Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

John Glasspool in the British Journal of General Practice writes as one of many who have taken early retirement. His final paragraph reads: “Many GPs are using their own strategy now to keep their sanity. “RLE”: Retire, Locum, Emigrate. A senior colleague recently said to me that the government has taken general practice back to the 1960s. What is proposed is too little, too late, but may possibly make the public think something is being done until the election in May”.

Just cry after reading the correspondence below, (Rationing by ineptitude.) at the bribery and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

Neil Roberts in GPonline 1st October: Conservatives pledge 5,000-GP workforce boost

Sofia Lind in Pulse 23rd September 2014: Miliband announces plans for 8,000 new GPs

and patients always go for the “free prescriptions (Itv News 18th November 2014): 5,000 more English patients signed up with Welsh GPs than vice versa says NHS chief

Christine Kenny in Pulse 26th Feb 2015 describes the latest panic bribe: GPs offered £25 per patient they register after practice closure leaves thousands without a GP

And the perverse recruitment of an excess of female doctors (due to undergraduate entry favouring women) is reported in The Mail 26th Feb 2014: Soaring number of part-time women doctors fuelling a crisis in GP recruitment, government warned

Exclusive GPs are being offered a £25 ‘administrative payment’ for every patient they agree to take on from the list of a closing neighbouring practice, after 3,000 patients face being left without a practice when it closes in two days’ time.

NHS England’s Surrey and Sussex local area team said that the ‘short term, one-off support’ was being made available to practices in light of the Eaton Place Surgery – which has a patient list of 6,000 – closing at the end of the week with the retirement of both its GP partners.

The closure of the practice has been mired in confusion after Simon Kirby, MP for Brighton Kemptown and Peacehaven, told local residents that the surgery was to remain open.

The practice manager told Pulse she was ‘disgusted’ by the actions of the MP, and warned there were 3,000 patients who had not registered elsewhere.

This is the first known offer of additional financial support to practices to take on patients from neighbouring practices.

Pulse has been campaiging for NHS England to pledge support to practices under threat of closure as part of its Stop Practice Closures campaign, after finding scores of practices on the brink of shutting, and has previously reported that one in five GP practices had struggled to cope with the influx of patients from closed neighbouring practices.

NHS England told Pulse that it was offering the support as an ‘administrative payment’ because of the short time frame in which practices will have to take on these patients.

A spokesperson said: ‘NHS England is providing short term, one-off support to reimburse practices in registering new patients. This reflects the imminent closure of Eaton Place and the number of patients other practices need to support to re-register safely within a short time frame.

‘Providing practices with a one-off administrative payment recognises the additional staff and resources they may need to make available to do this and will ensure they can maintain services at the same level for their existing patients while they are undertaking this work.’

The practice had contacted patients last week to confirm that it would close on 28 February after a neighbouring practice’s plans to install a branch surgery in the premises fell through.

Both the practice and the local area team had been advising patients to re-register with other providers since it was first earmarked for closure in November 2014.

However, Mr Kirby wrote to constituents in the practice’s immediate vicinity in January to tell them that the Eaton Place Surgery had been saved from closure following campaigning and lobbying on his part.

Practice manager Jeanette Corps told Pulse that more than 3,000 patients had yet to re-register elsewhere.

She said: ‘I’m pretty disgusted, to be honest. I don’t know exactly what the letter said, other than that the practice would definitely remain open.

‘We wrote to all the patients last week to tell them the surgery was closing. Some patients are very understanding, but others are obviously very upset. As much as I can understand that, it doesn’t help that I have at least four members of practice staff who still don’t have other employment to go to. It’s a difficult situation all round: there are no winners.’

In a statement sent to Pulse, Mr Kirby said that he was ‘frustrated and disappointed’ that the practice closure was to go ahead.

He said: ‘Having worked so hard to put all the interested parties together to enable the approval and ratification by NHS England of the branch application, I was very optimistic that local people would continue to enjoy a GP surgery at Eaton Place. […] I did indeed write to share the latest information at the time with local residents in the area surrounding Eaton Place.’

The MP offered to hold a roundtable with the current GPs, local GPs and NHS England to ‘try and find a way forward for patients, even at this late stage’.

NHS England told Pulse that there were 13 other GP practices within a two-mile radius of Eaton Place with the collective capacity to register all affected patients. All will be offered a £25 administration fee for each new patient they accept from Eaton Place.

A spokesperson said: ‘NHS England was clear in its communications to patients and local stakeholders that we could not guarantee that a new branch surgery would open at Eaton Place, or by what date. We therefore recommended to patients that they should continue to re-register with other local GP practices while these negotiations were ongoing. Unfortunately the practice that wanted to set up the surgery is no longer in a position to go ahead with its plans.

‘NHS England’s ongoing priority is to make sure all affected patients are able to choose alternative arrangements for their care and to guarantee that they will all have ongoing access to GP services once the current surgery closes.’

This comes after Pulse blogger Dr Hadrian Moss was threatened with a breach of contract notice after he informally closed his practice list.

Comments from readers:

One off support and then NHSE wishes it’s hands off and leaves you to perish- that’s what this sounds like. I think one has to be cautious of ‘offers’ not only from supermarkets.

6000 patients registering at 13 local practices so >460 per practice on average. This is a huge number to incorporate, assess, summarise notes and achieve working familiarity with their history in one fell swoop. What exactly is the £25 per head supposed to cover? Apart from the above, it seems likely that additional doctors will have to be recruited to provide continuing care if the surviving practices are not to be destabilised; that, too, takes time.

if you have mass registration it is not about incentives it is having the frontline staff in place to deal with it, extra clinicians to cope with the increased demand on appointments, extra admin support to get records tagged and summarised. The closing practice would have given 3 months notice of its intention to close so that is the time that NHS England should have come up with a support package and let neighbouring practices know as they are the ones that are affected by the fallout and I bet those practices probably did not get to know until the patients had been written to, this happened in Liverpool so in effect they only got 3 weeks to plan for the stampede to register.

PPPPPP as the management gurus would say
(poor prior planning produces piss-poor performance)

So NHSE are, in effect,, selectively paying practices to take on extra patients – while at the same time threatening a different doctor with breach of contract notice if he doesn’t take patients on when he can’t get the staff.
So what about all the other practices up and down the land who don’;t really want to take on extra patients as neighbouring practices close – or don’t they count?
It seems to me that this is short-term, discriminatory thinking of the worst possible variety.

Unfortunately, you are dealing with a QUANGO that has gone out of government hands and even the PM has no influence on those controlling funds in NHSE. As for NHS Fraud, they are probably preoccupied with small fry where there is no opposition.

I posted this last year as This is about my practice . We have 2 day left working as GP’s here and the outpouring of emotion from patients has had me in tears nearly all morning .I like to think I’m a pretty resilient chap , ridden Motorcycles all over the world , Kept pretty fit , but nothing could have prepared me for the bereavement that we are going through with our patients . I had really hoped it would continue as a practice but it was not to be . We have to sell the practice as we have a huge Mortgage a redemption Fee for early repayment of that Mortgage , and the redundancy package for staff , not to mention the other accountancy costs etc to wind down a business .When you consider £500 Million is being spent on our local Hospital you’d have thought the NHS buying our Practice would have been a better use of money than spending £100000 on “incentives” .How will the other local practices cope ? QOF ? Having the manpower to help our patients .I have been in this practice for 26 years .I thought I’d stay until 65 .i would not survive . I feel for my lovely patients .
Here is my Quote from Last Year

Our patients got the letter that we are closing today .A sad day , the practice has been there for nigh on 100 years .A mixture of increasing workload and dropping income meant there was no way we could safely carry on .The two of us are spent.The added stress of now managing the staff redundancies has me at the very brink of a silent MI .No one except the patients really seem to care that our old fashioned cradle to grave partnership is done.No new Doctors showed a realistic interest in taking up the challenge .It has been heart warming today to hear my patients come in , some in tears ( me too when they leave the room) to tell me I am like their family , what am I going to do without you ? I thought I had a job for life .How wrong I was .Twenty sis years in the same Practice and I feel like a Rat leaving a sinking ship .However if we do not shut the practice down we will not make old bones . I fear for the rest of you .I am lucky and can go as I am 55 soon .A new chapter will open to me .RIP the NHS family Doctor

Even the Kings Fund want us the “Think about Rationing”.

The King’s Fund has many publications, and in the run up to the election they intend to be prolific. There is little more important to the voters, especially the elderly.

Their latest is “Thinking about rationing”, and is trying to bring readers to terms with the inevitable, and let them realise its just a choice of methods that matters. The document also makes it clear that it is better to plan than to have knee-jerk responses. It can be downloaded in it’s entirety here.

Last year the King’s Fund suggested people should be in control of their own destiny… with regards to health and care, but this is “pie in the sky” as young people will not plan ahead, and we all hope to die  suddenly, even though this is the least likely outcome for any..

 

 

 

Older women are at higher risk, as are first pregnancies. The majority would be wise to seek delivery in specialist centres.

Rosemary Bennett in The Times 25th Feb 2015 reports: Teenage pregnancies plummet as more women start families later

Older women are at higher risk, as are first pregnancies. The majority would be wise to seek delivery in specialist centres… This means rural District General Hospitals will need to be close and have good transport links if they are to provide Midwife Led Maternity services. Patients will otherwise have to travel, in advance, to get the least risk of harm to precious pregnancies. Sensible rationing..

Teenage pregnancies have fallen to their lowest rate since records began more than four decades ago.

Once a cause of moral panic, the number of girls under 18 becoming pregnant fell to 24.5 per thousand in 2013, almost half the 1990 rate.

Successive governments, councils and schools have made commitments to address what has often been seen as an intractable social problem.

Experts said that better-targeted sex education, which informed girls at risk of the difficulties of having babies so young, had contributed to the dramatic improvement.

There have been other more controversial measures, including better access to contraception for teenagers and making the morning-after pill more accessible.

The Office for National Statistics, which compiled the figures, cited a “shift in aspirations of young women towards education”. Being trapped at home with a child had become something to avoid, it was suggested.

The UK’s rate of teenage pregnancy remains one of the highest in the European Union, but experts said that the achievement was cause for celebration.

“Despite popular perceptions about the prevalence of teenage pregnancy . . . the conception rate among under-18s has continued to fall and is now at its lowest level since records began in 1969,” said Clare Murphy, of the British Pregnancy Advisory Service. Of those who do become pregnant, many will seek an abortion, she said.

The coalition government did not claim credit for the most recent falls but Kevin Fenton, director of health and wellbeing at Public Health England, welcomed the figures.

“Young people who have the highest rate of unplanned pregnancy and teenage parenthood can be at risk of a range of poor outcomes, such as poor educational achievement, poor physical and mental health, social isolation and poverty, so it is vital this downward trend is continued,” said Professor Fenton.

The data found that the trend for later motherhood had gathered momentum. Record numbers of women were giving birth over the age of 35 as they pursued education and careers before settling down, despite this being the point at which fertility plummets.

Official figures show the conception rate for women aged 35 to 39 rose to 64.5 per thousand in 2013, and among the over-40s to 14.2 per thousand — more than double the figures for 1990.

Mr Murphy said that it was clear that women wanted to start families later and that they should not be overly concerned about their chances of successful pregnancy later in life.

“Pregnancy and childbirth for older women can present particular challenges, but rather than pressuring women into having children earlier than they feel is right for them, we need to ensure the maternity services are in place to deliver the care they need,” she said.

GP shortage blamed on part-time women doctors

Richard Ford in The Times reports 26th Feb 2015: GP shortage blamed on part-time women doctors 

True enough. But why was it not anticipated? Rationing by under-capacity.. and recruiting from abroad is a “disgrace” and as bad as the bankers causing the country to go to the brink of bankruptcy.

The growing number of female GPs has contributed to a shortage of family doctors of up to 550 a year, the government immigration adviser said yesterday. Women are more likely to work part time, requiring an increase in the number of trainee GPs, it added.

In spite of the shortage, the Migration Advisory Committee rejected a request by the health department to place GPs on a shortage list, which would allow more recruitment from outside the EU. Instead the department was told to recruit from within Europe.

Sir David Metcalf, chairman of the committee, said more should be done to make general practice an attractive option for medical students and suggested a review of pay or working hours.

The health department had failed to meet its target for GPs for some years, Sir David added. “There is no shortage of medical students. The issue is that they have got the incentives wrong and they are not encouraging enough people to go into GP training.”

Official figures show that there are 19,800 men and 20,435 women GPs practising in England and Wales. The committee said there was an estimated annual shortage of 450 to 550.

Department of Health workforce experts had told the committee that the “gender balance in general practice has shifted due to a significant increase in the number of women becoming GPs”, the report said.

It added: “This so-called feminisation of the GP workforce necessitates an increase in the number of trainees in order to maintain the current full-time equivalent workforce, as women are more likely to work part-time, at least for some periods of their career.”

The committee said that if GP shortages continued it should recruit from Europe. “It seemed the health service could do more to source recruits from within the EU notwithstanding what was said about problems with language and competency requirements.”

Paramedics are to be put on the shortage list for the first time because many are leaving their jobs to do doctors’ home visits, operate emergency lines and work in walk-in centres. There is a 10 per cent shortfall in the 12,500 paramedics in England at a time when demands on the ambulance service have increased by more than half.

Other posts added to the list include prosthetists, clinical radiology consultants and non-consultant training roles in paediatrics.

Maureen Baker, chairwoman of the Royal College of GPs, said: “We are pleased that the committee has drawn attention to the chronic shortage of family doctors in the UK, but we are disappointed at its lack of action to rectify the problem by unlocking the potential of skilled medical professionals in the many countries that have similar health systems to ours.”

The Department of Health said: “Since 2010 we have 1,000 extra GPs and almost 2,000 extra paramedics, however we accept it is difficult to recruit in some areas of the country. To combat this we will train 5,000 more GPs and ensure half of medical students become GPs by 2020, while incentivising GPs to return from career breaks.”

Power to the people as Manchester takes control of £6bn health budget

 

Once successive governments had enshrined “devolution” (smaller mutual) it was only logical that the Regional Health Service covering your post code be broken up into smaller units. In many ways this can be seen as positive, but it is also risky. The people of Manchester may well find that the “rules of the game” will not allow the overt rationing decisions that are needed to be taken. All the health services are going bust, so yet another “risk” does not upset the treasury any longer.. What is the safety net/? What is the worse case scenario? Who will pick up the tab?

Jill Sherman and Chris Smyth report 26th Feb 2015 in The Times: Power to the people as Manchester takes control of £6bn health budget

Ten Manchester councils are to be given control over £6 billion of NHS spending in a significant step to devolve powers from Whitehall to city regions.

The move is part of the chancellor’s plan to create a “northern powerhouse” to rival London’s economy in response to the Scottish referendum.

Doctors and nurses warned that the scheme must not become a way for councils to raid the NHS budget.

Key details have yet to be thrashed out, with council leaders claiming that they would get statutory powers over the NHS budget and health bosses insisting that it would be a voluntary arrangement.

In November George Osborne devolved £2 billion to the ten local authorities and promised greater powers over transport, housing and skills. The deal, seen as a political move to woo voters and wrongfoot Labour, was linked to a directly elected mayor, to be in post by 2017.

The councils, predominantly made up of Labour councillors, have since pressed Mr Osborne and the health department for greater powers over NHS spending so that they can better integrate health and social care. However, Labour nationally was cooler on the plans.

Andy Burnham, the shadow health secretary, said: “My worry is having a ‘Swiss cheese’ effect in the NHS, whereby cities are opting out.”

Simon Stevens, chief executive of NHS England, said: “We want to back local leaders and communities who come together to improve healthcare of their residents and patients. While this new model won’t necessarily be right for many other parts of England, for Greater Manchester the time is right.”

Tony Travers, a local government expert at the London School of Economics, said that if the entire health budget for Manchester were devolved it would be “the most radical change in health care since the NHS was created.” He added: “There will be a queue of every city region in the country, including London, wanting to get in on this.”

Boris Johnson indicated that he could be one of the first in the queue. A spokesman for the mayor of London said: “Devolving powers is vital to the future of cities.”

Mark Porter, chairman of the British Medical Association’s council, said: “There is no doubt that patients would benefit from more joined-up health and social care. However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn’t used to prop up a woefully underfunded social care budget.”

More details of the Manchester scheme are expected tomorrow.

Its an unreal world when those with least experience are asked to ant changes.. and an unreal world where patient expectations exceed our ability to deliver. Like “Honey on tap”.

Update 28th March 2015.

Healthier Together: The Greater Manchester Vision

Central Manchester University Hospitals – NHS Foundation …

Can the city of Manchester save the NHS? – Telegraph

Manchester’s health revolution will be a beacon for the rest …

Labour List comments: Devolving NHS budget to Greater Manchester will create a “two-tier health service”, says Burnham  Since writing the original posting it occurs that there is another disadvantage. If multiple cities are devolved, then the former system of varying monies from the richer cities to the poorer rural areas will be impossible as there will be fewer and fewer providers.

Signs of desperation in the media, and in the conservative party

There are signs of desperation in the media, and in the conservative party. Get a glimpse of the future… and the inadequate planning and cranky beliefs held by those who make decisions for us! Health needs to be de-politicised quickly, before the post code rationing and differential death rates leads to real disharmony in the UK. There is a new Health Service Hierarchy.

Ashifa Kassam for The Guardian in Madrid reports 24th Feb 2015: Meet the Spanish nurses desperate for a job in the NHS – Despite a creaking health system at home, lack of jobs means graduates are flocking to interviews in the UK. But for many, language skills are the highest hurdle

Résumés tightly in hand, the group of young nursing graduates nervously compared their English as they waited to be called for interview. Few had ever left Spain, and only one had been to Britain. But if all went well, they would walk out of the hotel in the centre of Madrid with an NHS nursing job in a hospital near London….

On Wednesday 25th Feb: Astrology could help take pressure off NHS doctors, claims Conservative MP

David Tredinnick says that astrology and complementary medicine could help healthcare and opponents are ‘racially prejudiced’

A Conservative MP has claimed that astrology could have “a role to play in healthcare”.

David Tredinnick said astrology, along with complementary medicine, could take pressure off NHS doctors, but acknowledged that any attempt to spend taxpayers’ money on consulting the stars would cause “a huge row”.The MP for Bosworth, in Leicestershire, who is a Capricorn and in 2010 paid back £755 he had claimed in expenses for software that used astrology to diagnose medical conditions, told Astrological Journal: “I do believe that astrology and complementary medicine would help take the huge pressure off doctors.“Ninety per cent of pregnant French women use homeopathy. Astrology is a useful diagnostic tool enabling us to see strengths and weaknesses via the birth chart.

“And, yes, I have helped fellow MPs. I do foresee that one day astrology will have a role to play in healthcare.”

Mr Tredinnick, 65, added: “Astrology offers self-understanding to people. People who oppose what I say are usually bullies who have never studied astrology.

“Astrology was until modern times part of the tradition of medicine … People such as Professor Brian Cox, who called astrology ‘rubbish’, have simply not studied the subject.

“The BBC is quite dismissive of astrology and seeks to promote the science perspective and seems always keen to broadcast criticisms of astrology.”

Opposition to astrology is driven by “superstition, ignorance and prejudice”, he said. “It tends to be based on superstition, with scientists reacting emotionally, which is always a great irony.

“They are also ignorant, because they never study the subject and just say that it is all to do with what appears in the newspapers, which it is not, and they are deeply prejudiced, and racially prejudiced, which is troubling.”

Allergies are on the increase – probably because of over-protection of children

The cost of allergies, and the increasing number of people carrying “Epipen” reflects the fact that Allergies are on the increase – and this is probably because of over-zealous protection of children by anxious parents. Chris Smith in The Times 24th Feb 2014 reports:Feeding your baby peanut butter cuts risk of allergies. If this applies to other allergies (which is likely) then we have the evidence to reduce rather than increase our expenditure on allergies.

Regularly feeding peanut butter to babies cuts their chances of developing an allergy by more than 80 per cent, a study has concluded.

A surge in peanut allergies in recent decades appears to have been partly driven by faulty health advice that told parents to avoid nuts, researchers said.

Babies shielded from peanuts were much more likely to develop allergies, the study found, prompting calls for the NHS to issue fresh guidance to parents.

Professor Gideon Lack, head of paediatric allergy at King’s College London, who led the study, said: “I believe this does settle the question. One can confidently say that introducing peanuts early to the infant diet will prevent the development of peanut allergy.”

Peanut allergies were almost unknown two decades ago, but have doubled in the past 10 years, with about 3 per cent of children now suffering. Medical advice introduced in 1998 said that young children should avoid peanuts, although this advice was withdrawn ten years later. “In part the rise in peanut allergy over the past few decades can be explained by the avoidance of peanuts,” said Professor Lack.

He looked at 640 children thought to be at risk of peanut allergies because they had eczema or were allergic to eggs. Half were told to avoid peanuts and half were told to eat the equivalent of three peanut-buttered slices of toast a week, which Professor Lack said they generally enjoyed. Of the 530 children with no signs of peanut allergy at the start of the study, 13.7 per cent of those who avoided nuts were allergic by age five, compared to 1.9 per cent of those who had peanuts regularly.

Of the remaining children who did have signs of allergy as babies, 35.3 per cent of those who ate no nuts developed allergies, compared to 10.6 of those who ate nuts regularly, according to data in the New England Journal of Medicine.

Professor Lack said that these children might need to see a doctor, but parents of children at lower risk should give their babies peanuts. “Once the infants have been successfully weaned to solids, ideally at four or five months, they should start consuming peanut products such as butter or snacks on a regular basis,” he said.

Researchers in Cambridge are looking into curing peanut allergies by gradually exposing children to small quantities of peanut protein, but this is done under close medical supervision. “Generally it’s easier to prevent a disease if you know how to do so than to treat it,” Professor Lack said.

Both studies support the theory that allergy is caused when babies are first exposed to peanut protein through the skin, triggering the body’s immune response, rather than through the digestive system.

Professor Lack began his study when doubts emerged about advice to avoid peanuts, with one study finding that Jewish children in London who were not routinely given peanuts were ten times as likely to develop allergies as Jewish children in Israel, where babies are introduced to peanuts early.

Protest while you can – Dead patients don’t vote. Rationing in action…

 

Access to Hospital Emergency Services is seen as an important safety net in the rural areas. From Rhyl to Pembrokeshire there is protest, and these people are not exactly the affluent who can afford to buy choice. Access to chemotherapy and cancer therapies close to home is a bonus, and avoids the problems of travelling feeling sick or vomiting. If the outcomes are going to be much better by travelling then it might be sold to the public as being worth travelling an hour to get better treatments. This is not the case for most minor ailments and for cancer, but it is for Ischaemic Heart Disease and Neurosurgery. I have not heard the protesters saying that cardiac surgery or neurosurgery should be available in Rhyl or Haverfordwest. But there is some consolation in protest. If we wait too long we certainly cannot vote or protest!

Ernest Hemmingway in “Death in the Afternoon” describes the process of waiting for help and hoping that the injury wont kill you. Recently  a friend attended the local hospital with 30 minutes chest pain across his chest shoulders and both sides of his body equally. The A&E attendance at 11.15 was followed by a 12 hour trolley wait. He might well have had a heart attack but in this area there is no quick access to cardiac surgery (Stent)  and the standard treatment is clotbuster drugs. He could easily have made it to Swansea, our nearest cardiac surgery unit, in 12 hours! As it was he had “angina” and is on treatment – but he might easily have died and lost his “vote” on the future of our health services.

A fairer way to ration would be to demand that the affluent in the cities, who have speedy access to tertiary services, pay a premium for that greater service. They already earn more and pay higher taxes. Is that enough? A final thought, if the Welsh Assembly still existed, would these cuts and changes still have happened, albeit later? Would the post code lottery in Wales be as bad as it is?Devon has not got away with their experiment in overt rationing. Most rationing will have to be universal, and seen to be fair to those in rural areas, if we are to avoid civil unrest…..An example is Proton therapy (coming to the UK after it’s unavailability shamed successive governments) (Ashya King and Freya Bevan), available to none, except if the CCG changes its mind (media pressure) or the family/community raise voluntary funds. Another example is Parkinson’s disease (Antonia Bannister reports for the Coventry Telegraph 23rd Feb 2015: Anguish as Coventry grandfather is denied Parkinson’s ‘wonder-drug’ on NHS ) where post code rationing is rampant.. because victims don’t have a voice. Politicians, you do not have permission to experiment with privatisation, and pharmaceutical excess on your people…S

pend the money where it is efficient but ration overtly.

Will Hazel for the Health Service Journal says 234d Feb 2015 that: NEW Devon was ‘pit canary’ for CCG rationing plans.

FINANCE: ‘Queues’ of clinical commissioning groups could have implemented controversial plans to restrict access to certain services had a high profile attempt at rationing in Devon been successful, a local commissioner has claimed.

David Jenner, chair of the eastern locality of Northern, Eastern and Western Devon CCG, said the group had been a “pit canary” for more radical NHS rationing, with CCGs around the country ready to follow suit if it had got its plans through.

In December NEW Devon announced plans to require obese patients to lose weight and smokers to stop smoking before they could have routine surgery…..

 

It’s not about money – it’s about a proper debate on philosophy and overt rationing

Today I received an e-mail from John Wilks at NHSmanagers.net. The implication is that we can solve the Regional Health Services by management, without debate on the philosophy. It is patently wrong… and it is sad to read such drivel when the shit is hitting the fan already… Its not the money, it’s the people that matter, and they are disengaged and wont buy in again without the debate.. How can managers have become so detached from the coal face?

“This is the first of our re-launched e-letter comment and news bulletins, focused on the UK health service and the opportunities and challenges that exist both for organisations seeking to enter and for organisations already present but keen to sharpen their commercial success. If you would like to learn a little more about UK HealthGateway,  click here. You already know UK HealthGateway as the publisher of nhsManagers.net.

It’s all about the money…

The NHS in England has an annual budget of £110bn. Lets assume that whoever is elected decides to at least preserve this. Then lets factor in an annual demand increase (due to ageing population, lifestyle factors, drug advances and the rest) of 5%. So over the period of a 5 year parliament, for the service to be maintained, the NHS needs to find an extra £30bn. In fact NHS England believes that £40bn is the required figure. The principal political parties are fighting to out-promise each other with Tories pledging no cut, Labour an extra £2.5bn each year, and the LibDems £8bn by 2020. Clearly there is yawning gap irrespective of who assumes power. So there has to be some radical thinking and planning done.

The 5 Year Plan & Integrated Care

Simon Stevens, CEO of NHS England, knows that the current status quo simply isn’t going to work. He has developed a 5 year plan and the key elements are:-

1. A radical upgrade of prevention and public health. 2. Patients assuming greater control of their own care, including shared budgets for health and social care. 3. Greater liaison between primary, secondary and tertiary care. 4. Far better leadership at a local level to enable innovation and flexibility. How can we summarise? Get ready for a transformation of the superstructure whereby GP practices, hospitals, mental health and community providers will be obliged to work together at a local level as never before.

Then there is the commercial …

The Outlook for NHS Suppliers

The emphasis (as usual) will be on demonstrating improved outcomes for less money. And everybody who is active in the market says that theirs can. So how to rise above the miasma of mediocrity? Concentrate on developing your SST – Single Simple Truth. Give yourself 5 seconds to convey a genuinely compelling, absolutely robust and totally relevant reason why the NHS should buy your product at a local level. Hang your business case (you haven’t got one? Get one!) on this SST. Secondly, focus on means by which your product or service can enable, encourage or support the 5YP aim of knocking primary, secondary and tertiary care together at a local level to force better efficiency and patient involvement. This isn’t a requirement, but it is a ‘great to have’ and your referring to it shows that you understand the priorities in the local health economies going forward. Overall, the opportunities for suppliers are vast. This is still a massive state funded operation – and it is open for business to products or services that can demonstrate a capacity to work with it. And Finally… If you are sitting at your desk with a great product, service or software technology and an aspiration to enter the UK health market, but don’t really know where to start, give us a call. We’ll give you a free 30 minute appraisal and strategy review and some guidance via phone, Skype or in-person if you fancy a day out in London. Spring is on the way and we can help put it in your step.

Review rejects claim of higher hospital death rates in England than in US. Compare like with like…

In the BMJ ( BMJ 2015;350:h787  ) a report : Review rejects claim of higher hospital death rates in England than in US

You cannot compare systems unless you address like with like; hence the Regional Health Services can no longer be compared due to managerial engineering. Even waiting list targets are different. But managers cannot obscure 5 year survival and death rates, which are WHO monitored and will emerge eventually… when it is too late and yet another re-organisation has occurred.

Hospital standardised mortality ratios (HSMRs) are an unreliable method for comparing the quality of hospitals in the United States and England, an investigation by the Academy of Medical Royal Colleges has concluded.1

The independent inquiry was commissioned after Brian Jarman, former professor of primary care at Imperial College London, who developed the HSMR index, said in media reports in September 2013 that the likelihood of dying in NHS hospitals in England was 45% higher than in hospitals in the United States.2 His claim, made on Channel 4 news and repeated in many newspapers, came soon after 11 hospitals had been put into special measures and shortly after Robert Francis QC’s report into failings in care at Staffordshire Hospital.

Jarman’s HSMR is the actual number of deaths at a hospital divided by the expected number of deaths over the same period, multiplied by 100. Scores are published annually in the Hospital Guide produced by the healthcare data analysis company Dr Foster Intelligence. However, some researchers have questioned the validity of HSMRs, saying that they are prone to bias.3

The academy’s review, commissioned by Bruce Keogh, NHS England’s medical director, found four main reasons why US and English hospital mortality rates cannot be directly compared. Firstly, in England patients are less likely than in the US to be categorised as being at high risk. For example, septicaemia is the primary diagnosis in 4.5 per 10 000 hospital admissions in England, but the number is eightfold in the US, at 35 per 10 000. This is because in the US there are greater financial incentives to put patients into a higher risk category, as hospitals receive more money from health insurers for patients who are more seriously ill.

Secondly, comorbidity and underlying conditions are under-reported in England. Again, because of financial incentives in the US, hospitals are much more likely to include secondary diagnoses in the hospital information system, where a third of admissions have 10 or more recorded. As a result patients in England seem to be at much lower risk of death than those in the US when admitted to hospital.

Thirdly, the report said that there was some evidence that patients in England may be sicker on admission to hospital. For example, the acute physiology score of patients admitted to critical care is 16.7 in England but 10.6 in the US. And the proportion of patients ventilated within 24 hours is 68% in England and 27% in the US. In addition, hospital episode statistics in England do not include patients who choose to pay for treatment by private providers, and such patients are likely to be less severely ill and at low risk of death.

Finally, a higher proportion of patients die in acute care hospitals in England and Wales (56%) than in the US (45%), mainly because of a lack of alternatives such as hospices. Whereas in England 5% of patients in acute care hospitals are transferred to alternatives such as domiciliary care and hospices, in the US 30% of patients are transferred.

The analysis concluded that HSMRs can be a useful “smoke detector” to highlight areas of concern. It said that where there were outliers and particularly high mortality rates in hospitals the ratio could be a useful tool for further investigation and evaluation. The report also noted that differences in quality of care were much greater within than between hospitals. Hospitals were more likely to fail in specific areas, paediatric cardiac surgery in Bristol, for example.

The Academy of Medical Royal Colleges said that Jarman was engaged throughout the inquiry process and his input sought. Jarman agreed that several variables would influence his HSMR calculations, but he said this influence would be of small magnitude and wouldn’t make a big difference to his conclusions. However, the working group could not access the full dataset that Jarman used in his analysis because of signed confidentiality agreements that they said hindered independent scrutiny.

Terence Stephenson, the former chair of the Academy of Medical Royal Colleges, who led the investigation, said, “Patient safety is our first concern, and when first reported the suggestion of higher hospital mortality in the UK than the US was very alarming. This more detailed analysis shows that while we must continue to improve quality we cannot rely on HSMR data to make a simple comparison between countries.”

Keogh said, “The NHS must never be complacent about safety and must do everything it can to prevent avoidable mortality. However, this report further illustrates the point I made at the conclusion of my review into 14 hospitals with higher than expected mortality rates: that these statistical constructs should be used cautiously.”