Monthly Archives: March 2014

Cap on doctors’ hours costs NHS £750m

Jack Grimston, reporting in The Sunday Times on 30th March reports: Cap on doctors’ hours costs NHS £750m The nightmare of inadequate training due to lack of exposure to sufficient clinical exposure is imminent…. Enforcing the EUWTD (European working time directive) is attractive to government as it seems to cut down on costs… at the expense of inadequate training.

RULES from the European Union limiting the number of hours that doctors can work are costing the NHS £750m a year, an inquiry by the president of the Royal College of Surgeons (RCS) has found.

Jeremy Hunt, the health secretary, is seeking to build an alliance of countries to back demands for a renegotiation of the 48-hours-a-week cap on doctors. Germany and Holland are among at least four countries understood to be sympathetic.

The report into the effect of the EU working-time directive on the health service, commissioned from Professor Norman Williams, found:
■ The NHS is spending an extra £750m a year on locum doctors because the regulations mean there are fewer staff doctors available
■ Hospitals are being “stretched too thin, particularly at nights and weekends, with … patient safety being put at risk”
■ 280,000 hours of surgical training are lost every month because of time limits
■ Patients are being seen by up to five different teams of doctors in a single day because of strict rota systems imposed by the rules
■ Doctors starting courses today will lose the equivalent of 128 days of training compared with those who studied before 2009. For some specialisms, including obstetrics and gynaecology, the situation is even worse
■ The rules are “undermining professionalism” by “promoting a culture of clock-watching”.

The report, expected to be sent to Hunt this week, is understood to include
findings from the Royal College of Physicians that nearly 60% of trainees believe that working-time rules worsen the quality of care.

A source close to Hunt said: “Ministers are concerned about the way the directive has interfered with continuity of patient care and the ability of doctors to learn.”

The directive is expected to be one of the areas targeted by David Cameron as he seeks to renegotiate Britain’s EU membership before his planned in-out referendum.

Charlotte Leslie, the Tory MP who co-authored a separate report on the directive for Fresh Start, a group that campaigns for EU reform, said: “Anyone on the ground, particularly in surgery, knows how devastating the directive is but the outside world, particularly politics, hasn’t twigged yet.

“Nearly every EU state is having massive issues with this. They are all trying to find ways to weave around this failing legislation.”

The RCS declined to comment on the report.

Additional reporting: Laura Hughes

Half of (our) MPs fear for future of free NHS – but have insufficient political will to change it!

Richard for in The Times 31st March 2014 reports: Half of (our) MPs fear for future of free NHS after a report commissioned by the NHS confederation was made public. The latest member survey and the thoughts of Rob Webster who commissioned the report are here.

and follows it up with Sonia Elks : Patients should pay £10 monthly fee for NHS, says ex-Health Minister

A £10 monthly “membership fee” should be introduced to use NHS services, according to a report co-authored by a former Labour Health Minister.

Patients would also have to pay hotel-style charges of £20 a night for hospital stays under sweeping changes to the model’s funding system proposed by Lord Warner, who was minister for health reform under Tony Blair.The Labour leadership swiftly rejected the plan.

“Even with major changes to care, it is now irresponsible to pretend to the public that current forms of taxation alone will be sufficient to provide a good quality health and care system”, said the report, which was published by the centre-Right think-tank Reform.

It comes as a poll found that more than half of MPs fear that a free NHS could be scrapped in the future. Senior health leaders have said they are concerned at the impact on the provision of services of an ageing population and an increase in long-term health conditions.

The paper suggests that cash could be brought in for the health service by raising the cost of prescriptions and vaccinations. Patients would also receive “telecare products” to “help people meet their own care using their own resources”, it said.

In return for the new monthly charge, patients would be offered an annual “health MOT” of basic health checks and be given targeted health goals. Those receiving free prescriptions would be exempt from the charges, the report suggests.

Higher “sin” taxes could also be introduced on products such as cigarettes, alcohol, and high-sugar foods to deal with the associated costs brought on by unhealthy lifestyles.

Lord Warner said that £6 billion a year could be raised by the changes, and argued that the health service should not get above-inflation funding increases from the general tax income pot to avoid starving other services of cash.

“We can no longer pay homage to an out-of-date and unaffordable NHS that’s unfit for today’s and tomorrow’s care needs,” he said.

“It should have no more hand-outs at the expense of other public services. It faces a hard slog of doing more with less and a tough conversation with the public about how we change services and accept new ways of funding the NHS.”

The report’s proposals were rejected by the campaign group Patient Concern.

A spokesman for Department of Health said: “The founding principles of the NHS make it universally free at point of use and we are clear that it will continue to be so.

“This Government doesn’t support the introduction of membership fees or anything like them. But we know that with an ageing population there’s more pressure on the NHS, which is why we need changes to services that focus far more on health prevention out of hospitals.”

The report comes as a separate poll found that half of British politicians think that a free NHS could be consigned to history unless challenges are tackled to ensure that it meets future patient needs.

More than 80 per cent of the respondents — 39 Conservative, 48 Labour and five Liberal Democrat MPs, plus five from other parties — said that in their constituency the NHS had to change. Yet almost two thirds said there was insufficient political will to do so……….”

An extra tax for the Regional Health Services would focus minds. Rationing by co-payments is just one of many options, but politicians are afraid to discuss any of them.. Who will be the first bold and honest politician, and where will he come from?

Richard Johnstone also comments in Public Finance 31st March 2014.


Hywel Dda Health Board chief executive Trevor Purt to leave his post

The Milford Mercury 25th March reports on a change of CEO (and Chairman) in the next few weeks: Hywel Dda Health Board chief executive Trevor Purt to leave his post There has been a lot of controversy over plans to centralise services in West Wales. The next CEO and Chairman will have to come from outside of the area, because whatever they do they will be pariahs to the locals. The 6 years ago offer of a new hospital, rejected by the media and the professions at the time, would be welcomed with open arms now….

Professor Trevor Purt, the Chief Executive of Hywel Dda University Health Board, is to leave his post.

He will take up the role of Chief Executive of Betsi Cadwaladr University Health Board in June.

During his time in west Wales, Mr Purt has overseen significant new developments including the new Urgent Care Centre and Renal Unit at Withybush Hospital.

But he is likely to be best remembered for the hugely controversial ongoing service changes which threaten the Special Care baby Unit at Withybush Hospital as well as maternity services, and has prompted several large demonstrations from angry campaigners.

Mr Purt joined Hywel Dda University Health Board in September 2009. He said: “I am sad to leave as I have thoroughly enjoyed my time in the University Health Board but feel the time is right for new challenges in North Wales. “We have come a long way in the last 4½ years and there is still more to do to ensure that Hywel Dda has the right services in the right place to provide the very best healthcare.

“I have full faith in my executive directors, the wider management and clinical teams and Karen Howell who will be interim chief executive officer to move forward to ensure our services continue to develop.

“These have not been the easiest of times and I want to personally thank all staff for their dedication and commitment – you are the university health board’s greatest asset.”

Chris Martin, Chair of the University Health Board, who is also to leave the organisation this year, said: “Trevor was the first chief executive officer of the new integrated health board and has successfully lead the organisation through some difficult times. During his time we have seen a significant improvement in quality and performance due in no small measure to his leadership. We are sorry to see him leave but wish him well in his new role.”

Britons overwhelmingly against GP charges to help NHS balance books

The Guardian’  Dennis Campbell reports 28th March 2014:

Britons overwhelmingly against GP charges to help NHS balance books

Poll suggests 27% would pay £10 but 56% against, with only 12% saying they would pay to guarantee next-day appointment

As if this poll means anything. Uninformed children will vote for ice creams every day if they have had them for free and there is a threat to take them away.. Utilitarianism means that the greatest good has to be done for the greatest number, and over a prolonged period.. Turkeys won’t vote for Christmas..

Stepping Hill deaths: Nurse Victorino Chua charged with murder

BBC News reports 28th March 2014: Stepping Hill deaths: Nurse Victorino Chua charged with murder

Victorino Chua, 48, of Churchill Street, Heaton Norris, is also charged with 31 other offences including GBH and attempted poisoning.

He is accused of murdering patients Tracey Arden, 44, Arnold Lancaster, 71, and Alfred Derek Weaver, 83.

He was remanded in custody to appear at Manchester Magistrates’ Court later.

Greater Manchester Police (GMP) said Mr Chua faced one count of causing grievous bodily harm with intent, 22 counts of attempting to cause grievous bodily harm with intent and eight offences of attempting to administer poison, under the Offences Against the Person Act.

Wider community

Investigators have been examining the contamination of various medical products, between June 1 and July 15, 2011 at the hospital……”

One of the principles of dangerous drugs management, such as diamorphine (heroin) is that there are two people who sign as correct the administered dosage…… Insulin is not classed as a dangerous drug, but now perhaps it should be… The potential for harm is just as great as for the opiates..

NHS boss Simon Stevens to base himself in London

Dennis Campbell reports in The Guardian 28th March 2014: NHS boss Simon Stevens to base himself in London (And all this applies to England, not Scotland, N. Ireland or Wales)

New chief executive opts for base in capital rather than at NHS England HQ, to improve ties with politicians and health bodies

The NHS‘s new boss plans to base himself in London, rather than at the organisation’s headquarters in Leeds, to give himself regular access to ministers and key national health bodies.

Simon Stevens, who starts as chief executive of NHS England on Tuesday, intends to spend more time in the capital than his predecessor, Sir David Nicholson.

Stevens was an adviser on health policy to Labour health secretaries Frank Dobson and Alan Milburn between 1997 and 2001, then moved to Downing Street to work with Tony Blair but left in 2004 when he joined UnitedHealth, a large private health company in the US.

Despite his background in Labour politics – Stevens was once a local councillor in Lambeth, south London – he was seen by David Cameron as the outstanding candidate to replace Nicholson. Jeremy Hunt, the health secretary, ratified his appointment, but only after he received assurances that Stevens would attend Monday midday briefings in London at which Hunt meets senior NHS staff.

Building work is under way at Skipton House, one of NHS England’s two bases in London, to create offices for Stevens and some of the £95.6bn organisation’s national directors, including Professor Sir Bruce Keogh, its national medical director. Stevens, though, will still spend time in Leeds, where many of the 6,000 administrative staff are based.

The organisation’s media team, based in Leeds, are also due to move to London, where it only has a small number of press officers despite the concentration of media in the capital.

NHS England was created on 1 April last year under the coalition’s NHS reorganisation as a supposedly independent body in charge of the day-to-day running of the health service. Stevens is keen for it to improve its image and make more of a mark nationally.

At the Commissioning Live event this week, Nicholson said the organisation deserved just “five out of 10” for its first-year performance, and that commissioning of health services, its key purpose, had been a particular weakness.

Stevens’ arrival has already led to some changes at the top of NHS England. Bill McCarthy, its policy director, and Jo-Anne Wass, the director of human resources, are leaving. Karen Wheeler, a senior Department of Health civil servant, is joining as its director for transformation and corporate operations. Other departures and arrivals are likely.

Stevens is preparing to make his first public statement during a visit to an NHS facility in the north-east on Tuesday.

His plans to attend the regular Monday meetings with Hunt contrast with Nicholson, who attended the first few sessions when Hunt instituted them in autumn 2012, but then shunned them.

It is understood that Hunt sought, and received, assurances from Stevens that he would regularly attend what the DoH calls its NHS delivery meeting, before ratifying his appointment.

An NHS England spokeswoman said: “Simon Stevens has not yet taken up post as NHS England chief executive but he hopes to work with all NHS England’s key partners, including of course health ministers and parliament.”

Jeremy Taylor, chief executive of National Voices, an umbrella group representing scores of health charities, said Stevens needed to use his position to oversee a major boost to the availability of non-hospital-based health services.

“The biggest challenge facing health and social care is to create a 24/7 out-of-hospital service that supports the growing number of people with chronic health problems, frailty and disability to live as well as possible. We all know this, and everybody has been saying it for years, but we haven’t seen a concerted drive to make it happen”, Taylor said.

An NHS England spokesman said: “The main base of the organisation will continue to be in Leeds where we have more than 800 staff. Simon will divide his time between there and London.”

I have tried not to refer to the NHS but rather to the Regional Health Services. We no longer have an NHS…

The Nuffield Trust comments on the “NHS @ 65: Our analysis & resources”

NHS @ 65: Our analysis & resources 4th July 2013

On 5 July 2013, the NHS reached retirement age. To mark 65 years of the health service, our analysis and resources reflect on the present state of the NHS and what it might look like in ten years’ time.

Key Points from the report: Political and clinical leaders call for a long term vision for the NHS ahead of its 65th anniversary (No mention of rationing or cost-code lottery, or “frontier” issues….)

Extra spending on the NHS throughout the 2000s may have helped the service to sustain its performance during the more recent period of financial austerity, but influential figures such as Lord Darzi admit that the resources might also have reduced the need for urgent reform, arguing that: ‘we missed the best opportunity in the history of the NHS to actually reform it… we just threw money at it.’

NHS England Chief Executive Sir David Nicholson appeared to concur, conceding that the additional investment may have ‘allowed us to subsidise poor care when we shouldn’t have done.’

Their remarks are contained within a new volume published by the Nuffield Trust to coincide with the 65th anniversary of the NHS (5 July 2013).

Edited by Nicholas Timmins, Nuffield Trust Senior Associate and former public policy editor of the Financial Times, the publication features essays and interviews with senior individuals from the worlds of politics, medicine, academia and journalism. Among the contributors to The wisdom of the crowd: 65 views of the NHS at 65 are:…..