Monthly Archives: July 2016

East Surrey placed in special measures – we need to be debating the ethics and ideological compromises in each method of rationing

As the failures mount, the government will change it’s own rules. Waiting time and other targets and penalties are being ditched, and standards are falling. Doctors and nurses are leaving or retiring early. Many Nurses have cheated to get their dubious qualifications, and the European Working Time directive still applies….  we need to be debating the ethics and ideological compromises in each method of rationing instead of risking a knee jerk response that seems inevitable ..

Josh Searle reports in the Surrey Mirror 21st July 2016: East Surrey CCG placed into special measures and in the same paper Debbie  King writes “Warning NHS “rationing” means treatment charges”… (Not on line)

Dennis Campbell in the Guardian reports: NHS bosses launch ‘reset’ plan to tackle £2.45bn deficit

Five hospital trusts and nine CCGs in England will go into financial special measures as campaigners voice fears for patient safety

NHS bosses have launched a plan to “reset” the health service’s broken finances that will see overspending hospitals taken into financial special measures, as part of a crackdown to tackle a £2.45bn deficit.

Five hospital trusts that are set to overshoot their budgets by a wide margin this year, and nine GP-led local clinical commissioning groups (CCGs) that are facing acute financial problems, are the first NHS bodies to be forced into special measures. Their bosses have been given weeks to devise an action plan to reduce overspending or risk being replaced.

The initiative was unveiled as it emerged that the Department of Health avoided busting its £118.3bn budget in 2015-16 only because it received £417m more than planned in extra national insurance receipts because of an “administrative error” for which it will not be punished.

However, the health secretary is likely to face a parliamentary inquiry into his department’s figures after the Commons public accounts committee accused him of “underhand” behaviour in publishing his department’s figures on the last day before MPs leave for their summer break.

The Labour MP Meg Hillier, who chairs the committee, wrote to Jeremy Hunt on Thursday, saying: “I write to express dismay that you published your department’s accounts today – the day that parliament rises for summer recess. This does not allow MPs to consider the accounts before recess and smacks of an underhand attempt to cover up the poor state of finances in your department.”

The National Audit Office also criticised Hunt’s department for its failure to come up with “a robust, credible and comprehensive plan to move the NHS on to a more sustainable footing”.

The tough action by NHS England and NHS Improvement (NHSI), the service’s financial regulator, is intended to reduce overspending by trusts from a record £2.45bn last year to nearer £250m by the end of this year.

Trusts will be given money from a £1.8bn “sustainability and transformation fund” to help balance their books only if they agree to make significant savings by the end of March 2017 by signing up to a “control total”. The five are among 17 trusts in deficit that have so far refused to agree their total with NHSI.

The five trusts going into financial special measures include Barts Health NHS trust in London, which is both the NHS’s biggest trust and the one that ran up the biggest deficit last year, at £135m. The others are Croydon Health Services, which overspent by £39.8m, Maidstone and Tunbridge Wells (£22.9m), Norfolk and Norwich (£31.1m) and North Bristol (£48m).

“This suite of measures will help ensure that the providers facing the greatest financial challenges are supported to bring about rapid financial recovery, while maintaining or improving quality. This plan is intended to restore financial discipline and ensure ongoing financial sustainability across the whole NHS,” said Jim Mackey, the chief executive of NHSI.

Critics said the plan would fail and lead to job cuts in an already under-staffed health service and the loss of beds or entire units.

“Simply loading up providers with savings targets and exhorting them to try harder won’t work,” said Saffron Cordery, the head of policy at NHS Providers, which represents hospitals. Singling out heavily overspending trusts would simply stigmatise hospitals that were struggling the most, damage staff morale and make it harder for them to recruit new personnel, she said.

There are also serious concerns that cost-cutting on the scale envisaged under the plan could damage patient care. Jennifer Dixon, the chief executive of the Health Foundation thinktank, said the strategy risked a repeat of a care scandal of the scale of that seen at the Mid Staffordshire NHS Trust between 2005 and 2009.

“Getting the balance right between carrot and stick is critical, as history tells us,” she said. “The Francis inquiry, published only three years ago, describes how radical steps by one NHS hospital – Mid Staffordshire – to improve its financial position had terrible consequences for patient care.”

Nigel Edwards, the chief executive of the Nuffield Trust thinktank, criticised the singling out of NHS bodies that were struggling to live within their means. He said: “With almost nine out of 10 acute hospital trusts in deficit at the last count, the idea that this is a problem caused by ‘a few bad apples’, where the management simply doesn’t try hard enough to balance the books, is long gone.

“I fear that in order for hospitals to virtually eradicate their debts, as NHS Improvement and NHS England want, the next steps could be a series of brutal service reductions and bed closures – which will shock an unprepared public.”

The nine CCGs that will also face intense scrutiny of their financial performance and intervention in their running by the two NHS bodies include those in Croydon, North Somerset, Vale of York and Walsall.

NHS Clinical Commissioners, which represents CCGs, said some were ending up in the red because the NHS was receiving too little money. “We urgently need a cross-government review into the overall financial position of the NHS and an open debate about what can be realistically delivered within the current level of funding,” said Julie Wood, its chief executive.

The “reset” is part of a longer-term strategy to show that the NHS can put its house in order as a way of persuading ministers to give it more than the £8bn extra by 2020-21 already planned. However, experts say fast-rising demand for care and continued reliance on agency staff means the NHS is unlikely to get back into the black soon.

  • This article was amended on 21 July 2016 to give the correct number of clinical commissioning groups (CCGs) that will go into special measures.

An ominous and repetitive failure to learn from mistakes…

In the UK health services there is an ominous and repetitive failure to learn from mistakes… Plus ca change… The perverse incentives not to change must be too high, and the gagging and fear continue..

James Meikle reported this on 5th June 2013: NHS trusts not learning from their mistakes, report says

Survey finds that only 20% took notice of complaints levelled against them and took resulting action to improve services

The Sussex Argus reports 18th May 2016: NHS trust ‘did not learn from mistakes’ after couple’s death

The son of a retired property developer who killed his wife and then himself has criticised an under-fire NHS trust for not learning from mistakes in mental health care.

Joe Goswell, whose parents Roger Goswell, 66, and Susan Goswell, 63, died nearly nine years ago, said the manslaughter conviction this week of Matthew Daley for killing Donald Lock, 79, revived painful memories.

He said the Daley case proved Sussex Partnership NHS Foundation Trust had failed to learn lessons following his parents’ deaths, despite recommendations made in the aftermath……

Chris Smyth reports 20th July 2016 for the Times: NHS did not learn from child’s needless death

Patients are dying because NHS investigations into mistakes are incompetent, defensive and lack independence, a damning review has concluded.

After a bereaved family’s five-year fight for answers over the death of their three-year-old son, the NHS ombudsman yesterday demanded a total overhaul of how the health service investigates harm to patients.

Investigations are often designed to avoid blame rather than find out what went wrong and why, the report says. Fatal mistakes can be repeated because hospitals, GPs and managers fail to accept the possibility that they have erred, and the NHS needs serious “soul-searching” to put it right, the ombudsman says.

The findings stem from the death of three-year-old Sam Morrish from sepsis in 2010. Hospital staff, GPs and out-of-hours services told Sam’s parents that he had just been “unlucky” and that there was nothing they could have done differently.

Scott and Sue Morrish refused to accept that, forcing a first report by the ombudsman which confirmed that Sam’s life should have been saved.

He was repeatedly sent home by GPs; call handlers failed to recognise danger signs; and when he finally got to hospital antibiotics were delayed for several hours because of a mix-up between staff.

Mr and Mrs Morrish said that this conclusion still did not get to the heart of the problem, which was why the original investigations into Sam’s death failed to learn lessons that could save other children.

In a follow-up report Dame Julie Mellor, the ombudsman, found that Sam’s GP, Torbay Hospital, NHS Direct and an out-of-hours service made no clear attempt to find out what they could have done differently.

Sam’s case “like so many others, shows that organisations were not competent in the way they investigated this serious complaint and that this incompetence went unchallenged”, Dame Julie warned.

She added: “Across the NHS a fear of blame pervades that prevents individuals and organisations being open to the possibility that their initial view of what happened might not be the right one, and means they are not asking questions about what happened and why.”

Dame Julie said that health services were therefore failing to learn how to prevent mistakes being repeated and insisted that the report must be “a wake-up call for NHS leaders” to change the way they investigate. She demanded a national programme to train NHS investigators, saying that it was wrong that staff can investigate their own mistakes or those of their colleagues or bosses.

Mr Morrish said that the report was “a huge step towards explaining how things go wrong at a local level”. He said “there should be no question that can’t be asked and none that can’t be answered”, insisting: “I hope that this report leads to rapid change in the culture of the NHS so that mistakes can be recognised, investigated and learnt from. Anything short of that isn’t safe for patients and isn’t fair to NHS staff.”

Jeremy Hunt, the health secretary, is creating a health safety investigation branch, modelled on how airlines investigate plane crashes, which aims to allow staff to be honest about mistakes without fear of blame.

Mr Hunt urged NHS leaders to learn from the report, adding: “The tragic death of Sam Morrish shows why it is so important we listen to patients and families — no other family should have to go through what they have, and we are determined to build the safest healthcare system in the world.”

Scott Morrish describes himself as someone who needs to ask questions (Chris Smyth writes).

The problem was, his local NHS did not feel it needed to answer them. It was this lack of interest in the truth about the death of his son that turned a personal desire to understand into a five-year fight to ensure the NHS learns from its mistakes.

Mr Morrish and his wife Sue could not understand how their happy, healthy boy was suddenly gone. But “shoulders were shrugged” and they were told to let it go.

The fight has taken up so much of his time that Mr Morrish, who runs a business with his wife, says: “If I had been in any other job I would have been fired years ago”.

Mr Morrish hopes to get some of his life back, but says he will “keep an eye on” whether the changes urged today actually happen. It is a heavy responsibility for a grieving family to bear.

NHS: Learning from Mistakes – Hansard Online 9th March 2013


The NHS is being torn from those who have cherished it for decades

At a recent meeting the other day I was asked how I felt about Brexit. I replied angry, but I could have added “ashamed” and “disillusioned” and “cheated” out of the country’s future. Did I fight strongly enough for the “In” or “remain” campaign? I had a poster up, surely, but who read it or took any notice? The same feelings are in many doctors who knew the NHS in it’s pomp, when it really did exist and work.  Technology is advancing faster than the states ability to cope, so we have to challenge Aneurin Bevan and see how the ideology needs to change from 1948… The EU leaders are in denial over their need to change, and the Health Services chiefs are equally in denial about the need to ration overtly. Once torn apart its much harder to reconnect.

Kailash Chand reports 20th July in the Guardian: The NHS is being torn from those who have cherished it for decades – By confirming that Jeremy Hunt stays as health secretary, Theresa May has signalled that she endorses the imposition of the unfair, unsafe junior doctors contract, a seven-day unaffordable NHS and rock bottom NHS morale.’

The NHS has just turned 68. Despite austerity, political meddling, cuts, [dis]reorganisations, years of misuse, battering and bruising and Brexit it’s still here, though gasping for breath.

A combined financial and staffing crisis could cause ongoing chaos for years and ultimately kill off the NHS for good. We have been squeezing the lemon for “efficiency savings” for years. But it is getting to the stage where there is nothing left to squeeze.

The government has closed nearly 10,000 NHS beds and 16% of A&E wards. Debt is at an all-time high, soaring numbers of sick people are waiting on trolleys in A&E, and key targets for treating cancer patients are being woefully missed. In addition, social care services have suffered a £2.6bn real-terms cut. This expected deficit could mean the loss of more than 20,000 nurses, 9,000 hospital registrars and 3,000 hospital consultants.

At each and every juncture this government has sought to blame doctors and NHS staff rather than accept the self-evident truth. Government cuts are the main cause of the NHS’s current woes.

News that Jeremy Hunt is to remain as health secretary has been greeted with surprise, disappointment and incredulity by many NHS staff. My own view is better the devil you know.

However, by confirming that Hunt stays in the post, Theresa May has signalled that she endorses the imposition of the unfair, unsafe junior doctors contract, a seven-day unaffordable NHS, rock bottom morale, and an ideologically driven privatisation of an unsafe, underfunded NHS.

The combination of Hunt remaining in post, £22bn “efficiency savings” and Brexit means grim times ahead for the NHS.

The Nuffield Trust recently looked at performance in the last parliament against six targets, covering A&E, operations, cancer and diagnostic tests. The report concluded that, the poorest performing hospitals had been getting worse on most measures for a while. But, worryingly, it said more recently performance had also started to decline in the top 10% of hospitals, particularly in terms of A&E, hospital operations and, to a lesser extent, hospital appointments.

If hospitals are struggling, general practice is in no better shape. Real-term GP funding has declined significantly and the number of unfilled GP vacancies has quadrupled.

Morale in the NHS family is at an all-time low. This is hardly surprising: four times as many staff say they suffer increased work stress, and physical assaults on NHS staff have increased by 20% since 2010. And twice as many staff report suffering bullying at work. Nurses’ pay has suffered real-terms cuts for four years and staff have been forced to accept a major downgrading of their pension benefits. In the social care sector we have seen low pay exacerbated by a rapid rise in the use of zero-hours contracts.

As it passes its 68th birthday, what is left of the NHS is just a logo; a once-cherished institution reduced from being the main provider of health services in England – with one of the biggest workforces in the world – to an increasingly fragmented, increasingly privatised service. Fewer treatments are available as cuts start to bite, with wealthier people able to “top up” treatments. Poor, old, weak and mentally challenged patients are routinely disadvantaged.

The NHS is Britain’s most civilised accomplishment. A nationwide activist movement in the US is devoted to trying to introduce an NHS-style model in their country. And yet our own government is itching to convert our NHS from a public service to a set of business opportunities for US-based transnational insurance and health provider corporations. Today’s gasping NHS is now scarcely able to make the changes it needs to because it is on the wrong path, a fast track to fragmentation and marketisation.

This is our NHS. We own it and pay for it. We have been proud of the care provided from cradle to grave. But the NHS is being torn from the caring hands that have so carefully cherished it for decades. Our NHS is being placed in the hands of accountants and businessmen who make financially driven decisions on whom profitable future contracts should be awarded to. Opening it up to an onslaught of smash and grab companies would cause money to flow out of the NHS in a method akin to death by a thousand paper cuts. Bevan would turn in his grave if he could see what the politicians are doing to his beloved NHS.

His quote is most apt today: “The NHS will last as long as there are folk left with the faith to fight for it.”

Let’s fight for its survival; the NHS belongs to us, not the planners or politicians and not the privateers.


Lies over the £8,000,000,000. More smoke and mirrors from Mr Hunt and his cronies..

Chris Smyth reports in The Times 19th July 2016: £8bn NHS funding claim ‘misleading’

The government is misleading voters by claiming that it is giving an extra £8 billion to the NHS when the true figure is closer to £4.5 billion, according to the health select committee.

Simon Stevens, chief executive of NHS England, said that the health service would need at least an extra £8 billion by 2020 and ministers have boasted of backing “the NHS’s own plan”. But the boost to NHS England has partly been paid for by a £3 billion raid on wider budgets and using 2021 prices to inflate the funding figure, today’s report says.

Sarah Wollaston, the chairwoman of the committee, rebuked the government for using “short-term fixes which are shoring up long-term problems”. Councils have had social care budgets cut by £4.6 billion and the report says that the NHS has to pick up the pieces. Mr Stevens recently warned the government not to “rewrite history” by claiming that his plan had been given all it needed.

A Department of Health spokesman rejected the report’s conclusions.

Dennis Campbell in The Guardian says:@ Jeremy Hunt has broken NHS funding pledges, report finds

MPs claim other parts of the Department of Health’s budget, such as public health, are being diverted to fund NHS England

The government has broken its pledges on NHS funding and is misleading the public about how much extra money it is actually putting into the health service, a committee of MPs has said.

In a highly critical report, the House of Commons health select committee accuses Jeremy Hunt and other ministers of giving the cash-strapped NHS “less than would appear to be the case from official pronouncements”….

…Giving the Department of Health the promised £8bn would mean “training for nurses and doctors, and money to invest in buildings and equipment: budgets which provide crucial support to frontline services,” said Nigel Edwards, chief executive of the Nuffield Trust thinktank.

Health services failure will make Brexit look cheap….

DANGER. Cheating confirms the lowering of standards. Exams for medics should never be continuous assessment but show they can think on their feet..

Alexi Mostrous reports in The Times 19th July 2016: Thousands of nurses cheat in exams – A rise in plagiarism means student nurses may not be qualified

Cheating confirms the lowering of standards, already explained by NHSreality. Exams for medics should never be continuous assessment but show they can think on their feet..

Thousands of student nurses in Britain have been disciplined for cheating amid fears of an epidemic in online plagiarism that puts patients at risk, The Times can reveal.

Universities have punished at least 1,706 nursing students in the past three academic years for offences including plagiarism, collusion and impersonating other students.

Experts fear that the figure may be the tip of the iceberg because it is feared that thousands more students are using websites selling bespoke essays, which are much harder for plagiarism software to detect.

Dr Thomas Lancaster, a plagiarism expert, said that “high hundreds or low thousands of nursing essays are bought every year in the UK”. He warned that cheating in nursing courses could have “potentially dangerous and fatal consequences” if nurses did not understand how to take notes correctly or read doctors’ notes.

The Times has uncovered a company in Pakistan called Nexus which runs a series of websites that target nursing students as potential customers.

A sales representative for one of the company’s websites, which charges £195 for a “first-class” standard essay, boasted to a reporter posing as a potential customer that the company had 100 in-house writers including “retired professors from UK colleges”.

In fact Nexus appears to rely on more than 40 young male and female “academic writers” working around the clock in Karachi to produce the work.

Nursing coursework is also available for as little as 99p on websites such as eBay and Gumtree.

Data obtained from 61 British universities under the Freedom of Information Act suggests that nurses are disproportionately more likely to cheat than other students.

Almost half of all students disciplined at the University of Dundee for cheating between 2010 and 2013 were nurses. Some 155 student nurses were found out compared with 17 medical students and seven would-be lawyers.

Professor Margaret Smith, dean of the school of nursing and health sciences at the University of Dundee insisted that its anti-plagiarism measures were among the most robust of any UK university.

At the University of Brighton 47 “major” cases of cheating and 79 minor cases were identified between 2010 and 2013. In 2012 nurses cheated more than any other faculty. A spokesman for the university said that it had 6,245 nursing students over three years and “the numbers [of cheats] are very small in comparison to the number of students”.

Almost 300 nursing students were caught cheating at Edinburgh Napier University, the highest number of any university surveyed. Fewer than five were referred for investigation by fitness-to-practise panels.

A spokesman for Edinburgh Napier said that the university had more nursing students than any other provider in Britain. “Often plagiarism owes much more to naivety than dishonesty and so we focus on educating students on good practice in their written work,” he said.

At Cardiff University the number of nurses caught cheating rose by more than 500 per cent between 2012, when 12 students were disciplined, and 2014, when 77 were caught.

Twenty-eight universities providing nursing qualifications did not respond to the FoI requests.

Nursing students are immune from investigation by the Nursing and Midwifery Council until they are qualified. The regulator relies on the universities to enforce good conduct but very few students are expelled for cheating. At least five registered nurses studying for professional qualifications have been referred to the council by universities.

A spokesman for the council said: “There is no place for cheats in nursing or midwifery. It is the responsibility of academic institutions to ensure individuals have legitimately passed all parts of their course before they are awarded a qualification and can apply for registration.”

The Quality Assurance Agency for Higher Education is the quango in charge of upholding university standards. It has launched an investigation into whether universities need to mete out tougher punishments for plagiarism and develop new tools to catch cheats using essay sites.

Dr Lancaster, who has studied contract cheating for a decade, said: “We know the whole essay marking business is worth millions of pounds a year in the UK,” he said. “We expect nurses to have our health in mind, to be able to correctly dispense the right amount of drugs, to know what to do in different situations.”

The NMC disciplined a nurse last December in what is believed to be the first case to explicitly mention a post-graduate student cheating by purchasing an essay online.

Bernadette Tolentino-Dean, who worked at a nursing home in Sussex, admitted that she had bought an essay from a website called Studymode and submitted it as part of a six-month professional development mentoring module at the University of Surrey in January 2014.

She said that she had felt under pressure to complete the course and bought it so that she did not have to do the work herself.

Mrs Tolentino-Dean was given a six-month suspension for serious professional misconduct and dishonest behaviour.

The NMC has also disciplined at least 20 other registered nurses for offences involving plagiarism. These typically involved copying another student’s work or submitting an essay that had previously been handed in on another course and was detected by plagiarism software.

Writers paid £324 a month
Although websites such as present themselves as British-based businesses anxious to provide students with “study aids”, an investigation found that dozens are run from Pakistan by two entrepreneurs who employ local writers on 12-hour shifts.

Anwar Haider and Moez Mujtaba set up Nexus Corporation eight years ago in Karachi. It now controls at least ten essay sites including nursingessay. and employs more than 40 people.

Another Karachi company called Academic Inside controls a spate of similar websites including nursingessay Its sales staff claim that it is based in Manchester and has “a team of experienced masters and PhD writers available from the area of nursing”.

Workers are employed on salaries of 45,000 rupees (£324) a month to work in two shifts — from 9am to 6pm, and a night shift from 6pm to 3am. Required skills include “excellent English writing skills in terms of language”. To mask its Pakistani origins, Nexus set up a British company called Nexuscorp Ltd with an address in a Folkestone business park.

When a reporter asked “Dan” where was based, he insisted Nexus was a British company and ended the conversation when pushed. A woman who answered the phone number of the Folkestone business park said that Nexus had never been based there.

Mr Haider, one of the founders, denied that his websites facilitate cheating. “We never promote students to use the services provided as their own,” he said.

‘The dangers are clear, patients can be at significant risk’

We have over 100 writers, the salesman boasted. “Eighty per cent are retired professors from UK colleges. Your paper will be 100 per cent customised as per your instructions. It will be 100 per cent non-plagiarised as well.” Calling himself Dan, the salesman worked for one of a burgeoning number of websites selling bespoke essays to British students for up to £1,000 a time.

Unlike similar operations targeted at English or history graduates, is aimed at Britain’s 150,000 nursing students.

Speaking to a reporter posing as a student, Dan offered to produce a first-class nursing essay on “national and international health policies” for £195.

With worrying implications for public health, is only one of dozens of websites, Twitter accounts, Gumtree adverts and eBay postings selling nursing coursework to British students for as little as £1.99. One site alone contains a “research database” of more than 5,000 nursing essays. Many of the websites purport to be British-based but are run out of Pakistan by companies controlling dozens of “essay mill” websites. The sites, which offer free samples and different prices depending on what standard is required, advertise their services as “study aids”.

The dangers of nursing students who cheat are clear, experts say. “The purpose of a student doing an essay or undertaking learning is to gain knowledge to improve safety of patients,” Lynne Phair, a consultant nurse, said. “If someone cheats by buying an essay then patients can be at significant risk of harm because the nurses will have been passed as competent when they don’t have that knowledge. It can be very dangerous.”

The growing number of essay mills has caused huge concern among British universities. While plagiarism software such as Turnitin can identify students who re-use someone else’s work, it struggles to pick up original material written to order.

As one online seller of bespoke essays to nursing students advertised: “We help get your academic paper ready to submit — it’s not been copied and pasted and will sail through Turnitin with flying colours.”

Yet universities caught more than 1,700 nursing students cheating in the past three years, freedom of information requests by The Times show. At some universities nurses appear to cheat in disproportionate numbers. Almost half of all students disciplined at Dundee University for cheating between 2010 and 2013 were nurses. However, only a handful of students have been kicked out of their courses or referred to fitness-to-practise panels. The government has started an investigation.

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

We don’t trust you Mr Hunt. What a pity you did not get moved on…

The Jeremy Hunt cartoon: Jeremy Hunt picks the perfect time to push the contract button

What lies in store for Jeremy Hunt and NHS in Theresa May’s government?

The length of time Hunt spent in Downing Street on the morning of his appointment may indicate the depth of the new prime minister’s concern about what she faces in the NHS.His first priority must be to end the dispute with junior doctors. The new administration is already fighting on too many fronts; medical staff back on picket lines is a problem it will be desperate to avoid.Hunt announced that he was going to impose a new contract on the doctors after the deal he negotiated with the BMA was rejected in a ballot. The dispute is more than just discordant background music; junior doctors feeling alienated seriously impedes reform of NHS services.

Crucially, Hunt stands accused by the doctors of misrepresenting evidence about hospital patient outcomes at weekends, and how that relates to the seven-day working he wants to introduce. If he is going to make any progress in rebuilding trust and finding a way forward which does not involve more strikes, he would be wise to concede some mistakes in the way he has handled the dispute. The alternative is to continue a trial of strength, which everyone loses.

The doctors’ anger is just one symptom of the health service’s chronic staff shortages; it needs more, not fewer, from the EU than the current 55,000. Maintaining the UK as an attractive place for European clinical talent to live and work is a serious problem as Brexit begins to take shape. Hunt needs to have a clear voice in the negotiations.

The biggest problem is, of course, the money. King’s Fund analysis indicates providers and commissioners ended the last financial year £1.85bn in deficit. The creative accounting which, according to the Health Service Journal, shaved around £900m off last year’s deficit total is not a trick that can be endlessly repeated.

With NHS Improvement pressing hard on staffing budgets, the NHS may be about to enter yet another downward plunge in its repeated cycle of boom and bust staffing levels. Constantly hiring and firing staff is clinically risky and financially stupid.

The apparent abandonment of the totemic policy of balancing the government’s budget by the end of this parliament might offer some modest respite, although we are unlikely to know what this policy change actually means until the autumn statement. But it is hard to imagine it delivering a substantive increase in health and care funding, and even the NHS sees the case for social care getting any extra cash first.

NHS England chief executive, Simon Stevens, is intent on reminding ministers of promises made during the EU referendum campaign about more NHS funding, but even if the government were to make a token increase on the back of Brexit, that is still more than two years away.

There is a desperate need for the government to inject some honesty and openness into the debate about health and care funding. If we can have a national debate about the EU, surely we can have one on what sort of health and care service we want, what sort of old age we want, and what we are prepared to pay for it.

Hunt will finally have to publish the government’s childhood obesity strategy – already six months late. The last budget included plans for a levy on drinks with added sugar from April 2018, but far more robust action will be required.

On top of the existing difficulties, May’s speech on the Downing Street steps put further pressure on her health team by stressing her determination to tackle inequalities in life expectancy and providing better life chances for those suffering from mental illness. Pledging to increase the life expectancy of the most disadvantaged is not credible while investment in public health is being cut.

Hunt has done well to survive a brutal cabinet reshuffle, but he should not take that as a licence to plough on regardless. He needs to reestablish trust with the staff and honesty with the public.

We don’t trust you Mr Hunt. What a pity you did not get moved on…


Obligatory Welsh Language option in consultations? Resentment and ignoring is likely.. Local choice is best..

THE WG is asking for feedback on the issue of Welsh Language Standards in the consultation.

WELSH LANGUAGE STANDARDS (HEALTH SECTOR) REGULATIONS – Consultation by Welsh Government – Deadline for responses: 16 September 2016

Following on from a standards investigation carried out by the Welsh Language Commissioner between November 2014 and February 2015, the Welsh Government is consulting on regulations that will define new Welsh language standards to be applied to bodies operating within the health sector in Wales.

The extent to which these bodies will have to comply with the new standards will be subsequently determined by the issuing of compliance notices by the Welsh Language Commissioner.

Part 1 of the draft regulations deals with the delivery of services by health boards and trusts and includes the following provisions:

  • Individuals attending a clinical consultation must be asked if they would like Welsh language support during the consultation. If so, such support must be provided at clinical consultations thereafter unless consultations themselves can be carried out in Welsh. This support could be provided by a Welsh speaking member of staff who is able to check the individual understands what has been said and, if need be, provide an explanation or translation in Welsh.
  • During case conferences, other than those only involving health professionals from a defined list, an individual must be asked if they wish to use Welsh. If so, translation from Welsh to English and English to Welsh must be provided unless the case conference is held in Welsh.
  • When a health board or trust is providing a clinical consultation or holding a case conference on behalf of a different health board or trust, the standards that should apply are those that apply to the body conducting the consultation or case conference.
  • When these standards refer to an individual, this means a member of the public who is ordinarily resident in Wales.
  • The standards outlined in this part of the regulations will not apply to a body when providing primary care services (whether provided directly or contracted), or when a body sub-contracts services to a primary care provider.
  • The standards will also not apply when responding to civil contingencies and other emergencies that occur outside a hospital.
  • The standards will also not apply when a body sub-contracts with a private hospital in Wales or a hospital located outside Wales.

Part 2 of the draft regulations concerns primary care[1] (defined as general practice, dental, ophthalmic and pharmacy services), and includes the following provisions:

  • Health boards to promote on their websites any primary care providers who are willing to provide all or part of their primary care services through the medium of Welsh.
  • Health boards will be required to provide a translation service for use by primary care providers to enable them to obtain Welsh language translations of signs to be displayed in connection with their services.
  • Health boards will be required to produce any document relating to primary care services which is for public use in Welsh.
  • Health boards to provide a Welsh language version of any document they make available to primary care providers that is intended for public use.
  • Information about primary care on health board websites must be available in Welsh.
  • Apps published by health boards which relate to primary care must be available in Welsh, and the Welsh language treated no less favourable than English when they use social media in relation to primary care services.
  • Health boards must provide and promote the wearing of badges that convey that a primary care provider (or staff member) speaks Welsh.
  • Health boards will be required to provide training courses, information or hold events aimed at primary care providers to raise awareness of the Welsh language and how it can be used in the workplace.

Part 3 of the draft regulations apply to various bodies which regulate health and social care professionals. This is to apply Welsh language standards to them which have already been agreed under previous regulations for the Agricultural Land Tribunal; the Education Workforce Council; the Mental Health Review Tribunal for Wales; the Residential Property Tribunal Wales; the Special Educational Needs Tribunal for Wales; and the Valuation Tribunal for Wales. The health bodies which it is proposed will now come under these same standards are the Care Council for Wales; the General Chiropractic Council; the General Dental Council; the General Medical Council; the General Optical Council; the General Osteopathic Council; the General Pharmaceutical Council; the Health and Care Professions Council; the Professional Standards Authority for Health and Social Care; and the Nursing an Midwifery Council.

Full details of this consultation, including the draft regulations, can be found via the following link:

If submitting a response to this consultation, please have regard to the following questions on which the Welsh Government is seeking views:

  • Do you agree that the definitions of clinical consultation and health provision are clear and comprehensive?
  • Is the proposed standard 25 (clinical consultation) practical in the various scenarios described in the consultation document?
  • Is keeping a record, and acting in accordance with the individual’s language preference practical?
  • Do you agree with the concept of Welsh language support during clinical consultations?
  • Do you agree that the definitions of case conferences and health-related provision are clear and comprehensive?
  • Do you agree that case conferences should be treated differently to clinical consultations and other meetings?
  • Does the list of healthcare professionals at paragraph 38 capture everyone who may be involved in a case conference or meeting that involves only healthcare professionals?
  • Do you agree with the approach that an individual can expect compliance with the Welsh language standards imposed (if any) on the body who is physically providing or carrying out the clinical consultation or case conference?
  • Do you agree that health care provision in prisons should be treated in the same way as other health care?
  • Do you agree with the proposed exemptions and the reasons why, e.g. responding to Civil contingencies and emergencies, excluding private hospitals and hospitals outside Wales?
  • Do you agree that contracted primary care services and services of a similar type provided directly by the local health board should be treated in the same way?
  • Do you agree with the proposed new standards that place duties on local health boards in relation to primary care services, both contracted and those provided directly?
  • Do you have any other comments in relation to Welsh language provision in primary care services?
  • We have asked a number of specific questions. If you have any related issues which we have not specifically addressed, please use this space to report them.


[1]  It should be noted that the Welsh Government is not proposing to accept the Welsh Language Commissioner’s recommendation that primary care providers must be subject to the same Welsh language standards as the health boards and trusts that were subject to her standards investigation.”

Just as schools could be offered (through their PTAs) the opportunity to use money on languages other than Welsh, so Patient Participation Groups (PPGs) where they exist, could be asked to say what they feel about this suggested option.

There is no reason to have a universal rule. Local practices/hospitals/trustss could decide differently.

The BMA response to the WG green (white) paper on health gives two areas of highest importance hidden deep in the document. The first is that there should be an honest language around rationing overtly in health care, and the second is that there should be exit interviews for all staff, and retirees especially. Exit interviews should be summarized and depersonalized to health boards and the WG on a regular (annual?) basis. They should be done by an independent outside body on account of trust! These are far more important issues than the irrelevance of the Welsh language.

I hope our local BMA will discuss the suggestion in the autumn, but somehow I doubt it as we have more relevant matters to discuss, and we don’t like to see money/funds/resources misdirected and wasted.

There is already a move towards the “nuclear option” of resignation from the contract in England. This could move to Wales..