Monthly Archives: January 2015

More magic – Labour will “create” 20,000 more nurses and 8000 more GPs

The Labour party says they will “Build and NHS with time to case” by providing 20,000 more nurse and 8000 more GPs.

This spell expands to 5000 more home care workers and 3000 more midwives.

Other spells cast are for “Cancer tests guaranteed within a week” and “shorter wait to see your GP”.. If patients wish for a rationally re-organised health service they would best vote Liberal, but even the Liberals are not speaking out honestly about rationing overtly.. yet. Where will these people come from? It takes years to train enough and we have neglected to do this. The only workforce available immediately is the newly retired, and from overseas with the language & cultural issues, and the ethical dimension of removing trained staff from countries who need them.

Why Liberal philosophies are better for the UK. Who will be the first party to re-invent a truly National Health Service?

Abracadabra – problems disappear. The Kings Fund 11th March 17.30…..

The worried well demand more in a free service.. More information is good, it’s the perverse nature and philosophy of the health services that needs to change.

Public confidence in the Welsh NHS has plummeted, especially in rural areas

Figures show extent of NHS reliance on foreign nationals – Thinktank warns stricter immigration rules could hit service …

Leaked documents show UKIP leaders approve NHS privatisation once it becomes more ‘acceptable to the electorate’

The truth is spoken: “The NHS cannot last for ever”, but is an insurance based system better and fairer?

Update 30th Jan 2015: Labour plans GP safety checks for older people – are they going to clone the professionals. I know DNA technology is advancing but this beggars belief.



Happy with the NHS? Only if you have not used it!

Chris Smyth in an article in The Times, 29th Jan 2015 reports: Voters are happier than ever with NHS

It beggars belief. Who commissioned the report? What were the questions and how much bias was there in both the questions and the questioned? Yes, some targeted areas do very well, but access to A&E and GP services is dreadful, and there is chronic undercapacity. Politicians have ignored the long term investment needed – a natural weakness in our political system. The Regional Health Services, especially in rural areas are imploding. You may feel happy with the NHS if you have never used it. You certainly cannot complain if you are dead.. Without a New Zealand style approach to honest and overt rationing, and especially if Health and Social Services are combined, there will be an increase in covert rationing – mainly directed at the elderly, mentally ill, and inarticulate.

Pugh cartoon

John Appleby points out “… support for the NHS might be rising as health climbed up the political agenda rather than because care was improving markedly…. As well as an actual increase in satisfaction, this may in part reflect a desire among the public to show support for the NHS as an institution.” Read the whole article – Voters are happier than ever with NHS

Dead people don’t vote… End-of-life care ‘deeply concerning’

Alex Neil rules out ‘gagging’ former NHS staff

Anne Clwyd MP, “Husband Treated Like Battery Hen”

Will Hutton “How Good We Can Be” : The Guardian reports 25th Jan 2015 ‘Inequality has become a challenge to us as moral beings’

Pugh cartoon


Manchester, Liverpool, Hartlepool: Death rates in your local DGH are too high..

Dean Kirby of The Manchester evening news reports 27th Jan 2015: Tameside Hospital had ‘higher than expected’ death rate in the year after being placed in special measures 

Tameside General had a higher than expected death rate in the year after it was placed into special measures.

The hospital saw 185 more deaths than expected in the year to June 2014, according to new NHS figures.

Tameside was placed into special measures in July 2013 after a highly critical report into patient care.

Inspectors from the Care Quality Commission said in July 2014 that there had not yet been enough progress for the hospital to leave special measures.

Hospital bosses said at the time that they were making significant progress in its ‘journey of improvement’…..

Manchester, Liverpool, Hartlepool: Death rates in your local DGH are too high.. And other hospitals have the same problem.

South Tyneside and Sunderland NHS Trusts’ death rates higher than expected

Hartlepool and Stockton hospitals still have ‘higher-than-expected” death rate

The 16 NHS hospitals with higher than expected death rates

Death rates too high at 16 NHS hospital trusts, report reveals


The Election. Health v Wealth? Or a more balanced approach…

The Times leader 27th Jan 2015: Health v Wealth or a more balanced approach (Why Liberal philosophies are better for the UK. Who will be the first party to re-invent a truly National Health Service?)

For the next three months, Labour will spread fear about the NHS and the Conservatives will warn of economic anarchy if the opposition wins

The Fixed Term Parliament Act means that this is the first time we can be sure that there are 100 days to go before a change of government. Already, the terms of the election on May 7 are set. Labour will claim that the NHS is not safe in Tory hands and the Tories will say that the economy is not safe in Labour hands. It is going to be a long 100 days.

Yesterday Labour set out its case on the NHS. Andy Burnham, the party’s health spokesman, claimed in effect that all the problems of the NHS are down to the past five years of coalition. Mr Burnham accuses the government of extensive privatisation. This, a decade after Labour licensed competition and with a mere 4 per cent of hip and knee replacements in the private sector.

Even with allowance for the hyperbole of an election campaign, Labour’s claim that the NHS is on the brink of a cliff is preposterous. Certainly there have been problems in A&E departments, some of them severe, waiting times have gone up and the GP service is not as comprehensive as it should be. Yet to say this amounts to near collapse is false. Whoever wins the election, Britain will still have a functioning health service on May 8.

Labour’s solution, to force integration, is a chimera too. Integration of services is a noble objective. Seventy per cent of the health budget is spent on the 15 million people who look after their own chronic disease. There is also strong evidence that integration improves the quality of cardiac, cancer and stroke care.

It is true that the NHS contains too many organisations. This can mean, for example, that a mental health patient can pass through 15 separate agencies. This fragmentation of the NHS was written into its origins in 1948 when consultants became salaried staff in state hospitals and primary care was established in private GP services. “Our basic purposes”, said the former health minister Baroness Serota, “are to unite the NHS and to integrate its separate services.” That was in 1970.

The notion that this can all be achieved by combining the NHS and social care is a fantasy. The only way to integrate services is to do as the health authority has done in a pilot scheme in Torbay and focus integration around the patient. Here, officials invented a fictional patient, Mrs Smith, and modelled services around her needs . This strategy led to emergency hospital admissions of the over-65s being all but eliminated, with the elderly treated at home.

This is the direction that Simon Stevens, chief executive of the NHS, wants to go. Labour’s number two at health, Liz Kendall, speaks this language, but Mr Burnham and Ed Miliband are happier hanging on to central control. The mooted changes also come with a price tag. Labour has not said how it will find the £8 billion the NHS needs to close the funding gap by 2020. Mr Burnham’s plans for more care workers have to be paid for as does his plan for integration, which costs money before any savings are made.

The Conservatives, meanwhile, are hoping that distrust of Labour’s handling of the economy will give them a default victory. Voters are far from enthused. When asked what the coalition has achieved, the answer is usually little apart from cutting the deficit. The Conservatives will need to convince the electorate that they have made progress in education and welfare, too.

Equally Labour has to try to address its lack of economic credibility. It has to be clearer about how it would clear the deficit, especially now that some of its MPs will be tempted in the wake of Syriza’s victory in Greece to abandon any pretence of austerity. Labour needs to offer something more optimistic than the empty threat that the NHS will fall apart without Mr Miliband in Downing Street. The big parties are set for their lowest share of the vote in electoral history. If all they have to offer is fear, this will be no surprise.

Why Liberal philosophies are better for the UK. Who will be the first party to re-invent a truly National Health Service?

For once, Nice lives up to its name

Chris Smyth reports in The Times 27th January 2015: For once, Nice lives up to its name

Is it good news that a treatment so expensive is funded by England? Will it be funded by the other Regions? Will funding this treatment cause fury in those whose lower cost treatments are refused?

Two weeks ago, the headlines were about thousands of cancer patients being refused life-extending treatments because the health service could not spare £50,000 each. Now the NHS is agreeing to pay up to £10 million for a lifetime of treatment. What’s going on?

Two things: one is that eculizumab is much more effective than any of the medicines in the government’s cancer drugs fund, which offer a few extra months of life to patients who are going to die anyway.

Eculizumab is literally life-saving: it can offer a normal, healthy life to people who otherwise would have no chance of one. NICE, which has been noticeably more aggressive with angry drug companies recently, likes to point out that it is willing to shell out for the most effective cancer medicines.

Second, aHUS is such a rare disease that NICE believes that the utilitarian calculations it applies to other drugs break down, and allows itself more discretion. It accepts that with so few patients from whom to recoup the cost of research, drug makers have to charge more for each one. Yet without a formula, it can’t decide quite how much.

Although NICE criticised the company’s price and said that the cost would have knock-on effects for others needing specialised care, the plight of patients with nowhere else to turn ultimately won out.

NICE, often attacked as a desiccated calculating machine, in the end could not condemn people to death to save £82 million a year.

Professional Contact Sports – should the Health Services cover them fully?

Update 3rd Feb 2015. Comparable figures for risk of sporting activities is in these two files.

Spinal injuries                                                        NEXUS

As I post this update 13 of the first England 15 are injured for the International on Friday evening.. 

Should the Health Services, at a time of financial bankruptcy, still cover professional contact sports? With the 6 Nations about to be broadcast it might be time to review our approach. How many players are not available due to injury at the beginning, and how many at the end? Being inactive is equally dangerous, but there is no need to compete in contact sports, there are plenty of other options. The Roman Games demanded more and more dramatic competitions… are we going the same way?

Brain Damage cartoons, Brain Damage cartoon, funny, Brain Damage picture, Brain Damage pictures, Brain Damage image, Brain Damage images, Brain Damage illustration, Brain Damage illustrations

The Economist article: Violence in sport indicates that both parents and the public might be wising up to the risks. Co-payments by way of club insurance policies are one option, and the sports that deliberately target the human body should be the first ones to be re-examined. Deserts based rationing demands there is some co-payment. What should we do about the high risk non contact sports such as Cycling, Skiing, Rock Climbing or Parachuting/Bungee Jumping? NHSreality feels all sports should have insurance now that we are re-examining the costs of our health.

Boxing (of course) – covered by the New Scientist in August 2013 (Ban boxing – it’s demeaning and dangerous – New Scientist) and the medical journal repeatedly.


American Football


Danger of boys’ rugby exposed. Should participants in sporting activities be insured or face co-payments?

Cyclists, disability wheelchairs, and all dog, cat and exotic pet owners should be insured, licensed and registered

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

Couch Potatoes deserve deserts based rationing..



Abracadabra – problems disappear. The Kings Fund 11th March 17.30…..

Roy Lilley on 27th Jan 2015 says “problems disappear” … under the banner of Sarah Woollaston Chair of the Health Select Committee – pity the invitation to stay in touch at the end does not include an opportunity to give an exit interview. Even better if the exit interview was in the public domain.. The Kings fund will debate on 11th March. NHSreality predicts that “Overt Rationing” will not be allowed onto the agenda.

I’ve been out and about again. Legging it to catch trains and sitting in queues of traffic. Parked in airport lounges. If there is an upside it’s the time it creates to think. This is what I’ve been thinking about.

Abracadabra cartoons, Abracadabra cartoon, funny, Abracadabra picture, Abracadabra pictures, Abracadabra image, Abracadabra images, Abracadabra illustration, Abracadabra illustrations

We have to be mindful that NHS has all the disadvantages of being a state run bureaucracy. However, the benefits are universality, fairness and accessibility. It is only by being nimble, efficient, open to innovation and constantly asking ‘is this the best we can do’ that we can continue to make the advantages outweigh the disadvantages.

Bad policy has made the bureaucracy worse; fragmentation, complexity, diffuse leadership and no ownership. The vacuum creates a leadership opportunity. It is not about being in charge it is about creating time and space for good people to do great things. We can do that for each other.

It is the doubts that politicians have in their own ability to lead and inspire that makes them resort to regulation, inspection and targets; all of which are demoralising, encourage fear, gaming, cover up and waste. Don’t use your energy on it. Focus on doing the best job you can. Ask yourself; if this person was my family is this what I’d do? If this was my money, is this how I’d spend it? We can all do that.

All healthcare systems have money, quality and demand issues. None of this is your fault. Life chances, happenstance, systems, policies and pressures to make it look-good for the boss are the real causes of problems and out of your control. Try and build alliances with like-minded people to focus on the patient, concentrate on learning and improving. Put all your efforts into encouraging the goodwill of the people around you. You are who you hang out with.

Understand, sometimes, the obvious things are the most difficult. It is obvious that keeping people healthy for longer is a good thing. Why is it so difficult? It is obvious getting people better and home, safely, as soon as you can, is a good thing. Why is it so difficult? Be curious about the difficult things. Don’t back away from them. Ask why they are difficult. Difficult things take root, tackle them before they do and the rest will fall into place.

The NHS is quite unlike any other workplace with its low dependence on the management of information by the use of technology. This has to change. Being open-minded about innovative technologies and data analysis can give us the answer to 9 basic questions which, since 1948 have been too difficult to answer: who gets ill; with what; why; can we stop it; how did we fix them up; did it work; what did it cost; was the ‘customer satisfied’; do we want to do it again.

Healthcare is dangerous, things can go wrong. It is the measure of the organisation and the individual how well and quickly things are put right and arrangements put in place to make sure it doesn’t happen again.  Inspection, special measures, humiliation all create a fearful workforce who will never understand this. Ask; what can we do to make their work a pleasure, where they do it a good place to be and let them know it’s OK to have fun at work?

There is not an example of poor care, a fiddle, a callousness, a corner cut that can exist without secrecy. Making it easy to speak frankly and to listen is more fruitful than waiting to hear the sound of a distant whistle being blown. Each one of us has to be an open source of what is happening, what we don’t want and what we want more of. We protect ourselves from inconvenient truths. Would we buy an egg if, at the supermarket checkout, we saw a picture of the suffering of a battery hen? Why would we blow the whistle knowing the last person who did so ended up in tears with no job.

In the maelstrom of the day it’s easy to get doing and forget thinking. Thinking takes time and space but we can’t solve our problems using the same thinking that gave us the problems in the first place.

‘What is the point of a select committee’ come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.

Kings Fund 11th March – details here.

Contact Roy – please use this e-address

Know something I don’t – email me in confidence.

Leaving the NHS, changing jobs – you don’t have to say goodbye to us! You can update your Email Address from the link you’ll find right at the bottom of the page, and we’ll keep mailing.