Monthly Archives: June 2014

‘Wildly generous’ rewards for NHS executives exposed

Laura Donelly reports in the Telegraph 28th June 2014: ‘Wildly generous’ rewards for NHS executives exposed

Yes, outrageous, but not surprising. The implosion continues..

Investigation reveals that a hospital with a desperate shortage of nurses has hired dozens of temporary managers on rates of at least £100,000 a year

A failing hospital has paid at least ten senior managers annual rates of more than £200,000 despite providing unsafe care and suffering from a major shortage of nurses.

An investigation by The Sunday Telegraph can disclose that Medway Foundation trust has hired more than 30 interim managers on six-figure packages over the last few months. The most highly paid are receiving annual rates of up to £540,000 a year.

However, the hospital is about to be branded “inadequate” by regulators – the worst possible rating – while its own reports admit that the trust needs 120 more nurses in order to provide patients with safe care.

The trust was put into special measures last year after an investigation into high death rates found dangerously low staffing levels in Accident & Emergency and in wards caring for the seriously ill.

Since then it has hired an interim chairman on a £200,000 package to work as little as one day a week, and a temporary chief executive on annual rates of £360,000 for a four-day week, as revealed by The Telegraph last week.

This newspaper’s investigation has now revealed that they are just two of dozens of “interim” administrators who have been awarded such packages by the trust, with ten managers receiving pay equivalent to more than £200,000 each a year.

Nurse leaders last night urged the Government to get a grip on the scale of excess in parts of the NHS and said “wildly generous” packages for some administrators were starving frontline services of funds.

Among the highly-paid managers, some of whom are paid via private companies, are a banking specialist who costs the trust more than £45,000 a month, which is equivalent to £540,000 a year.

Robert Griffiths received the package for acting as “treasurer” for the trust, while his assistant James Mitchell, has been paid £25,000 a month.

Both men come from consulting and restructuring firm Red Clover Partnership.

Mr Griffiths’ entry on its website says “his experience, in particular as a restructuring banker, provides him with a unique insight into the different requirements and mindset of all stakeholders in stressed and distressed company negotiations.”

It can also be revealed that the trust has now just appointed a temporary finance director Tim Bolot, a barrister and accountant who charged £40,000 a month for previous NHS placements, with funds paid via his company, which specialises in “turnaround programmes”.

Interim director of operations Mark Morgan costs the trust around £28,000 a month.

The trust’s chief executive Nigel Beverley, who was hired in February on a £30,000 a month package, left the trust last week, several weeks before his contract as an interim was due to expire, leaving the trust’s medical director to act in the role.

The disclosures come after The Telegraph revealed last week that in February, Christopher Langley, the trust’s chairman, was awarded a package worth £190,000 a year for one or two days’ work a week.

The funds are paid to his private company, and under the deal, he can claim £17,000 in expenses a year, without any proof of how or whether the money was spent – a deal which patients’ groups described as “indefensible”.

However, despite the large sums being spent on mangers, latest figures show that the trust is spending almost £1 million a month on agency nurses, while a report to the board says 120 more nurses are needed to provide a “safe establishment.”

Figures published earlier this month suggest the worst shortages of nurses and healthcare assistants are occurring at night.

Board papers from this month warn that the trust is currently “being challenged to deliver a clinically safe minimum staffing levels”.

Last night nurse leaders said the revelations were an outrageous example of a wider problem in the NHS, with senior managers being given “wildly generous” rewards, while frontline services were desperately overstretched.

Dr Peter Carter, Chief Executive of the Royal College of Nursing urged the Government to “get a grip” on the situation.

He said: “Frontline staff and patients alike will be shocked that interim managers are receiving such wildly generous payments while the trust is in desperate need of more nurses.

“The NHS faces massive financial challenges and what’s been happening at Medway is an outrageous example of a wider problem in the health service.”

Katherine Murphy, chief executive of the Patients Association, said: “It’s a disgrace. These are vast sums being spent bringing in all these senior people, yet meanwhile the shortages of staff are risking patient safety and compromising care.”

Monitor – which regulates foundation trusts – ordered the appointment of Mr Langley as chairman in February.

It justified his salary by saying the trust “needed the right people in place to make urgent improvements needed for its patients.”

A spokesman for Medway Foundation trust said: “Use of interim staff with appropriate skills has been necessary during a period where the trust faces significant challenges. A key priority for the board is to recruit permanent staff for all key roles throughout the organisation.”

He said the trust was trying to recruit more nurses, and had held several open days and intended to search abroad for more staff.

A Department of Health spokesman said: “We have been absolutely clear that while executive directors and senior managers, like other staff, deserve to be paid fairly for the important work they undertake, we do not believe in a culture within the NHS where high pay is normal.”

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Hogarth’s NHS – and burn’t out doctors

Hogarth’s NHS – The Times letters 30th June 2014:

Sir, While everyone who works for the NHS within modern A&E departments has the best of intentions, there is no doubt that the chaos and misery experienced by many patients would make Hogarth’s depiction of destitution in Gin Lane pale into insignificance.

We need a modern Hogarth and his cartoons to shock us into realising how badly our society manages the vulnerable and how vocationally committed clinicians are burnt-out.

George Lewith, Professor of Health Research, University of Southampton; Alastair Dobbin, Honorary Fellow, School of Clinical Sciences, Edinburgh University; Chris Manning, Convenor, Action for NHS Wellbeing; Professor David Peters, Director, Westminster Centre for Resilience, Faculty of Science and Technology, University of Westminster; Sheila Ross, Director, Foundation for Positive Mental Health

GPs who fail to spot cancer could be named. No government could have designed a better perverse incentive to over investigate and over refer.

BBC News 29th June 2014 reports: GPs who fail to spot cancer could be named (In England only!)

This idea, presumably by managerial zealots who are not allowed to mention the “R” word, is their suggestion for deflecting some of the criticism which is going to come their way. Most of it, really and truly, should be directed at the politicians…. The single most important factor determining outcome is how soon you present to your doctor. In lower social class areas people present later and at A&E departments. These are the areas where recruitment is most problematic… is this suggestion meant to help recruitment? Once embedded as a Performance Indicator, think of the perverse incentives to over investigate and to over refer? And the implications on the Regional Health Service budgets? Better to let GPs continue to gatekeep in the most efficient system in the world, which is the envy of most ministers of health.

GPs with a poor record in spotting signs of cancer could be publicly named under new government plans.

Health Secretary Jeremy Hunt wants to expose doctors whose failure to spot cancer may delay sending patients for potentially life-saving scans.

Labour called the idea “desperate” and accused Mr Hunt of attacking doctors.

The Royal College of GPs said it would be a “crude” system and one that could lead to GPs sending people to specialists indiscriminately.

It warned this could result in flooding hospitals with healthy people.

The move is part of the health secretary’s plans to make the NHS more transparent.

Ranking GP surgeries on how quickly they spot cases of cancer and refer patients for treatment is among proposals being considered….

No government in any UK Region could have designed a better perverse incentive to over investigate  and over refer. I doubt it will be a runner..

A biased report supports the British Health Services- and claims our overhead as 3.4%. Trusts vary greatly, and probably don’t know..

Update 30th June 2014 Times Letter from Dr Sarah Murray:

GPs may see 50 potential cancer victims in one day, and they have to rely on their skill to make the best diagnoses

Sir, GPs do not miss cancer through wilful negligence or incompetence (June 30). Each GP sees about 50 presentations of potential cancer symptoms every day. The only way to be certain of never missing a diagnosis would be to refer every one of these for a consultant opinion or further investigation. A CT scan for every headache. A colonoscopy for every tummy ache. A chest X-ray for every cough. A biopsy for every mole or swollen lymph node. This would not be a measure of a “good” GP. The NHS would collapse within days and patients would be harmed by over investigation (radiation-induced cancers, unnecessary surgery etc). GPs use their clinical acumen, time and simple investigations to make a judgment about appropriate referral. Inevitably a few early cancer presentations will be missed — it is tragic, of course, for individual patients when this happens, and we feel dreadful too — but these are a tiny percentage of the decisions made every day. It is a reflection of the real problem that cancer is not a single disease with a simple diagnostic presentation, and not a reflection of poor GP quality. It is impossible to have an accurate cancer diagnosis in every single case within the current system and bounds of knowledge.

Dr Sarah Murray

Yelverton, Devon

Update 1st July 2014 from The Derby Telegraph: Shaming plan would cripple NHS, says Derbyshire doctor

Update 3rd July 2014: GP diagnosis and cancer of the Pancreas. Letters in The Times:

Survival rates for pancreatic cancer have hardly improved in 40 years

Sir, That one extra case which Dr Mark Porter claims could turn his practice from excellent to worst performance (“The NHS has a problem with cancer survival rates but naming and shaming GPs won’t help”, July 1) could have been my daughter’s.

Had her general practitioner been more aware of the “suspicious symptoms” which she presented to him four or five times and had she been referred for testing, she might have had a chance of survival.

Had the out-of-hours hospital doctor had more imagination than to say “I can feel a lump, you’re constipated”, her chances might have been greater.

The statistics of which Dr Porter is so wary represent lives, and surely a life saved is worth many unnecessary tests.

GPs should be accountable, and the public should be aware of how well they are performing. Earlier diagnosis, using the tools available over the weekend and for longer weekday hours, would in the long run avoid costly last-ditch attempts at care. The “unnecessary tests” reassure far more effectively and quickly than repeated visits to a GP.

The survival rate for pancreatic cancer, from which my daughter died, has hardly changed for 40 years, with only 4 per cent of the 8,000 people diagnosed each year surviving more than five years.

When are things going to change? We do not need the complacency of GPs worried about statistics, but concern by GPs to save and protect the lives in their care.

Celia Goodman

Twickenham

Sir, Mark Porter’s defence of GPs in the face of yet another secretary of state for health who seeks to blame others for “mistakes” and shortcomings without taking responsibility, will be applauded by his peers but misses the point.

In the case of pancreatic cancer — which suffers from almost universally late diagnosis, few treatment options and has an exceptionally high mortality rate — GPs tell us they need help understanding the disease.

In this sense, a number of groups are at fault. The GPs for not coming forward and seeking a better understanding, secondary-care surgical and medical oncologists for not making more opportunities available for GPs to learn, the NHS bureaucracy for not being able to think outside the box, and politicians for, well, getting in the way.

Although pancreatic cancer in the UK is only the tenth most common cancer it is the fifth (soon to be the fourth) biggest killer. The average survival time post diagnosis is six months, and fewer than 4 per cent of those diagnosed survive for five years, and those two statistics have hardly changed in 40 years, unlike the (fantastic) improvements in the statistics for breast cancer, leukaemia and some other
cancers.

Pancreatic cancer is a prime example of where GPs need help, not shaming, but health professionals continue to stay in their bunkers.

For pancreatic cancer patients and their loved ones the issue is rarely about any meaningful period of survival, but earlier diagnosis will give families more time together in a situation where days and weeks are like gold dust.

More leadership is required.

Gerald Coteman

The Elizabeth Coteman Fund (Pancreatic Cancer Support & Research), Cambridge

How is pancreatic cancer diagnosed?
Mayo Clinic: Pancreatic cancer Tests and diagnosis – Diseases and
Treating pancreatic cancer : Cancer Research UK Pancreatic Cancer Treatment (PDQ®) – National Cancer

And that’s all without the “frontier” issues: Patient in Wales fights to be treated in England – I wonder what the outcome was?

Listen to us or ‘kids will die’

The Pembrokeshire Herald reports 27th June 2014: Listen to us or ‘kids will die’

The title is true. Until improved transport links are funded and then provided, more will die than is necessary.. This however does not mean that the Hywel Dda decision is wrong: it might still be the best utilitarian decision  for the people of all the area, with the least harm for the most people given the financial constraints and the “rules of the game” from the WG.

THE SAVE WITHYBUSH ACTION TEAM (SWAT) descended on Cardiff in full force this week in the continued campaign to save our fantastic local hospital.

Ten coaches and over a 1000 people arrived at the Senedd in our capital city on a gloriously sun drenched summer’s day. The desperate fight to keep essential services and funding at Withybush Hospital has been further accentuated after figures last week from The Nuffield Trust predicted demand on the NHS will outstrip the money it receives by 2025, and that the NHS in Wales is facing a £2.5bn funding gap over the next 10 years. In the short term, the Nuffield Trust said the NHS faced a challenging funding gap of £200 million in just the next two years.

As waiting lists increase, and service standards fall, extra insurance is worth considering… carefully… fearfully

Update July 18th 2014 – Chris Smyth July 17th reports in The Times: One in 20 on an NHS waiting list

An opportunity for extra cover? At first glance it seems all diabetics and those with Ischaemic Heart Disease, especially those living in areas with longest waiting lists, should apply. The risks of adverse selection don’t seem to bother Benendon Health. What’s the catch? It appears to exclude most of what I am afraid of getting… As a GP I was worried that many Benenden claims would not be met… Remember that there are perverse incentives in every system.. In the end, as th Regional Health Services deteriorate, there seems little option than the return of “fear”..

Benendon offers a list of what it does not cover:

  • Emergency care
  • Heart surgery
  • Cancer treatment
  • Surgery for arterial, cardiac, neurological or complex orthopaedic problems or Bariatric surgery. However, benenden health members can receive 25% off hip and knee replacements at the benenden Hospital
  • Cosmetic, breast, plastic, sterilisation, nerve, dental or maxillofacial surgery, or surgery for transplants
  • Diagnostic consultations with consultants who do not have an NHS post and are not registered with a royal college such as the Royal College of Surgeons or Physicians
  • Appointments with specialists such as radiologists, dentists, opticians or complementary therapists and pain management specialists
  • Retrospective services, where our written authorisation hasn’t been sought
  • Consultations, tests and treatments outside the UK
  • Services which are delivered by non-UK, non-VAT registered organisations
  • We are unable to support ongoing monitoring, follow-up consultations or treatment for the same medical condition. You should seek support through the NHS

You can compare private health cover (Private medical insurance: which one to choose by Naomi Coleman, Mail Online 29th June 2014), and get a quote, and tmy favourite options for private cover include:

BUPA:

Western Provident:

Aviva:

AXA:

SAGA:

A more comprehensive list includes:

Insurers

 

 

Radical plan to save our overstretched doctors’ surgeries. “Every patient should be able to see their family doctor when they need to”.

Lucy Johnston in The Express Sunday 29th June reports (exclusively!): Nurses to the rescue! Radical plan to save our overstretched doctors’ surgeries

There is one thing a Doctor does that no one else does: make a diagnosis. To get to a diagnosis efficiently and with minimal risk is the main skill of a GP. Was there ever a bigger admission of failure and implosion than to have too few? If you were asked to look after the crown jewels of the NHS, would you fail to plan as badly as this…? Who will provide the medico-legal insurance cover for this “routine” work, and at what price for these nurses? Will they be absolved with a no-fault compensation scheme? When there is vast undercapacity, those who are available will move to the desirable locations. Thus the poorest areas of the country will be the worst served: The North East and Wales. In addition many GPs are not good at delegation, (or triage) and only feel comfortable if they see the patients themselves..This is rrationing by neglect, deliberate undercapacity, political cowardice and denial….

The controversial proposals will be discussed at talks between doctors’ leaders and Health Secretary Jeremy Hunt next month. The crisis, caused by a shortage of family doctors, has led some overstretched surgeries to axe thousands of patients from their registers.

Maureen Baker, chairwoman of the Royal College of General Practitioners, said: “This is an extremely distressing situation for patients and for GPs. Every patient should be able to see their family doctor when they need to.

“Unfortunately, what we are seeing is a sad consequence of the desperate shortage of GPs in many parts of the country.

“Many practices are finding it difficult to find replacements for those doctors who have retired. This is leaving general practice ­teetering on the brink of collapse.

“Family doctors are heaving under the strain of increasing patient demand due to a growing and ageing population and plummeting investment.

“Over the last decade the number of patient consultations has risen to an all-time high and there are now 40 million more consultations in general practice than there were even five years ago.”

Under the rescue plan nurses would take over routine tasks such as check-ups for chronic conditions. This would leave doctors free to focus on where their expertise is needed most.

Nurses and health care assistants would also be asked to look after vulnerable, sick and elderly people in their homes.

Incentives for GPs to carry on working could include flexible hours, reduction in workloads and more support staff.

Dr Chand Nagpaul, head of the British Medical Association’s GPs committee, has already had informal discussions with Mr Hunt.

The group will also hold talks with MPs about the package next week.

Dr Nagpaul said: “This is not just a rescue package for GP practice. It will support the rest of the system.

“An investment in GP services will reap huge savings that will more than make up for the amount lost in the increasing numbers going to A&E, which is far more costly.

“We are also calling for greater support from nurses and health care assistants who may do some of the work, including managing chronic diseases such as asthma, lung disease, high blood pressure and diabetes.

“GPs need support to provide proper care, particularly for some of the most needy in our population. Older people with chronic conditions need more care and trying to provide care in 10 minutes is impossible. We need a system where we can provide time.”

A spokesman for the British Medical Association said: “The Government urgently needs to invest more in GP services or else it faces collapse.”

Clare Gerada, former chairwoman of the Royal College of General Practitioners, said: “I welcome these plans. There needs to be a rescue package to address the huge problems we…..

The multitasking implicit in care of the elderly in the community is denied by this simplistic suggestion. In addition the standard of GP education and examinations needs to be raised to address the future needs of the ageing population. Medical Education: Competency based training is a framework for incompetence

There is no plan. The lunatics are running the asylum – and we are condemned to a “managed decline”. (by our politicians)

“Every patient should be able to see their family doctor when they need to”

Maureen Baker, Royal College of General Practitioners

Just £1 buys enough beer to reach your daily alcohol limit

Hannah Summers reports in the Sunday Times 29th June 2014: Just £1 buys enough beer to reach your daily alcohol limit 

Somehow we need to ration alcohol consumption … Abuse is destroying many town centres and making them no go areas… Indirect Taxation is one way, more severe sentencing for drunks, especially when in charge of cars or violent would be another, and national pricing policy might also help… If the Regions make different legislation to England then the “frontier” issues of today (perverse incentives) will pale into insignificance as alcohol smuggling becomes big business..

THE price of alcohol has been slashed so heavily in some supermarkets that it is cheaper than mineral water, prompting experts to warn it is fuelling antisocial behaviour and health problems.

The price cuts mean consumers can drink more than their daily recommended alcohol limit for less than £1, despite demands by ministers and health officials for such offers on alcohol to stop.

Public health and crime prevention experts have written an open letter to the government — published today on The Sunday Times website — claiming it has failed to tackle the burden that cheap booze places on society.

It warns England risks being “left behind to deal with a growing burden of disease and social disorder” as Scotland, Wales and Northern Ireland push ahead with plans for minimum unit pricing for alcohol.

Research by Channel 4’s Dispatches found that Tesco is selling the cheapest lager at 69p a pint compared with 73p a pint for sparkling Perrier water….