Monthly Archives: January 2014

NHS patients ‘face more treatment rationing since coalition restructuring’

The Guardian (, Health correspondent) reports 31st January 2013: NHS patients ‘face more treatment rationing since coalition restructuring’

Doctors say restrictions on access to healthcare have increased since creation of NHS clinical commissioning groups

“Patients are facing growing rationing of treatments such as counselling, cataract removal and IVF since the coalition restructured the NHS last year, GPs say.

In a survey of 315 family doctors, GP magazine found that 71% believed that restrictions on access to treatment in their area had increased since April 2013, when the controversial shake-up of the NHS in England began.

That led to the creation of 211 GP-led clinical commissioning groups (CCGs), which control the budget for healthcare in an area and decide who can receive what treatment. GPs said patients were encountering  growing difficulty in receiving care from community nurses, counselling, cataract surgery and fertility treatment. Rationing has increased significantly in the past nine months, doctors responding to the survey said….”

In the face of this survey, from self-selected GPs admittedly, the government and the media will almost certainly fail to respond meaningfully – again. From their perspective it’s not rationing, but prioritization or restriction…. From a patient’s perspective however, when a service is unavailable when it used to be, its RATIONING.

Personal Health Budgets – an idea too far without overt rationing

Personal health budgets: surplus of cash or deficit of ideas? Krishna Chinthapalli, clinical fellow in the BMJ2012;345doi: 10 December 2012)

Doctors are unaware of “fantastic opportunities” offered by personal health budgets, says health department. Caroline White reports in BMJ2013;346doi: 28 January 2013)

Expect to hear a lot more about Personal Health Budgets, until it dies a natural death.  The idea flies in the face of mutualistic risk in a large group… It’s patching up and not addressing the ideology.

Personal health budgets are good for the few but not for the many, conference hears – Matthew Limb reports in BMJ2014;348doi: 27 January 2014)

Update 18th September: Times Letters “Should we give patients their own budgets?”

Allowing patients to spend NHS money on their own healthcare has divided public opinion

Sir, As your leader (Sept 2) says, it is important to focus on the health benefits gained rather than on what is being bought, but there is some doubt over whether this kind of disruptive change will improve care. Indeed, an independent evaluation of the pilot schemes by the University of Glasgow and King’s College London indicated that personal budgets cost £4,000 more per patient compared with usual care, and could have a negative effect on patient outcomes.

Your headline (report, Sept 2) concentrated on holidays and video games bought with NHS funds, but there is a much more fundamental issue at stake. We all pay into the NHS and expect our money to be spent wisely on services that are there when we need them. But this scheme is already destabilising existing services, and has the potential to drastically reduce the choice available to patients. We know of one charity-run mental health day centre that was recently forced to close due to its funding being cut in order to fund personal health budgets. It will not be the last.

If the primary concern is the wellbeing of patients and enabling them to take greater control over their care, a far fairer solution would be to fund NHS services adequately and enable them to give patients a greater choice of treatments. As you say, the best decisions are not made by a “distant bureaucracy” but by patients in partnership with experienced healthcare professionals.

Nigel Praities
Editor of Pulse

Sir, Those living with long-term health conditions face daily challenges that the NHS often cannot solve. Morevoer, the NHS is still oriented towards providing treatments for medical problems in the form of pills or operations; it is predominantly a biomedical service.

What if the NHS helped people with long-term conditions or disabilities to focus on outcomes that matter to them — for instance, spending time playing with grandchildren — as well as on the narrow clinical outcomes that health professionals focus on? What if it then provided a range of not just treatments but also support to help independent living and feeling in control of health and healthcare?

This is the kind of NHS that people who have their own budget experience; an NHS that works with them to help them to manage their daily problems as effectively as possible.

The Five Year Forward View as set out by the chief executive of NHS England makes the case that promoting wellbeing and independence need to be the key outcomes of care, with personal health budgets being part of this. Contrary to the views of the BMA and Pulse magazine, the evidence would seem to support him.

Professor Alf Collins
Clinical associate, Health Foundation

Sir, News that patients are spending public money on items such as game consoles and music lessons may sound profligate but it may actually represent a sound investment of NHS money by preventing far more costly hospital stays. The cost of a games console, exercise board for someone with respiratory rehabilitation needs, or music lessons for a patient with a mental health condition, is a mere drop in the ocean compared with the alternative hospital treatments.

Rather than demonising patients and clinical leaders for searching for brave alternatives to the status quo, we should encourage this kind of innovative thinking to help the NHS to meet its £22 billion funding gap.

Sam Burrows & Kate Woolland
PA Consulting Group, London SW1

Sir, Where is the money coming from to fund personal budgets? It can only be from other services when the NHS has to “save” £20 billion by 2020. This scheme only adds to the healthcare lottery. Some patients will enjoy riding lessons at taxpayers’ expense while others are deprived of the medications or operations they need.

Roger Goss
Co-director, Patient Concern


Towards the patient revolution (BMJ Editorial)

Fiona Goodlee, editor of the BMJ comments in the edition 1st February 2014: Towards the patient revolution

BMJ2014;348doi: 29 January 2014)

“In an editorial last year we called for a patient revolution (doi:10.1136/bmj.f2614). We said that patients, far more than clinicians, understand the impact of disease and treatment. We said that clinicians and patients therefore needed to work in partnership if we are to improve healthcare. We talked about corruption in the mission of healthcare and the need to challenge deeply ingrained practices and behaviours. We said that we wanted to develop a strategy for patient partnership at the BMJ, that we planned to establish a panel of patients and clinicians to help us with this work—and that we would report back on progress…..”

An informed patient is a pleasure to consult with, especially if the Doctor has time. An assertive but uninformed, or even worse, badly informed patient is very hard to handle. Doctors try to assess ideas concerns and expectations for each patient but when assertiveness (Dr Haslam’s recommendation) is combined with rationing, doctors will face difficulties and possibly confrontation..

Gagging clauses used to protect NHS reputation at expense of safety

The National Health Safety Executive website on 24th January 2014 reports that MPs in the Public Accounts Safety Committee say “Gagging clauses used to protect NHS reputation at expense of safety”. This is also reported in the BMJ by Clare Dyer in the 1st February 2014 edition.

The facts are still emerging, but this type of corruption (Adverse selection?) will not be stopped unless we ALL get to grips with the reality of the Regional Health Services, and the lack of debate about philosophy. Here is a list of articles by a “gagging” search of the BMJ…. the number and depth of entries will shock most readers.


Access to some NICE approved drugs varies hugely across England – BMJ

Ingrid Torjesen reports in the BMJ 3rd February 2014: Access to some NICE approved drugs varies hugely across England

BMJ2014;348doi: 22 January 2014)

A “postcode lottery” still exists in access to the latest drugs in England, show figures in a report by the NHS Health and Social Care Information Centre.

For the first time the centre’s annual analysis of actual versus expected use of drugs recently approved by the National Institute for Health and Care Excellence (NICE) also looked at use by local area.1 It found wide variation, including a 28-fold difference in use of the newer anticoagulants rivaroxaban and dabigatran for stroke prevention in atrial fibrillation and a more than nine-fold variation in use of denosumab for osteoporosis.

The analysis looked at the actual versus expected use in England of 18 drugs in 10 categories. It found lower than expected …

This type of covert Post-Code rationing is now endemic. The whole idea of a National Health System should be that we are all treated with equal rights. Fortunately for any government ,the media wont cover this, and the politicians wriggle away from facing the truth. Aneurin Bevan please return to this world..

DDT: Pesticide linked to Alzheimer’s – change the licensing of agricultural products

BBC’s James Gallagher in the News 28th January 2013 reports: DDT: Pesticide linked to Alzheimer’s

“Exposure to a once widely used pesticide, DDT, may increase the chances of developing Alzheimer’s disease, suggest US researchers.

A study, published in JAMA (Journal of the American Medical Association) Neurology, showed patients with Alzheimer’s had four times as much DDT lingering in the body as healthy people.

Some countries still use the pesticide to control malaria..”

Elsewhere in NHSreality I have commented that we need to change the standards by which we judge agricultural research. The standards need to be analogous with those for drug company research on humans, and the emphasis on productivity and consumption needs to be balanced by that on the environment as a “stakeholder” as well as the “human being”. We need EU legislation to change the licensing of agricultural products…

Midwives and patients warn of ‘devastating’ staff shortages

The Independant’s Charlie Cooper reported on 3rd January 2013:  “Midwives and patients warn of ‘devastating’ staff shortages”.

“Exhausted, frustrated and dissatisfied, so that I am not able to the good job I know I am capable of doing”…

Now the “Shortage of midwives may be putting mothers and babies at risk”, say MPs from the Commons public accounts committee, who  issued a highly critical report on state of NHS maternity care. Rajeev Syal in The Guardian reports 31st January 2013.

There are not enough of so many medical staff: Physiotherapists, Psychologists as well as Nurses and Midwives. Fortunately there is no shortage of applicants as we are attracting people from the new EU accepted countries….. Which will encourage the government of the day to continue to train too few. A perverse incentive to less than desirable communication skills and cultural awareness, but better than doing without..

A call from the midwife: Why I am resigning after 10 years in the NHS

Look at the regulations and licensing of midwives in the UK by the Nurses and Midwifery council.

Dont say we weren’t warned – Radio 4 – Thursday 17 February 2011

Find out the latest on Stillbirths and Perinatal Deaths..