Monthly Archives: August 2015

BBC News covers “NHS rationing” – without honesty from our politicians we cannot move forward: only backward

A search through the BBC archives gives an interesting list of reports on “NHS rationing”. The fact that there is in many ways no “national” health service has not yet occurred to the BBC reporters…. Politicians have denied the existence of “rationing” for over two decades. There is no sign that they will change their “lines” now. The economist comments in “Pay-as-you-go government – August 29th 2015” about the temptation to tax indirectly and on consumption …. and admits that it’s a sensible way to be honest. Without honesty from our politicians we cannot move forward: only backward

 

….”Charges can be an efficient way of rationing public services. London’s congestion charge, an £11.50 levy on cars entering the city centre, prevents its streets from getting clogged. Parking charges force people to vacate sought-after spaces. After Newcastle introduced a small fee for its municipal rat-catching service in 2014, the number of call-outs dropped by 35%, which the council put down to residents dealing with the problem themselves by “clearing out their sheds” (others say there are simply more rats about). Local authorities rightly balk at cutting spending on social services while subsidising bars’ licensing applications to the tune of £170m a year.

Taxing decisions

But some of the so-called charges are much more like taxes. Technocrats at the Office for National Statistics classify a charge as a payment related to the use, and cost, of a service. If a charge is above cost, or separate from the person’s use of a service, then it is a tax. That leaves the Home Office’s pricey visas and NHS surcharge looking uncomfortably tax-like….

 

Nick Triggle 22nd May 2012; Patients suffering under NHS rationing, say GPs

1st December 2012 – The moral maze: Rationing the NHS

2013:‘Stark variation in NHS surgery due to rationing’

24th September 2007: NHS rationing rife, say doctors

Catriona Renton on 22nd November 2017: NHS rationing

6th August 1999: NHS rationing: The key areas 

1999 Richard Hannaford: GPs admit to rationing care

January 18th 1999: Rationing row hots up 

7th Jan 1999: Patients suffer from NHS rationing 

1998: Dobson ‘must accept NHS rationing’ 

Devolution of health to Wales was a mistake?

Updated links 1st September 2015 – after apology.

The problem regarding Wales relates to size, poverty (Health Minister Mark Drakeford warns boards on spending), rurality and relative ignorance. The people might prefer to have worse outcomes, waiting times, perinatal mortality, and survival/life expectancy if they have relative convenience. They might also be willing to put up with less “choice” than others paying the same taxes. Perhaps they prefer less information and a more paternal state? In other words Wales might knowingly choose a spread of resources different to that in England, where people are willing to travel and have more inconvenience for better outcomes. We don’t KNOW because we have never had the debate..  In a land where the health system debate began, there seems to be no fire left in the Welsh dragon..

The State of Wales: we should all rage against it dying

No U-turn over Welsh NHS Reforms

Trust disintegration, and a disintegration of Trust

Richard.Blogger in his NHSvault 19th January 2015 comments in: Fill in the gaps

No, the Tories aren't killing off the NHS.

This is my response to Bill Morgan in a blog on the Spectator (The coalition government is not blame for the latest NHS ‘crisis’). Bear in mind that Morgan was a Special Advisor to Lansley so there is a whiff of the Mandy Rice-Davies about his post.

You rightly start by saying that the 2010 winter was affected by a flu outbreak. However, you then go on to say that 2011, 2012 and 2013 were uneventful. This is not true. There was more flu and norovirus at this point last year compared with now. Last year the NHS could cope (just) with the flu, this year the NHS cannot cope even without flu. It is this problem we have to address. The run up to Xmas was mild – just like it was the year before – so why wasn’t 2014 like 2013?….

…“Your Wales argument is a red herring. Wales is mostly rural, it has higher levels of deprivation than England and is arguably too small and too dispersed to be an effective health system. The problem in Wales is not Labour, it is Wales, and maybe we should accept that devolution of the NHS to Wales was a mistake.”

“Too Hot to Handle” – Data on needless hospital deaths may stay secret

Update: The parlous State of NHS Wales and its aspirations does not help doctor recruitment.

There is a Perverse Incentive not to diagnose Autism and Asperger syndrome

There is a Perverse Incentive not to diagnose autism. In addition to the other reasons given by Kat Lay following the official line. NHSreality very much doubts that the savings claimed possible would be made, and the net result of efficient (over?) diagnosis would be greater than now. Prolonged rationing by undercapacity and incompetent manpower planning in paediatrics is responsible..

Kat Lay reports in The Times 29th August 2015: Families are waiting years for children’s autism diagnoses

Families are waiting more than three and half years for diagnoses of autism in children, pushing many to crisis point, experts have warned.

The National Autistic Society said that the average waiting time for autistic adults to receive a diagnosis was two years.

In a letter in The Times today, 11,627 of its supporters say: “Delays mean that autistic people are developing mental health problems, falling into anxiety and depression, and that families are breaking down under the strain of being left to look after loved ones without any support.”

Earlier diagnosis could save £67 million a year by reducing the number of GP appointments and emergency admissions and the use of mental health services, the letter goes on to say. Reasons for long waits include larger numbers of people asking for assessment, a lack of understanding of the condition among some GPs and a lack of diagnostic services and resources. ….A study of parents writing about their child’s diagnosis found that the average wait between first contacting a healthcare professional and getting a diagnosis was 3.6 years. More than half said that the process had left them dissatisfied, with 84 per cent reporting it had been stressful.

A separate study of autistic adults found that their average time between first contacting a healthcare professional and receiving a diagnosis was two years. Almost a third had been forced to seek help privately.

According to the National Audit Office, identifying and supporting adults with high-functioning autism and Asperger syndrome would save £67 million per year….

Affirming a right to die with dignity

In both California and the UK, politicians, press, and people are slow at coming to terms with the change in public opinion. This is a question of ultimate autonomy over ones own life, which has to end some time.. NHS reality supports Sir Keir Starmer whose is reported in The Times, and is printed beneath that of Frances Gibb in The Times.

George F. Will  writes from San Diego in the Washington Post 28th August 2015: Affirming a right to die with dignity – and describes the case of mother Debbie Ziegler showing a photo of her daughter, Brittany Maynard who ended her life legally..

Brittany Maynard was soon to die. The question was whether she could do so on her own terms, as a last act of autonomy. Dr. Lynette Cederquist, who regrets that Maynard had to move to Oregon in order to do so, is working with others to change California law to allow physician assistance in dying…..

Laws must change to give people right to die, says Sir Keir Starmer (The Times 29th August 2015)

The law must be changed so that people can be helped to take their own lives without having to “traipse off to Switzerland”, a former director of public prosecutions has said.

Sir Keir Starmer was responsible for drawing up guidelines that spelt out how people who acted with compassion might avoid prosecution for assisting a suicide.

He is now convinced that it is time for a new law to save dozens of Britons every year from making their way to the Zurich clinics of Dignitas to end their lives.

Sir Keir, who became Labour MP for Holborn and St Pancras this year, has always declined to give his view of the law, but he has decided to go public before the Assisted Dying Bill returns to parliament next month.

“The law needs to be changed,” he told The Times. “The important thing is to have safeguards.”

Crown Prosecution Service guidelines “simply don’t deal with the problem of people wanting to end their lives in this country, medically assisted, rather than traipse off to Switzerland”, he said. “The present guidelines have in-built limitations, which mean that there can be injustice in a number of cases.”

One of the key problems was that doctors were not allowed to help, which meant that chronically ill people might have to rely upon friends or relatives to help them to die.

Since he issued draft guidelines in 2009, the CPS has received files on assisted suicides in 110 cases — 70 were not proceeded with by prosecutors and 25 were withdrawn by police. The others are still being considered or have been referred for prosecution. Only one, in 2013, was prosecuted. Assisted suicide is punishable by up to 14 years in jail.

“In my time as DPP, there was only one prosecution — of someone who provided petrol and a lighter to a vulnerable man said to have suicidal intent, who subsequently suffered severe burns as a result,” Sir Keir said.

An analysis from the Dignity in Dying campaign group shows that 166 Britons went to Dignitas to take their lives in the six years to last December. Assisted suicide and euthanasia are illegal in every country in Europe apart from Belgium, Luxembourg, Switzerland and the Netherlands.

Sir Keir believes that the law does not “strike the right balance” between allowing those with a “voluntary, clear, settled and informed wish to die to be assisted by someone acting out of compassion” and protecting those who are vulnerable to being pressurised to take their lives.

Concerns over the vulnerable are overstated, he believes. “In almost none of the 80 or so cases I reviewed when DPP was this an issue.” Sir Keir asked: “Do we keep something there to protect the vulnerable and ignore the plight of those actively committing suicide or being assisted to attempt suicide, or move to a different position where there are strong safeguards?”

His intervention comes amid concern that the law is struggling to cope with cases where people want to die but cannot physically take their own lives. This month Bob Cole, 68, who was terminally ill, said that he would take his life at Dignitas. He fulfilled his wish the same day, 18 months after watching his wife, Ann Hall, do the same.

Lorraine Grant and David Brown, who were together for 40 years, also killed themselves this month in a five-star hotel after making a suicide pact. Ms Grant, 57, who had terminal bladder cancer, had been given six months to live. Her partner, who was 63, said that he could not face life without her.

Also this month, a healthy woman, Gill Pharaoh, ended her life at a clinic in Basel, after her partner said that she had been planning her exit for years.

Sir Keir will outline the case for reform at a Westminster seminar on September 8, hosted by Dignity in Dying, with the Society of Labour Lawyers and Society of Conservative Lawyers. Lord Falconer of Thoroton’s Assisted Suicide Bill ran out of time in the last parliament but will return for a second reading on September 11.

An amendment to introduce judicial oversight of any decision to help a person to die attracted wide support. The amendment would require a High Court judge to confirm that a terminally ill patient, with less than six months to live, had reached “a voluntary, clear, settled and informed” decision to control the time and manner of their death.

Lord Falconer said: “I welcome Sir Keir’s intervention. He is the author of the guidelines and understands best how they work.

“His voice saying there is a need for change and that they don’t work is significant further support for the bill. It is right now that the Commons allows the bill to have a second reading so that the issue can be properly considered by parliament.”

A Populus poll of 5,000 people this year, the largest conducted on assisted dying, indicated that 82 per cent of the public supported Lord Falconer’s bill. The same poll also found that 44 per cent of people would break the present law and help a loved one to die.

The final guidelines, published by Sir Keir in 2010, indicate factors where those acting “wholly out of compassion” are likely to avoid prosecution for helping people to end their lives. They also list circumstances that would make prosecution more likely.

The dam’s about to burst on the right to die – but politicians and administrators are either fearful or have their hands tied, or both.

Right to die at home register ‘would save cash’. Many of us would prefer to die at home, less than a third (29%) are able to do so.

Campaigners lose ‘right to die’ case – “Parliament should now act”….

Doctor-assisted dying – The right to die: Doctors should be allowed to help the suffering and terminally ill to die when they choose

Staff morale in the Midlands – Its rock bottom, commonplace and near you

Staff morale is very low, bullying is endemic and its all commonplace and happens near to where you live. Only open and public domain exit interviews with all the parties concerned would be enough. I invite all and any of them to have a digital audio interview for NHSreality. (Worcestershire hospitals anti-bullying policy ‘not fit for purpose’ (BBC News 27th August 2015). Related entries in NHSreality include: An epidemic of nationwide bullying. In most dictatorships this precedes dissolution or breakdown…. and Bullying, intimidation and reprisals. A gagged staff culture in the Health \services across the UK. and Demand for full truth on NHS ‘bullying’ – the culture of fear

BBC news reported 11th March 2015: Alexandra Hospital consultants’ resignation reasons revealed

Four accident and emergency consultants who resigned en masse said planned changes at their hospital meant it would have “neither an A&E service nor a safe service”, it has emerged.

They quit their jobs at the Alexandra Hospital in Redditch on 13 February.

However, their resignation letter has only now been published following a Freedom of Information request to the trust that runs the hospital.

It said it had published the letter to rebut suggestions they had been gagged.

A fifth A&E consultant working at the Worcestershire Royal Hospital resigned at the same time.

In a statement, the Worcestershire Acute Hospitals NHS Trust said it had “not prevented its four A&E consultants from publishing a letter outlining their reasons for leaving”, adding that it had “always been happy for them to put it in the domain”.

The trust also published a response from what it described as “five of its most senior clinicians”.

The trust published the two letters on the same day it emerged that a review into bullying at Worcestershire hospitals will be carried out by the independent body the Good Governance Institute.

It will examine how complaints about bullying are handled and the trust’s policies on whistle-blowing.

In their resignation letter, the four consultants claim successive management decisions have “undermined services”.

The consultants described themselves as “battle-weary and exhausted by the continuous pressure that we have been under”.

“The situation has taken a heavy toll on our personal and family lives; the stress has been unbearable at times,” they said.

They said they resigned because they could no longer see a way forward to secure safe and sustainable A&E services at the Alexandra Hospital “especially whilst the current senior management and senior clinical leadership remains in place”.

The future size and shape of the Alexandra Hospital has been uncertain for several years.

All four consultants have accepted jobs at Warwick Hospital because it is “a trust who are investing in their services and value their staff”.

In the response letter published on the trust’s website on Wednesday, the five senior clinicians said they were “disappointed” their former colleagues had not acknowledged “the serious challenges to NHS services in this area”.

They said that the plan to keep “a networked A&E department” at the Alexandra Hospital, linked to the A&E department in Worcester, was based upon recommendations made in a report by Sir Bruce Keogh on the future of emergency services.

“[The consultants who resigned] are, of course, entitled to express their views but it would be wrong to suggest these views are shared by all of our clinicians at the Worcestershire Acute Hospitals NHS Trust – they are not,” the letter said.

The trust said it was in discussions with a number of potential partners to replace the four consultants.

A&E consultants who wrote the letter

  • Richard Morrell
  • Sarah Crawford
  • Christopher Hetherington
  • David Gemmell

Five divisional medical directors who replied

NHS rationing: NHS hospitals face massive deficits and demands for further cuts

In other countries it has had to be the left wing parties that have bought financial discipline to their health services. So don’t expect any change to the denial going on in your region for the next 5 years. Covert rationing will continue and important speedy diagnosis and treatment will suffer accordingly… The Health Services are understaffed, underfunded AND overplanned and overmanaged…

Ajanta Silva on the World Socialist Web Site reports 27th August 2015: NHS hospitals face massive deficits and demands for further cuts

Unprecedented levels of funding cuts in the National Health Service (NHS) have severely undermined the ability of many hospitals to operate without jeopardising patient care. Due to the cuts, many hospitals are saddled with massive deficits.

Some 114 NHS providers—NHS trusts and NHS Foundation Trusts—have recorded a net deficit of £800 million for the 2014/2015 financial year. The Quarterly Monitoring Report (QMR) of the Kings Fund think tank stated that “estimates by NHS Providers indicate that overspending by all trusts could amount to more than £2 billion by April 2016.”

In the financial year, 2011/2012, one quarter of NHS providers were reported to have overspent, while the latest figures for 2014/2015 suggest that half have overspent.

Many hospitals previously recording surpluses or breaking even have plunged into deficit, with the NHS going through the biggest financial squeeze in its history. Over the last five years, the NHS budget was not only effectively frozen, but the previous Conservative/Liberal Democrat coalition government, with utter disregard for patient safety, also took a further £20 billion in “efficiency savings” from it.

The Conservative government now demands a further £22 billion in “efficiency savings” over the next five years, regardless of the dire financial position NHS providers are in because of previous cuts.

Cuts are coming while demand and service costs are growing by around 4 percent every year. Annual real-term NHS funding is increasing on average by less than 1 percent. During the last five years, the NHS recorded the lowest funding increases in its entire history. Interest payments for expensive Private Finance Initiatives (PFI) in building and maintaining hospitals also have a crippling effect on hospital finances.

According to NHS England, which oversees the commissioning budget and operation in England, there are currently 13 NHS providers under “special measures.” Many are also under investigation by the NHS regulators—Monitor and the NHS Trust Development Authority. Special measures are imposed when there are concerns about the quality of care hospitals are delivering.

David Bennett, chief executive of Monitor, wrote to all foundation trusts early this month warning of the financial difficulties ahead. His letter stated, “As you know, the NHS is facing an almost unprecedented financial challenge this year. Current plans are quite simply unaffordable.” He ordered the trusts to “ensure vacancies are filled only where essential.”

He wrote that Monitor was already “reviewing and challenging the plans of the 46 foundation trusts with the biggest deficits” and called on “all providers—even those planning for a surplus this year—to look again at their plans to see what more can be done.”

The Monitor chief declared, “As I have said before, if we are to do the best we can for patients we must leave no stone unturned in our collective efforts to make the money we have go as far as possible.”

No one should have any illusions that these demands are “to do the best for patients,” as he claimed.

It was reported that the other regulator, Trust Development Authority, had sent a similar letter to NHS trusts.

The cuts were first suggested in the planning document “Five Year Forward View,” published in October 2014 by NHS England. Health Secretary Jeremy Hunt, in a speech to the NHS Confederation in June, endorsed the cuts, acknowledging that the NHS was facing a “very, very challenging period in its history.”

For NHS patients and NHS workers, this means a massive erosion of patient care services that are at breaking point. It means further unnecessary deaths and suffering, huge waiting lists for elective surgeries, long delays to get a diagnostic test done and long delays in seeing a General Practitioner (GP). More rationing of vital health services is inevitable.

For NHS employees, massive attacks on their jobs, pay, terms and conditions, along with staff shortages, are on the table. There are calls for reducing the pay bill. Monitor’s order to fill vacancies only where essential will put more pressure on already struggling clinical staff. The Royal College of Nursing’s new chief executive and general secretary, Janet Davies, warned, “It is… unclear what constitutes a non-essential job in an NHS trust. If you get rid of support staff, their work does not disappear. Instead, it will mean frontline staff picking up extra paperwork and spending less time with patients.”

The last five years have seen the closure or downgrading of dozens of Accident and Emergency (A&E) departments, and the shutting down of maternity units, children’s heart units, walk-in centres, ambulance stations and GP surgeries. Some hospitals have shut down wards, operation theatres and other services in order to balance the books.

Bed capacity in the NHS has been severely curtailed, increasing “trolley waits” and putting pressure on ambulance services. The crisis of bed availability in Mental Health Trusts is such that there are recurrent reports of children being treated in adult wards and patients being treated hundreds of miles away from their homes.

Many of the Clinical Commissioning Groups (CCGs) that were established by the coalition government’s 2012 Health and Social Care Act, in order to expedite the NHS’s privatisation, have already started to ration vital health services. An investigation by Pulse magazine exposed widespread rationing measures within the NHS. A survey of 652 GPs found 36 percent had experienced increased restrictions to services in the last year.

Among the rationed services are hip and knee surgeries, hearing aid provision, spinal physiotherapy, vasectomies and female sterilisation procedures. Some CCGs have introduced abrupt eligibility criteria that discriminate against the most vulnerable people, obese patients and people who smoke, in disregard of the NHS constitution. These attacks lay the ground for a further widening of health inequalities in society.

NHS performance indicators reveal the ongoing erosion of patient care services.

The total number of patients on the waiting list in May 2015 stood at 3.4 million, the highest since 2008.

The Kings Fund stated that in first quarter of 2015/2016, “the proportion of patients spending more than four hours from arrival to discharge, admission or transfer in all A&E departments was 5.9 percent (more than 337,100 patients). This was an improvement on the previous quarter but the highest figure in quarter one for more than a decade. Compared to the same quarter last year there were an additional 52,540 (18 percent) patients who spent more than four hours in A&E.”

One third of all providers missed the four-hour target in the first quarter of 2015/2016.

According to the Kings Fund, “for major A&E departments overall, just under 9 percent of patients waited more than four hours and less than a third of providers achieved the target.”

The number of patients waiting more than four hours to be admitted into a hospital bed from A&E or trolley waits has increased to 7.2 percent (71,382). This is the highest number for the first quarter of the year for more than a decade.

Patients languishing in hospital beds when they are medically fit for discharge or delayed transfers of care have dramatically increased over the last few years due to lack of appropriate care, facilities and support in the community and patients’ homes. The total number of days delayed in May 2015 was 136,900, an increase of more than 9,880 on the same month last year.