Monthly Archives: November 2014

Rugby and Dementia pugilistica…. an unfair cost on the health service

Update 6th Feb 2019. The Economist 26th Jan 2019: Knocking heads together – Few sports are doing enough to protect athletes from brain damage – Small rule changes can reduce concussions in rugby and American football

FANS OF LARGE men colliding with one another are in luck. Next weekend the Six Nations, a rugby contest for the best teams in Europe, gets going in Paris. Two days later the Super Bowl kicks off in Atlanta. Some 115 cameras will beam the final of the National Football League (NFL) to fans around the world, along with advertisements urging viewers to drink beer and eat nachos. It is not a time for healthy living. Yet there is growing awareness that it is not just gluttonous fans who suffer. Contact sports can lead to serious health problems for the players, too……

Update 14th April 2018: Tom Whipple in the Times May 8th Blow to head ‘can double dementia risk’

BBC News reports 18th November 2014: Dementia fears for rugby players, academic warns

Of the 164 people with high cynicism scores, 14 developed dementia

Multiple blows to the head from playing rugby may accelerate brain ageing and potentially lead to early dementia, according to a Welsh academic.

Prof Damian Bailey carried out research on 280 current and retired players.

The International Rugby Board (IRB) already accepts there could be a link between repetitive head injuries and long-term problems.

Prof Bailey’s work is yet to be published but could be the first study suggesting a clearer link.

The IRB said it would not comment until the study is published while the Welsh Rugby Union (WRU), which issued guidance on concussion in September, said it plans to meet Prof Bailey to discuss his research.

We know this is true about boxing (Dementia pugilistica), so why not rugby?

Professional Rugby: the price we all pay. Co-payments or insurance are needed..

MPs back bill designed to limit NHS ‘privatisation’Comments (146)

BBC News 21st November reports: MPs back bill designed to limit NHS ‘privatisation’

There are many Comments (146) – well worth reading..

A bill which aims to curb the private sector’s role in the NHS has cleared its first parliamentary hurdle.

Under the bill, compulsory tendering for NHS contracts would end and NHS hospitals’ income generated by private patients would be restricted.

Although MPs backed it in a vote by 241 to 18, as a private member’s bill it has only a slim chance of becoming law.

The government insisted its priority was to ensure care was “delivered in the right way for patients”.

Labour MP Clive Efford brought in the bill, which he said would “cut the heart out” of the coalition’s reforms.

It would restore ultimate responsibility for the NHS to the health secretary, stop NHS hospitals earning up to 49% of their income from private patients, and would exempt the NHS from an EU-US trade treaty known as TTIP.

Critics fear TTIP could lead to American companies suing future governments for reversing privatisation.

Those who voted in favour of the bill included two Conservative and seven Lib Dem rebels.

When and who will eventually speak out honestly? 10% now to 20% of GDP by 2061

The Politicians’ denial continues and is summarised well in The Economist. What a pity that the media is letting the politicians off the hook in their coverage and questioning.. We are still a long way off the “Honest debate” that Mr Stevens called for, and the rationing which I suspect he thinks has to happen….


The English NHS reformation… (from the Economist 22nd November 2014)

The Guardian 23rd October reported: Politics Weekly podcast: the cost of saving the NHS

Michael White, Anne Perkins and Rafael Behr join Hugh Muir to discuss the plans to reform the NHS, the debate on Britain and the EU and the ill-advised Ukip calypso


Handing more control to patients could just be cost-cutting in disguise

Lisa Kidd (Research Fellow in Public Health at Glasgow Caledonian University ) and Andy Cassidy in The Conversation opines 21st November 2014: Handing more control to patients could just be cost-cutting in disguise 

In Austerity Britain, few cutbacks capture the public ire like those directed towards the beloved NHS. In the public consciousness at least, it seems the NHS must remain outside the whims of party politics. As such, few policies are as divisive as the rationing of healthcare. Often perceived solely as an economic measure, many objective observers would argue it has no place in the health professional’s toolkit.

Yet where healthcare is concerned, there clearly have to be changes in service delivery. That patients are living longer and with increasingly complex conditions demonstrates the abilities of our health service, but it also places an ever-increasing burden on it. As such, economic restrictions are often essential.


Explicit rationing already occurs in many instances and is often welcomed by service users. For example it is well known and generally accepted that cosmetic procedures and specific drug treatments are tightly controlled for financial reasons. The area of palliative care restricts treatment to patients with life-limiting illnesses. This is entrenched in NHS policy through the guidelines for treating terminally ill patients at the end of their lives.

Where rationing is publicly acknowledged and explained in this way, it allows patients to influence funding decisions. It also helps to legitimise difficult choices and takes some of the burden of these rationing decisions away from healthcare professionals.

When rationing is done implicitly it is more controversial, since it becomes harder to see which treatment options are being funded. It also means that patients have no ability to influence the decision.

It emerged recently, for example, that the NHS in England and Wales was not using best evidence to decide whether to fund cataract surgery, but deciding purely on financial grounds. Yet it cannot be denied that implicit rationing has its advantages: it ensures that decisions are made on a patient-by-patient basis by a qualified professional, and perhaps most importantly, for purely objective reasons.


One variety of this kind of rationing may not be intuitively obvious. It refers to a policy that has risen high on the healthcare agenda in recent years: giving patients more control over their care…..

Wait times to be halved for latest NHS drugs

Chris Smyth reports 21st November 2014 in the Times: Wait times to be halved for latest NHS drugs

This is good news, but of course it does not apply to Wales Scotland and Ireland…. Their smaller mutual cannot afford what they are currently supplying..

Waiting times for cutting-edge drugs will be cut in half under government plans to rip up a “broken” system that has denied many NHS patients life-extending treatments.

Ministers want to bypass traditional clinical trials by using patients as a “test-bed” for promising new drugs, linking their health service data to pharmaceutical company records to discover much more quickly how effective treatments are.

Firms would be paid different prices depending on how well drugs work for individual patients.

Medicines are increasingly being tailored to the genetic make-up of patients. Ministers argue that the system of assessing new treatments is no longer up to the job and that the National Institute for Health and Care Excellence (Nice) needs to catch up.

While charities and drug companies have welcomed the plans, they warn that they will not be a “magic wand” that ends the notorious slowness of the NHS in introducing modern therapies.

There is also likely to be unease about the practicalities, including safety concerns over fast-tracking new treatments, and fear over handing NHS data to drug companies.

Companies take more than a decade to test and get regulatory approval for medicines before submitting them to Nice. Senior sources with the government have gone as far as to say the system is broken.

They are promising to halve the time it takes to get new treatments to NHS patients, arguing that this can cut the £1 billion average cost of developing new drugs, and ease some of the outcry over Nice’s refusal to pay for a string of new cancer therapies.

George Freeman, the life sciences minister, told The Times: “The one-size- fits-all model of blockbuster drug discovery is ending — to be replaced by a new generation of personalised drugs designed around our genetic profile and medical data.

“This will transform the landscape of drug development from the 20th century model to a world in which the NHS becomes a partner in innovation: testing, proving and adopting new drugs and devices in research studies with real patients.

“With accurate data we can then start to measure — and pay by —results and health outcomes.”

Mr Freeman will launch a review today into the role of Nice and the safety regulator, the Medicines and Healthcare Products Regulatory Agency, aiming to produce recommendations for radical change early next year.

He said that patients must “get access to new life-saving drugs years faster than they do now. Not one or two years, but six or seven”, promising that this would save hundreds of lives a year.

Doctors were at present practising “blind medicine”, where they prescribed on the basis of average responses rather than personalised data.

Mr Freeman, a minister in both the Department of Health and the Department for Business, added: “For too long NHS patients have seen drugs and innovations developed in the UK but not adopted here in our NHS. We are determined to unlock the power of our NHS to be a test-bed for the 21st-century medical innovations we all need, getting NHS patients faster access, reducing the cost of drug development, and boosting our life science sector, which is increasingly central to our ability to generate the revenue to pay for the costs of advanced healthcare in a prosperous and ageing society.”

Aisling Burnand, chief executive of the Association of Medical Research Charities, said: “The vision is right in terms of trying to get promising compounds into patients quicker.

“Patients do want faster access to innovative medicines that are going to enhance their life or even save it. At the moment there are barriers in the way that slow things down.”

But she added: “It is complex. It is not going to be a magic wand waved tomorrow, it’s going to be a ten-year process.”

The present deal on drug pricing runs until 2019 and the government concedes that changes are unlikely to be put in place before that.

Paul Catchpole of the Association of the British Pharmaceutical Industry said that the review could be “transformative”, arguing: “It must be an end-to-end review that covers all parts of the system from the [lab] bench to the bedside. It’s going to be a key factor that this review includes the role of Nice. We need a fundamental review of Nice.

“We need to make joined up assessment where there is earlier dialogue between manufacturers, regulators and Nice in order that we can get medicines to market quicker. The danger is if we don’t manage to get that then patients won’t benefit.”

Nice itself has acknowledged the need for an overhaul of how the NHS tests new drugs, signalling a willingness to work with pharmaceutical companies to test more targeted treatments, but it has rejected suggestions that its methods are outdated.

Sir Andrew Dillon, chief executive of Nice, said: “The escalating pace of change in medical science offers enormous potential benefits for patients and the economy. This review provides the opportunity to think carefully about how together we can work through the NHS to deliver the greatest benefit.”

GP trainee recruitment hampered by lack of future workforce clarity

Neil Roberts for GP Magasine reports 18th November 2014: GP trainee recruitment hampered by lack of future workforce clarity

We need to de-politicize health if we are to get over-capacity… In my own area at least 6 trained GPs, mostly from abroad, have emigrated to Australia in the last 5 years. We need to train sufficient UK doctors, and preferably graduates..

Lack of consensus over the future size of the workforce is undermining efforts to train more GPs, Health Education England (HEE) has said.

In its submission to the Doctors and Dentists Review Body (DDRB), which advises the government on doctors’ pay, HEE said GP registrars are already paid more than hospital equivalents in order to increase recruitment but that ‘pay is only part of the strategy’.

The report added that while measures to increase supply through higher pay were reasonable, those efforts were hampered by the lack of consensus over the future shape and size of the GP and wider primary care workforce.

‘We must quickly move to a position where the training we are commissioning is validated by reference to a transparent perspective of future need,’ it said.

There was, it added, a lack of ‘compelling narrative on the future demand for GPs’.

HEE noted the forecast of the recent Centre for Workforce Intelligence study that if the target for 3,250 training places a year by 2016 were reached, it would sustain moderate annual growth to the GP workforce.

Call for 8,000 more GPs

The RCGP has repeatedly called for 8,000 new GPs in England by 2020, a target the Labour party has committed to. The government has said it will increase the workforce by 5,000.

An unprecedented ‘desperate’ third round of recruitment this year added just 72 extra trainees for 2014, bringing the total to just 2,688 for 3,067 available posts.

The government has required HEE to ensure 50% of medical students go into GP training.

HEE said in its DDRB submission that Local Education Training Boards are proposing to recruit an additional 222 new GP trainees compared to the number they would have recruited if no expansion were planned.

Responding to a DH DDRB response earlier this month GPC chairman Dr Richard Vautrey said the government had responded to the NHS funding crisis by cutting GP pay and that was ‘seriously impacting on GP recruitment’. DDRB should help address that ‘through a fair award to GPs’, he said.

Health education chiefs make ‘desperate’ push for new GPs

Education GP challenges Simon Stevens on GP recruitment

Third round of GP trainee recruitment cost £113,000 to fill 72 posts

Surgeons’ mortality rates (and cancer survival rates) – those failing to publish face penalties

BBC News 17th November reports: Surgeons told to publish mortality rates or face penalties

Today the Consultant Outcome Data were published on My NHS for the first time, and indeed a first in the world. This is just the beginning of a process that GPs have been going through since 1998. (If performance management gets overdone and overblown it can lead to disincentives and demoralisation…There’s a doctor shortage – So should we bring back the “Stocks”?) But it is good news. There will eventually be figures showing that going to a tertiary or a cold orthopaedic unit (Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres) is safer, and in the English mutual, patients will be able to take advantage of this if they are prepared to travel. Scotland and Wales do not choose to have comparable data in their much smaller mutuals… and their patients will be less informed and have no benefit.

The people with  most ability to make a choice based on this information will be the political representatives, in any of the Regional mutuals, as they have a genuine dual residency, along with the very rich.. They can play the game of “post codelottery” best.  Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

Surgeons who refuse to publish their mortality rates could face sanctions, NHS England’s medical director says.

Performance data for about 5,000 surgeons in England is expected to be released online on Wednesday.

Sir Bruce Keogh said publishing rates improved safety and the NHS was looking at “penalties to force that”.

Some surgeons have warned the move could lead to consultants refusing to take on difficult cases.

They argue the statistics do not take full account of the circumstances of each operation….

Sarah Kate Templeton in the Sunday Times reports: Surgeons told to publish deaths

…The data shows death rates can range from 0% to 16%, depending on the surgeon’s specialism. Patients have the right to refuse to be operated on by a particular surgeon if they are concerned about his or her death rate — though this may delay the surgery.

In a further development that will expose poor NHS performance, Jeremy Hunt, the health secretary, and Keogh will also order all hospitals to publish their cancer survival rates from next year. Every hospital will be obliged to publish its one- and five-year survival rates for the four main cancers: breast, bowel, lung and prostate. This will cover about 50% of cancer patients…..The performance of consultants in 12 specialties, from heart to kidney surgery, will be published this week. The NHS maintains that of the 5,000 consultants, only four have results outside the range considered acceptable.

Consultant treatment outcomes – Patient choice – NHS

FAQ: Outcomes data — The Royal College of Surgeons of England & Wales 

BBC News 2012: NHS medical director wants surgeon league tables – BBC

BBC News 298th June 2013: BBC News – Surgeon data: ‘Historic’ move for NHS

Medics’ NHS league table mortality figures mired in confusion

Surgery league tables ‘hitting heart patients’


HSj: It’s a myth myth that integrating health and social care services is best way forward

Dennis Campbell in The Guardian 19th November 2014 reports: Parties’ plans for NHS future are wishful thinking, say experts

If the political parties are going to hide behind the forthcoming change implied by integration of health and social care budgets, they might do well to listen to Jon Skone. These budgets have been integrated in Wales for 5 years – without solving the capacity issues… Waiting lists, bed blocking, lack of GPs and applicants for rural hospital posts.. Jon explains that Emergency care always trumps prevention and long term care in debates.. (Interview with Jon Skone, retired chief of the combined Social Services and Health budget in Pembrokeshire)

HSJ Commission of inquiry says politicians have fallen for the myth that integrating health and social care services is best way forward

Plans by the Westminster parties and the NHS leadership to safeguard the health service’s future constitute “magical thinking” that will not ensure its survival, a group of experts has said.

In a strongly worded critique, a commission of inquiry claims that both the coalition’s and Labour’s policies are not based on evidence and will not help the NHS to close the £30bn gap in its finances that is expected to open up by 2020.

Politicians of all parties have fallen for a myth that integrating health and social care services and moving many medical services out of hospitals represent the best way of keeping the NHS sustainable, they say.

The experts also accuse Simon Stevens, the chief executive of NHS England, of making a “heroic assumption” in pledging that the service will save £22bn a year by 2020 through extra efficiency after an overhaul of how patients receive care….

The findings constitute a stark challenge to the broad consensus about the best way to help the NHS withstand rising demand for healthcare while it also deals with an ongoing financial squeeze. They come from a year-long inquiry by the commission on hospital care for frail older people, set up by the Health Service Journal, (Read Sophie Barnes in HSJ 19th November 2014: Integration will not save money, HSJ commission concludes) which is widely read among senior NHS managers.

The group is chaired by Dame Julie Moore, the chief executive of University Hospitals Birmingham NHS foundation trust. The health secretary, Jeremy Hunt, has described the widely admired Moore as one of the NHS’s outstanding leaders.

Her co-authors include Prof John Appleby, chief economist of the King’s Fund health thinktank, and Prof David Oliver, a government health adviser, specialist in older people’s care and president of the British Geriatric Society.

Their report says: “There is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies. The commission found no evidence that these assumptions are true.”

It urges political parties and NHS leaders to “avoid wishful thinking that improving intermediate and community care, while perhaps the right thing to do, will automatically mean we can disinvest significantly in hospitals.”…

Chris Smyth in The Times 19th November 2014 reports: Labour will withhold NHS cash until reforms are made 

Labour has refused to give the NHS the extra money it is demanding until it makes radical reforms in its payment system to eliminate wasteful care.

Andy Burnham, the shadow health secretary, told health leaders yesterday that voters would not stand for handing billions of pounds more to a health service in which glaring inefficiencies remain.

His words are the party’s toughest since Simon Stevens, the head of NHS England, said last month that the health service would need an extra £8 billion a year from taxpayers by 2020….

The Wild Frontier: More English patients with GPs in Wales than vice versa – Rationing by choice restriction is unethical when there is a frontier option for some, and not for the rest of Wales.

BBC News reports 18th November: More English patients with GPs in Wales than vice versa

which-hospital - choice in England

Of course. No surprise here. If I had a choice and lived on the border I would register in Wales for free prescriptions and in England when I got ill. Therefore it is no surprise that Wales loses out. There are 35,000 patients concerned and Wales has 5000 excess. It was all forecasted by Aneurin Bevan In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear – look at the appendices.. So who will be the first WG Labour member in Wales to say ” Wales Health Services cannot continue to match English standards unless they work under the same “rules”. Rationing by choice restriction is unethical when there is a frontier option for some, and not for the rest of Wales.

There are more English patients registered with GPs in Wales than vice versa, a top NHS official has told MPs.

Helen Birtwhistle, director of the Welsh NHS Confederation, said 20,000 English patients were registered with Welsh GPs compared to 15,000 Welsh patients with English GPs.

No extra money comes to Wales for the additional 5,000 patients, she said.

The Welsh Affairs committee’s hearing comes amid a bitter political row over the state of the NHS in Wales…..

Jesse Norman, Conservative MP for Hereford and South Herefordshire, told the committee that 3,500 people in Herefordshire were with Welsh GPs mainly because they were the nearest and English GPs would not accept them.

He called for assurances such people would be given the same rights as other English patients under the English NHS in terms of waiting times for treatment and access to the cancer drugs fund in England…..

Bill Proud / Cartoon Stock