Monthly Archives: November 2014

Rationing won’t solve NHS . There is no NHS Ellen. Come and live in Wales.

Ellen Howley, chairman of Keep Our NHS Public, Cornwall writing in the Plymouth Herald, 22nd November 2014 opines: Rationing won’t solve NHS

With a General Election in less than 6 months, it’s time for all of us to consider the future of the NHS, and to speak up about it.

Because this election is likely to decide whether the NHS survives in any recognisable form.

Sounds dire. There is no NHS Ellen. Come and live in Wales.

If you read Ellen’s whole article you can see that she is only really considering “deserts based rationing” by denial. Her PCT is disobeying the law of the land by acting as it is, and the minister will rightly come down on the board who made these decisions like a scalpel.. However, rationing can occur by reducing demand (prescription charges and co-payments), by restricting choice, by limiting drugs and by denial of sufficient funding for important services like rheumatology, physiotherapy or psychological assessments and treatments after a number of conditions. There is long term rationing of medical and nurse places in training, and there is waiting list rationing whereby the longer you are on the list the prospect for cure for serious conditions is less. There is overt rationing and covert rationing, and the only good thing about Plymouth is that it seems to be overt. There is knee jerk rationing and planned rationing with pragmatic acceptance.. There is a possibility of rationing the low cost high volume rather than the high cost low volume services, and there is a possibility to reduce demand by encouraging patient autonomy… Whichever way we ration, it is inevitable. It’s just a question of whether politicians can discuss it honestly so that there is acceptance, or whether it remains covert and post code: which could eventually lead to civil unrest. I pay the same taxes as an English citizen. I get less choice and lower standards, as many posts on NHSreality show.

Rationing and Models



Waiting lists and times matter. Should Katie Mayum have been more assertive?

Francesca Angelini in The Sunday Times 23rd November 2014 reports: Dying mother sues over 5-month delay

Adams cartoon December 22

A MOTHER of two with terminal breast cancer is suing the NHS for £750,000 after she was forced to wait 5½ months before being seen by a specialist, despite an urgent referral from her GP.

Katie Maytum, 35, went to her local doctor in Maesteg, south Wales, in July 2010 after noticing a lump in her left breast.

The GP, concerned that it had been present for six weeks and was easily distinguishable, faxed an urgent referral form to the South West Wales Cancer Network, which brings together organisations involved in planning, commissioning and provision of cancer care across the region.

But after reviewing the referral, Vummiti Muralikrishnan, a consultant surgeon at the Princess of Wales Hospital in Bridgend, downgraded it to routine and classed the case as not one of “urgent suspected cancer”.

At the time Maytum, mother to Megan and Zac, was working for an estate agent while training to become a mental health nurse.

In documents lodged for a High Court hearing in Cardiff that is due to begin tomorrow, Maytum’s lawyers claim Muralikrishnan was negligent. The surgeon will argue that the downgrade was reasonable.

Increasingly concerned about the lump, Maytum returned to her GP practice in September 2010. She claims she was told that, because she had already been referred, she should wait to hear from the hospital.

Maytum says she called the hospital on several occasions to ask what was happening but received notification only in December 2010 of an appointment booked for 13 January, 2011. An ultrasound scan performed on that day revealed that she had cancer.

She underwent surgery and lengthy chemotherapy treatment but was told in April this year that the cancer had worsened. She has been given 18 months to live. Maytum, who is due to get married this month, believes the delay in diagnosis and treatment contributed to her developing advanced cancer.

Her grandmother and four great-aunts all had breast cancer but the history of the disease in the family was not noted on the referral form from the GP.

Under guidelines from the National Institute for Health and Care Excellence (Nice), Maytum should have been seen within a fortnight of the urgent referral being made.

NHS Wales is arguing that, rather than follow the Nice advice, it used the rules for managing referral to treatment waiting times, an alternative set of guidelines that allow urgent referral times to be downgraded and which do not require a two-week response for suspected cancer patients.

In documents submitted to the court, Maytum’s lawyers say that “as a result of the [trust’s] negligence she has been deprived of a cure for her cancer. Alternatively she has or is likely to suffer a loss of years of life which . . . is in the region of 44 years”.

Her damages claim includes the “loss of unquantifiable services of a wife and mother”. These include £7,500 a year from April 2017 to April 2027, when her younger son will be 21, to cover the cost of a nanny for 20 hours a week at £6.93 an hour.

NHS Wales admits Maytum’s referral was downgraded and that, under the hospital’s own internal rules, she should have been given an appointment within three months.

The case comes amid criticism of NHS Wales for missing key waiting time treatment targets. Figures released earlier this month showed just 85%of patients diagnosed with cancer started treatment within the 62-day target between July and September this year. The target set by the Labour-led Welsh government is 95%.

Abertawe Bro Morgannwg University Health Board, which runs the Princess of Wales Hospital, was the worst-performing trust with only 81% of patients suspected of having cancer and urgently referred by their GP starting treatment within 62 days. The hospital is also at the centre of a police inquiry into allegations of neglect regarding vulnerable patients.

Tom Goodhead, a member of Maytum’s legal team, said: “We are not able to comment on the specifics of the case due to the ongoing nature of the proceedings. However, this is a tragic human story which raises issues of both alleged medical negligence and the effects of the devolution settlement in Wales.”

Abertawe Bro Morgannwg University Health Board said it was unable to comment.

Challenged about missed cancer waiting times targets, a spokesman for the Welsh government said: “We are determined to ensure every person in Wales gets the best quality care they need and we are continuing to work closely with health boards to make further improvements.

David Haslam in the Telegraph 24th Jan 2014 says: NHS patients should be pushy with GPs about treatment   and Mr Hunt for England said Patients told to go online in radical NHS reform in NHS reality  Oh dear…. She was assertive, and in Wales where Mr Hunt has no jurisdiction, but was still seen too late. Rationing by exclusion, and lack of sufficient assertion? No wonder patients opt out of the Health Services and choose private care.


Superbug fears at hospital in Edinburgh

Mark Macaskill in The Sunday Times 23rd November 2014 reports: Superbug fears at hospital

SERIOUS concerns have been raised over hygiene standards at one of Scotland’s largest hospitals, it was claimed last week, after filthy mattresses and soiled commodes were found during an unannounced inspection.

Officials from the Healthcare Environment Inspectorate (HEI) made a surprise visit to Edinburgh’s Western General Hospital on Tuesday and are understood to have criticised senior managers for basic hygiene failings that could aid the spread of superbugs such as MRSA and Clostridium difficile (C diff).

The disclosure comes on the eve of the publication of a long-awaited report into an infectious outbreak at the Vale of Leven Hospital in Glasgow six years ago, which killed dozens of patients. The inquiry was ordered by Nicola Sturgeon in 2009 when she held the health portfolio.

According to a well-placed source, hospital managers at the Western General were summoned by HEI inspectors on three occasions after filthy mattresses and dirty commodes were found. Some mattresses were condemned on the spot and removed. The source claims a temporary lack of replacement mattresses meant the dirty ones had to be put back on beds after the inspectors left.

“The management were badly criticised,” the source said. “The nurses were hauled over the coals and that has caused a lot of anger. The problem is that staff are badly overstretched and the Western has an increasing elderly population to care for.”

Last night opposition politicians and relatives of victims who died in the Vale of Leven outbreak expressed concern at the failings uncovered at the Western General….


Inequality revisited.

The Economist Nov 8th 2014 opines: Forget the 1% its the 0.1% who are getting ahead in America.

The Gini Coefficient in Europe and the UK may be going in the same direction as in America… This is not healthy and will lead to social division. Whether we like it or not we live in a world where the richest can evade the taxes that the middle classes have to pay.. A global approach to taxation seems a long way off, so inequality will rise.

AMONG the most controversial of Thomas Piketty’s arguments in his bestselling analysis of inequality, “Capital in the Twenty-First Century”, is that wealth is increasingly concentrated in the hands of the very rich. Rising wealth inequality could presage the return of an 18th century inheritance society, in which marrying an heir is a surer route to riches than starting a company.

Social mobility

Free exchange -forget the1%

Downward mobility on the rise for the first time in generations



BMI_Doing_more_with_less_Economist 2013

Health Inequalities in Primary Care- Time to face justice

Are you ready for your “Trolley Stay” in your District General Hospital?

Chris Smyth in the Times Saturday 22nd of November 2014 reports: More patients wait on trolleys as crisis looms in A&E units

Rationing by waiting…. you might have to provide your own trolley soon. Are you ready for your “Trolley Stay” in your District General Hospital?

'We thought the 'bed shortage' was bad, until the 'hospital trolley shortage' came along.'

The NHS is heading into an A&E crisis even before winter has begun, patient leaders said after figures showed that thousands more people waited more than four hours to be seen last week.

Emergency units are overflowing and thousands of patients are enduring long waits on trolleys because hospitals are too full to admit them, official data showed yesterday.

The worsening performance will alarm ministers, who are pouring £700 million into the A&E system in a desperate attempt to prevent a catastrophe months before the general election.

More patients are waiting too long than at any time since April last year, when doctors likened hospitals to war zones. Last week 92.9 per cent of A&E patients were seen within four hours, the seventh consecutive week that the NHS has missed the target of seeing 95 per cent patients within this time.

The picture is even grimmer in large units, which have not reached this level for more than a year.

There has also been a sharp rise in patients waiting more than four hours waiting to be admitted to a hospital bed, with 6,587 such “trolley waits” last week, twice the level at this time last year.

Katherine Murphy, chief executive of the Patients Association, said: “This paints a very bleak picture of an NHS in crisis, when we haven’t even had the winter pressures yet. Patients must not suffer as a result of financial pressures from management. Care cannot and should not be compromised.”

Health chiefs blamed a record number of patients needing emergency admission for the figures, which reached 108,301 last week, the highest total since weekly data began in 2010….

…Figures this week suggested that “bed blocking” was at record levels, as hospitals struggle to discharge elderly patients because of a lack of social care support at home. Senior doctors are concerned that wards are already filling up, leaving little capacity for winter.

Chris Hopson, chief executive of the Foundation Trust Network, said hospitals were so fragile that a “small gust of wind” like the closure of a local nursing home could cause them to miss crucial targets. The Department of Health said: “The NHS is performing well despite unprecedented demand.”


Elderly patients threatened with eviction notices

Chris Smyth reports in The Times November 21st 2014: Elderly patients threatened with eviction notices 

hospital is threatening so-called “bed blockers” with eviction from their wards, saying overstaying patients could face legal action if they do not leave within a week.

Staff at the Royal Bournemouth Hospital say that families are parking elderly relatives in NHS beds while they redecorate or go on holiday, and senior doctors believe it is now common for relatives to “hold the ward to ransom” for selfish reasons.

Campaigners attacked the policy as “completely unacceptable”, saying the NHS should focus on arranging support for elderly patients in the community rather than using legal threats.

The controversy highlights a growing flashpoint, as hospitals increasingly struggle to send vulnerable patients home because of problems with social care. Two sets of figures this week showed rising numbers of beds “blocked” because of difficulty discharging patients.

The Bournemouth hospital said that it had dozens of patients who were medically fit to leave but did not want to do so. Katie Whiteside, clinical manager for discharge services, said one family asked them to “keep hold” of a relative while they had a two-week holiday in Turkey.

“At the moment we have relatives coming back telling us they don’t like the decor of care homes, or they don’t like the member of staff who met them at the door,” she told the BBC.

“Sometimes they are decorating the house or having a ‘granny annexe’ built and they know that, while the patients are here, they are being fed, watered and looked after.”

“Bed blocking” has been blamed for delays in accident and emergency, cancelled operations and other problems, as hospitals struggle to admit new patients.

Analysis by the Health Service Journal this week found that 1.4 million bed days were lost to delays in discharging fit patients in the past year, the highest level on record. Sky News said 1,000 patients a day cannot be discharged because there is no care at home.

Ms Whiteside said: “We would be in a position to commence legal proceedings and formally evict a patient if that was necessary. It would be an absolute last resort but it’s something we are in a position to do with the solicitors here at the trust.”

Caroline Abrahams, Charity Director at Age UK, said: “We understand the NHS is under great pressure but it is completely unacceptable for any hospital to deal with an older person in this way.”

She said it was very difficult for families to make quick decisions about moving relatives into care homes or adapting where they live.

“There’s a lot hospitals can do to make it easier for older people to be discharged as soon as their medical conditions warrants it, like having good arrangements in place with care homes and local authority social care services. Threatening older people with legal action is emphatically not the right approach,” she added.

A spokesman for Royal Bournemouth Hospital said: “Once medically fit for discharge, an acute hospital environment is not in the patient’s best interest . . . We are asking that when patients and their representatives are given names of care homes from the hospital staff, for example, they view these homes and come to a decision within seven days.”

The NHS and ‘cradle to the grave’: Rationing by exclusion?

Cradle To The Grave cartoons, Cradle To The Grave cartoon, funny, Cradle To The Grave picture, Cradle To The Grave pictures, Cradle To The Grave image, Cradle To The Grave images, Cradle To The Grave illustration, Cradle To The Grave illustrations

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..