jones to ‘see through’ Welsh NHS shake-up

First Minister Carwyn Jones has vowed to see through controversial NHS reorganisation plans.

He said to “leave things as they are” would store up exceptionally difficult problems in the future. Mr Jones also said he would seek “appropriate” NHS funding, following a review announced last week.

Good news (for motorists) Insurers want MRI scans to curb whiplash claims. Miles Costello in The Times reports.

Whiplash victims should be required to provide clear evidence of injury through MRI scans or x-rays to prevent false compensation claims, insurers have said.

In a report set to be published tomorrow, the insurer Axa will urge the coalition to ape parts of France and Sweden’s approaches to the injury, which costs insurers £2 billion a year in claims.

In The Times 17th July a report (Hats off to the boy racers) indicates that young men are now being subsidised by young women in order that there is no premium prejudice. Surely if the young men cause more long term demands on the Health Service they should pay more? WIll mutualisation be extended to premiums for life insurance avoiding ageism? If so I will immediatrely take out maximum cover as aged 63 years i am not a good risk!

The Times Letters NHS bureaucracy on 15th July 2013 (in response to NHS facing £30 bn shortfall) Drs Caroline Bonwitt from Todenham, Glos & Dr Andrew Bamji from Rye, E Sussex

The old NHS was cheap — there were no transactions and all monies were spent on clinical care; now too much is spent on administration

Sir, May I remind everybody that in the days before the ludicrous “internal market” of John Major (1990), the NHS cost less than 7 per cent of GDP yet turned in morbidity and mortality figures that rivalled any health system in the world (“NHS faces £30bn shortfall and needs radical reform, say chiefs”, July 11).

Now it costs about 10 per cent of GDP per annum and has fallen radically behind in all measures. All of this money has gone on bureaucracy. The old NHS was cheap because there were no transactions and all monies were spent on clinical care. It is true that there were long waits but priorities were decided by clinical need which is surely how it should be.

Dr Caroline Bonwitt Todenham, Glos

Sir, Financial analysis of two failed hospital trusts came to the same conclusion in each — their problems were largely caused by an unaffordable PFI debt. Your report states that NHS debt is approaching £30bn. Two years ago the debt was estimated at £20bn so despite debt reduction measures over the last two years things are worse.

Extrapolating from the analyses at South London Healthcare Trust and Peterborough & Stamford, the majority of current debt nationwide is attributable to PFI. Widespread hospital closure is not possible as PFI hospitals are “locked in” for the duration of their contract — usually 25-35 years. Closures can only occur of non-PFI hospitals which by definition are financially more stable.

The failure of government to abandon, and/or buy out the PFIs, can only be explained by its wish to see the NHS fail, so that it may be replaced by private sector “efficiency”. The report on GP services in the South-West, which you printed adjacent to the debt crisis article, does not lead to any sense of confidence that involvement of private enterprise is either reasonable or safe.

Dr Andrew Bamji Rye, E Sussex

4th June 2013 in The Scotsman Alex Neil rules out ‘gagging’ former NHS staff

Treasury knew of NHS whistle-blower gagging deals: The Mirror 12 Jun 2013

Sir David Nicholson was attacked by MPs over claims he covered up £2million of payments spent on at least 52 gagging deals

BBC News 16th July 2013: Report focuses on high death rates at NHS hospital trusts

By Nick Triggle Health correspondent,

Jenny Booth in The Times 16th July 2013 reports: Blame game over hospital deaths as damning new report published

The last Labour government was today accused of deliberately ignoring evidence that thousands of needless deaths were taking place in its flagship foundation trust hospitals.

Rachel Sylvester in The Times 16th July 2013 reports: Using NHS as a football will be a Tory own goal

The NHS is in the line of fire as never before. Today a report will set out the failings of 14 hospital trusts that are said to have been responsible for as many as 13,000 unnecessary deaths since 2005.

A four-month investigation by Sir Bruce Keogh, the medical director of the NHS, has concluded that the scandal at Mid Staffordshire, where hundreds of patients died needlessly through lack of care, was anything but an isolated incident and that up to ten trusts all over the country are “failed regimes”.

…..

Couldn’t Care Less -The Times leader 16th July 2013

The main problem with the NHS is that it does not take patients seriously enough

Jenny Booth, n The Times July 16 2013: Six hospitals placed in special measures over care failings

Six NHS hospital trusts were today placed in special measures as a damning report found a catalogue of medical blunders, poor care and bad management that led to high death rates.

Outside teams will be sent into ensure that urgent reforms are carried out, after a review by Professor Sir Bruce Keogh into 14 hospital trusts where death rates exceeded the national average.

‘Appalling’ care system for dying patients shut down

• members were upset by the evidenceGeraint Lewis

Rosemary Bennett, Social Affairs Correspondent, July 16 2013

Nurses shouted at relatives for giving their dying loved ones a sip of water, according to an inquiry into how the end-of-life Liverpool Care Pathway is being used by hospitals.

It said that the pathway should be scrapped, not because its guidance was wrong, but because it had become “an excuse for poor care” from nurses and doctors. The recommendation was immediately accepted by ministers.

Te Times Tom Whipple, Michael Savage and Jenny Booth 17th July headlines:

PM hammers Labour over failure of NHS Trusts

“…Presenting the report to the Commons yesterday, Jeremy Hunt, the Health Secretary, said that efforts to make improvements at many of the trusts had failed. “Failure or mediocrity is so deeply entrenched . . . that they have continued to decline,” he added….”

Hospital trusts rapped over major failures By Nick Triggle Health correspondent, BBC News

16 July 2013 BBC News – Wales Audit Office finds NHS ops postponed to cut costs

By Owain Clarke BBC Wales health correspondent

“… Some health boards, which manage hospitals, achieved their savings by reducing the number of planned operations on patients at the end of the financial year to help manage budget pressures….”

16 July 2013 in The Times reports: Hospital trusts rapped over major failures Nick Triggle

“Eleven hospital trusts are being placed in special measures because of major failings, the government has announced.

Health Secretary Jeremy Hunt said the trusts, among 14 investigated for high death rates, had problems so entrenched that tough action was needed.

He cited examples of staffing problems, poor care and weak leadership as he announced the move in Parliament.

The other three trusts investigated in England were also told to make improvements following the review.

But the health secretary said investigators had confidence the leadership at those trusts was capable of making the changes needed……..

The 11 trusts in special measures are: North Cumbria University Hospitals NHS Trust, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Tameside Hospital NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, Basildon and Thurrock University Hospitals NHS Foundation Trust, Burton Hospitals NHS Foundation Trust, East Lancashire Hospitals NHS Trust, George Eliot Hospital NHS Trust, Sherwood Forest Hospitals NHS Foundation Trust, Buckinghamshire Healthcare NHS Trust, Medway NHS Foundation Trust.

The other three investigated are: Blackpool Teaching Hospitals NHS Foundation Trust, The Dudley Group NHS Foundation Trust and Colchester Hospital University NHS Foundation Trust.

Between them the trusts run 19 acute hospitals (16 among those trusts on special measures). There are 160 acute trusts in England overall.

…”

I have tried to collect examples of local media coverage of your NHS Hospital Trusts which are known to have been failing.

United Lincolnshire Hospitals Trust under special measures ITV News Tue 16 Jul 2013

United Lincolnshire Hospitals Trust ‘fully accepts’ findings of Keogh Review into quality of care Market Rasen Mail 17th July 2013

North Lincolnshire And Goole Hospitals NHS Trust Fails To Meet Standards Viking News reports 15th July 2013

Sky News 17th July 2013 – NHS Report: Teams Sent In To 11 Failing Trusts

The Daily Mail 17th July 2013 reports: Labour’s day of shame over the NHS: Thousands of unnecessary deaths, 14 hospital trusts condemned, and now devastating report demolished Labour’s claim that the NHS was safe in its hands

HSJ reports: East Lancashire staffing ‘insufficient to meet basic needs’, Keogh review finds

WORKFORCE: Staffing on some of East Lancashire Hospital’s wards was “insufficient to meet the basic needs of patients”, a review of trusts with high mortality rates has concluded.

Nuneaton’s George Eliot Hospital placed in special measures after ‘fundamental breaches of care’ 16 Jul 2013

Health secretary Jeremy Hunt MP has today announced the trust which runs the hospital is one of 11 to be placed in special measures

Medway; NHS Trust Put In Special Measures Heart News reports 16th July 2013

North Cumbria: Keogh review: North Cumbria hospitals trust in special measures The News & Star Tuesday, 16 July 2013

Burton: Keogh probe will reveal truth behind failings in hospital trust – Laura Hammond reports 15th July 2013 in The Burton Mail

Blackpool: The Nursing Times reports: Keoch Review highlights staffing challenges at Blackpool Trust.

Dudley: HSJ reports: Keogh review highlights Dudley staffing concerns

PERFORMANCE: The Dudley Group Foundation Trust has said it is to carry out a review of staffing levels after concerns raised by the Keogh mortality review panel.

Colchester: Hospital trust defends record after ‘excess deaths’ report – July 15th

The Ipswich Star 16th July reports: Colchester: Hospital trust avoids going into special measures but report calls for improvements in priority areas

Neil Phillips on 16th July in Bucks Free Press reports:

Buckinghamshire Healthcare NHS Trust placed in special measures after Keogh review

The Nursing Times reports 16th July: Bucks Heathcare Trust “unsafe” staff told Keogh

Cumberland: HSJ: CQC finds failings at West Cumberland Hospital 27th June 2013 report by David Williams

The Express 17th July 2013 It’s Labour’s ‘darkest moment’, says Jeremy Hunt over NHS care scandal

THE NHS care scandal was ¬condemned as “Labour’s darkest moment” during a furious Commons clash yesterday.

The Guardian’s Sarah Boseley and Denis Campbell report 17th July: Jeremy Hunt accused of turning NHS deaths into ‘political capital’

Medical leaders criticise stance of political briefings as Keogh report finds ‘mediocrity’ rather than disaster in hospitals

The debate on rationing possibly begins to start this week, and at Crawley – but not a debate that includes the politicians as yet.. NHSreality is considering its own knighthood for the first politician to endorse rationing. Meanwhile the ship is sinking..

Hard to put a positive spin on the Keogh report but somehow the Guardian finds a way to make it less negative!

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

“Human Beings cling to their delicious tyrannies and to their exquisite nonsense like a drunkard to his bottle and go on until death stares them in the face.” Sydney Smith.

I am not sure I am right, but to me the NHS closely resembles a tyranny.

“To live a creative life, we must lose our fear of being wrong.” Joseph Chilton Pearce

A reader of these pages can see that my overall intention is to get a more honest debate on the principles and the philosophy behind the RHSs (Regional Health Services – There is no NHS). There have been over 340 postings, and 6 interviews in less than six months. I and many others do not believe it is founded on a rock, and sustainable. If it was to remain “paid for by taxation, universal (cradle to grave), comprehensive, free at the point of access,  and treatment based only on clinical need, and without reference to means” (Andrew Lansley on BBC News 31st Jan 2011) and these criteria were written in stone, then we have to address the issue of “everything for everyone for ever” which is not sustainable. In addition the regionalisation warned about by Aneurin Bevan is already upon us.

Almost all the medical professions understand this, and increasingly expensive technology improvements for rare conditions, and demographic changes, are challenging our ability to deliver. The philosophy needs to be clear: Is the (N)HS utilitarian and should the state encourage autonomy for individuals and families whenever possible, and if so will it encourage the Information Age? The need for change is clear: but not how to change it. …..Polly Toynbee disagrees with the changes.

The original document, “In place of fear” is the starting point for all readers who wish to understand the (N)HS as originally formed. Aneurin Bevan did not have any truck with regional variations which he felt would be the beginning of the end. ( Wales, Northern Ireland and Scotland all now have different systems to England.) Is the regional health service about encouraging autonomy for small/cheap health issues and services – or not? Is it about a paternal state which claims it can be universal and comprehensive? Is it about fairness overall (eg for cancers) or only regionally?

The recent headline about a new attitude to GP training indicates a government in fright/panic. A shortfall of 16,000 GPs is threatening.. along with a £30bn budget deficit. Politicians will of course blame their successors when they need to recruit (again) from other countries in 2-3 years time. But then its much cheaper to have a Dr trained in Africa and appointed here… Forget the linguistic and cultural issues – its another seat occupied. But then…

“The only good government is a bad one in a hell of a fright. ” Joyce Cary, The Horse’s Mouth, 1944.  David Cameron (and The Coalition) is in a mess about the NHS and he is beginning to contradict himself.

Interviews with impending or retired Specialists and GPs and other professionals are very useful, truthful, and so far seem to give a consensus response – give the professions charge of their departments and units, and ask the managers to implement the decisions taken by their professional leads. These interviews are not inhibited by “gagging” threats. I just wish more people would come forward. to bear witness.

We need to legislate to allow Trusts to dispose of staff who have bad sickness and absence records, and ensure a full working week. (weekend deaths should be no different to the working week) If this requires breaking up the health service further in order to reconfigure it might be worth it. Trusts allowed to go bust and be taken over will ensure the loss of staff with poor work records, and reconfiguration of working practices and timetables. We should measure follow-up rates for consultants against their peers. Every letter which asks a patient to return should say when, why and what is to be done which could not be done in General Practice. The return should involve an examination of the patient: so many Out Patient appointments could be done with a phone call… This should be universal…

We should override the GPS right to decide their own IT system of choice, and start by inducing them to, and then punishing them if they don’t, conform to the local/regional system. Bring this IT system into locality A&E and OOH services and then allow it to spread like a cancer throughout the Trust. Get all GPs involved in the management of OOH, and if they wish the operating of both A&E and OOH. Measure GPs on continuity of care – a long negotiation is needed… Measure their crude referral rates relative to their peers (this happens now), and then the appropriateness of those referrals (do the surgical referrals need surgery? Could another GP have handled the dermatology referral?)

Take on the media, and encourage open debate about pragmatic solutions. Bear in mind that “Any philosophy that can be “put in a nutshell” belongs there. Sydney J Harris, Leaving the Surface, 1968″ The media love Information and facts and will support the change from Industrial to Information Age Medicine. It’s their NHS as well..

Increase Medical Student recruitment to British Medical Schools so that a small excess is produced in years to come. (It will take 10 years from the implementation to produce new GPs) Encourage and facilitate a period abroad during their training, with exposure to a different system. Review medical student places, finances and debt at the end of training. Some specialist training may need a “rebate” or a debt write off on qualification (possibly Psychiatry, Venereology, Community Paediatrics and Epidemiologists at present, where recruitment is difficult).

Reduce the number of criteria in the QOF (Quality and outcomes framework) for GPs and the equivalent Management Information Systems (MIS) for nurses, giving them back some “space” and choice in the shape of their jobs.

Make Health Care Assistants into Nurses, (despite criticism of the Nursing Times) and then Train nurses to be “hands on” again, and accept that for good care we need to give them good pay.

Bring back “choice” in regions where it has been lost. Then act immediately to decide what services are important enough to insist on equal access and choice across the nation, ignoring regional boundaries. These might be cancers needing chemotherapy and other treatments, and heart diseases needing surgery in the first instance. Then, some treatments will need co-payments, different in people’s different situations, and some will need part payment and some will be excluded. If regions/practices are aware of the excluded treatments/services, they can be induced to make general savings so that these might be made available the following year… but some might never be.

Politicians need to decide whether the information age for patients is to be encouraged – or not. There is no point in providing information if you don’t believe in choice.

Leave NICE to clinical excellence. Form the British Equivalent of The Dunning Committee. (see page/post on rationing) which might be a virtual committee, and would encourage feed in from Trusts, Charities and the Public.

GPs as the gatekeepers are the most efficient part of the NHS, seeing 90% of the consultations with 10% of the budget. GPs should be allowed to remain the advocate for their patients, and the conflict of interest of GP commissioning should be removed. The RCGP published “What sort of doctor” back in 1982, before all the current perverse incentives were created. The report should be revisited. My prediction that more and more Trust Chairmen, Board members and CEOs will resign is coming true. They are finally appreciating that they will become the scapegoats for the politicians’ cowardice and “head in the sand” behaviour. NHS staff resignations tell a story, as do lack of exit interviews.

Readers might be interested in the INVESTIGATION IN TO MANAGEMENT CULTURE IN NHS LOTHIAN (N.b. see summary chapter 2) which is mild and would be repeated all over, where it would of course be covert. Full marks to Lothian for bringing this forward, but what is omitted from their report and beneath the surface?

We cannot ignore the politicians – unfortunately – they hold the purse strings. Many don’t actually believe in the (N)HS and use private providers. They are cowards when it comes to public debate about rationing along utilitarian lines. Because their mandate is from a small locality they, like Claire Gerada will oppose change, and they will not discuss a change of philosophy or principal. The religious dedication of the people to the (N)HS was revealed by the reaction to the recent exposures in Mid Staffs – this is classic communal denial of an inconvenient truth.

Remember:

Regarding rationing which politicians call prioritization, limiting and restricting:

“Since a politician never  believes what he says, he is surprised when others believe him.” Charles de Gaulle, 1962.

Regarding honesty:

“The most distinctive characteristic of the successful politician is selective cowardice.” Richard Harris in the New Yorker Magasine, 1968.

Regarding principles:

“The effectiveness of a politician varies in inverse proportion to his committment to a principle.” Sam Shaffer, in Newsweek Magasine, 1971.

Regarding speaking out:

The (N)HS has been likened to the most modern religion, but religions don’t change and don’t have to address new technologies, and failure does not lead to deaths.

“Religion is excellent stuff for keeping the common people quiet.” Napoleon Bonaparte.

I believe the people will get increasingly vociferous as the Health Service fails further. There may be a stampede, of those who can afford it, to leave the “religion” which has no clothes. The result could be increasing inequality and civil unrest, and an early sign will be private hospitals running casualties, and patients using these more and more, particularly at weekends and in August after staff changeover.

P.S .There are about 25 website followers but a lot more through Facebook and Linked In., I have no idea how many through twitter. Please e-mail me if there is a burning issue you wish put on NHSreality.

NHS legal claims will cost £15bn, it has been warned.

Every Year the NHS Litigation Authority (NHSLA) publishes an annual report on litigation.

NHS choices offers “Other options to making a complaint”.

By Rebecca Smith, Medical Editor Aug 2010

Official figures show cost of settling legal claims against the NHS that have already made and expected to be made has risen from £11.9bn two years ago to £15bn now.

This money must be set aside by NHS organisations over the coming years to pay for settlements in cases where patients have been harmed by their care and for claims made by staff for employment issues.

Experts have warned that the cost of settling claims is rising too fast as lawyers are taking high fees and in some cases the costs exceed the damages paid to the patient, they said.

December 2008

The true cost of clinical negligence litigation as described by Thompsons Solicitors is steady at 1% of the whole (2007)

Public perception of clinical negligence claims against the NHS is that despite the best efforts of the service to reduce the number of accidents, the cost of claims is increasing due to our increasingly litigious society; taking up a larger proportion of the NHS budget and, therefore, putting the service under increasing pressure. The evidence, however, reveals a different picture. The prevalence of accidents within the NHS has remained reasonably constant over the past 10 years, if not increasing slightly1. Similarly, the cost of litigation has remained fairly uniform, and accounts for less than 1% of the total NHS budget.

The No Win No fee situation may have changed this…Francesca Robinson in Hospital Dr 2010

But we now need more information – preferably in graphic form.

The Independent 2010 reports: Massive rise in cost to NHS of settling compensation cases

MPs demand cap on the huge fees solicitors can charge for successfully representing patients.

I personally think that a limited form of “no fault compensation” is appropriate especially in a country where legal rights are being attacked as they are with the changes to Legal Aid in the UK. New Zealand and Scandinavia have had  such a system for years, and although too expensive, with adjustments they have persisted.

NHS Bureaucracy – Insightful letters in The Times

The Times Letters NHS bureaucracy on 15^th July 2013 (in response to NHS facing 30 bn shortfall) Drs Caroline Bonwitt from Todenham, Glos & Dr Andrew Bamji from Rye, E Sussex

“The old NHS was cheap — there were no transactions and all monies were spent on clinical care; now too much is spent on administration

Sir, May I remind everybody that in the days before the ludicrous “internal  market” of John Major (1990), the NHS cost less than 7 per cent of GDP yet  turned in morbidity and mortality figures that rivalled any health system in  the world (“NHS  faces £30bn shortfall and needs radical reform, say chiefs”, July 11).

Now it costs about 10 per cent of GDP per annum and has fallen radically  behind in all measures. All of this money has gone on bureaucracy. The old  NHS was cheap because there were no transactions and all monies were spent  on clinical care. It is true that there were long waits but priorities were  decided by clinical need which is surely how it should be.”

Dr Caroline Bonwitt Todenham, Glos

“Sir, Financial analysis of two failed hospital trusts came to the same  conclusion in each — their problems were largely caused by an unaffordable  PFI debt. Your report states that NHS debt is approaching £30bn. Two years  ago the debt was estimated at £20bn so despite debt reduction measures over  the last two years things are worse.

Extrapolating from the analyses at South London Healthcare Trust and  Peterborough & Stamford, the majority of current debt nationwide is  attributable to PFI. Widespread hospital closure is not possible as PFI  hospitals are “locked in” for the duration of their contract — usually 25-35  years. Closures can only occur of non-PFI hospitals which by definition are  financially more stable.

The failure of government to abandon, and/or buy out the PFIs, can only be  explained by its wish to see the NHS fail, so that it may be replaced by  private sector “efficiency”. The report on GP services in the South-West,  which you printed adjacent to the debt crisis article, does not lead to any  sense of confidence that involvement of private enterprise is either  reasonable or safe.”

Dr Andrew Bamji Rye, E Sussex

I agree.

“Too Hot to Handle” – Data on needless hospital deaths may stay secret

Tom Whipple and Francis Elliott in The Times July 15 2013

“Estimates of “excess” deaths resulting from failings in NHS trusts could be left out of a report to be presented this week because they are “too hot to handle”, it was claimed yesterday.

Sir Bruce Keogh is due tomorrow to release the findings of his four-month  investigation into 14 NHS trusts where it is alleged that management and  medical errors led to “needless” patient deaths.

However, Sir Brian Jarman, a professor from Imperial College London who  advised Sir Bruce, said that he feared crucial data implying that 13,000  deaths over the past seven years could be attributed to blunders and  negligence in those trusts would be excluded from the report.

“It’s basically too hot to handle,” he said. “They’ve taken the political  decision not to publish.”

He also criticised the previous Government and suggested Labour ministers had  presided over a “denial machine” adding: “When they had a problem with  quality they couldn’t really say what it was so things were suppressed …  spin.”

Open government? Will the figures really be suppressed now that the media has the information? How apathetic are the public, the CQC, and the patient participation groups (in Wales)? Will they INSIST this information is available and comparable across the UK as it should be in a truly National Healthcare System? Of course not. Even if England does publish comparisons with N Ireland, Scotland and Wales will not happen because they do not collect the data in the same way. Since choice is “missing” in Wales, and rationing is covert throughout the Regional Health Services, no politician can afford to address the issues of unnecessary deaths honestly. Is the patient really at the centre of the Health Services?

Why we need a seven-day NHS. A young mother is one of thousands who have died because much of the NHS is shut on Saturdays and Sundays. Today The Sunday Times exposes the scandal and launches a campaign to improve care at weekends

Sarah-Kate Templeton and Jon Ungoed-Thomas Published: 14 July 2013

Interview with the mother of Rebecca Ben-Nejma who died after being denied treatment as no staff were available at the weekend to treat her condition