Things are going nuclear over the NHS – cartoon. This is the era for “soft targets”. Quality of dying reflects this..

In The Guardian 20th April 2016:  “Sick Notes” – Things are going nuclear over the NHS – cartoon

Jeremy Hunt may have abandoned his ‘nuclear option’ of imposing a contract on junior doctors, but the issue still has a toxic afterlife

Pressure mounts on Jeremy Hunt over handling of junior doctors’ dispute

Health secretary retreats from claim he has right to impose contract – but threat may mean he has misled parliament

Sarah Johnson 22nd April reports: Healthcare staff, how do you feel about an all-out junior doctors’ strike?

Whether you’re a junior doctor going on strike, or a nurse or consultant working in a hospital, we want to hear from you

Scott Murray in The BMJ reminds us that “cradle to grave” is simply not true. End of life care still not living up to public and doctors’ expectations (BMJ 2016;353:i2188 ). The quality of death and dying is being reduced, partly because of staff shortages, partly because of lack of teamwork and tribalism, partly because of unshared electronic notes, partly because of inadequate training, partly because of changes to the GP contract and partly because of funding insufficiency over many years. In general the public has accepted this covert rationing because the victims don’t vote, and they assume it cannot be changed… Dying people are a soft target, just like smokers, the obese and the mentally ill. Surely it is better to know what is excluded, and then we all can as groups, families or individuals plan for the deficit?


Dennis Campbell reports 22nd April 2016: Smokers and obese people ‘soft targets’ for NHS savings, say surgeons

Royal College of Surgeons says financially challenged clinical groups are restricting access based on lifestyle factors

Update 23rd April 2016: Chris Smyth in the Times – Thousands are still dying thirsty, hungry and in pain

Thousands of people are dying hungry, thirsty or in pain, a survey of more than 20,000 grieving families claims.

One in eight people is not getting the food or water they need as they approach death, while more than half of those dying at home are in pain some of the time, the Office for National Statistics poll found.

The survey is the first since the abolition of a checklist that a review found led to dying patients being refused food or drink under harsh protocols. The report found that little progress had been made since the review.

Simon Chapman, of the National Council for Palliative Care, said: “Very little is changing. What’s good remains good and what’s poor remains poor. We need to see improvements in the areas that are lagging.”

The survey of families found widespread dissatisfaction with rushed hospital nurses, who in a fifth of cases were said not to have usually treated the dying with dignity and respect. Overall, 13 per cent of families disagreed or strongly disagreed that the patient’s need for food or nutrition was met in their last two days, while 12 per cent disagreed that their relative was helped to receive fluids. Ten per cent said that their relative’s pain was not relieved.

Fran Woodard, of Macmillan Cancer Support, said the latest findings showed that basic failings persisted. “Dying people and their families should never be left in such terrible distress in this day and age,” she said.

“It is disgraceful that almost one in four carers felt that someone dying of cancer did not get good care overall in their last three months of life.”

Each year in England about half a million people die, mostly in hospitals, which are rated once again as the worst places to die, with 31 per cent saying care was fair or poor. This compares with 18 per cent who said care was fair or poor in care homes and 21 per cent in hospices. Pain relief was best in hospices, where two thirds said their relatives never suffered, compared with 40 per cent in hospitals and 19 per cent at home. Hospice staff were also reported to be most respectful of the dying.

Ros Taylor, of Hospice UK, said: “We urge the NHS to harness the expertise of hospices, especially on pain relief, good communication and support for families, so that high-quality care is available to people at the end of life across all settings.”

The phasing out of the Liverpool care pathway for dying patients in 2014 was meant to usher in more individualised care. An audit by the Royal College of Physicians reported last month that staff were free to act with compassion.

Scott Sinclair, head of policy at the charity Marie Curie, said, however, that people’s experience of the care they received before death had not changed substantially. He said: “There are still areas of concern around pain relief for people at home.”

Quality of dying is post-code rationed

Cradle to grave? Why the cost of dying is rising.

Mid Staffordshire NHS trust fined for ‘avoidable and tragic death’ – we may all need an advocate..

Family advocates needed? Hospital patients at risk of falls as ‘thousands cannot reach walking sticks’..

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..

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

The NHS and ‘cradle to the grave’

Briefing Paper: Who cares for Care? Is there going to be a Care Crash? The Time Bomb is ticking..


This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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