Monthly Archives: July 2014

Right to die at home register ‘would save cash’. Many of us would prefer to die at home, less than a third (29%) are able to do so.

Francis Elliott on 29th July in The Times reports: Right to die at home register ‘would save cash’

The demographics of increasing numbers of people in “Old Age”, allied  to improved technology and treatments (usually expensive) mean we have to ration out the cheap and cheerful to be able to afford the technical, and the care.. Life Expectancy & Demographics . Dying is expensive, wherever it happens, but it is possibly cheaper at home when large numbers are involved. NHSreality believes Palliative and Terminal Care should be fully funded. This means cheap cheerful treatments need to be paid for by the person concerned. There is another problem: we would prefer the same doctor, or “continuity of care”, but this is another problem. If it happens, It will be the team and the team ethic that looks after most of us..

Giving people the right to register a wish to die at home with their GP would improve care and save cash, a former health minister said yesterday.

Most people want to die at home surrounded by friends and family rather than in the “hectic and impersonal environment of an acute hospital ward”, said Lord Warner.

The peer was speaking ahead of the introduction of his private members bill which would enshrine patients’ rights to register the wish and compel heath staff to honour it where possible.

Less than half those that die each year do so in their own residence or in care homes with London patients most likely to die in hospital.

“The great majority of us want to die at home or the place we normally live. Perversely, we end up not only dying in the place we least want to be but in the most expensive place,” said Lord Warner yesterday.

Figures compiled by the Marie Curie charity suggest that the cost of palliative care in the community is around a third of that in hospital.

“I am not trying to dragoon people into dying outside hospital to save money. But it would mean fewer people dying in hospital and would reduce pressure on A&E departments and acute hospital beds – a not inconsiderable benefit given current NHS clinical and financial pressures. There is every prospect that the cost-savings involved would pay for exempting terminally-ill patients from local authority social care charges – another way of improving people’s end of life experience.

Lord Warner’s bill, which has yet to clear its first parliamentary hurdle, has little chance of becoming law but the former health minister says he hopes it can produce a cross-party consensus in favour of a right to choose to die at home.

Assisted dying debate must be thorough

GPs back the right to die for terminally ill

Making choice at the end of life a reality – Macmillan Cancer

NHS Confed Briefing on End of Life Care – Gold Standards

Removing the NHS ringfence: the next stage for healthcare rationing

Tony Yeoman writes in the Health Service Journal (HSJ) 29th July 2014: Removing the NHS ring-fence: the next stage for healthcare rationing – NHSreality agrees, and moreover decries the political cowardice that is stopping any open discussion. In the end it will be a knee jerk reaction from government, without public support, as the average man who is “well” still expects “everything for everyone for ever”. Mr Jo Public does not realise the shortfall until he is ill, by which time it is too late. Hospital and community managers are gagged and feel they will lose their jobs if they acknowledge the need to ration, as then it will have to be overt… and the regional differences will lead to gaming and frontier issues.

With an increasing recognition of the squeeze on NHS services, attention is turning to the legality of provider policies on rationing expenditure. But the approach has been well tested and should continue, argues Tony Yeaman

Scarcely a week goes by without a public figure speaking out on the predicament facing the NHS. Senior MPs have warned that it is crunch time, with more funding needed if the NHS is to avoid collapse.

‘There is already judicial recognition that rationing of expenditure is sadly inevitable’

Despite greater optimism about the economy, NHS finances and the rationing of funds remain a political hot potato.

Martin McShane, NHS England’s director for long term conditions, underscored this issue in January when he argued that the massive increase in the number of people with chronic conditions such as diabetes and dementia was threatening to “overwhelm” the NHS and represents the “healthcare equivalent to climate change”.

Caring for 15.4 million people in England with at least one long term condition already takes up 70 per cent of the NHS’s £110bn budget, as well as just under £11bn of the £15.5bn spent on social care in the country. Now the debate is starting to include conversations on whether to charge patients.

A survey by found 32 per cent of 800 GPs supported charging patients for visits to accident and emergency, as it is believed 30-40 per cent of these visits are unnecessary; charging would also ease the crisis in emergency care in relation to problems that can be dealt with by them. However, the British Medical Association and the Royal College of GPs are opposed, arguing that this penalises the poorest.

In March, former Labour health minister Lord Warner urged everyone to pay a £10 per month NHS “membership charge” to prevent it from sliding into a decline that threatens its very existence.

In a report written for think tank Reform, Lord Warner said dramatic action is needed as the NHS faces an expected £30bn a year gap by 2020 between demand for healthcare and its ability to respond.

Weight of reform

On top of this are proposed reforms following reviews into care and the health service over the last 18 months, with Francis, Berwick and Keogh being key. With the new statutory duty of candour, the financial challenges look harder than ever.

It is useful from a legal point of view that there is already judicial recognition that rationing of expenditure, in the guise of withholding or refusing certain treatments, is sadly inevitable, with the availability of certain treatments being restricted.

‘A failure to make rationing decisions would mean the irresponsible diversion of valuable resources away from patients’

The courts have made this clear in decisions about experimental cancer treatments, where it was felt that a failure to make rationing decisions would mean the irresponsible diversion of valuable resources away from the majority of patients to benefit a smaller cohort.

The court noted in the leading case authority on this issue that, ideally, treatment would be provided regardless of cost, but to believe this was possible would be impractical, and health bodies have had to regard resources in determining what treatments they could provide.

Updating policies

There have been further decisions where providers’ policies and therefore funding decisions have been found to be unlawful. But the providers, rather than being required to provide the treatment sought, have instead had to make the necessary policy amendments to bring these into line with the law.

The courts have, for example, previously accepted a primary care trust’s case that it could, in exercising a rational approach to treatments, rule out funding in cases where clinical effectiveness was not proved.

‘There is recognition that resources are limited and rationing inevitable, leading to focus on the legality of the provider policies’


Meetings in the Regional Health Services – tarnished with the NHS managerial inactivity brush

A relative working in a private provider to the Health Service (In England) was made redundant. They were offered a job in the local Regional Health Service (RHS) –  in a similar accounting role. The change in focus and style of the meetings was the first thing that struck them. Where the private company was focussed and rarely wasted time, and made decisions in meetings,  which were then carried through,  the RHS meetings usually failed on all these counts.

Leadership was lacking. The fear of making a decision which might be criticised by line management as a mistake, over-rode the need for action. It’s as if they were in a different world. Champix makers thrive whilst patients die..











Youmight get the impression that NHS England has wonderfully creative Board Meetings where “members of the public are invited to attend and observe”……. This is rue of NHS Highland (Welcome to MeetingsNHS Highland) and most others.

Meetings, Bloody Meetings is a 1976 British comedy training film that stars John Cleese as a bumbling middle manager. The film was written by John Cleese and Antony Jay, and was produced by Cleese’s production company Video Arts. Wikipedia

Meetings bloody meetings – YouTube
Meetings, bloody meetings 2012 | Video Arts

The benefit of handing over the Hospitals to locally based staff mutuals (Hand hospitals over to their staff, says Francis Maude) would be a reassertion of leadership and focus.. The benefit to my relative would be in job satisfaction. As it is, they know that if they don’t move on quickly, they will be tarnished with the NHS managerial inactivity brush, and might never get another post.

This is what most professionals are thinking:


Hand hospitals over to their staff, says Francis Maude

Rowena Mason in The Guardian reports Tuesday 29th July: Hand hospitals over to their staff, says Francis Maude

Cabinet office minister believes NHS services should increasingly be run as mutuals and taken out of public hands


NHSreality can think of many disadvantages, such as tertiary referrals, or making the disinvestment changes needed to move services from Hospital into the community.. However, the finances would be overt to all, as would the rationing.. The inspection system need not be changed, but how about the capital provision and decision making for new builds? Most of the Hospitals and their plant is old and needs replacing. The location of the replacements is most important, and this is a political decision (at present). The suggestion is worth exploring….

More NHS hospitals and youth services should be taken out of public hands and owned by the people who run them as mutuals, Francis Maude, the cabinet office minister, has said.

The senior Conservative MP told the Guardian that he was “more and more convinced” this was “the way of the future” for a greater proportion of public services – suggesting the only exceptions from possible spin-offs should be front-line police and the armed forces.

Unison has criticised the process as a “Trojan horse for privatisation”, as spun-out services can subsequently be taken over by private firms. It also claims they “frequently mask top-level buyouts without any real input or buy-in from staff”….

..One of the most prominent hospitals to become a “mutual joint venture” did so under the last government. Hinchingbrooke in Cambridgeshire is 49.9% owned by its employees and 50.1% by private investors, with its supporters pointing to improved standards under the new ownership….

..Maude’s comments come as Andy Burnham, the shadow health secretary, prepared to give a speech in Manchester warning against creeping privatisation in the NHS. He will accuse David Cameron of misleading the public and call for contracts that put health services “up for sale” to be frozen until after the election.

He will highlight two ten-year contracts for cancer care in Staffordshire worth a total of £1.2bn and a five-year contract worth £800m for the care of older people in Cambridge. Burnham has now written to NHS England chief Simon Stevens calling for a halt to any further contracts for NHS clinical services being signed for the next year. “The reason why people love and trust the NHS is because, for all its faults, it is a service that is based on people, not profits,” Burnham will say. ” When his reorganisation hit trouble and was paused, David Cameron explicitly promised that it would not lead to more forced privatisation of services. But, as always with the NHS and this prime minister, the rhetoric and the reality don’t match.

“On his watch, NHS privatisation is being forced through at pace and scale. Commissioners have been ordered to put all services out to the market. NHS spending on private and other providers has gone through the £10bn barrier for the first time. When did the British public ever give their consent for this? It is indefensible for the character of the country’s most valued institution to be changed in this way without the public being given a say.”


Rationing of GP services by undercapacity – poor manpower planning due to the political system

Two stories expose the NHSreality of rationing of GP services by undercapacity in the provision and training of GPs, and poor manpower planning due to the political system which only worries about the next 4 years.

Lawrence Dunhill in the Lancashire Telegraph reports 25th July: Lancashire doctors in GP workforce ‘crisis’ call

LANCASHIRE doctors have called for urgent action to tackle a workforce ‘crisis’, after a new report highlighted the dwindling number of GPs in training.

The GP Taskforce report, published by Health Education England, found GP recruitment has been ‘stubbornly low’ for the last four years, while many family doctors are approaching retirement age….

The result of this denial and lack of willingness to plan properly is exposed by Chris Smyth in The Times 28th July 2014: Millions shut out of doctors’ surgeries

One in nine people trying to see a GP cannot get an appointment, with doctors turning away their patients more than 40 million times this year.

Doctors’ leaders said that the figures were a “shocking indictment” of a failing system and warned that the early signs of cancer and other deadly diseases could be missed when patients were shut out of surgeries.

Patients have to queue out of the door at emergency sessions, go to A&E or simply give up and hope that they get better, experts said. Receptionists and callers are trying to judge who is in need of emergency treatment, with the rest told to phone back at another time.

Patients in London and Birmingham face the most frustration, with one in seven being turned away.

The Royal College of GPs said that the system had been “brought to its knees” by the weight of patient demand and warned that it was only going to get harder to see a doctor…..

A reminder from July 3rd of the problems in Knowle and the announcement of the retirement of 2 GPs.


Making Road Travel less risky – and less of a drain on health services

The Regional Health Services are all strapped for cash. Road Traffic Accidents are a significant drain on resources. David Lock asks Should accident victims who get a pay-out be entitled to free NHS care? The NHS Injury Costs Recovery scheme: April 2013 – March 2014 shows a recovery of £200 million in the last 12 months, broken own by region. It is evident that we are not getting everything back that we should, and particularly the cost of long term care and brain damage. Chris Greenwood, Crime reporter for the Daily Mail reports: Police to seize mobiles in EVERY car crash: Crackdown on calls and texting at the wheel in bid to cut deaths by distracted drivers.

You can already find the sites of RTAs in your area or at any particular post code at CrashMap.

Exactly how many people were killed on our roads is an audit done annually and available for 2012 from the Royal Society for the Prevention of Accidents..(ROSPA).

The Government office for National Statistics reveals that deaths have settled at around 1700 per annum. It is an attempt to reduce this further that has led to the suggestion to examine every mobile phone, and NHSreality think it is sound. And it could save a lot of money as well as deaths once the real cost is passed on to the insured. However, BBC News – Casualties on 20mph roads up by quarter in 2011 suggests use of mobiles might be the cause…

Whiplash Injuries from mainly RTAs are another drain on resources: Responding to the compensation culture – New Zealand’s Faultless Fix – Time for a change. Write to your MP and ask for a longer and fairer view for the future.

Motor Insurance is compulsory but is ruled by cost in advertising to customers, rather than quality which is what matters to the claimant. How can this be altered?

And then there is smoking – and lighting up in cars, especially with children present…

Smoking in cars with children will be banned in Wales – BBC

BBC News – Car smoking ban ‘will be brought in’

Banned! Smoking in cars carrying children to be a criminal




Breast cancer patients to get new quick radiotherapy treatment

Rebecca Smith in The tElegraph 25th July 2014 reports: Breast cancer patients to get new quick radiotherapy treatment

Breast cancer patients will be given a 20-minute one off dose of radiotherapy during surgery to remove their tumour instead of repeated visits afterwards, following approval by Nice

I wonder how quickly all patients will be offered this “good news”? In the interest of raising standards England will allow all prepared to travel to select this on “choose and book”. In the interests of reducing inequalities Wales will have to wait until it is “universal”. Can we afford not to do it?

The BBC News (James Gallagher) also reported this 26th July 2014: Breast cancer: One-shot therapy gets NHS nod

Draft guidance from the National Institute for Health and Care Excellence (NICE) said it would improve patients’ quality of life.

The technique, called intra-operative radiation, is suitable only for patients who have caught their cancer early.

Currently, those patients would have surgery to remove the tumour. They would then face at least another 15 trips to hospital for radiotherapy to kill any remaining cancerous cells.

One shot wonder

Intra-operative radiation is performed during surgery.

Once the tumour is removed, a probe is inserted into the breast and delivers radiation to the exact site of the cancer for about half an hour.

Tests on more than 2,000 people suggest the technique has a similar level of effectiveness as conventional radiotherapy…

“One-stop” breast radiotherapy advance 18 MAY 2007, HEALTH