The NHS is facing an exodus of senior hospital doctors as new figures show that more than 80% may retire early because of work-related stress

According to a survey by Hospital Consultants and Specialists Association ( HCSA) the stress on Consultants and Associate specialists is reaching breaking point (link to original survey results (This contains the results of an HCSA survey of 817 senior hospital doctors on the impact of workplace stress, conducted between August 27th 2015 and September 8th 2015))

Who cares for the carers? HCSA hospital doctors’ stress survey reveals shocking results

…….More than 800 consultants and specialists responded in order to be able to relate their experiences of life on the front line.

The results are stark – painting a bleak picture of relentless and rising stress, pressure from senior management, relationship breakdown and ill-health among consultants. Against the backdrop of the government push for a ‘cost neutral’ shift to seven-day hospital services the findings are more worrying still. They also suggest a potential, highly damaging exodus of experienced consultants, with more than eight in 10 respondents revealing that the current levels of stress had caused them to re-evaluate their retirement plans.

 

Who drives UK Government Health policy?

I was drawn to this  article by George Monbiot written back in 2008 when the then PM Gordon Brown talked of a need to improve GP access …… but who were the drivers of this demand? It would seem they are back at the wheel driving David Cameron and Jeremy Hunt’s Health policy vehicle…….Despite a change in government there seems to be no change in philosophy. Having a market and choices is only important where there is overcapacity, and we are in a world of under capacity: too few doctors and nurses, and too many patients.

. This link will take you to the original article.

The CBI has produced a long list of complaints about GPs’ failure to “rise to the challenge” of the market(15). In truth they are among the most efficient workers in the NHS. One of the reasons why their pay has jumped so quickly is that they have responded more effectively than the government expected to the incentives in their new contract (giving the government a further stick with which to beat them). They are way ahead of the hospitals in their use of information technology. But there is money in primary care, which is why they are now in the firing line. GPs say that the government was hoping they would reject its demand for longer opening hours, knowing that the private sector could then step into the breach.

………..The richest opportunities for capital exist within that part of the economy controlled by the state. Here, because the government cannot allow services to fail, the risks are low and the gains, for early movers, can be astronomical. An army of lobbyists, assisted by the corporate media, has been demanding ever greater access. Blair discovered that as long as you conceal your plans, you can give the CBI, Rupert Murdoch and Lord Rothermere what they want and get away with it. If you show your hand, as Cameron has done, you blow it.http://www.monbiot.com/2011/05/16/a-death-foretold/

 

 

 

 

Only 52% of doctors completing foundation training chose to enter specialty training

NHSreality has already suggested that we train graduates rather than undergraduates at medical schools, and with distance learning they can be dispersed around the DGHs (District General Hospitals) for most of their training. Attendance at a centralised overseeing “medical school” need not be more than once a month, or even less. Graduate entry will correct the gender imbalance, and dispersal will lead to their being more likely to remain in or near their training location. Medical training provides an excellent knowledge basis for becoming a parent, but this drop out rate is unacceptable and a scandal.

Alarm at specialty exodus   07/12/2015

From an article posted on Doctorsnet

A link to the report can be found here

Senior doctors have warned of the impact on the NHS of a growing exodus of foundation doctors.

This year just 52% of doctors completing foundation training chose to enter specialty training, according to new figures.

Growing numbers of doctors are taking career breaks or seeking other kinds of appointments, according to the figures from the UK Foundation Programme Office, reported in Doctors.net.uk news on Friday.

Four years ago some 71.3% of foundation doctors went straight into specialty training.

Doctors were making their decisions about the next stage in their careers at the point when junior doctors’ leaders had already expressed dismay at what was being offered in a prospective new contract and withdrawn from talks – but before the move to strike action in the last three months.

Speaking to The Guardian, the president of the Royal College of Psychiatrists Professor Sir Simon Wessely described the reduction in specialty applications as “disturbing.”

He said: “All this is very worrying. The loss of anything other than a tiny minority of these junior doctors will be a substantial loss to the NHS if these expensively-trained, excellent young medical graduates choose not to pursue a career in the NHS.

“The figures show that more people are less willing to commit themselves to further training to become a GP or consultant in the NHS. They tell us that more and more are reluctant to join the NHS or are hedging their bets.”

The chair of the British Medical Association’s junior doctors committee, Dr Johann Malawana, said: “These figures should serve as a serious wake up call to the government, and highlight the significant impact that increasing demand, recruitment issues, and falling resources are having on NHS staff.

“The unprecedented pressure combined with the anger and frustration around the government’s plan to impose a new contract, has left many junior doctors voting with their feet.”

Medical Student debt – time for government to change policy on doctor recruitment

Pulling the plug on the medical brain drain – starts Tuesday

A demented government? Medical Staff migration: a map and a bar graph could shame a government to action…

So – who wants to be a doctor? Let’s give (at least) 5 places per secondary school.

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

Safety fears over doctors who trained outside EU – open up more medical student and GP training posts urgently

 

‘Silent majority’ of older people do not complain about substandard care

No junior doctors will be surprised. Neither will GPs. We all want to work for an organisation we can be proud of. Nobody wants to strike (Junior doctors likely..). We constantly hear “I could not understand the doctor”, and GPs no longer even discuss this; they just nod their head in sympathy. That we ALL need an advocate if we happen to be admitted to a District General Hospital and are unable to represent ourselves is a shame. It needs to be acknowledged in the political world. Perhaps a debate on overt rationing will follow.

The Guardian reports 30th December 2015: ‘Silent majority’ of older people do not complain about substandard care – More than half of over-65s who have faced problems did not complain as they feared it might impact treatment, ombudsman finds

Older people are reluctant to make complaints about substandard healthcare – or do not know how to go about doing so – and could be suffering in silence, according to a report by the parliamentary and health service ombudsman.

It found 56% of people over 65 who had experienced a problem had not complained because they were worried about how it might impact their future treatment. Almost one in five did not know how to raise a potential complaint, while about a third felt that complaining would not make any difference.

The authors of the report, published on Wednesday, were told by one carer in Manchester: “When people have a problem they don’t know where to go. They are referred to a computer which they don’t have, they are referred to a library which is too far away to get to … [and] they wouldn’t know what to do anyway.”

The research was based on a national survey of almost 700 people over 65, as well as focus groups and case studies.

Julie Mellor, parliamentary and health service ombudsman, said: “Older people are some of the most frequent and vulnerable users of health and social care services but are the silent majority when it comes to complaining.”

She added: “Their reluctance to complain could mean that they are suffering in silence and could lead to missed opportunities to improve the service for others.”

The research is a cause for concern and it is vital every hospital patient or healthcare client feels any potential complaints will be properly addressed, according to Age UK.

The charity’s director, Caroline Abrahams, said: “Patient feedback is a great barometer of the quality of care and this report suggests hospitals need to do much more to reassure older patients that they can complain if they need to, free from fear.”

She added: “Seeking and responding to older people’s views and experiences is crucial if we’re to prevent future care scandals like those that have too often blighted our hospitals and care homes in recent years.”

The report urged action, particularly because of Britain’s ageing population. By 2030, about one in 10 people in the UK will be 75 or over, according to the Office for National Statistics.

The report recommended a more concerted approach from NHS providers, which it said need to make sure all patients are aware of how to complain and reassure them there would be no repercussions.

Commissioners of healthcare should also use the ombudsman’s complaint-handling guidelines, My Expectations, as a way of measuring their own performance, the report recommended.

The report also pointed out progress was being made, including steps by the government to explore options for a new streamlined public ombudsman service to handle complaints.

A universal, independent complaints advocacy service that was easy to find and simple to use would improve the situation, Healthwatch England said.

A spokesman said: “We know the NHS is under pressure at this time of year, it is therefore vital that if things do go wrong patients are informed how to raise concerns and how to get help to do so if they need it.

“Without this support, thousands of incidents will continue to go under the radar every year and mistakes will never be learnt from.”

The group said there was support available for those who feel let down by the NHS, but added: “When it comes to care homes and home care services there is little to no complaints support at all, leaving very vulnerable adults with little protection.”

Plan your hospital advocate…. NHSreality warned you that it was happening near you. The problems of Mid Staffs and Sussex Mental Health services are endemic, and Christmas is not a time to be ill..

Resilient NHS – gutless politicians – the problem that seems to prove the rule – politics is small and cannot discuss philosophical issues

In a letter to The Times, Lord Hunt remarks on the “the resilient NHS” – a problem that seems to prove the rule – politics is small, local, and cannot discuss philosophical issues. No wonder the professions are disengaged. There is an opportunity for an honest party to challenge the status quo, but has anyone got the guts?

Sir, Your leader (“Small politics”, Dec 28) states that the NHS “keeps demanding more money yet is constantly on the verge of crisis”. In fact the NHS has been remarkably resilient in the face of a population increase of more than 7 per cent since 2003, an ageing population and the sharply rising burden of avoidable illness. Yet the average annual real terms funding increase over the last parliament was less than 1 per cent compared with a historic average of 4 per cent since the birth of the NHS in 1948. The next five years promises a meagre 0.85 per cent real terms increase per annum.

The recent OECD analysis (Health at a Glance 2015) shows that 24 countries spend more on healthcare as a share of GDP than we do. Not surprisingly we have, per capita, fewer doctors, nurses, hospital beds, and access to sophisticated medical equipment than any comparable country. Surely the right conclusion to be drawn is that the NHS is remarkably robust.

Lord Hunt of Kings Heath

Shadow deputy leader of the Lords

Small Politics (Times leader 28th December 2015)

British politics is changing even though the election result seemed conventional. Neither the government nor the opposition appear capable of rising to the challenge

In British politics everything is changing, yet it all remains so familiar, at least for now. This was an election year in which the opinion pollsters got their predictions wrong, in which a hung parliament looked likely as new parties waxed and old parties waned. Yet the year ends with a majority Conservative government locked in an argument about Britain’s place in Europe.

The May general election did reassert one hardy perennial of political knowledge. No party with a commanding lead on both leadership and economic competence has ever lost a general election. The quirks of the electoral system made it seem possible that 2015 would be an exception. Labour never dealt with the accusation of profligacy and, despite the government’s flawed and tardy programme of deficit reduction, the Conservative party remained the trusted custodian of the public finances. Though David Cameron had been a strangely complacent prime minister, he looked a comfortable occupant of the office, and the public never saw Ed Miliband in the same guise.

On the face of it, the Conservative overall majority looked a traditional victory. Yet politics is becoming more volatile. In 1945, Labour and the Conservatives between them took 97 per cent of the popular vote. In 2015 they commanded just 67 per cent. A political system designed to give full executive power to the more popular of two large parties just about coped with the change.

The insurgent force of British politics in 2015 was and is nationalism. The Scottish National Party shattered the granite Labour vote and took 56 of the available 59 seats. The prospect of a coalition led by Labour but upheld by a party that did not believe in the state it was helping to govern was an important incentive for people to stick with the Conservatives. In England, the votes of those disaffected with the two main parties and with politics itself went in large numbers, not reflected in seats, to Ukip. The impact of Ukip was felt as much by Labour as by the Conservatives.

The election resolved the identity of the government but little else. England, Scotland, Wales and Northern Ireland are now all dominated by different parties and the union lies in the balance. This country’s membership of the European Union may well be settled, if the government holds a referendum in the year to come. If the prime minister’s renegotiation is rejected he will probably resign. Even if he wins, Mr Cameron has pledged not to fight another term. The second half of this parliament will be dominated by the question of who the Conservative party will choose to be the next prime minister. In the absence of any viable opposition, politics is, for the moment, a wholly-owned subsidiary of the Conservative party. Under the unexpected leadership of Jeremy Corbyn, whose rankings are irrecoverably low, Labour has gone backwards. The shattered Liberal Democrats will take more than Tim Farron’s cheery demeanour to recover. This poses a constitutional question of some importance as, with no alternative government on offer, opposition is reduced to mere lament. Mr Corbyn’s leadership will be tested in May, in the London mayoral election, which Labour ought to win, in elections for the Scottish parliament and for local government in England.

This will matter because the government faces some tough problems. The deficit is still to be cleared and debt is piling up. The NHS keeps demanding more money yet is constantly on the verge of crisis. Universal Credit is a good answer to the benefits conundrum but it is beginning to seem that it might never arrive. The same can be said about the decision over airport capacity. It is even possible that Britain may end the year no longer a member of the European Union. It is hard to avoid the feeling that the issues are big but the politics, at the moment, is rather small.

How I’d Reimagine America’s Health Care System

The following is a post from the Head of one of the USA’s largest Healthcare providers and one that influences the UK Governments thinking on the future of Healthcare….

How I’d Reimagine America’s Health Care System

Bernard J. Tyson

Chairman and CEO of Kaiser Permanente

Dec 14, 2015

Just a few years ago, millions of Americans who now have access to the health care system lacked coverage. Taken alone, it’s an incredible sign of progress that we have provided access to so many.

Considering many of the other changes we have navigated as a country in that time, it’s impossible to deny the significant steps we have taken towards the health care system we deserve. We have introduced new ways to evaluate and access health insurance, begun the move away from our fee-for-service payment system and toward one that rewards value and outcomes, and started to seriously address our problem with affordability in achieving health.

Despite all of this positive progress, the time has come for an even bigger change. 2016 needs to be the year we finally reimagine what health can look like in the future, and commit to turning health care into health as a reality in the coming years.

While I’m thrilled to be able to point out the progress we’ve made, we have no time to waste. This reimagined system will be personalized, affordable and convenient to all of us as consumers. Here are the four areas I believe we must focus on to reimagine and realize the future of health:

Technology

 

Technology delivers care with flexibility and mobility from your home or work.

Technology is key to making care more connected, convenient and accessible. Telemedicine will offer consumers care at the touch of a button. Better interoperability of electronic health records across the country will ensure we’re providing everyone with the coordinated care that’s necessary for us to succeed.

That doesn’t mean more technology always means better care, it means we need to understand how technology can improve the care our wonderful nurses and physicians already provide. If I were designing our system from scratch I would design it around technology, not buildings. Which leads me to…

Design

 

A medical office welcomes and engages patients in their health, creating a gathering place for wellness. This medical office opened in December.

Build it and they will come. That has been the operating mantra for the medical industry for hundreds of years — to build facilities where people who are sick come to be treated.

The doctor’s office of the future will be designed with the patient in mind and as much focused on keeping them healthy as treating them when they are sick.

Let’s create more open and inviting spaces that are used not only as the place where people come to see the doctor, but as centers of health, where consumers can access health information, learn something helpful, and be a part of their community. When they are in with a doctor, those exams should be taking place in spaces that make discussing health matters or receiving treatment more comfortable. That, in turn, should allow for better…

Consumer Experience

Patients have access to video visits, virtual consults and the ability to locate, access and receive information on mobile devices so they can be partners in their own care.

Better use of technology and design should help us deliver better, more personalized experiences for everyone interacting with our health care system (everyone). In the future, physicians and care teams will use data and confidential health records to more effectively treat each individual. This in turn will help us eliminate health care disparities and provide each person with the unique care they need to live a longer, more productive and happier life.

In addition, health care systems will need to meet patients where they are, whether it is offering convenient access to preventive care in retail, work and home environments to providing new methods for helping those with chronic conditions lead their lives outside the hospital as much as possible.

We know that each patient is a unique individual and should be treated as such. Yet, personalized care won’t realize its potential if it isn’t…

Affordable

All of this will be pointless if we can’t deliver health for a price that is affordable to consumers. Moving away from a fee-for-service system is a start. Prevention and healthy beginnings are key to provide early detection and treatment of disease, and we must start moving health care dollars upstream, so everyone can enjoy longer, healthier lives. Finally, every part of the health care system needs to be realistic about its role in providing better, more affordable care and coverage to every person in America.

If we can start to reimagine a system that looks more like the future I’ve shared with you here, we’ll be off to a good start for 2016 and far into the future. Making lives better is the goal we should all strive to achieve — and it’s all possible by working together to redefine life, liberty and the pursuit of happiness.

Renderings courtesy of HDR, Inc.

GP trainee fill rate 2015 vs 2014

The following graphs are from an article in GP magazine that show an increase in overall GP trainee numbers but a stark north v south divide in the popularity of training schemes.

The graph above shows the change in recruitment from 2014 to 2015 by geographical area. 

the overall increase by area is mind boggling I can only assume these trainees are getting the ticket ( MRCGP) and emigrating the day after they receive it only a lunatic would consider practising in the UK under the present system. 

The original article can be found here (from GP online magazine)

GP trainee map reveals stark north-south recruitment divide

By David Millett on the 18 December 2015 http://www.gponline.com/

http://www.gponline.com/gp-trainee-map-reveals-stark-north-south-recruitment-divide/article/1377495

The perils of public office: Will Mr Hunt outlast Mr Zuma?

The perils of public office – A merry life but a short one. Politicians beware. Success can seriously curtail your lifespan. (The Economist Christmas edition 2015)

NHSreality speculates that it is the half truths and frank dishonesty which shorten the lifespan of politicians. 2.7 years extra, at age 83 .Will Mr Hunt be any more honest than, or will he outlast Mr Zuma? NHSreality suspects the figures wont stack up, but a spoof of this nature does brighten the holiday.

THE idea that power could corrupt physically as well as morally—that the strain of high office might damage an incumbent’s health—took a serious knock in the 1970s, with the publication of the first “Whitehall” study by Michael Marmot of University College, London. This showed that, among British civil servants, it is those at the top of the pyramid who are healthiest and live longest, even when other factors are taken into account. Being the alpha dog, Sir Michael found, is itself an elixir of life.

Research just published in the British Medical Journal, though, tells a different story. Anupam Jena of Harvard University and his colleagues looked not at civil servants, but at those who won elections to take the position of head of a government. Dr Jena compared the subsequent lifespans of 279 winners of elections in 17 countries (going back, in the case of Britain, to the early 18th century) with those of 261 runners-up in such contests who never subsequently won the top office. Using actuarial data, he concluded that winning and exercising the highest of offices in these countries takes an average of 2.7 years off the victor’s lifespan. For elected, rather than unelected politicians, then, supreme power really does look like a Faustian bargain.

Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries (2015;351:h6424 )

Pure politics. No wonder the profession are disengaged. This will only make it worse..

Pure politics. The Health service is open for emergencies and consultants work nights and weekends already.. No wonder the profession are disengaged. This press release, and the media’s naïve coverage only make it worse..

James Meikle in The Guardian 22nd December 2015 reports: NHS leaders set out plans for seven-day access to services in 15 months – Guidance includes aim for quarter of patients in England to have week-round access to acute care and a fifth to GPs by March 2017

A quarter of England’s population should have access to some seven-day services in acute hospitals in only 15 months, NHS leaders have said.

They also laid out their ambition for a fifth of people to have better week-round access to GPs and other primary care by March 2017.

Other “must-dos” include returning to meeting key targets that demand 95% of patients wait for less than four hours in A&E and all ambulance trusts respond to 75% of immediately life-threatening calls within eight minutes.

These changes must be achieved while “embedding a culture of relentless cost containment” rather than trying to grow income, planning guidance issued by the NHS’s main organisational and financial bodies said on Tuesday.

Their aim is to restore “financial balance” by the end of the next financial year – a tough target given the fact that the NHS was £1.6bn in deficit six months into this one.

The guidance, the latest attempt to bring “joined-up” care rather than concentrating on individual health and social care organisations, does however offer hospital trusts a glimmer of financial hope, saying that they will only have to make annual efficiency savings of 2%, a measure said to reflect rising healthcare costs and half the 4% that was originally envisaged.

The seven-day ambition set for patients at hospitals covering 25% of the population should mean that by the end of the 2016-17 financial year all emergency admissions are seen, and have a thorough clinical assessment, by a suitable consultant as soon as possible, but at the latest within 14 hours from the time of arrival at hospital.

Patients in such hospitals should also have scheduled access to diagnostic services such as x-ray, ultrasound, MRI or endoscopy, and “timely 24-hour access, seven days a week, to consultant-directed interventions”. Patients in high-dependency areas such as intensive care units must also be seen and reviewed by a consultant twice daily.

Other priorities include reductions in “avoidable deaths” and improvements in one-year cancer survival rates, in meeting referral to treatment and other waiting time standards, and in access to mental health services.

“Transforming” care for those with learning disabilities and achieving overall improvements in quality, especially for organisations that have been put in special measures, are among other ambitions.

All this must be done by improving “workforce productivity”, ensuring “the right staff are in the right place at the right time to ensure patients get the right hours of care and minimum time is spent on bureaucracy”.

The guidance – from a group of national health and care bodies including the Care Quality Commission, Public Health England and Nice – also reiterates warnings that reliance on agency staffing must be cut. It comes as the question of new contracts for junior doctors remains unresolved – the health secretary, Jeremy Hunt, sees changes as vital to delivering a 24/7 service.

The guidance, designed to kickstart changes to the way services are run over the next five years, comes a week after a £560bn sum was promised for the NHS up to April 2021.

Simon Stevens, chief executive of NHS England, said the guidance represented the next steps in making the vision of changing services in its Five Year Forward View (pdf) a reality.

Jim Mackey, chief executive designate of NHS Improvement, a new regulator, said: “We all know how big the financial challenge that we’re facing is and the next year will be absolutely critical as the NHS gets a grip of the situation.

“Now is the time to stabilise hospital performance and finances so we can give the NHS a firm footing to make the necessary improvements.

“We also need to look seriously at what can be done to realise the long-term improvements needed at a local level and to get on with making changes happen so that patients can rely on strong and sustainable services.”

 

 

Care homes added to NHS comparison website – For England only..

Once again comparators are not National but Regional. Wales and Scotland cannot compare their Care Homes!

BBC News reports 23rd December 2015: Care homes added to NHS comparison website

The performance of every care home in England can now be compared on an NHS website.

Homes have been added to My NHS, part the NHS Choices site, allowing users to leave ratings and reviews to help other people assess services.

Each care home is scored on its level of safety, staff turnover and food hygiene, among other standards.

The National Care Association said if information was not up to date, it could be “unfair” to care providers.

On the website, a database can be searched using a postcode, region or home name to check on facilities with or without nursing.

People can access:

• user reviews – including star ratings
• Care Quality Commission inspection ratings of care homes
• Food Hygiene Standard rating
• levels of staff turnover
• whether the home has a registered manager in post
• key information such as location, services on offer, contact details

Health Minister Alistair Burt said: “We know how difficult important decisions about care for a loved one can be – this is a victory for those who are worried about care – with a click of a button the public will be able to make an informed choice about care and make those difficult decisions easier.

“This data will show clearly the difference in quality across care homes and will help drive up standards by highlighting poor performers which will mean they have to shape up their services or lose out.”

Nadra Ahmed, chair of the National Care Association, which represents independent care sector providers, said the move could help people “answer some of the questions” they may have about care.

But she warned that if the “snapshot” of the provider’s rating or profile on the site was not regularly updated it could disadvantage those who improve their service.

“I don’t know how [improvements] would be indicated… especially if that report is not going to be reviewed for a period of time, which would be unfair.”

She added: “Nothing beats actually going to see a service for yourself. If you think that it’s good [but the website] says there’s something that’s not quite right, don’t let it put you off.

“When you look at the website you know that responsible services who may have an inadequate rating will be working towards making that better.”