Monthly Archives: July 2015

Making cuts in health services without involving politicians in discussion or debate about why!

As far back as 27th October 1995 the Independent reported; Health bosses ‘agree NHS rationing is inevitable’

The latest cuts have been made by politicians , without making tough choices themselves, and by denial and leaving the interpretation of the philosophy to the minister himself. It is politicians who are responsible for the abdication of any responsibility to discuss what is essential and what is desirable and what could be “self care” – in other words a pragmatic solution to our Regional Health Services, using ethical and educational arguments… We are making cuts in health services without involving politicians in discussion or debate about why!

Julia Hartley-Brewer in the Independent 31st July 2015 opines: The latest NHS cuts aren’t about health. They’re about blame – Tough choices don’t just have to be made by doctors – they have to be made by patients, too

Right, pay attention everybody. We’ve some tough choices to make. The NHS has to make £22bn of efficiency cuts by 2020, so where shall we start?

Do I have any bids for cutting children’s cancer treatment? Anyone? No, I thought not. What about knee surgery for the severely obese, or nicotine patches for smokers, or IVF treatment for infertile couples? Do you think we can get away with cutting those?

These are precisely the sorts of conversations that – like it or not – are going on right now within the health service. Our beloved NHS, created in 1948 to care for us from the cradle to the grave, has become a bottomless money pit. And it’s all our fault.

For a start, we’re all living a lot longer (tut tut, you selfish octogenarians), and many of us are eating too much, and then those pesky scientists among us keep coming up with new and clever ways of keeping us alive. It all costs money: £115bn a year, to be more precise. The £22bn of spending cuts will have to be found from somewhere.

An investigation by Pulse magazine has revealed that, to make the cuts, doctors are now “rationing” treatments such as hip and knee replacements and vasectomy operations – and even the fitting of hearing aids – in a bid to cut costs. A number of NHS Trusts have imposed stricter eligibility requirements for some of the most common operations, insisting that patients lose weight or give up smoking before surgeons will operate, while many trusts already limit access to expensive, non-emergency treatments like IVF. The truth is that these cuts aren’t just about simple pounds and pence. They are about assigning personal responsibility and – yes – blame. The question asked by the NHS is no longer “are you sick?” but “are you the deserving or the undeserving sick?”

What seems cruel and heartless to one is common sense for another. Most of us would probably not put an alcoholic top of the list for a liver transplant over another donor recipient whose liver had failed through no fault of their own. The limitations on hip and knee replacements are no different. After all, the single biggest reason why so many patients need new joints is because they are obese. Their bodies simply weigh too much for their joints to cope. The solution, then, is not expensive surgery but a trip to Weight Watchers.

The issue at the heart of the problem is whether we believe obese people, or alcoholics, or drug addicts, or smokers are to blame for all their ills and therefore not as deserving of free treatment on the NHS as someone who has led a healthy lifestyle but is then, say, diagnosed with leukaemia. While cancer sufferers may be high up on our list of “deserving” patients, 40-a-day smokers who get lung cancer or sun worshippers who get skin cancer are perhaps a little further down. It all comes down to whether it’s your own fault. But where does this end? And what’s next? Do we refuse to treat NHS patients, or charge them, if they cannot prove that they eat their required five fruit and veg a day? If we’re going to play the blame-game, what about people who ride horses or play rugby and get head injuries that could so easily have been avoided?

Making cuts to NHS spending will mean tough choices for politicians and our doctors; it may well mean tough choices for us patients too.

The Independent 31st July 2015: Leading article: The wrong sort of NHS rationing

Tony Yearman in the HSJ 29th July 2014: Removing the NHS ringfence: the next stage for healthcare rationing and in the same journal Crispin Dowler reports 15th Jan 2013: Commissioners have rationed cataract surgery on inferior evidence, Keogh admits

Reality – a word not used by Politicians in Health – is that Hearing aids and vasectomies are rationed as NHS pressures bite

Once “rationing” overtly has been accepted as reasonable in the different Regional Health Services, then we can start to debate exactly how services should and could be rationed. None of the current parties accepts the use of the word “rationing” and their lexicon uses “prioritization”, “restriction” and any other synonym..  The politic of speech hides the truth: in effect lying to all of us.

A first debate in West Wales BMA – on rationing – wins a majority in favour

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

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

We are rationing the wrong way – and without a philosophical debate it will get worse

An election debate by pithed, fearful politicians. Impotence and denial ensure no significant change in philosophy.

Laura Donelly reports in The Telegraph reports 30th July 2015: Hearing aids and vasectomies rationed as NHS pressures bite – One in three GPs says NHS rationiing has increased in the last year, as investigation finds hearing aids, vasectomies and hip and knee operations are being restricted

The NHS is increasingly “rationing” hearing aids, hip and knee replacements and vasectomy operations to try and cut costs, an investigation has found.

More than one in three GPs say access to treatment has been restricted in the 12 months, with senior doctors warning of “unacceptable” decisions being taken.

Charities said many of the rationing measures are affecting the most vulnerable, with the decision to restrict hearing aids branded as “cruel”.

The health service is attempting to make £22bn efficiency savings by 2020, in order to close a looming deficit.

Areas with the worst financial problems have been ordered to draw up emergency plans to cut spending.

An investigation by Pulse magazine discloses widespread rationing measures being introduced in a bid to bring costs down.

A survey of 652 GPs found 36 per cent had experienced increased restrictions to services in the last year.

The rationing measures mean NHS North Staffordshire clinical commissioning group will no longer fund hearing aids for those with mild hearing loss.

Charity Action on Hearing Loss said it was “deeply opposed” to such restrictions, which would cut off a lifeline for some of the most vulnerable.

NHS North East Essex CCG is restricting vasectomies, female sterilisation procedure and spinal physiotherapy, as part of efforts to save £1m.

NHS Basildon and Brentwood CCG is considering withdrawing funding for patients with “mild or moderate” hearing loss, and has capped the number of vasectomy referrals it will pay for.

Mid Essex CCG has drawn up plans to save £1m by reducing access to procedures including hip and knee operations.A number of areas have tightened up eligibility for some of the most common operations, including hip and knee replacements.

NHS Great Yarmouth and Waveney CCG says obese patients must lose weight, and smokers give up, before hip and knee replacement procedures. It says such restrictions may be expanded to cover other operations.

Dr James Kingsland, president of the National Association of Primary Care, said such decisions could not be defended.

He said: “The idea of rationing necessary care in a service that is free at the point of use is just unacceptable. Any health commissioning body looking at rationing services need to question whether they are fit for purpose.”

Marcus Warnes, Interim Accountable Officer at North Staffordshire CCG, said: “Our decision to introduce an eligibility criteria for hearing aids for people with mild to moderate hearing loss was not financially driven but clinically-led and based on a significant volume of research and extensive engagement with local people, stakeholders and a variety of national bodies with specialist expertise.”

Dr Gary Sweeney, NHS North East Essex CCG chairman said: “We have no choice other than to stay within budget. If we do not implement these decisions we will have to select other services to restrict.”

A Department of Health spokesman said: “Blanket restrictions on treatment are unacceptable and all decisions on treatment should be made by doctors based on a patient’s individual clinical needs.”

Recruiting foreign nurses ‘frustrating and expensive’: British Nurses should cash in on the bonanza

British nurses with desirable high specialty skills such as A&E and Intensive Care should cash in on their opportunity. Travelling a few miles or even a few hours could boost earnings considerably. The employer benefits from knowledge of training quality, probity, professionalism and communications skills – as this is often absent for long periods if these nurses are not appointed. It also applies to doctors at both consultant and junior level. Are YOU, a potential long term patient (even a politician?)with multiple chronic diseases, confident of YOUR future care, or would you rather bury your head? It is the staff who spend time and identify with you who you really remember. The Health visitor for a mother, the psychologist in depression, the physiotherapist after an injury or stroke. It is not only Nurses, but also the softer specialities of the Health Services that are really thin and unable to sustain quality. A change in funding, philosophy and patient expectation is needed..

 Jane Dreaper in the BBC News team reports 28th July 2015: Recruiting foreign nurses ‘frustrating and expensive’

It is “distracting, frustrating and expensive” to have to recruit large numbers of nurses from overseas, the head of a leading NHS hospital says.

Dr Keith McNeil, who runs Addenbrooke’s Hospital in Cambridge, urged officials to “figure out” what resources were needed and improve UK recruitment.

Around 7,500 nurses from countries such as Spain, Romania and Italy registered to work in the UK last year.

Health Education England said national training places had increased.

Figures from the Nursing and Midwifery Council (NMC) show the recruitment of overseas staff to the UK is growing.

The number of nurses coming here from other parts of the EU has risen steadily during the past six years – now making up the vast majority of new overseas recruits – while the number of foreign nurses from beyond Europe has dropped…..

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Third round of GP trainee recruitment cost £113,000 to fill 72 posts (and now you wonder why locums cost so much!)

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…

Implosion. Cynical – over 20% GPs from overseas, and 100s of places unfilled in GP training. Why not consider why?

Not enough nurses or doctors? Or are we just inefficient? The situation is a disgrace and a scandal, and needs a war like atmosphere of honesty to address it…

Healthcare Alert: “We could fall behind in health” – and yet ” Britain has the chance to be the world’s doctor” – REALLY?

Building from nothing? A workforce for the Regional Health Services and rural areas…

New plan to develop frontline NHS Wales workforce

OOH GP services – A Shameful reduction in standards, and increase in expense

Australia offers free weekends to lure NHS consultants

Why not become a locum? Earn more, Standard hours of your own choice, no administration and control of your own life? Training bribes won’t work: undercapacity controls the rules




Grieving for the NHS. The softer specialities and locums. Ration for higher earners, and where insurance could cover.

As doctors and nurses grieve for the former health service that they knew and were proud to work for, and since “goodwill” is fast disappearing, I wanted to reflect on the softer specialities, and the post-code lottery of provision. The 24/7 service planned by Mr Hunt will need all staff on rotas, and many more of them. Since sickness and absenteeism in the UK Health Services are the worst measured across organisations throughout the world, we need to think what is happening and why when an absent person or persons affect care. Why is it that doctors and nurses have locums, but psychologists, physiotherapists and Occupational Therapists do not? It is the urgency (life saving) and speed and volume of decision making, and turnover of patients that means there have to be locums for medics. If we want the whole service to function properly we need politicians to feel this will gain votes, and we are going to need locums for other staff because we all work in teams… And once we accept this, then we need to appoint enough permanent staff so that locums are not needed and we save money. Rationing out some of the softer services overtly and with due notice, especially for higher earners, would be a sensible option in these stringent times.. Insurance could also cover many more sports.

Grieving has many stages (Kubler-Ross), and the politicians are still in denial. The consultants and GPs are angry but many have moved on to reluctant acceptance of lower standards or retired. The softer specialities have been through bargaining (and failed) and are now in depression. The managers are still bargaining and in disorganisation. The public don’t understand and are in sudden shock (pre-denial) when they need the service!

The NHS culture is sick – and so are its staff – But is there any “quick fix”?

Living through the NHS’s famine years. Quality reversals and increasing deficits are symptomatic of deeper problems

Cornwall and Barnsley have worst morale and absenteeism

Is the NHS going to blow a gasket?

Physiotherapy can transform the NHS and lives of older adults

Rationing and Physiotherapy

This will hurt – hospital flaws inspire new play. Stroke victim has very little physiotherapy: covert rationing and deliberate undercapacity

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

Four in ten stroke patients don’t get specialist treatment in time – so 6/10 do!

Specialisation: Hundreds of lives a year could be saved by closure of local hospital stroke units

‘Let’s add life to years, not just years to life’

Midwives and patients warn of ‘devastating’ staff shortages

Foreign nurses still propping up the NHS: At least 40 trusts actively recruiting from abroad …

Ad then there are those who no longer wish to preserve the NHS, and shed crocodile tears..


Goodwill for the Health Service is fast disappearing, as is the safety net. Fear is returning as pre 1948.

Goodwill for the Health Service is fast disappearing, as is the safety net. Fear is returning as pre 1948. The politicians have burnt the boats, and need to build a new fleet. (In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear)

A letter in The Sunday times explains well:

Doctors’ goodwill a splint for understaffed NHS

AS A junior doctor, I routinely work about 10 extra hours a week. The NHS is propped up by the goodwill of all the staff, and with interventions such as Jeremy Hunt’s, morale sinks even further. We already work seven days a week and support the service. What we need at weekends is better access to diagnostic tests and more members of the whole team, not empty threats from the health secretary.

You have the perfect case study of what happens when you push people beyond the point they are prepared to tolerate in A&E. Punishing rotas make it nearly impossible to maintain a family or social life — hundreds of consultant and training posts are unfilled, and expensive staff have to fill the gap.
Dr Hannah Mitchell, London N1

We have rationed OOH and Weekend care for years. Now the comeuppance…

There is nothing wrong with aspiring to a 24/7 service but the rhetoric that suggests consultants and GPs are at fault is nonsense. The problem is of short termism and undercapacity issues, and standards are falling so far and fast that many altruistic doctors and nurses, especially juniors don’t wish to practice in the UK Regional Health Service systems. It is wrong to print that the doctors union is “resistant” – they are just telling us the feasibility in the short term..(Seven-day NHS service plan must prioritise emergency care, BMA says Priority must be given to urgent and emergency care in plans to boost seven-day hospital services, doctors’ leaders have said. ) More analytical, and less emotional, is Sir Bruce Keogh and his contribution is below. The biggest NHS shake-up for 50 years.

Anecdotal evidence from Jon Ungoed-Thomas and Marie Woolf  in the Sunday Times 26th July 2015 is illustrative:

Ending weekend ‘ghost town’ care comes too late for Millie – After tragedies involving children, the NHS is working to introduce a seven-day service in hospitals despite resistance from the doctors’ union

HSJ: Keogh: New research confirms ‘weekend effect’ on mortality

Sir Bruce Keogh’s thoughts:

The transparent provision of data and information to the public is one of our strongest drivers for promoting quality in healthcare. But the use of data to promote quality also exposes some inconvenient truths. Weekend care is an example.

We have evidence that mortality rates for patients admitted to hospitals are higher at weekends; that those patients tend to be sicker; that our junior doctors and trainee specialists feel clinically exposed and unsupported at weekends because of the complexity and demands of modern medicine; and that hospital chief executives are worried about weekend clinical cover.

It also seems inefficient that in many hospitals at weekends expensive diagnostic machines, laboratory equipment and pathology and imaging facilities are under-used, operating theatres lie fallow and clinics remain empty. Yet access to specialist care is dogged by waiting lists, and GPs and patients must wait for diagnostic results.

It is clear the lack of continuity of many services over seven days undermines our ability to tackle the mortality issue, provide continuous support for people with chronic conditions, achieve our safety ambitions and, frankly, provide a modern patient-centred service.

These concerns have led to calls for different service models in hospitals at the weekend from Health Education England, the Academy of Medical Royal Colleges, the Royal College of Physicians, the Royal College of Surgeons and organisations representing NHS managers and patients, with the aim of not only improving outcomes but also enhancing the training of the next generation of NHS doctors.

We have an ethical obligation to address these issues; but we also have a duty of care to NHS staff to ensure they have a reasonable work/life balance.

Every weekend, many consultants are going in to see their patients in hospitals, but it is not universal, which means our weekend services are fuelled by professionalism and goodwill rather than good NHS design. This is not sustainable. We need to design and organise our NHS to make it easier for clinicians to provide the care their patients deserve. The will is there. This is confirmed by junior doctors who tell me there has been a notable increase in consultant-led care at weekends over the last couple of years. The NHS is moving in the right direction.

The problem of diluted services and poorer outcomes at the weekend is not unique to the NHS.

The issue is complex with no single causative factor or solution. To tackle the problem we have developed 10 clinical standards, based on evidence and consensus.They seek to improve the availability of diagnostic tests at weekends, the availability of senior doctors to interpret and act on those tests and the provision of support services to enable the right treatment in a timely fashion. So this is not just about doctors, it is about teams and facilities.

This is potentially the biggest change in NHS philosophy and design since the advent of district general hospitals over 50 years ago. Some of the ambition can be achieved by offering services in a more networked and collaborative fashion between historically competitive NHS organisations. Some changes will require significant investment. So to get going we propose to focus on those patients requiring urgent or emergency care.

We already have 22 trauma networks in England that ensure we have the flexibility to provide first-class care to people who have had a major accident, whatever time of day or night. This has resulted in a 50% increase in survival over the past three years. Now we have announced how we will build on these networks, starting in the northeast and in West Yorkshire, to extend provision of seven-day services to the full spectrum of urgent and emergency care needs.

Professor Sir Bruce Keogh is medical director of NHS England

Setting up the Health Service to fail. Exhausted nurse sums up what many NHS workers think of Jeremy Hunt

David Burke in The Mirror 25th July 2015 , and the Metro carry a link to a video of Nurse Jacqui Berry telling the truth. Jacqui does not realise there is no NHS, and she may not state that health care is covertly rationed, but she speaks from the heart. NHSreality agrees that staff are working weekends.. and the reason that deaths are higher at weekends and in changeover months (August and February) is that there is not a full compliment of staff and back up services available for patients 24 hours, and the changeover August day is in Holiday time. To counter this should need an increase the budget for Health by approximately 1 or 2/7 or 14%, and a move from August/Feb to September/March or October/April for staff training changeover. The Health Services are too big and cumbersome..


Exhausted nurse sums up what many NHS workers think of Jeremy Hunt

An NHS nurse has left a tearful message for health minister Jeremy Hunt the morning after finishing a 14 and a half hour shift.

Jacqui Berry’s eyes well up as she tells how she took inspiration from a fortune cookie with her Chinese takeaway – which she ordered because she was too exhausted to cook.

Her voice wavers as she said: “Yesterday evening I left the hospital an hour and a half late – 14 and half hours after I first arrived. I’m not complaining that happens sometimes, it was a hard day.

“When I got home I didn’t have the time or the energy to make a healthy, nutritious meal so I got a Chinese takeaway.

“Hopefully this pattern doesn’t cause me to develop a costly and complicated long-term condition like diabetes.

“Anyway I got this fortune cookie which read: ‘Sooner or later those who win are those who think they can.

“We have to fight them [Government] and we have to start thinking we can win.”

Mr Hunt has recently come under attack for his plans to enforce seven-day working for NHS staff.

More than 175,000 people have signed a petition calling for him to be sacked or tweeted messages on #ImInWorkJeremy.

Open letters from medics have gone viral on Facebook, including one from 34-year-old Janis Burns.

She blasted the £7,000 MPs’ pay rise and complained many doctors earn less than the £41,000 for managers in coffee chain Pret a Manger.

One furious nurse on £26,000 told Mirror Online of the horrors of an average shift – comforting a dead patient’s wife as she collapsed screaming in hysterics.

And junior doctor Benjamin Carter blasted Jeremy Hunt as a ‘totalitarian Disney villain’, telling him: “My colleagues have children that they only fleetingly see because of work.”

Anti-austerity campaigner Ms Berry added in her message posted on You Tube: “Last week health minister Jeremy Hunt accused of of being a bunch of 9 to 5-ers which is ironic coming from someone heading off for a seven-week break.

“It may surprise the minister to learn that people don’t become critically ill exclusively within office hours

“The truth is we already have seven day working in the NHS it just this government doesn’t want to pay us for it.”

Is there a future for the NHS? Live Debate – The Guardian

Call for public debate on NHS finances post-Budget – NHS …

Medical leaders call for debate on funding NHS in England …

The PFI hospitals costing NHS £2bn every year

NHS drugs to be stamped ‘Funded by the Taxpayer’ to reduce waste

Lydia Wilgress for Mailonline reports 25th July 2015: ‘I’m in work Jeremy… are you?’: Angry doctors take to Twitter to post pictures of themselves on duty after Jeremy Hunt claimed medics weren’t doing enough weekend shifts 

August comes around again – don’t be ill this month

Dont be Ill in August & particularly on the 11/12th …. A reminder that nothing much has changed and how hard it is to make the change

Improving safety needs a “buy in” by professionals. Scapegoating and denial, and causing antagonism are not the way to treat professionals.. but they might start a war.

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

Let hospitals go bust, says watchdog – What I believe