Monthly Archives: March 2016

Quality of dying is post-code rationed

Dying is a problem throughout the world. Most 2nd and 3rd world countries have hospices as add-ons to Hospital or Community care in centres of population. The pretence that care for the dying is not rationed is partly responsible, as is the denial of most politicians and the public. A collusion to deny quality care to the dying has been inevitable since GPs were relieved of their 24 hour responsibility for patients. In my own area of the country there were 5 doctors with a diploma of palliative care, but they were never facilitated to work where they could have been most useful – in Hospital. The result of not using their skills is that fewer GPs have applied for the diploma, and the ones who did have retired; their skills have been lost. There will be no fuss because dead patients do not vote. Hospice at home is a good solution and if state funds went in this direction some form of equity might be possible.

Chris Smyth in The Times 31st March 2016 reports: Thousands die thirsty and in pain due to poor care – The review found that many hospitals are still not taking care for the dying seriously enough

Thousands of people are still dying thirsty and in pain because doctors and nurses are “terrified” of talking about death, a review by the Royal College of Physicians has found.

End-of-life care has improved since the abolition of a controversial death checklist freed staff to act with human compassion, the audit concludes.

However, there is still “unacceptable variation” in care, with many hospitals not taking caring for the dying seriously enough. Only one in ten has full palliative care services available 24/7.

The audit is the first since the scrapping of the Liverpool Care Pathway (LCP), which an official investigation found led to dying patients being ­refused food and drink by staff acting on “tick box” protocols.

Sam Ahmedzai, who led the review, said that it was heartening to see ­improvement after staff were urged to listen more to their patients.

“Many people felt that when the LCP was withdrawn that would lead to a breakdown of end-of-life care. Far from it: in almost every area there has been improvement,” he said. “Doctors and nurses are paying more attention to ­individual needs rather than blanket prescribing.” However, the review of 9,300 patient records across 142 hospitals found that in 21 per cent of deaths there was no ­evidence of pain relief.

Half of dying patients had not been helped to drink in the last day of their lives and a third had not been checked to see if they needed fluids.

One hospital failed to check whether 90 per cent of dying patients needed water and many checked fewer than half. “That’s not acceptable, we need to do better,” Professor Ahmedzai said.

Many families appear to have been left in the dark, with a fifth not told that a “do not resuscitate” order was placed on a dying relative and a third not consulted about “nil by mouth” ­orders.

Tony Bonsor, a patient representative on the review, said: “Too often relatives’ first sense [that someone is about to die] was a nil by mouth above the bed. That is not the way to communicate.”

Almost half of the 500,000 deaths in England every year take place in ­hospital but Mr Bonsor argued that hospitals still see caring for the dying as an afterthought. “We have to understand that one of the functions of the health service is to give people good end-of-life care,” he said.

Amanda Cheesley, of the Royal College of Nursing, said that failings often stemmed from a deep-seated desire to avoid an uncomfortable topic. “People are terrified,” she said. “People would cross the road to avoid talking to somebody who is actually ­dying or bereaved. “We mustn’t do that in hospitals.”

The audit also expressed concern about a shortage of trained staff to help patients at the end of their lives, with only 37 per cent of hospitals having face-to-face palliative care services from 9 to 5 and 11 per cent providing them around the clock.

Adrian Tookman, clinical director at the charity Marie Curie, said: “We can’t ignore the fact that the vast majority of dying people still have limited or no ­access to specialist palliative care support when they need it in hospital. This is not right nor good enough.”

NHS England said the audit showed that there had been some improvement. A spokesman added: “There are clear variations in the support and services received across hospitals, and areas where improvements must be made.”

•Millions of older people are stuck on too many tablets that could be doing them harm, the NHS treatments adviser has warned. The National Institute for Health and Care Excellence wants doctors to try to replace drugs with alternatives such as exercise or therapy.

Smitha Mundasad reports for BBC News: Around the clock care for dying ‘not good enough’

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

Traditional In-patient Hospices are not viable in small populations

Local government grants cut to charities which are health related – The pretence that there is no rationing has to be ended, before meaningful debate and cultural change can begin.




Pressure grows on Cameron to avert all-out strike

Pressure grows on Cameron to avert all-out strike 12 30/03/2016

Original article from doctorsnet

( for full article

The government was continuing to resist growing pressure to return to talks on the junior doctors’ contract yesterday.

The Academy of the Medical Royal Colleges stepped into the dispute urging the government and junior doctors to “step back from the brink” before next month’s all-out strike.

This was followed by a 1,200 signature letter to David Cameron organised by senior GPs urging him to intervene.

Last week health secretary Jeremy Hunt and other ministers insisted they would not negotiate any further on the contract they intend to impose this summer.

But even their senior medical adviser, NHS medical director Bruce Keogh, warned the dispute had “derailed” plans to improve weekend care.

Yesterday Labour shadow health spokeswoman Heidi Alexander promised to keep up the pressure on Mr Hunt to “find a solution” to the dispute.


A flawed regulatory process and the bodies continue to pile up ? Time to end the interrogations that blight doctors lives , a call to reform the GMC


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Article link below  , from the BMA website 

Stand by me: surviving a GMC investigation

An investigation by the GMC is a stressful experience and it can be a protracted process. Tammy Lovell reports on an initiative to help doctors cope by providing emotional support.

On the brink of losing his career and livelihood as a result of a GMC investigation, a GP found himself sinking into anxiety and overwhelmed with feelings of shame.

The overseas-qualified doctor, who we will call Dr Handen, says: ‘I didn’t know what would happen next. I wasn’t sure about anything. I was at the point of losing my job and my licence and everything I could survive from.

‘I wouldn’t be able to get any job other than [as a] doctor. It would mean someone would cut my feet off and leave me alone to walk.’

GMC investigation

Dr Handen faced an investigation after concerns were raised about his clinical skills and ability to speak English during a 360-degree appraisal.

Following a clinical governance audit, it was suggested that his primary care trust place him in a training practice so that he could become more familiar with UK practices. However, after nine months they had still failed to find him a suitable post………………….

The rest of the article is available here


“Militant” Junior doctors ( what the ones who haven’t been involved in industrial action for more than 40 years prior to this episode)

A government health minister has accused ‘increasingly militant’ junior doctors of holding the country to ransom after the BMA announced plans for an all-out strike next month.

link to full article at GP MAgazine


( …….the same group of sensible ,dedicated employees of the NHS who haven’t been involved in industrial action for more than 40 years prior to this episode . No Jeremy we don’t believe you. This is a result of the long term rationing of places at medical school, the gender bias caused by undergraduate entry, and inept manpower planning).

Hunt says Brexit would be a threat to NHS

Mr Hunt’s tries harder to remove any remaining credibility from his ministerial role with more pro EU  “claptrap” and scaremongering on an incredible scale.Perhaps we should put Mr Hunt on this T shirt ?

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What next the UK Daffodil population would be under threat from a Brexit ???

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More scaremongering from the Pro EU lobby one would think that leaving the EU was akin to adding £1 trillion to the national debt ( or selling off vast swathes of public asset  for a song …. NHS Privatisation policy , Royal Mail / Rail network / Utilities and the Proposed all schools to become Academies )chart

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Hunt says Brexit would be a threat to NHS

Mark Gould for ONMEDICA link above to full article

Tuesday, 29 March 2016

The Health Secretary Jeremy Hunt has stepped into the Brexit debate saying that a UK exit from the European Union would be bad for the NHS.

Writing in The Observer, Mr Hunt says that leaving would precipitate budget cuts, falling standards and an exodus of some 100,000 doctors and nurses.

He quotes a report by the independent Office for Budget Responsibility which says “there appears to be a greater consensus that a vote to leave would result in a period of potentially disruptive uncertainty while the precise details of the UK’s new relationship with the EU were negotiated”. He says that this period of disruption could be a risk to the NHS.

“Those wishing to leave might say this uncertainty is a price worth paying, but my concern is more practical. The NHS consumes the second biggest budget in Whitehall. Next year, thanks to this government’s success in turning around the economy, it will have the sixth biggest increase in its history.


Whole town looking at employed model of general practice

In a move that looks like a return to the ” Local Health Service of Pre 1948 ” an advance in the provision of GP services or a retrograde step ?

Whole town looking at employed model of general practice

 LINK to Article below

EXCLUSIVE A town in the south of England could see its entire general practice population give up their independent contractor status and move to an employed model, Pulse has learnt.

GPs in Gosport, south Hampshire have approached the ‘new model of care’ provider in the region to give a presentation on how a salaried model could work for them, the GP lead has told Pulse.

Such a move could see a ‘significant reduction’ in the number of traditional practices in the area, he added.

Calling DIY SOS! Maybe they can save the NHS – cartoon

Calling DIY SOS! Maybe they can save the NHS – cartoonWhat can we do about the secret cut George Osborne made to the NHS repairs fund in his budget last week? The production line for patients needing scanners is analogous with the production line for doctors. It needs maintenance and review of capacity given future demographics. Model updating is equivalent to graduate entry as default. Thanks to The Guardian