Monthly Archives: January 2015

The Duthie report. Time for Trust Boards and CCGs to re-visit this excellent and altruistic work from 1981

Orthopaedic waiting lists are getting worse. Yet the solution was offered as long ago as 1981. We will try to re-invent the wheel, write more reports, delay changes, but this excellent and altruistic report was in the Cardiff University library and had been taken out only twice (in 1991) before I borrowed it. The report is not on line, and yet it should be essential reading for all Trust Board members, Clinical Commissioning Groups, health planners and anyone interested in improving the Regional Health Services. I have scanned it in…

My original report 5th October 2014 before scanning: Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

Orthopaedic Services: Waiting time for out-patient appointments and in-patient treatment. Report of a Working Party to the Secretary of State for Social Services. If you only have time to read one part read the summary and recommendations.

Duthie 1981 Orthopaedics 1

Duthie 1981 Orthopaedics 2

Duthie 1981 Orthopaedics 3

Duthie 1981 Orthopaedics 4

Duthie 1981 Orthopaedics 5 (summary)

Anger as hearing aids are rationed by the NHS: Hard of hearing patients given only one device to be worn on left OR right ear

Victoria Fletcher in The Daily Mail 24th Jan 2015 reports: Anger as hearing aids are rationed by the NHS: Hard of hearing patients given only one device to be worn on left OR right ear

This follows Devon Health Board deserts based rationing – and political dishonesty & denial at Cabinet level at PMQs. and Deafness in professionals – are you one of them? and DEAF MAN, EIGHTY, TREATED AS IF HE HAD DEMENTIA -watchdog finds

The NHS has started to ration hearing aids for the deaf – with thousands of people being offered only one device when experts say they need two.

Specialists recommend that patients who are losing their hearing in both ears should be offered two aids, but some NHS authorities have started to offer just one to such people, in a cost-cutting exercise that saves a modest £90 per person.

The charity Action on Hearing Loss, formerly the RNID, has found four hospital trusts in England and two health boards in Wales now initially offer one aid. 


Ambulance response times fall to record low in Wales – but the politics of Wales ensures continuing denial

The WG  has rationed the money it gives to it’s Trust Boards, and is also rationing other services such as ambulance, mental health, continuing care, social care and support. If Wales went back to a Welsh Office we would all be less punished relative to England. But don’t be mistaken: England is in trouble as well, just not as much trouble – yet. The politics of Wales ensures continuing denial….

Chris Smyth reports in The Times 30th Jan 2015: Ambulance response times fall to record low in Wales 

Ambulance response times in Wales have reached record lows, according to figures which reopened a bitter political row over who is to blame for the problems facing the NHS.

Less than 43 per cent of Welsh high-priority calls got an ambulance within eight minutes in December, down from 51 per cent in November and well below the target of 65 per cent. In England, which has a target of 75 per cent, about 70 per cent of calls are reached within eight minutes.

David Cameron wielded the figures during Prime Minister’s Questions, blaming “catastrophic cuts and mismanagement” of the Welsh NHS by Labour. Ed Miliband accused Mr Cameron of a war on Wales and using the Welsh NHS “for political propaganda”.

Tracy Myhill, interim chief executive at the Welsh Ambulance Service, said: “We completely appreciate that this presents an unacceptable level of service delivery across the whole health and social care system.” She said there were “a number of mitigating factors”, arguing that “an ageing population and more people with long-term illnesses means that more people than ever before are relying on our ambulance service”.

Waiting times for diagnostic tests are also higher in Wales than in England, while claims from patients of mistreatment amounting to a “Welsh Mid Staffs” have fuelled Tory claims that the health service there is in crisis.

Rurality and Utilitarian decision making: Wales is let down by its inept politicians.

Welsh NHS ‘is a scandal’, says David Cameron

Fewer than half the population know who runs Welsh NHS, says poll

Sam Tegeltija on 20th January 2015 reports in Walesonline: Figures produced by the Royal College of General Practitioners show North Rhondda has the highest percentage of GPs over the age of 55 in Wales

Cancer drugs fund is illogical. More money should be spent on radiology and radiotherapy.

On the theme that governments should focus on populations, and doctors on the individual patient, the Cancer Drugs Fund is an obvious example of the paradox. The Cancer drugs fund (NHS England) is illogical. If it is spent on cancer, more money should be spent on radiology and radiotherapy, but what about Mental Health? …And it could be right to ration some of the most expensive services. The UK politicians should say/publish this paradox overtly and honestly to their citizens. The first party to do so may be surprised by the level of public support. I apologise for reprinting the whole article.. but felt it too important to omit… It provides a perverse incentive to overtreat and leads NHSreality to wonder about the lobbying by big Pharma to both politicians and doctors .. (The Reith Lectures 2014 – Being Mortal – Don’t miss out on modern philosophy of medicine.) I expect the Chief Medical Officer (CMO) would agree with Prof Sikora if he was put in the dock by a barrister..

The Economist  24th Jan opnes: Benign or malignant?  A well-meaning gesture is causing more and more trouble

“ENGLAND denied miracle bone cancer drug”. A few years ago that sort of headline was common in newspapers. The accompanying stories tended to explain that the National Institute for Health and Care Excellence (NICE), which advises the NHS, had rejected a cancer drug as too expensive. David Cameron, who worked in public relations before becoming a politician, decided to do something. In 2010 his government created a Cancer Drugs Fund to pay for medicines rejected or not yet evaluated by NICE. The headlines diminished. But now they are back.

Since it was set up, the budget of the Cancer Drugs Fund has grown from £200m to £280m ($423m). That is to be expected. The whole point of the fund is that it vets drugs quickly and less stringently than NICE. So as the number and cost of cancer drugs increases, so does spending. But the fund has overspent: last week 25 treatments had to be struck off the list. On January 19th a new group, involving the health department, NICE, the Association of the British Pharmaceutical Industry and various cancer charities, met to work out what to do with the fund. It is likely that NICE will take over some of its work. But a more drastic remedy would be kinder.

Whereas NICE weighs the cost and benefits of drugs and is often able to drive down prices, the more accommodating Cancer Drugs Fund pushes them up. Eisai, a drugs company, once offered NICE a breast-cancer drug “at the lowest price [it] ever offered”, according to Gary Hendler, the company’s president. After NICE rejected the application, the company charged the Cancer Drugs Fund one of the highest prices in Europe for it (in France, a vial costs about a third less). And a high price in Britain can make it difficult for health bodies in other countries to negotiate prices down.

The fund could probably be made more discerning. But it would be better to do away with it altogether. According to a cost calculator developed at York University, if the £230m spent on the Cancer Drugs Fund between April 2013 and April 2014 had instead been spent in the wider NHS, it could have added over 17,800 “quality-adjusted life years”—a measure that combines survival and quality of life. It estimated that the Cancer Drugs Fund added less than 3,400 during that time.

Oddly, the fund may even have short-changed cancer patients. It considers only drugs. Surgery and radiotherapy need money too, and they respectively account for around 49% and 40% of cancer cures; chemotherapy accounts for only 11%. The damage to the NHS is also political. The existence of the Cancer Drugs Fund suggests that NICE is not up to the task of vetting cancer drugs—last week the fund’s chairman told Westminster Health Forum he regretted that the Cancer Drugs Fund had undermined NICE.

The outcry over the drugs cull is a sign of the political burden the Cancer Drugs Fund will become. It will need regular trimming, but that will provoke the very headlines the fund was set up to avoid. Worse headlines, in fact: whereas NICE has evidence-backed reasons for its decisions, the Cancer Drugs Fund does not. Dismantling the fund would be even harder, were any government minded to do so (Labour has pledged to preserve and extend it). Cancer’s emotive power, which made it easy for Mr Cameron to get support for his fund, makes it all the more painful to appear to give up fighting it.

Clarification: Eisai, the pharmaceutical company mentioned in this article, has asked us to make it clear that the Cancer Drugs Fund has lacked a mechanism through which drugs companies might lower the prices of their products. The company says it was not given an opportunity to reduce the price of Halaven, the breast-cancer drug alluded to in the article, before the NHS abruptly decided to stop paying for that drug through the Cancer Drugs Fund. We are happy to clarify this.

Overt rationing of cancer drugs…. The Cancer Fund should not be needed in an un-rationed system.

Post-coded rules? 25 vital cancer drugs deemed ‘too expensive’ for the NHS will have to be rationed within weeks unless drastic changes are made

Age based deserts rationing: the opinion of Professor Karol Sikora. : “Doctor wants to deny elderly cancer drugs”

In the illness lottery, cancer is winning special treatment. The Medical Innovation Bill.

Introducing “more patient reality’ into NHS spending decisions

Value Based Pricing: Drug prices guaranteed to bring headaches

UK medical professionals paid £40m last year by drug companies

Barefoot Doctors in the first world? Training cuts could harm patients, doctors warn. Health services are bust..

Sarah Bloch reports for BBC news 20th Jan 2015: Training cuts could harm patients, doctors warn

This regression towards the world mean is tacit admission that we may be training doctors to too high a standard for the population. Never mind that the individual patient benefits. The duty of government is towards populations and the duty of the doctor to individuals. The government has derelict it’s duty by poor manpower planning and failing to be honest. This report is the outcome! Do we really want to go back to barefoot doctors – in the first world? It’s another case of the BBC giving the News before any broadsheet gets a chance… so look for an update when the broadsheets have commented. Even Dr Sarah Jarvis is thinking of retiring early (Radio 4 interview 30th Jan 2015) .. she blames successive cuts and re-organisations along with a great increase in workload and shortage of GPs. She claims there is going to be a domino effect (she is part of it) and that over 40% of female GPs under 40 are leaving the profession.

In effect we are going bust, both financially and in manpower.

Dennis Campbell tells it as it really is in theGuardian 29th Jan 2015: England’s biggest hospitals veto NHS budget over patient safety fears

Hospitals that provide 75% of all NHS services refuse to sign deal, saying £1.7bn cuts involved will put patient care at risk

Chris Smyth in The Times 29th January reports: Hospitals revolt risks £1bn hole in budget

Hospitals have rebelled against funding cuts with a legal challenge that could blow a £1 billion hole in the NHS budget.

Patient safety will be at risk unless health chiefs back down on plans for extra efficiency savings, according to hospitals covering three quarters of NHS care. They say they are being asked to “achieve the impossible” and cannot cope with a 3.8 per cent budget squeeze due in April.

The unprecedented veto of the NHS payment plans for 2015-16 means that hospitals head into the general election period with no clear idea of their budgets for the year, throwing planning into chaos for a year which is meant start a crucial £22 billion efficiency drive.

If no deal is reached, hospitals will continue to be paid at this year’s rates, giving them about £1 billion more than planned. Health chiefs are adamant there is no extra money, meaning the cash would have to be found through a raid on GPs or other services.

Chris Hopson, chief executive of NHS Providers, which represents hospitals, said the move was a “last resort” move to force health leaders to listen. “[Hospitals] can no longer guarantee safe and effective care unless they are properly and fully paid for the patients they treat. We have now reached the point where patient care is at risk,” he said.

“Either we fit the money to the care provided; or we fit the care to meet the money available. What we can’t carry on doing is pretending that NHS trusts can achieve the impossible and then berate and criticise them when they inevitably fall short.”

For the past four years, hospitals have faced a 4 per cent annual cut in what they are paid for treating patients, as part of a £20 billion savings programme. With 80 per cent of hospitals now in the red, Mr Hopson said there were no more efficiencies to be made without harming patients.

“A month ago Circle, a private health company, announced it was handing back Hinchingbrooke Hospital to the NHS because it was impossible to run sustainably. NHS providers don’t have that luxury,” Mr Hopson said. “This is a similar statement that it is now impossible for all but the very strongest NHS providers to cope with rising demand, meet performance targets and achieve financial balance.”

Under powers in the coalition’s health reforms, funding plans can be vetoed if half the NHS reject them. Thirty-seven per cent of hospitals, ambulance services and mental health trusts responsible for 75 per cent of patient care have objected this year, forcing goverment to renegotiate. If no deal is reached, the Competition and Markets Authority will have to rule on whether the price-setting process was fair in a judicial-review-style process that could take months.

Richard Murray, director of policy at The King’s Fund think tank, said the move would throw NHS planning “into disarray” as the new financial year approaches. “The two main ways used to reduce NHS costs over the last few years -limiting staff salary increases and reducing payments to hospitals – have now been largely exhausted. With financial problems among hospitals now endemic, waiting times rising and staff morale a significant cause for concern, this once again indicates that the situation facing the NHS is becoming critical,” he said.

Big hospitals are also angry about plans which would see them paid only half-price for extra patients they take on who need complex, specialist care, claiming this is a mood to ease pressure on NHS England’s own overstretched budget.

Paul Baumann, chief financial officer at NHS England said: “Since the overall NHS funding totals for 2015/16 are now agreed, any changes to the proposed tariff would in practice just be robbing Peter to pay Paul – meaning less investment in other hospitals, mental health or GP and community services – the exact opposite of what pressures this winter show is now needed.”


The people of Norfolk will need more doctors – so will we all if GPs are all going to work weekends and Bank Holidays

The Eastern Daily Press has several recent reports on the GP crisis, which to them is one of access and availability, rather than one of poor manpower planning and a bankrupt political system. The rural areas will suffer most as the financial noose tightens. Post election we may see co-payments and overt rationing if we are to avoid civil unrest.. The recruitment of GPs is at a low point, as are their emergency skills, and lady GPs with a young family will not be impressed by this change to our contract.

Norwich GP surgeries could open on weekends and evenings

A poll by the uninformed will surely get a positive result: Poll: Should Norwich GP surgeries open on weekends?

Cancelled operations are legion during the winter months. Remember this Hospital was a PFI (Private Finance Initiative) about 10 years ago: Norfolk patients tell of cancelled operation stress

Why our hospitals are feeling the strain of winter pressures

Companies report “no interest” in care insurance – smaller mutuals will lose out

It is natural that people looking into their future should be in denial of the real risks. Going into care will happen to some 20% of us. Premiums paid into an insurance policy might be wasted… The obvious answer is a state funded insurance based system, and without an opt out for the majority who have average incomes. Richer people might opt out, but there are great advantages to the system being comprehensive and universal. Size! Exactly what Scotland, N Ireland and Wales have rejected in voting for their much smaller mutuals.. When Health and Social Care are combined, it will be interesting to hear how politicians justify rationing social care, but not rationing health care overtly..

The BBC News website has a calculator for cost of your care by post code and it is interesting to compare the different regions. Whilst England uses a calculator depending on assets, the rates for Wales are clearly outlined on one page.

The cost of care was posted on 29th January.

Nick Triggle reports 27th Jan 2015: Does the (care) cap fit?

…From April 2016 the government is capping care costs after the age of 65 at £72,000 over the rest of a person’s life. However, there are three important caveats to this.

First, you have to get into the system. Only when an individual is deemed to be eligible for care does their spending count towards the cap. But access is rationed to people with high care needs.


There is a complex definition of what this means, but essentially it is when a person is really struggling with daily tasks such as washing, dressing and eating.

Most people in care homes will obviously qualify, but that is not the case for people who are just about getting by at home.

Alison Holt on BBC News reports 29th Jan 2015: Dementia: The implications for the care system

  • Care spend ‘cut by fifth in decade’

  • Care calculator launched by BBC

  • Care cuts ‘leave old high and dry’

  • Many elderly ‘struggle’ at home

  • The ageing challengeDementia: Is the care system failing people?

    Your questions answered WatchCare expert sheds light on the complexities of system

  • ‘It’s frightening’ WatchThe difficulties of working out how to pay for care
  • A guide to careWatch as the BBC’s Nick Triggle explains how the calculator works
  • Planning for my care WatchHelen Center has set-aside money to pay for her future care
  • ‘I have no help’ WatchPeggy is nearly blind and has arthritis, yet gets no support
  • Day in the lifeA look at what really goes on in residential care
  • ‘Our money has gone’ WatchHow dementia has cost a couple their £46,000 in savings
  • Tough callsHow assessors decide who gets care from councils
  • ‘We subsidise the system’ WatchMy mother has paid £80,000 more for her care than a council would