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“Many people felt that when the LCP was withdrawn that would lead to a breakdown of end-of-life care.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

(http://www.doctors.net.uk/news/article.aspx?newsid=23996&areaid=5) 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

http://www.bma.org.uk/news-views-analysis/news/2015/february/stand-by-me-surviving-a-gmc-investigation

 

“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

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( …….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 ?

xda_wd_tshirt.jpg.pagespeed.ic.U4gCiyOyop .

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

(http://www.theguardian.com/lifeandstyle/ng-interactive/2016/mar/23/calling-diy-sos-maybe-they-can-save-the-nhs-cartoon)

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No place but cells for those having mental breakdowns

This situation is the result of prolonger and covert capacity rationing. The rationing occurs in training, plant, support services and all aspects of mental health.

Alice Thomson, Rachel Sylvester in the Times 28th March 2016 report: No place but cells for those having mental breakdowns

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The police are picking up the pieces for cuts to mental health services because they are the “bank that can’t say no”, according to the independent watchdog.

Dame Anne Owers, head of the Independent Police Complaints Commission, said that forces would struggle with a law limiting the use of police cells for those suffering a mental health crisis because there was nowhere else to take them. “The criminal justice system becomes the gateway to mental health service because it’s the bank that can’t say no,” she said. “It’s no good just saying the police shouldn’t be dealing with these people; you’ve got to ask the question, ‘Who should?’ ”

Legislation going through parliament will make it illegal for children to be detained in a police cell during a mental health crisis and limit the circumstances in which adults can be held there. It is an issue on which The Times has been campaigning as part of its Time To Mind initiative.

Dame Anne said that apart from training the police to deal properly with people in mental health crisis there need to be many more services to deal with them. She said that half of the people who die in police custody or immediately afterwards are known to have mental health problems.

Sir Bernard Hogan-Howe, the Metropolitan Police commissioner, said that mental health was a significant problem. “We were treating it as a marginal issue when in fact 40 per cent of the people we come across have got a mental health issue,” he said.

Staff speak out against NHS watchdog – no NHS resurrection is likely

Kate Gibbons in The Times 29th March 2016 reports: Staff speak out against NHS watchdog

Pressure is mounting on the NHS ombudsman to resign as whistleblowers at the watchdog expose a “toxic environment” fuelled by unachievable targets with hundreds of patients’ complaints remaining unsolved.

Dame Julie Mellor, the parliamentary health services ombudsman, has been accused of creating a climate of fear in which workers are penalised for raising concerns that patients’ complaints are poorly handled and pushed through simply to meet targets. Last week about 180 members of the executive committee of the Public and Commercial Services Union backed a motion of no confidence in her.

This month Mick Martin, Dame Julie’s deputy, took leave of absence pending an investigation into allegations that he helped to cover up a sexual harassment case at a hospital that cost the taxpayer almost £1.5 million.

A handful of current and former staff have spoken out against the PHSO. Their testimonies, published by the Health Services Journal, reveal an atmosphere in which inadequacy and poor quality are accepted.

One member of staff said: “It would be better to provide no service at all than to give service users false hope that their concerns will be meaningfully investigated.”

A spokeswoman for the PHSO said: “Our staff are our greatest asset. We are working positively with staff and trade unions to address the issues they have raised, as we continue to modernise our service for the benefit of the public.”

NHS errors in Wales double under Labour . A possible sign of cultural change? Or worse, “reality”….

Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming…

Who will resurrect the NHS? No miracle is forthcoming…

NHS errors in Wales double under Labour . A possible sign of cultural change? Or worse, “reality”….

The Investigating clinical incidents in the NHS – United Kingdom situation is now an “on line” report process, which is centralised.

Sanya Burgess for The Sunday Times reported 27th March 2016: NHS errors in Wales double under Labour .

Now this could well be good news, as it may indicate that staff are less inhibited than they were before about reporting incidents. It could be bad news, but NHSreality very much doubts the numbers have altered that much. There may be a worsening in the figures, as NHSreality predicts a managed decline degenerating slowly into post-code anarchy….. Do you believe in luck – or NHSreality?

THE annual rate of serious health service blunders resulting in death or injury has more than doubled under Labour, according to official figures.

More than 900 “serious untoward incidents” (SUIs) were recorded in 2014-15 compared with 414 in 2011-12.

The number of SUIs at the Betsi Cadwaladr University Health Board in north Wales rose from 100 to 303 over the same period, and the Hywel Dda University Health Board in west Wales saw an increase from 25 to 82.

This weekend, Darren Millar, the Tories’ shadow health minister who obtained the figures, demanded an independent inquiry and accused members of the Welsh government of “burying their heads in the sand”.

He said: “Incidents such as these where patients could come to serious harm or death are avoidable and should never happen. The fact that they are rising and have increased threefold in some health boards in recent years is very concerning and provides further evidence of the impact of Labour’s record-breaking cuts on the NHS budget in Wales.

“One avoidable death is one too many, and the alarming rate at which these incidents are being reported to the health minister suggests there are problems which need to be urgently addressed.”

However, Mark Drakeford, the health and social services minister, accused the Conservatives of “yet another sloppy attempt to attack the Welsh NHS”. He said the increase was the result of staff being encouraged to speak up when things went wrong.

“The number of incidents has increased because we have asked the Welsh NHS to report more things . . . NHS staff are encouraged to report all incidents, including near misses,” he said.

David Williamson reports for Walesonline 15th Jan 2015: Labour attacked on performance of Welsh NHS as new report compares our service with England’s so this is a sustained attack. It will only be solved once WHO reports on the comparative results (Maternal Mortality, perinatal mortality, life expectancy) between the different UK health systems.

Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming…

Endemic cultural failure – managed decline only is possible without the staff…