Monthly Archives: March 2014

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:…..

Bed blocking – due to Local authorities ‘rationing care’

The Press Association on 3rd March 2014, as in the Sunday Post, reported: Local authorities ‘rationing care’ The cost of care is one of the main reasons why beds are blocked (Denis Campbell in The Guardian 25th Jan 2014 – NHS hospitals face record levels of ‘bed blocking’ New figures show total number of bed days lost because of delayed transfers of care hit 70,124 in December 2013).

Care of the elderly is an extension of Health Care philosophy, discussion of which the politicians wish to avoid. It is painfully obvious that commissioning care is a tricky issue, and rationing is inevitable. Lets make it overt.. then we can discuss the best ethical way to do it. The incentives for hospitals to move patients out of beds are still not as strong as the incentives for patients to stay in hospital…

“Too many” elderly people who struggle with simple day-to-day tasks are not getting any help from social care services, a damning new report has warned.

Some older people in England are being left to “fend for themselves” instead of getting the care and support they need to complete basic tasks such as getting out of bed, bathing, preparing meals or doing their shopping, according to Age UK.

And families who care for loved ones are being placed under “intolerable strain” because they are not receiving any assistance for their loved ones, the charity said.

Its new report states that cuts to social care budgets have led to a care crisis – which is only worsening with an ageing population.

The report suggests that access to care has become restricted for many as councils feel the pinch of funding cuts.

Local authorities, which provide social care to people in their areas, are “rationing care”, it adds.

Many are so stretched that they are only able to provide help to people whose needs are deemed to be ” substantial” or “critical”. Elderly people whose needs are deemed to be “moderate” or “low” are ignored until their needs become greater, the charity said.

The report states that 87% of authorities in England only provide care if the need is deemed to be ” substantial” with a further 2% only providing care for those in dire need.

Just a “few” councils pay for care for people with “low” or “moderate” needs to prevent them from reaching a crisis point later on, it adds.

As a result, people in need of care face a “postcode lottery”, the report states.

People deemed to be in “moderate” need are unable to to carry out several personal care or domestic routines, while those at “low” risk have an inability to carry out one or two of these tasks.

“As council funding has come under increasing pressure, they have raised eligibility thresholds,” the report states.

“This results in fewer people being able to access care services.”

Between 2005/6 and 20012/13 the number of people who received social care dropped by 27.2% – despite the fact that the population in this age group has grown by more than a million, the report says.

Age UK said that despite the rising demand for care the amount spent on services has dropped by £1.2 billion since 2010…….”

Laura Sharman reports for LocalGov.co.uk 26th March 2014: Councils rationing care for the elderly – LocalGov.co.uk – Your

“Most local authorities are ‘tightly rationing’ their social care for older people, according to new research.

The research, from the Nuffield Trust and Health Foundation, reveals that many councils are cutting or reducing services for the over-65s, with home and day care spending falling by 23% between 2009/10 and 2012/13…..”‎

Also reported in Evening Standard: Local authorities ‘rationing care’  and many of the Regional Newspapers such as the Shropshire Star

And in a New Book: Rationing Medical Care on the Basis of Age by Eric Matthews and Elizabeth Russel  published by the RCGP and the Nuffield Trust.

Many A&Es ‘have missed wait target this winter’

Nick Triggle reports 28th March 2014 for BBC News: Many A&Es ‘have missed wait target this winter’

Nearly two thirds of England’s major A&Es missed the waiting time target this winter, BBC analysis shows.

Hospitals are meant to see 95% of patients in four hours, but just 52 of the 144 type one trusts achieved this over the 20-week period to 23 March.

Northern (Ireland) Health Trust: Five babies among 11 deaths probed

BBC News reports 28th March 2014: Northern (Ireland) Health Trust: Five babies among 11 deaths probed

The deaths of five babies are among 11 under investigation at the Northern Health Trust.

The health minister told the Northern Ireland Assembly that he had been made aware of 20 cases in which the trust’s response was said to be below standard.

The patients were seen in the emergency, obstetrics, gynaecology or X ray departments.

It is not clear whether the deaths were avoidable. Edwin Poots said the trust’s response should have been better.

He said this was especially true, where cases were not identified as “serious adverse incidents”.

Retiring north Norfolk doctor warns of GP ‘burn out’

Adam Gretton for The Eastern Daily Press, (EDP) reports 24th March 2014: Retiring north Norfolk doctor warns of GP ‘burn out’

A senior doctor has warned that the NHS is facing a GP recruitment crisis because of unmanageable workloads, which has caused him to take early retirement.

John Harris-Hall, 57, who is a partner at Mundesley Medical Centre, near Cromer, has said “enough is enough” and that he had no choice but to quit the profession early.

Dr Harris-Hall has worked as a GP for 31 years, but said that increasing demand and declining funding had caused him to retire early to avoid “burn out.”

He said: “It has been a great privilege to care for patients at my practice for almost 30 years, and I am sad to retire early, but I feel there is no other choice. GPs are constantly being told by the government to do more with less. The increasing demand and workload pressures are leading to low morale and stress amongst the current workforce – causing many GPs, like myself, to consider early retirement to avoid ‘burn out’.

“If this situation continues and general practice loses even more experienced and dedicated doctors, it could lead to a serious workforce crisis where we don’t have enough GPs to treat our patients.”….

 

Fresh concerns raised about GP recruitment after figures showed more than 40% rise in number of GPs over age of 55 in past decade

Julia McWatt for Wales on lone (Western Mail) reports 27th March 2014: Fresh concerns raised about GP recruitment after figures showed more than 40% rise in number of GPs over age of 55 in past decade 

Fresh concerns have been raised on recruitment and retention of GPs in Wales after latest figures revealed more than a 40% increase in the number of practitioners over the age of 55 in the last decade.

The statistics published by the Welsh Government show the number of GPs in Wales aged 55 or over has risen from 330 to 469 – an increase of 42.1% – between 2003 and 2013.

And while the figures also showed an increase in the number of practitioners below 45-years-old, the rate was significantly slower with numbers increasing by just 1.2% throughout the 10-year period.

The number of GP practitioners in Wales stood at 2,026 as of the end of September 2013 – a rise of 1.5% on the previous year and an increase of 11.2% since 2003.

Meanwhile, the percentage of GPs who are female has increased over the last decade. In 2003, female GPs accounted for 31.7% of the total, while in 2013 they accounted for 46.6%.

The figures have prompted fresh concerns about the problem of the ageing workforce and recruiting and retaining GPs in Wales.

Dr Charlotte Jones, chair of the British Medical Association’s GP Committee, said urgent action was needed to address the issue.

She said: “Although the overall numbers of GPs have gone up, that does not mean they are all working full-time. We know that GPs, irrespective of age or sex, are deciding to work less than full-time hours.

“We are particularly concerned about the age profile and the number of GPs over the age of 55, and the recruitment and retention of new GPs.

“We are also concerned about the impact of the pension changes on this group of GPs and some of these changes mean that many GPs feel it is not in their interests to continue working. And if we look at where these older GPs tend to be, they are in areas where we already have concerns.

“We have highlighted these issues to the Welsh Government, not just about the recruitment and training, but importantly about the retaining of GPs. This is crucial with the focus on GPs on health service reorganisation and also with the Health Minister’s development of prudent healthcare.

“We want the Welsh Government to urgently look at these figures and what they mean for the workforce.”

Dr Jones said that if action was not taken, there was a risk that some practices in Wales may close…..

Skimping on GPs ‘is a false economy and puts patients at risk’ – see the correspondence

Chris Smyth on March 24th reported for The Times: Skimping on GPs ‘is a false economy and puts patients at risk’ – NHSreality agrees with Dr McEvedy at end of this post.

Four in ten patients wait so long to see a GP that they are worried they are putting their health at risk, according to the Royal College of General Practitioners, which claims that family doctors are under “severe threat of extinction”.

Maureen Baker, chairwoman of the college, said yesterday that a “toxic mix” of rising workloads and falling budgets was putting patient care at risk. She argued that skimping on GPs was a false economy because more patients would end up in A&E, as she demanded more money to recruit thousands more family doctors.

A ComRes poll of 1,000 patients for the college found that 28 per cent could not get an appointment within a week the last time they tried to book and almost two thirds believed that the number of patients GPs dealt with was a threat to standards of care.

Correspondence: The GPs’ leader wants more investment but some patients want a better service first

Sir, I agree with Maureen Baker, chairwoman of the Royal College of General Practitioners (RCGP) (“Skimping on GPs is a false economy”, Mar 24). There is a definite correlation between rapid access to a GP and a lowering of admissions to A&E departments.

When our surgery was taken over by Elgar Healthcare of Worcester, the number of GP appointments more than doubled and the surgery extended opening hours from four and a half days to five. This, and daily open-access surgeries in the mornings and doubling the number of GPs on duty at that time, has ensured that admissions to A&E units from its patient group remain the lowest in Worcestershire.

Any patient may attend morning surgery, without an appointment, and be guaranteed to see a GP. This is not the case in many surgeries in nearby towns.

Paul Skinner

Grey Gables Surgery,

Inkberrow, Worcs

Sir, As a GP I have enjoyed sending many letters to The Times regarding health matters over the years. At the moment I just do not have enough time to write.

Dr Mike Betterton

Skelton, Cumbria

Sir, I am a GP who took early retirement. Whenever I said that general practice could not survive as it currently runs, the official response was the usual ostrich’s backside. For decades governments have imagined that health is a product like any other, best made available following market principles. If so, this product can also disappear from the market.

Dr Trevor Griffiths

Ivybridge, Devon

Sir, The Royal College of General Practitioners claims that the lack of GPs is putting patients at risk.

It occurs to me that if GPs worked five days a week instead of four and a half, they would be able to see far more patients.

Karen Ansell

London NW4

Sir, The chairwoman of the Royal College of General Practitioners has described the current crisis as being due to lack of investment and shortage of doctors. This is disingenuous. The cause can be traced back to the lavish contract with GPs which Patricia Hewitt, the then Secretary of State, agreed in 2004. Family doctors then went on to limited hours, nominally five days per week. For this they were richly, if not extravagantly, rewarded.

In addition, extra doctors were hired to do duty to cover out-of-hours requirements. Some of them were even flown in from the Continent at tremendous cost.

The president of the RCGP now calls for more money and more doctors. In fact what is required is that the present cohorts of GPs should provide extra duties.

I suggest that every general practitioner in the country should do one evening surgery of two hours each week and should work one Saturday or Sunday, in a rota every month, to provide emergency cover.

This would take much pressure off A&E departments and would
deliver a better service to their patients.

Practice duties during public holidays could be allocated on a rotational basis. This is not going to be too arduous for the doctors but might save general practice — and it would deliver a better service to their patients.

Dr Douglas Bell

Edinburgh

Peter McEvedy respondson line:

It is impossible to go back to the old system. In the intervening time, the workforce has completely changed. When I joined my practice, there were 5 full time GPs, all male, and each took a full share of the 24hr on call. In the intervening 25 years, the practice that I am now in has 3/4 the list size and has 7 doctors, only I am full time, and 5 are female. This offers far more choice to the patients but I doubt any of them would be clamoring to work overnight or on Sundays. We do open on Saturdays and some of us do work for the out of hours service which is provided by local GPs. The contract was devised to sort out a recruitment and retention crisis in Primary Care. I think it likely that reversing it would simply lead to the older GPs that are left retiring en masse and it would be impossible to fill their posts immediately.