Monthly Archives: May 2014

Top insurers under fire for medical snooping

Ali Hussein in The SUnday Times 25th May 2014 reports:

Top insurers under fire for medical snooping

Watchdog orders inquiry after unwitting customers give L&G and Aviva access to their entire records

SOME of Britain’s biggest life insurers face an inquiry into claims that they are gathering unnecessary medical information about customers from GPs — including details about contraception, mental health and relationship problems.

The Information Commissioner’s Office (ICO) is to investigate growing concerns about the number of personal details requested for life insurance applications.

The move follows a Sunday Times investigation, which found that some insurers, including Aviva and Legal & General (L&G), routinely make “subject access requests” under the Data Protection Act to access all records held by GPs, rather than bespoke medical reports highlighting only relevant information.

John Canning of the British Medical Association expressed “grave concern”, saying: “A GP will hold all your medical history, containing details such as contraception use, termination of pregnancies and relationship issues that would have no bearing on an insurance policy.

“Our concern is that the consent obtained by insurers isn’t always understood by the person applying for a policy. Our belief is that this is a misuse of the Data Protection Act.”

How often is it that patients records are “not available” in the different Regional Health Services – which have failed to computerise, an act that would solve the problem? The opposite side of the coin of having too little information is giving away too much…

 

YOU could die on the waiting list: Patients kept waiting for months to start cancer treatment

Hannah Devlin reports in The Times 24th May 2014: Patients kept waiting for months to start cancer treatment

If there is one area where inequality of access and rationing will lead to more fear than any other it is in the treatment of cancer. This can be either palliative or curative, but in either case, along with delays in diagnosis (by imaging waiting lists) and treatments as above, there is a real risk of anger in the population. It is also wrong of any party to try to blame the other. This situation is the result of decades of neglect, undercapacity in staff, worn out plant, and out of date philosophy (everythig for everyone for ever). YOU could die on the waiting list.. The good news is that “Cancer no longer a death sentence as half of victims survive a decade“.. So we must be doing something right. It’s just that there is a system being covertly rationed – if it is to be rationed then we all have a right to know how, and to be treated equally.

Cancer patients are being made to wait longer before starting treatment, official figures show.

The health watchdog Monitor has found that an increasing number of foundation trusts are failing to begin treating people with cancer within 62 days of their being referred by a GP.

In the latest quarter, 26 trusts failed to meet a target of diagnosing cancer and treating 85 per cent of patients within two months, compared with 16 in the same period last year. In part, hospitals are struggling to meet the targets owing to a 3 per cent increase in referrals, linked to public awareness campaigns. The Midlands performed worst on cancer waiting times, while London hospitals performed best.

Finances are also suffering at many of the country’s 147 trusts, with the average financial surplus being one third of the size of last year. The number of trusts in deficit has doubled to 40 since last year, with the combined value of deficits running at £307 million.

Jason Dorsett, finance and reporting director at Monitor, said: “The majority of patients attending foundation trusts are receiving quality services in very difficult financial circumstances. Times are tough and hard decisions will have to be made to ensure patients continue to get the services they need at an affordable cost to the taxpayer.”

Richard Murray, director of policy at the King’s Fund think-tank, described the worsening of waiting times for cancer patients as “grim” and the overall finances of hospitals as “quite scary”. He added: “You really shouldn’t delay treatments for some cancers and the anxiety for patients is enormous.”

The report noted that many foundation trusts increased staffing after the Stafford Hospital scandal, making it harder to balance the books. Overall, staff numbers had increased by 24,000 (4 per cent) since last year.

A Department of Health official said that NHS staff would look into the causes of dips in performance on cancer waiting times, and added that trust chief executives needed to keep a tight grip on their finances. “The Government has made tough decisions on the economy but at the same time we have increased the NHS budget in real terms,” the official said.

Andy Burnham, the shadow health secretary, said: “David Cameron has to accept responsibility for this serious deterioration in the performance of the NHS.”

The report also found that trusts narrowly missed an A&E target as 94.7 per cent of patients were seen within four hours, below the required 95 per cent.

Update 25th May 2014: Letter in The Sunday Times from Prof. Andrew Jones

Give radiotherapy the cancer funds it needs

YOUR campaign to improve access to innovative radiotherapy is vital and could be addressed by broadening the £200m annual Cancer Drugs Fund. Despite a highly effective £25m, one-off investment in 2012-13, supporting a growth in delivery of the most advanced forms of radiotherapy across England, there is no regular investment for radiotherapy equivalent to the Cancer Drugs Fund.

This stark contrast in funding for new developments is worthy of public debate to ensure innovative radiotherapy techniques continue to be exploited.

The King’s Fund 2011 report How to Improve Cancer Survival: Explaining England’s Relatively Poor Rates states: “It is more important to improve access to surgery and radiotherapy than access to cancer drugs … this suggests that the contribution of the Cancer Drugs Fund to improving overall outcomes will be very limited.” Nevertheless, the Cancer Drugs Fund continues to have strong political support and has been extended to 2016.

This fund should be increased by about £50m a year to provide improved access to innovative radiotherapy techniques and the effective training of the workforce.

This would produce a significant boost to the most cost-effective cancer treatment available for patients.
Professor Andrew Jones, President, the British Institute of Radiology

 

Devolution and health: data and democracy. Any differences will be because of tribalism and a smaller mutual

Sott L Greer writing in the BMJ in 2008 (Analysis BMJ2008;337:a2616 Devolution and divergence in UK health policies) explores how political variation in the UK has led to differences between the health systems of its four nations since devolutionDAPC05GCC

Devolution and spending will probably be the two main health legacies of Tony Blair’s Labour government. Spending, because the historically low cost NHS received one of the greatest bursts of funding in history, with long term consequences for workforce, infrastructure, and patients; and devolution, because it created four distinct health systems just as that spending started. The politics and policy debates of the four systems are very different, and their leaders have used autonomy to pursue different values with, increasingly, different success.

Autonomy and diversity

Devolution gave the Northern Ireland Assembly, Scottish Parliament, and National Assembly for Wales great power over health services and public health. Under the 1998 legislation they are highly autonomous and not subject to any law of shared standards or values. They receive block grants that are not related to need but can be spent as they choose. Some regard them as overfunded, especially relative to English regions outside London (fig 1⇓); questions arise as to whether their worse statistics with respect to health and other issues (fig 2⇓) justify their higher rates of funding.

Now in 2014 Scott Greer writes again and says: Devolution and health: data and democracy (BMJ2014;348:g3096) He calls it “about as good a natural policy experiment as you could imagine.” He says that “rather than UK politicians planning to learn from the experiment, the Nuffield Trust and the Health Foundation are amongst the few organisations that have tried to learn from this experiment. Their fourth report on devolution and health is ingenious and thorough, required reading for anyone wanting to understand health policies in the UK.”

darwins-devolution-theory

There is no mention of the benefits of being in a larger mutual, and the disadvantages of tribalism.  The Professor does say that “there is scarcely an idea that couldn’t benefit from comparative data and learning across borders”. To most of the profession it appears deliberate that Wales cannot compare outcomes and data with England. Only after sufficient years have passed for WHO approved data: perinatal and maternal mortality, will it be evident which regional decisions were best. Even then, those decisions might have been appropriate if made from the point of view of the size of the mutual concerned.

Only now are the important frontier issues becoming noticed (Infertility post code inequality) and it is evident that access to Stroke treatment centres cannot be eqitably speedy to ensure universally good outcomes… I wonder how many PCT and LHB members have actually read and digested the Nuffield document on quality of care? About as many as have read In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear. Any differences will be because of tribalism and a smaller mutual…

Update 15th July 2014. The Economist July 12th in “A Costly Solitude” on Scottish Independence: Wales GVA (Gross Value Added, or output per person) which explains why there is more pressure to ration more in Wales..

 

Too many checks are “planned” – they should all be spot and random – including educational ones

BBC News reported 13th May 2014: Spot checks into OAP hospital care

Failings in patient care at two Welsh hospitals have been criticised in an independent report.

The Trusted To Care review was held after concerns at Neath Port Talbot Hospital and the Princess of Wales Hospital in south Wales.

It followed the neglect of patient Lilian Williams, 82, who died after being treated at both hospitals.

Her family complained and it led to the review, they are now calling for a public inquiry.

Mrs Williams, from Porthcawl, had been admitted to both hospitals a total of four times between August 2010 and November 2012, when she died.

Her family claimed she suffered “appalling” neglect.

The ombudsman who investigated her family’s complaint was highly critical of her care, and called the case tragic.

Abertawe Bro Morgannwg University (ABMU) Health Board subsequently apologised and admitted the case had been “completely unacceptable”.

Since then, campaigners have called for a public review and the resignation of the board’s chief executive. They claim “hundreds” of examples of poor care have come to light.

A review was ordered by Health Minister Mark Drakeford into levels of care offered by both hospitals.

It catalogued a series of failings at the two hospitals, describing “a sense of hopelessness” in its care for frail and elderly patients. It found “poor professional behaviour” and a “lack of suitably qualified, educated and motivated staff.” One patient told the review team: “I am in Hell.”

Others said elderly patients were instructed to go to the toilet in their beds, medicines had been recorded as given when they were not, and staff tolerated dangerous practice.

The report also found there was:

  • Variable or poor professional behaviour and practice in the care of frail older people
  • Deficiencies in elements of a culture of care based on proper respect and involvement of patients and relatives
  • Unacceptable limitations in essential 24/7 services leading to unnecessary delay to treatment and care
  • Lack of suitably qualified, educated and motivated staff particularly at night
  • Adversarial and slow complaints management
  • Disconnection between front-line staff and managers and confusion over leadership responsibilities and accountabilities
  • Problems with organisational strategies on quality and patient safety, capacity development and workforce planning
  • The report also says some staff felt ill equipped to meet the needs of patients with dementia

The report said: “There are aspects of the care of frail older people which are simply unacceptable and must be addressed as a matter of urgency.

“ABMU has not at any point been ‘another Stafford’. But no one should be in any doubt that there are aspects of the care of frail older people which are simply unacceptable and must be addressed as a matter of urgency through action by the Board of ABMU and by the Welsh government.”

Health Minister Mark Drakeford apologised to those patients affected.

Too many checks are “planned” – they should all be spot and random – including educational ones

22nd May Princess of Wales Hospital wait ‘did not cause death’

19th May Apology over failings at Singleton hospital, Swansea

19th March South Wales NHS: Health bosses agree shake-up recommendation

 

Even the profession is in denial. GPs say no to charging patients – and Welsh MP shows just how disconnected he is

Nick Triggle for the BBC News 22nd May says: GPs say no to charging patients

Even the profession is in denial. One of the problems of BMA meetings is that coal face GPs don’t attend, and postal votes are not allowed. Big issues which might lead to philosophical change do not get a proper airing and the politically motivated attendees fail to connect with their members. If NZ and Australia can do it, so can we.,,

Calls to charge patients for GP visits in the UK have been rejected by family doctors.

The issue was debated at the British Medical Association‘s annual GP conference in York.

Delegates voted against the idea, but warned that services were being stretched so much that care was being put at risk.

BMA GP leader Dr Chaand Nagpaul said general practice was becoming “conveyor belt medicine”.

He pointed out that some GPs were having to see up to 60 patients a day.

“Add to this the sheer volume of phone calls, visits, repeat prescriptions, results, reports and hospital correspondence and we have an unmanageable, exhausting and unsustainable workload that puts safety and quality at risk,” he said.

Dr Nagpaul highlighted figures showing that in England the share of the NHS budget given to GPs had been shrinking in recent years and now stood at under 9%, despite GPs dealing with 90% of patient contacts with the NHS.

This has happened during a period when the number of consultations have been rising – by more than 10% over the past five years to 340m last year.

‘Unethical’

During the debate on charging, which comes after calls in some quarters for charges of between £10 to £25 to see a GP, doctors also expressed concern about rising workloads.

Dr Helena McKeown, a GP from Wiltshire, who spoke in favour of the motion which called for charging to be considered, said it gave her “no pleasure” in proposing it.

“A fixed fee for some services for some patients will emphasise our value.

“Dedicated funding for general practice will assist practices to take on new GPs.”

But other doctors spoke against the proposal. Dr Rob Bailey, from Cambridgeshire, said: “Charging will fundamentally change the unique relationship between GPs and patients.

“Charging will blur the boundaries between the NHS and non-NHS services.”

Dr Laurence Buckman, a GP from London, added the idea was “unethical, dangerous and disingenuous”.

When it was put to the vote it was rejected by delegates.

A Department of Health spokeswoman said: “We recognise the vital job GPs do.”

She said ministers recognised the challenges GPs face, but pointed out that the government was trying to relieve the pressure by reducing bureaucracy and taking on more trainees.

Disconnected MPs: Things may go in the opposite direction. David Williamson for The Western Mail 10th May reports on Chris Ruane’s misguided thoughts: New calls for England to follow Welsh example and scrap prescription charges

A Welsh Labour MP has challenged Health Secretary Jeremy Hunt to consider introducing free prescriptions in England.

Vale of Clwyd MP Chris Ruane claims the policy pioneered in Wales is a “Welsh solution to an English problem”.

building-dependencies-on-free-apps-and-services-is-bad-practice

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Update 14th August 2015. Nicola Woolcock in The Times reports: Women take record lead in university admissions – This will only make things worse and we need even more doctors is 80% are to be women

The gap between women and men at university has grown to its largest in modern times as the number of female students increases.

Women overtook men in higher education only two decades ago, yet they have pulled 14 percentage points ahead. University admission figures showed yesterday that only 43 per cent of new undergraduates this year would be male. If the trend were to continue at the same rate as in recent years, women at university would outnumber men by two to one within 20 years.

Yesterday, a record number of candidates — 409,000 — were awarded university places on receiving their A-level results, and there were 60,000 more women than men.

The odds of getting into medical school, one of the narrowest of entry gates into higher education, are 11.2 When careers officers have recommended someone applies and is able enough, and when the system is so short of British doctors, why does this situation persist? The projected demographics for the future indicate we will need far more doctors than we have planned. Perhaps elderly citizens will have to move abroad to get affordable quality care?

medschool_177_big

Deborah Haynes reports in the Times 19th May 2014: Students told to steer clear of medicine amid excess of applicants (with apologies I am printing in full)

Bright students, particularly girls, are being encouraged to become engineers rather than doctors because of a “gross excess” of applicants for medical degrees.

Medical schools across the country received more than 11 applications for every place last year compared with fewer than nine applications in 2008, new figures have revealed.

David Willetts, the universities minister, said the level of competition to pursue a career in medicine was “one of the most dysfunctional features” of the education system.

The popularity of the medical profession is thought to be linked to parental pressure on children to secure a well-paid job upon completion of university, particularly given the expense of a degree course following a hike in tuition fees.

“There are every summer several thousand very unhappy 18-year-olds, predominately but not exclusively female, who think they will become medics who, sadly, do not get a place despite being very smart and well-qualified,” Mr Willetts said.

“And this is one of the most dysfunctional features of the English school leaving A-level system.”

He added: “The truth is that the number of young people -and it does tend to me more girls than boys – with an aspiration to do medicine way exceeds any number of places that the NHS is likely to have.”

New figures released by the Universities and Colleges Admissions Service (UCAS) showed around 4,800 students with straight As at A-level failed to get in to British universities last year.

Of those, the largest number of “unplaced” students – 1,780 – were those aiming for medicine. Of that group, 930 were female students.

UCAS said the vast majority of unplaced students were successful when they reapplied a year later.

Mr Willetts said many students hoping to take medicine at degree-level choose biology, chemistry and maths at A-level, but drop physics.

If they miss out on medicine then they are unable to switch to a course like engineering, bioengineering and climate change, which demand physics as a core requirement.

“This is really not a good way of running a school and university application process,” the minister said, urging universities to adopt a more flexible approach.

They could perhaps allow students to take a catch up physics course for example.

The minister said that schools needed to inform students about the risks of setting their sights on medicine given the chance that they may fail to achieve their dream because of the massive demand for places.

“We have so many students who are aiming for medicine and it’s way ahead of any likely number of medical places we may have,” he told a conference of head teachers last week.

“Part of my challenge to you as school heads is that your students do need to know that,” he said.

The UCAS figures revealed that in 2013 there were 84,395 applications for a place on a medical degree course and just 7,515 acceptances. The applications-to-acceptance ratio was 11.2.

This compared with 71,330 applications made in 2008 and 8,013 acceptances, which created an applications-to-acceptance ratio of 8.9.

One student can make up to four applications.

Safety fears over doctors who trained outside EU – open up more medical student and GP training posts urgently

2013 – NHS facing GP ‘workforce crisis’ – 2014 No change

A Comparison of demographics and health spend between 1948 and today

Life Expectancy & Demographics

Health is closely correlated to Wealth – If you are poor you get no choice (Wales), and live a shorter life, but if you are rich, or born abroad, you live longer and you do get choice! So much for equity…

NHS understaffing may have effect on baby mortality rate, says top doctor

anatomyworkpeopleMedical-School-Debt

Medical Student debt – time for government to change policy on doctor recruitment

gunner1medical_school_specialize_insura_678495

 

Undercapacity but: Improved access to doctors during the day is urged… but Students told to steer clear of medicine amid excess of applicants

Nicola Woodcock in The Times 21st May reports: Improved access to doctors during the day is urged

GP surgeries would be better off improving access to doctors in the daytime than opening in the evening, research suggests.

Academics looked at the experiences of more than half a million patients who had seen their GP in the past six months. They concluded that the increased use of out-of-hours services, such as A&E departments and emergency services, was not caused by doctors’ surgeries being closed in the evening. Instead, poorer access during normal working hours was linked to greater use of out-of-hours services.

The research, published in Emergency Medicine Journal, analysed whether use of late-night services was linked to patients’ ability to see their preferred GP, to get through to their surgery on the phone and to how easy it was to book a routine or urgent appointment.

Even after taking account of factors such as age and deprivation levels, those with poor access to their GP put a greater strain on out-of-hours services. Improving access to GPs could cut demand for evening health services by up to 11 per cent, the findings indicate.

Rationing by undercapacity in GP services will not be corrected for 10 years, and even if we import from the Eastern European countries, the third world, and the Commonwealth, we will not have enough. Times to open up access the Medical Schools to those determined and willing rather than those who are most “intelligent” at the entry exams. The careers masters would not recommend them to apply if they were not capable… Instead “competition is getting tougher”! Deborah Haynes reported Monday 19th May: Students told to steer clear of medicine amid excess of applicants

“Bright students, particularly girls, are being encouraged to become engineers rather than doctors because of a “gross excess” of applicants for medical degrees.

Medical schools across the country received more than 11 applications for every place last year compared with fewer than nine applications in 2008, new figures have revealed.

David Willetts, the universities minister, said the level of competition to pursue a career in medicine was “one of the most dysfunctional features” of the education system….”

 

Where is the duty of care? 400 patients thrown out of hospital beds every night …

A Case Study by Nicola Woodcock in The Times 22nd May reports: Where is the duty of care?

as part of a wider investigation into “400 patients thrown out of hospital beds every night “.

The case study records a 97 year old lady discharged on her own with a fractured pelvis in the middle of the night following her admission.. and another of 75 years discharged in nightclothes..

The main article includes:

“Hundreds of thousands of patients are being sent home from hospital in the middle of the night despite a promise to limit the practice.

During the past two years at least 300,000 people, many of them elderly, have been discharged between 11pm and 6am to relieve pressure on wards.

An investigation by The Times in 2012 revealed that patients were being woken and removed from their beds, even if they had no way of getting home. Some were left in night clothes, with no medication or paperwork, and in vulnerable or dangerous situations.

At the time, health chiefs promised that patients would be moved at night only in exceptional circumstances, but new figures obtained under a freedom of information request show that the practice remains just as widespread.

More than half of the NHS trusts that responded reported that the number of patients sent home at night had increased during the past three years. Almost 60,000 of the patients were over 75. The true number of patients discharged overnight is likely to be much higher because less than half of England’s 160 NHS trusts responded to the data request by Sky News.

Katherine Murphy, of the Patients Association, said: “These figures are truly shocking. It is simply unacceptable that patients are being discharged from hospital late at night.

“We are particularly concerned that tens of thousands of these patients are aged over 75. For older people, spending time in hospital can be extremely distressing and disorientating.

“Patients need to be treated with care, compassion and dignity. For the many older people who live alone, being discharged after early evening shows not only a lack of care and thought, but can actually be dangerous.”

Nadra Ahmed, chairwoman of the National Care Association, said that elderly patients were returning home or arriving at care homes in disarray.

“They come out very often without the appropriate papers that would give information and the history of what has happened to them. Often they will come out without the appropriate medication, because the hospital pharmacy has closed, and there is no cross-referencing to what medication they’re already on….”

A utilitarian approach demands that when there is undercapacity the least harmful decision is taken to address it… The hospital managers are not the people who should be in the dock, but the politicians, whose denial and cowardice in the face of overwhelming evidence (some of it for 2 years on NHSreality) is evident to all the caring professions. Commissioners are being asked to ration care covertly, and differently by post code and region. This arms length approach by government is not enough to absolve them of responsibility… It is only fear and gagging of staff that is stopping more stories coming out… The government in England has tried to address inappropriate discharge by a fine for re-admission, but many patients choose a different hospital after losing faith in the first one…

Early discharge bus home

Sam Coates and Chris Smyth  on 20th May report in The Times: Doctors fear cash crisis if funds are used for social care

A coalition health reform could trigger a fresh cash crisis immediately after the election, NHS officials have warned.

Doctors fear that the NHS budget is going to be used to provide funding to plug gaps in social care at a time when the system is already under huge strain….

Implosion after election?

 

 

 

Five things the NHS must learn about empowering patients – but not for Wales.

Meg Hillier MP for Hackney South and Shoreditch, co-chair of the all party parliamentary group on global health writes for Guardian Professional, Tuesday 20 May 2014 Five things the NHS must learn about empowering patients It seems empowering patients excludes the Welsh who without choice for a decade have GPs who are relatively uninformed about options which should be available to their patients (and would be in England). Is Wales in denial of The Information Age?

Despite the huge changes to the NHS, there has been little progress in terms of patient empowerment

Half of all patients in hospital say they aren’t as involved in their care as much as they would like. This figure hasn’t improved in a decade.

There’s been a lot of talk from recent governments about giving more power to patients. The latest commitment is that the NHS will get “dramatically better” at involving people in their own care, but the change so far has been anything but dramatic.

Despite all the structural overhauls to the NHS there has been very little change in the areas that matter most: how involved people feel in the big decisions about their care, and whether patients’ voices are heard when things go wrong, or are ignored as we have seen in several high profile scandals.

I recently led a coalition of MPs and peers concerned about health to look at what we could learn from other countries that were trying to solve this problem. Across over 100 examples we looked at, five key lessons stood out….

Knowledge is power

Make shared decision-making the easy choice for clinicians

Invest in supporting carers

Groups of patients are a powerful asset

Listen to what patients have to say

the APPG has published a report, Patient empowerment: for better quality, more sustainable health services globally (pdf)

 

 

The NHS and ‘cradle to the grave’

Nick Triggle for the BBC reports 14th May 2014: The NHS and ‘cradle to the grave’

The NHS was set up to provide health care from the cradle to the grave.

22.08.2012: Martin Rowson on Andrew Lansley and the NHS

But is this really happening in today’s NHS? If you read the latest report from the Royal College of Physicians you could be left wondering.

Doctors who carried out the audit said they found the standards of care provided to the dying “deeply worrying”.

This followed last year’s report by Baroness Julia Neuberger which was highly critical of the way the Liverpool Care Pathway – one aspect of end-of-life care – was being used.

But these concerns are not new. Back in 2000 the Department of Health’s cancer plan was lamenting the fact that too many patients experienced “distressing symptoms, poor care and inadequate communication”.

So what is going wrong? The reasons – as made clear by this latest report – are complex.

It is partly societal. Death still remains a taboo subject in England – and the rest of the UK for that matter.

A survey published earlier this month by the Dying Matters Coalition showed 83% of the public are uncomfortable discussing death.

That reluctance appears to have been transmitted to doctors. The survey showed a quarter of GPs did not initiate conversation with patients.

Attitudes

By comparison, in countries such as Spain there is much more openness about death and a natural acceptance that it is part of the cycle of life.

As a result, death is planned in advance, funerals are much more slanted more towards a celebration of life than an opportunity to grieve than they are here and, in terms of organ donation, the country is a world leader.

Even in the US, which has traditionally been much closer to the UK in approach, attitudes are changing thanks to initiatives such as The Conversation Project, which encourages people to start planning for death with their loved ones….

But – and this is a point made by the authors of the RCP report – there is also evidence it is not being prioritised properly by hospitals.

Between 5% and 10% of patients who come into hospital end up dying there.

Dr Kevin Stewart, who authored the report, says this shows it should be seen as part of their “core business”.

Yet it is quite clear it isn’t. Specialist palliative care services are all too often only available Monday to Friday – something that is virtually unheard of in other areas, such as cardiac care.

While, at the top of trusts, there seems to be little appetite to tackle it head on. Less than half of trust boards had even discussed palliative care in the previous 12 months.

Death, it seems, is too much of a taboo subject everywhere.

Its a taboo to discuss the philosophy of health care, the break up of the NHS, rationing, co-payments and whether we should encourage “everything for everyone for ever”…. Commissioning for death is uncommitted and only partial.. and relatives of non-voting dead are ignored, whilst staff live in fear and are gagged…

Everything for everyone forever? (Philosophy, honesty and accuracy)

Why do all the forbidden words in the NHS begin with R: “Rationing”, “Reorganisation” and Rationalisation?

Palliative and Terminal Care should be fully funded.

Death discussions ‘taboo’ for many in UK, survey finds

Ann Clwyd’s husband ‘spent 27 hours on A&E trolley’: “My husband died like a battery hen”

The cover up and denial. “Help us, doctor. We’re frightened of being ill in Cover-up General”

Dead people don’t vote… End-of-life care ‘deeply concerning’

Gagging and Whistleblowing – Raj Mattu to speak directly to Simon Stevens.

Gagging clauses used to protect NHS reputation at expense of safety