Monthly Archives: June 2016

Cancer patients keep getting aggressive end-of-life treatment, despite lack of benefit

This is one way we could help improve care and save on the health budget. We need to reduce end-f-life overtreatment. To achieve this we will need more, not less, home trained communicant professionals, and they will need cultural as well as linguistic sensitivity to their patients. Difficult decisions and judgements need time and skill. This news comes from an as yet unpublished study in the US, but it was reported in The Times 28th June 2016. It is not enough for a professional to say “we have to retain hope” – this does not justify the overtreatment and prolonging of dying.

Sharon Begley in Statnews reports 6th June 2016: Cancer patients keep getting aggressive end-of-life treatment, despite lack of benefit

Cancer patients and their doctors do not want to give up.

Despite efforts by the professional association of oncologists to persuade physicians to treat cancer patients less aggressively at the end of their lives, that is not happening, researchers reported on Monday.

The study, presented at the annual meeting of the American Society of Clinical Oncology in Chicago, is the first to examine aggressive end-of-life care in cancer patients younger than 65.

It is also the first to investigate end-of-life cancer care since ASCO warned physicians in 2012 that such treatments can be more harmful than beneficial. The professional organization recommended not giving chemotherapy or radiation, or performing invasive procedures like biopsies, when cancer patients are in such poor health that there’s virtually no chance of them benefiting from these interventions.

That seems to be a very unwelcome message, researchers led by Dr. Ronald Chen, a radiation oncologist at the University of North Carolina Lineberger Comprehensive Cancer Center, found.

Chen and his colleagues examined insurance claims from people enrolled in Blue Cross or Blue Shield plans in 14 states, pulling the de-identified records of patients 65 or younger who died between 2007 and 2014 and had metastatic lung, colorectal, breast, pancreatic, or prostate cancer. Of those 28,731 patients, about three-quarters received aggressive care within the last 30 days of life.

For patients with incurable colorectal cancer or breast cancer, the percent receiving aggressive care in their last month (71 percent and 74 percent, respectively) was essentially unchanged after ASCO’s 2012 recommendation from before. For those with incurable lung, pancreatic, or prostate cancers — all between 72 percent and 76 percent — it actually increased.

Aggressive care includes chemotherapy after multiple earlier rounds of treatment have stopped working and being admitted to an intensive care unit. Such interventions at the end of life “are widely recognized to be harmful,” Chen said.

That’s because most cancer drugs have serious side effects (vomiting, nausea, heart failure, fatigue, mouth sores, constipation, and more), making a patient’s last days tortured, and because a patient who has not responded to earlier treatments and is fading has almost no chance of benefitting from more.

For instance, one study cited by ASCO’s so-called Choosing Wisely recommendations found that in patients with non-small-cell lung cancer, only 2 percent responded to third-line chemo and none to the fourth-line drugs doctors tried.

These so-called “nth-line chemotherapies” are typically tried after cancer has spread to distant organs despite earlier rounds of chemo. And although cynics might guess that doctors are giving dying patients expensive drugs out of a profit motive, the practice is also common in countries where physicians are on salary rather than being paid a percentage of the cost of cancer drugs, as they are in the United States.

Because the study has not been published yet in a peer-reviewed journal, it has not been thoroughly vetted. One concern is that because ASCO’s Choosing Wisely guidelines did not use the phrase “end of life,” patients receiving aggressive treatment do not meet the criteria laid out in the recommendations, and only in retrospect is it clear that they were in their last month of life.

However, experts on end-of-life cancer care suspect something else is going on.

Most terminal cancer patients are not even aware they are approaching the end, found a study published last month in the Journal of Clinical Oncology.

In that study, researchers in New York interviewed 178 patients with advanced cancer, and recorded their conversations with their physicians, before and after they underwent scans to see if their tumors were continuing to grow and spread. Before their scans, 5 percent of patients acknowledged they had only months to live. Even after, only 7 percent did.

“These were people whose cancer has already metastasized, it’s all over the place, and it had progressed after at least one chemotherapy,” said Holly Prigerson, director of the Center for Research on End-of-Life Care at Weill Cornell Medicine, who led the study. “Yet patients didn’t know it wasn’t curable” and that they were approaching death.

The interview tapes suggested why. Physicians said things like “your tumor had grown only 0.2 centimeters,” which sounds minuscule but could be a significant fraction of the original tumor size, and therefore an indication of rapid growth. They said “some of your tumors grew, some didn’t,” suggesting things were so-so, when even one tumor that’s proliferating is very bad news because it indicates chemo isn’t working.

None of the patients pressed their doctors about their chances. As a result, they were “basically making treatment decisions in the dark,” Prigerson said.

It’s therefore no surprise that they, or their families, press their physicians to try one more drug. Oncologists “are very, very reluctant to put a number on how long patients have to live,” Prigerson said.

“They have very little to gain” by doing so, she added. “They’ll be accused of giving up or of being too pessimistic.”

According to Prigerson, that mindset, more than a profit motive, likely explains why, as Chen’s ASCO study found, three-quarters of patients with advanced, fatal cancers were given aggressive treatments.

“How can you make an intelligent decision about treatment and what your last days will be like,” she asked, “if you don’t even know” you’re approaching the end?

What’s Important to me. A Review of Choice in End of Life Care

Disease Type May Dictate Quality Of End-Of-Life Care: Study

Cancer and dementia patients receive better end-of-life care than others, study finds

Why end of life care needs to improve, and what we need to do next

Time to choose: making choice at the end of life a reality

A time and a place – Sue Ryder

Aggressive cancer treatments in last days questionable – According to an expert in palliative care, aggressive cancer treatment at the end of life is often not helpful, and can be emotionally and physically harmful for patients

Late Stage and End-of-Life Care: Caregiving in the Final Stages of Life



GPs (Commissioning Groups in England) spend vast sums on temporary managers – no its not happening in Scotland or Wales

The fact that (English) commissioning groups cannot easily fill such well paid posts is due to the managers also realising that their job is impossible without overt rationing. Is there a conspiracy – “a good time to bury bad news”, whilst we are all focussing on the EU? No, its not happening in Scotland or Wales… No wonder the government is suppressing/withholding its report on GP support… until 2017

In an an-accredited article in The Times 29th June 2016, and not on line (as the article on end of life care spending yesterday) a report reads: GPs spend vast sums on temporary managers.

GP-led groups that look after the bulk of the NHS budget are spending hundreds of thousands of pounds on interim directors, it has been reported.

One interim director cost a clinical commissioning group (CCG) £335,000 for just over 11 months work, according to the Health Service Journal (HSJ) 28th June 2016.

Another group, – Surrey Downs – employed a director of turnaround last year at £195,000 for six months.

A chief officer at another CCG cost £85,000 for less than 3 months work, and a director of clinical performance £55,000 for the same period.

NHS England has the right to issue legal directions to CCFs, giving it power over issues such as finance plans and appointments. These cannot be issued when a CCG is in deficit.

urreyDowns CCG said that reducing the use of interim staff was a top priority. Claire Fuller, its clinical chairwoman, told HSJ: “When setting pay rates to senior staff, we take into account the national guidance to ensure we are paying a rate that is appropriate.

“in some circumstances sometimes we do need to bring in short term, interim support. For example when NHS England placed directions on us, we were reqired to bring in a turnaround director to support our financial recovery – so this is what we have done”.

KERNOW CCG spent £25,000 on a turnaround director for less than three months. KERNOW chairman, Iain Chorlton told HSJ: “This appointment was approved by NHS England”……

Pulse: General practice cannot escape need for reform, NHS England warns

Alex Matthews king in Pulse reports 23rd June 2016: NHS to withhold report on primary care support problems until 2017

Is the future of health to be defined by the ultra right? If we don’t ration overtly, it will be.

Whistleblower Bullying hotline – proposed by petition for Scotland – could be rolled out across the UK

Peter Gregson, who works for the Scottish Health Service (NHS Scotland) has proposed that the Scottish Parliament cover the costs of a Whistleblower Bullying hotline in his i-petition. If accepted then this should be rolled out across the UK. But barriers to acceptance include the trade unions. Peter was asked to leave a meeting in which he was handing out leaflets (see below) recently. ( Peter Gregsons press release. )

whistleblower cartoon

So if we do stay together this could be one area where we improve the culture together. The current system of relying on line managers to back you up, is not good enough.

Whistleblower HotlineHealth workers in Scotland are being blocked from debating whether to support a Parliamentary Petition calling for a whistleblower hotline. It would allow NHS staff to report mismanagement, bullying, perceived negligence, malpractice or ill treatment of a patient by a member of staff.

The Petition PE1605 is shortly to go before MSPs and union support is crucial to seeing it implemented. But all four big health sector unions either won’t support (or won’t allow their members to discuss) the Petition, which calls upon the Scottish Government to establish an independent national whistleblower hotline for NHS staff to replace the current helpline. It would differ in that it would investigate reports about mismanagement and malpractice, often without recourse to NHS managers.

The reason why the unions oppose the measure is because they say they are tied into partnership arrangements with NHS Boards and will do nothing that might undermine that. But it is clear that they have not even discussed the scheme with NHS Management; they have rather instinctively chosen to side with what they think managers will say.

It is unreasonable of them to assume that NHS bosses will oppose a hotline. When a similar approach was made by the same petitioner to Edinburgh Council in 2013 the Corporate Management Team initially opposed it, but now pay tribute to its success. The hotline has been in place since May 2014 and was recently lauded by the Council in its Whistleblowing Annual Report : “Many of the recommendations that have resulted from investigations have led to amendments to policy, improvements to procedures and processes, the development and sharing of best practice and improved service delivery.”


Whistleblower reports are taken by the Council’s Governance Risk And Best Value (GRBV) Committee and have led to numerous improvements at the Council.

The Petition to the Scottish Parliament has been signed by politicians from right across the spectrum. Supporters include MSPs Kezia Dugdale (Scottish Labour Leader); Jeremy Balfour (Conservative Shadow Minister for Childcare & Early Years- who also helms Edinburgh’s GRBV Committee) and Green MSPs Alison Johnstone and Andy Wightman.

It is supported by The UK Patients Association, by Action for a Safe and Accountable People’s NHS (ASAPNHS), the Scotland Patients Association, the NHS Lothian Branch of Unite and Accountability Scotland.

The only agencies refusing to support the scheme are the unions and staff associations…..

Whistleblowing cartoons, Whistleblowing cartoon, funny, Whistleblowing picture, Whistleblowing pictures, Whistleblowing image, Whistleblowing images, Whistleblowing illustration, Whistleblowing illustrations

'And this is Mr Proctor, he manages the hospitals whistleblowing support team.'..


Reducing standards officially – across the board – intended delivery of incompetence?

It is not just the standard of communication and language in nurse which is being lowered. Across the board standards are being lowered in Medical Education and in service delivery. It is particularly important to have good language in Mental Health nursing… which is even harder to recruit for. It is hard to raise standards when you are in deficit…. and NHSreality is using the Norfolk region only as an example. It could be anywhere in the UK. Are our masters intentionally delivering planned incompetence?

Chris Smyth reports 28th June 2016 in The Times: Foreign nurse language tests relaxed.

Language tests for foreign nurses will be made easier to pass in an attempt to address NHS staff shortages.

Regulators said that they had been lobbied by hospitals desperate to hire nurses from overseas and had changed the rules to help deal with “staffing pressures”.

They insisted that relaxing the rules would not be a risk to patients. Nurses will still have to reach the same standard, but will be given more opportunity to get there.

Foreign nurses, from both inside and outside the EU, must sit English tests and are only allowed to work in the UK if they reach a certain score. At present they must reach this level in reading, writing, speaking and listening in one exam. Under the new rules, they can take the exam twice and secure a pass if they hit the standard in all four areas in at least one of the two tests.

“We are mindful of the staffing pressures in the health service and after listening to feedback from stakeholders we have introduced changes to our process,” said Jackie Smith, chief executive of the Nursing and Midwifery Council, which regulates nurses.

She added: “We will continue to listen to feedback from nurses, midwives and their employers and assess any opportunities to introduce further flexibility.”

Vacancy rates for nurses are running at 10 per cent in some parts of the health service. Last year the Home Office agreed to make it easier to hire from outside the EU by designating nursing a shortage occupation.

Health chiefs said that there was little chance of reducing the £3.6 billion bill for agency staff without hiring more doctors and nurses from overseas.

Yesterday Jeremy Hunt, the health secretary, attempted to reassure 110,000 European NHS staff potentially unnerved by a Brexit vote. “You are a crucial part of our NHS, and as a country we value you,” he said. “We all must now do everything we can to ensure our whole workforce feels secure — because that is the only way we’ll ensure we can deliver high-quality care.”

Katherine Murphy, chief executive of the Patients Association, said: “If we do employ nurses from other countries, we must ensure that they are fully qualified and . . . competent enough in English to effectively communicate with patients.” She added: “We must invest resources in the training and recruiting of nurses from within the UK, rather than embarking upon the costly recruitment of foreign nurses, who are often a short-term measure to fill a gap.”

Nicholas Carding in the Eastern Daily Press (EDP) 23rd June reports: Mental health trust struggling to fill nursing shifts on region’s inpatient wards

David Powles, editor reports in the EDP 1st Feb 2016: One in four care homes failing to meet standards – but are inspections too tough?

Sam Russell reports 21st May 2016 in the EDP: Norfolk and Suffolk hospitals record multi-million pound deficits

Mark Chandler reports in the Evening Standard 14th June 2016: North Middlesex hospital A&E threatened with closure over ‘serious risk’ to patient safety

Andrew Hirst reports 26th June in the EDP: Norfolk and Suffolk NHS Trust’s could lose medical training deal with University of East Anglia

Bosses at the Norfolk and Suffolk NHS Foundation Trust (NSFT)have been warned that its undergraduate education programme is not meeting standards.

Directors discussing the programme at last week’s board meeting were told the University of East Anglia (UEA) had proposed to remove its students from the trust because of the poor standard of teaching for undergraduates.

The university’s students receive training at trust-run facilities in east Suffolk, central Norfolk, Yarmouth and Waveney, which provides around £921,000 a year in service increment for teaching (SIFT) funding for the NSFT.

Medical director Bohdan Solomka presented a report to the meeting, which said UEA’s concerns represented a “key risk to the trust’s finances and reputation.”

He said that while consultants enjoyed teaching, time pressures meant less than 60% of training was being completed, compared with a 90% target to be achieved by September.

Feedback from students indicated they “feel unwelcome and a bit of a burden” when they visit the trust, Dr Solomka said. To improve performance, new job plans are being written with teaching included so that consultants are able to allocate more time for students. However Dr Solomka admitted 11 staff were yet to complete the task.

Chief executive Michael Scott said the education programme “had not moved forward as we would have wanted”.

“I don’t think we are there yet,” he added. “We’ve got to do more to move faster.”

Board chairman Gary Page asked why more had not been done to ensure the job plans were finished.

“It seems they don’t want to play ball,” he added. “Why don’t we just haul them in and tell them to do it?”

Dr Solomka said there had been improvements “but we are starting from a very low base”.

“All I can say is that it’s an improvement on last year,” he added.

The NSFT runs a separate training programme from west Suffolk for students from Cambridge, which is said to have been far more successful. Dr Solomka said the money for that scheme had been ring fenced to ensure teaching was provided.

Speaking after the meeting he said: “The feedback we have received from Cambridge University medical students undergoing mental health placements in our west Suffolk services has been very positive.

“However, we recognise the standard of teaching, in some other areas, has dropped below the high standards we would hold ourselves up to.

“We are fully committed to putting that right and to delivering excellent teaching right across student doctor placements in the trust.

“So, we intend to take what we are doing well in west Suffolk and replicate this right across our Trust in the future.

“To achieve this we are undertaking a complete review and restructure of our medical undergraduate teaching and we will be reinforcing the importance of good teaching. We will offer greater clarity on the training standards we expect our staff to offer to students, and we will offer support to those delivering the training to ensure they can meet the high standards expected.”

Hamish MacDonell reported 6th June 2013 in The Times: Health review could lead to wholesale dismantling of NHS targets

The numerous targets that have underpinned the Scottish health service since devolution could be swept away in a major policy shift announced by the SNP government last night.

Shona Robison, the health secretary, unveiled a review of all NHS national targets in Scotland in what could herald one of the biggest shake-ups in health policy for decades.

Ms Robison told MSPs that she was setting up an expert group to lead the review. It will examine the objectives that the Scottish health service is required to meet and decide whether this is the right way of ensuring patients receive the best care.

The announcement came as new figures were published showing that a majority of health boards have failed to meet the treatment-time target for mental health patients. According to the figures released yesterday, just five of Scotland’s 14 boards met the requirement to see at least 90 per cent of patients within 18 weeks.

Health service managers have been driven by targets since the first Labour-Liberal Democrat administration was elected in Scotland in 1999. Gradually expanded over time, these have covered everything from waiting times at accident and emergency units to the number of operations carried out and number of patients treated.

Health services failure will make Brexit look cheap….

The emperor Nero fiddled while Rome burned. Politicians denial is similar. Is it surprising that the body politic rejects the advice of its great and good when it is so obvious they have been, and all parties are, lying on health? We cannot afford what we are doing now, let alone the future…Health services failure will make Brexit look cheap….

Brexit Bus cartooncropped-nhs-hands-safenh01.jpg

The distraction of the EU referendum has put the Health Services into the background, but now they will come into the media headlamps as more and more failures occur. Unfortunately it will remain a two syllable and un-sustained debate – until things get much worse.

There is some good news though. In England the “Number of patients receiving advanced brain tumour treatment to double” according to The Commissioning Review 21st June 2016, a government publication. The Good news does not apply to the 3 celtic regions, and is expensive, time consuming, resource dependent and naturally rationed….. In Wales there is far too little radiotherapy capacity, too few radiotherapists and radiologists……

Twice as many patients are set to receive a new treatment for brain tumours over the next three years, says NHS England.

The new seven-year contracts for stereotactic radiosurgery and radiotherapy (SRS/SRT) form part of the NHS England’s Cancer Strategy.

The specialist treatments can be used to treat patients with intracranial conditions, such as benign and malignant brain tumours.

More than 6,200 patients a year are expected to benefit from these services by 2018-19, compared to just over 2,400 in 2014-15.

The new SRS/SRT services will be spread across England, improving access to services and making it possible to treat more people closer to home.

Furthermore, by increasing access to these radiotherapies, fewer people will have to undergo invasive surgery.

Angela Collett, information manager at the Brain and Spine Foundation, said: “The Brain and Spine Foundation welcome this important step from NHS England to increase access to specialist stereotactic radiosurgery and stereotactic radiotherapy, which will make a major difference for thousands of patients diagnosed with life changing brain illnesses.”

The treatments require specialist radiographers and physicists, which means the SRS/SRT can only be delivered in certain hospitals.

The services are arranged to ensure that patients in all areas of the country have access to the treatments for more common brain tumours and metastases.

Larger national centres will be set up to provide specialist care and support for children and patients with rare and complex conditions.

NHS England says the increased number of SRS/SRT treatments will also be delivered at a lower cost due to expected efficiencies of 25%.

Dr Jonathan Fielden, NHS England’s director of specialised services, said: “As a result of this procurement thousands more patients will benefit from this very precise and effective form of treatment.

“This is another example of how NHS England is working hard to achieve better services and outcomes for patients at the same time as better value for the health service.”

Further improvements to radiotherapy access and quality are set to be the subject of a separate Radiotherapy Services Review.

The review will plan for a modern national radiotherapy network by September, with a revised radiotherapy service specification by the end of the year.

GB needs a general election and a clear choice between a “remain” and a “brexit” party – Liberals v the Rest?

In a two horse race you can expect the organiser to plan for either side winning. There were no political party plans for the Brexit vote because the politicians felt it was like turkeys voting for Christmas. Scotland has rightly suggested a legal challenge.. (Simon Johnson in The Telegraph 26th June 2016: Nicola Sturgeon threatens to block Brexit in face of English fury ).


Another referendum (BBC: results in maps and charts) will only bring up more lies, rumours and allegations. It will not settle anything. NHSreality believes that the UK needs a new law allowing a quick general election and a clear choice between a “remain” and a “brexit” party. The Liberals are in a good position to lead the remain party. Many new members are currently joining the Liberals ( David Millward in The Telegraph 2th June 2016: Liberal Democrats will fight next election with pledge to scrap Brexit  ) . It is interesting that Wales and Scotland voted opposite directions even thought they are both recipients of similar EU largesse. Does this tell us something about the relative educational levels of the two countries, or is it that they are led differently by their media and politicians? It is noteworthy that, if the age of voters was given a weighting related to their youth, (or adversely against life expectancy) the vote would have gone the other way…

It will take 6 months to push through legislation an fix a date for the new election. So during that time interest rates may rise, and the fossilisation of investment and decision making will bring home the reality of fewer jobs and a weaker pound. Matthew Paris is right in writing “Pity voters deceived by the Pied Pipers of Brexit” – Many MPs believe that leaving would be a calamity for Britain and will be tempted to thwart the referendum result

There is a crisis elsewhere which has been ignored during the Brexit debate. In the Guardian  Sarah Whitehead reports 25th June: The other NHS crisis: the overworked nurses who are leaving in despair

The junior doctors’ dispute may be nearly over, but another crisis is brewing in the nursing profession, where staff shortages, a lack of recruitment and funding cuts have left many feeling they cannot carry on in the job they love

The crisis in leadership, throughout the country and in all the main parties is evident. BBC News today reports: Brexit: ‘Half’ of Labour top team set to resign, and David Cameron has shown a lack of judgement in giving the uninformed the right to change the constitution and break up the UK. His resignation speech: (The Telegraph 24th June 2016)

As far as the Health Services are concerned The Guardian’s Ben Quinn comments “Leave campaign rows back on key immigration and NHS pledges”

Tory MEP Daniel Hannan says Brexit voters will be ‘disappointed’ if they think there will now be zero immigration from EU

The lack of honesty has been part of the process by which the body politic has shown two fingers to the politicians. The remain party should be honest about the need to ration health care, and the welfare state, and in general to encourage autonomy.

The two authors of NHSreality have voted differently. One voted remain and wonders if he missed something which all the exciters see, and the other voted brexit, but is now fearful he has made the wrong choice. An interesting twitter from Kai  Pflughaupt reads:

Other EU exitsIn general we are doing a good job in shooting ourselves in the foot.

Shoot in foot

The idea that we were wiser than the right wing in the USA is now in tatters, until November!

You don’t let te troops have a vote on whether they go to war or attack or retreat…

Update 29th June: Times letters:

Sir, Jeremy Hunt’s proposal that there should be a second referendum on the terms on which Britain would leave the EU is a shrewd and sensible way of potentially uniting Leave and Remain supporters; it would allow the British electorate to understand clearly what is in prospect. Throughout the campaign the most common complaint heard was that people just did not understand the issues.

Before voting for a second time, the British people should expect clear answers to the following questions on the economy and immigration. Does the government want Britain to remain in the single market, and if so what is the likely cost to the taxpayer? Will the government be applying to join the European Economic Area and how much will that cost? If the answer to both these questions is in the negative, what will be the cost to British industry of paying the common external tariff (CET) on British exports to the EU? Will the government be imposing tariffs on goods coming from the EU into the UK, equal to the CET? On immigration, what is the government’s position in respect of EU citizens currently resident in the UK, and what is its policy in respect of new immigration from the EU?

The government must also explain that the two issues are interconnected: that on past precedents access to the single market also involves accepting the free movement of people.
Geoff Hoon
Minister for Europe 2006-07

Sir, The French presidential system provides for a two-stage vote, the first allowing the heart to express itself and the second to allow the head to do so in the light of the heart’s vote.

Giving the British people the chance to think again is not to express distrust, but the belief that they can in truth do better. The decree nisi does not render the decree absolute inevitable.
Timothy Young, QC
London WC2

Sir, There is widespread concern that the Brexit side made untrue claims during the referendum campaign about the cost of EU membership and immigration. So narrow is the margin of the result that voters may have been persuaded to vote to leave on the basis of dishonest information. The British electorate deserves an immediate public inquiry into these claims. If true, a second referendum must be held before December. A proper independent body must oversee all information provided to the electorate, outlawing untruths and innuendo. The EU would have an opportunity to offer a cap on immigration and other concessions.

A second referendum, if dishonesty is proven, will not undermine democracy but will underpin it.
Sir Anthony Seldon
Vice-chancellor, University of Buckingham

Sir, In certain financial decisions involving, for example, insurance or annuity purchase, there is usually a cooling-off period to allow further reflection before the decision becomes binding. The people of Britain should surely be allowed a similar period to reconsider a decision of such monumental impact, and a second referendum would either confirm the initial decision or give an opportunity to reconsider.
Andrew Mckinnon
London N14

Sir, If a surgeon performed an operation on a patient without fully informed consent, knowingly used inaccurate data about the likely outcome, and then had no idea how to proceed after the initial incision, they would be struck off the medical register and not allowed to practise further. Isn’t it time politicians too were held properly accountable for their individual actions?
Tony Weetman
Emeritus professor of medicine, Sheffield

Sir, Your leader “Boris in Denial” (June 28) rightly took Brexit’s frontman to task over his fanciful assertion that immigration wasn’t the driving force behind Leave’s victory. You were also right to say that “the country needs a plan”. That raises the fundamental question of whether, for all his charisma, Boris Johnson really can be the man with the serious plan for the UK’s future. Meanwhile, evidence is growing that not insignificant numbers of Brexit voters are beginning to switch horses to “Regrexit”, including the veteran EU-baiter Kelvin MacKenzie.

The increasing clamour for the referendum to be re-run makes no sense. But what does begin to do so is for an early general election in which whether to push ahead with Brexit or abort it becomes a key dynamic of all parties’ manifestos.
Paul Connew
Editor, Sunday Mirror, 1994-95

Sir, May I add to Sonia Purnell’s critical assessment (June 27) of Boris Johnson the following legacies from his period as mayor of London: new Routemaster buses that run almost entirely on diesel because of malfunctioning batteries and which are being retrofitted with opening windows because of malfunctioning air conditioning, water cannon that cannot be used, a Thames cable car that has few passengers and, most significantly, appalling pollution levels resulting in large measure from inadequate controls of taxis.

The next PM? I don’t think so.
Richard Bond
London SW7

Sir, In the past, and in times of crisis, we have accepted a government of national unity under the leadership of the party in power but with trusted involvement from all MPs from all parties. Is now the time for us to bring the best of our representatives together for the good of the UK?
Sir Peter Redwood
Hindon, Wilts
Sir, Professor Michael Sheppard asks how the people of Cornwall and Sunderland can possibly have voted to leave the EU when they are so dependent on EU funding. The answer is simple: they value their freedom more than they value money.

I refer him to the Declaration of Arbroath of 1320: “It is in truth not for glory, nor riches, nor honours that we are fighting, but for freedom — for that alone, which no honest man gives up but with life itself.”
Graham Senior-Milne
Norham, Northumberland

Sir, As Sir John Chilcot will be free after next week, he could be put in charge of activating Article 50. This should delay our exit for at least ten years, and give us time to find a way out of this shambles.
Edmund Humphreys
Blaenau Ffestiniog, Gwynedd


Hundreds die because of A&E overcrowding

One sign/symptom that the Health Service is cracked beyond redemption will be patients demanding private A&E care, private ambulances etc.

Sarah Kate Templeton in The Sunday Times 26th June 2016 “Hundreds die because of A&E overcrowding”.

More than half of the A&E departments in England are substandard, according to the NHS regulator, putting patient’s lives at risk.

An analysis by the Care Quality Commission (CQC) found that 57% of the 176 A&E units inspected under a new rating system were either ­performing badly or not as well as they should have.

The figures came as the president of the Royal College of Emergency Medicine, which represents A&E doctors, warn­ed that patients were dying unnecessarily because of overcrowding in hospitals.

Dr Clifford Mann said: “Quite a lot of people are having worse care because of overcrowding and some people, undoubtedly, will not recover from their illness, whereas had they been seen in a properly resourced department and seen as promptly as possible, they would have ­survived.”

Dr Adrian Boyle, an A&E consultant and spokesman for the college, said: “Emergency departments across the UK are under significant pressure with a toxic mix of increased attendances and lack of beds.

“This has resulted in increased work for emergency departments and increased pressure has reduced our ability to look after seriously ill and injured people.”

The college estimates that 500 patients die unnecessarily every year because of overcrowding in A&E departments.

Mann believes that 15 new A&E units should have opened in the past five years to cope with rising demand. Instead, some closed.

Of the A&E departments inspected by the CQC, 16 were rated as “inadequate”. This means that they were performing so badly that the regulator was forced to take action against the trust that ran them.

Reports into those units reveal a catalogue of failings, which include:

•Inspectors had to intervene personally at one department to ensure that 11 patients at risk of deteriorating were made safe

•Patients had to wait outside hospitals in large multi- occupancy ambulances known as “jumbulances”

•An A&E unit became so overcrowded that a third of an entire ambulance service fleet was held up outside the ­hospital, leaving a shortage of ambulances to attend other emergencies

•A quarter of patients with blood poisoning at one A&E unit failed to receive safe and timely treatment

•Medical staff inserted cannulas and examined patients on trolleys in corridors

•Patients were either “stacked” in the middle of the department because of a shortage of bays or forced to share cubicles

•An A&E department which considered being in a state of crisis as normal

•Staff failed to report unsafe overcrowding to management because it happened daily

•A failure to dispose safely of clinical waste, such as needles

•Unqualified A&E staff telling patients to go elsewhere when there were long delays.

In one report about the A&E department at William Harvey Hospital in Ashford, which is part of the East Kent Hospitals University NHS Foundation Trust, inspectors wrote: “We saw patients left on trolleys rather than beds consequently not receiving relief for pressure areas. We saw patients on trolleys and chairs in the corridor and patients stacked in the middle of the department as there were no bays available.

“Patients were having ­cannulas inserted in the ­corridors . . . We saw patients being examined in the main corridor.”

Another report — into Birmingham Heartlands Hospital A&E unit, run by the Heart of England NHS Foundation Trust, said: “High risk and high stress from overcrowding and poor patient flow had become accepted as standard practice by nursing and medical staff and their leaders. Crisis was normalised within the emergency department.”

Both hospitals have said they are addressing the problems raised by the CQC.

Whipps Cross University Hospital in east London, which was given an “inadequate” rating in its latest inspection, apologised this year to Leanne Kenward who suffered a ­miscarriage after A&E staff ignored her requests for help for six hours.

“Compassion should be the first thing you receive on the NHS, especially when you turn up at A&E,” Kenward said. “But no one thought about me or how I felt.”

Barts Health NHS Trust, which runs the hospital, said: “We sincerely apologise for the distress caused to Miss Kenward and her partner during this difficult time.”

More evidence of problems facing some A&E departments is provided this weekend by a photograph of an elderly woman on a trolley in a corridor. It was taken at 10pm on April 4 after the patient had been waiting for 4½ hours and has been released by Karl Deitch, president of the Hands off HRI (Huddersfield Royal Infirmary) campaign.

The Calderdale and Huddersfield NHS Foundation Trust plans to downgrade the hospital’s A&E unit to an urgent care centre and Deitch says that it is being left to deteriorate.

David Birkenhead, the trust’s medical director, said: “That night was one of our ­busiest of the year with many patients requiring admission and out-of-hospital care.

“All patients arriving in A&E were clinically assessed and prioritised and, for some less urgent cases, this meant there were, that night, regrettably, some delays.”