Monthly Archives: August 2016

Smith warns of ‘secret Tory NHS privatisation’: The Health services are like a sacred cow – with rabies.

Like a sacred cow in the Hindu culture, even if it has rabies the health system ideology cannot be touched.

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BBC News reports 15th August 2016: Smith warns of ‘secret Tory NHS privatisation’

Labour leadership contender Owen Smith has accused the government of having “a secret plan to privatise the NHS” in England.

In a speech, Mr Smith said NHS spending on the private sector has doubled to £8.7bn during the six years the Conservatives have been in power.

The Department of Health said his analysis was “simply wrong”.

Meanwhile, leader Jeremy Corbyn has said he wants a “National Education Service” based on NHS principles.

3 days ago in the Express: Tories ‘have secret plan to privatise NHS’ says Owen Smith

3 days ago BBC: Reality Check: Has private contracting in the NHS doubled?

2 days ago in the Guardian Dennis Campbell reportds: How much is the government really privatising the NHS? = Figures show privatisation to be less of the explosion that Owen Smith warns about and more a gradual, inexorable rise in the outsourcing of services

1 day ago: Co-operation, collaboration and competition – inside the mindset of NHS managers

Peter Hill reports in the express 16th August: The NHS is sacred and politicians are scared of it,   – THE NHS lurches from crisis to worse. Hospitals openly admit they can’t cope, operations are cancelled, patients lie on trolleys for 12 hours, drugs are denied, it’s even harder to see your local doctor and don’t bother to try A&E instead.

Doctors are leaving for EU already, health chiefs warn

Chris Smyth warns us in The Times 16th August 2016, on the reduction in EU trained doctors threatening staffing levels further. So even more medical student places need funding…

Doctors are leaving for EU already, health chiefs warn

Medical expertise in areas from cancer treatment to brain surgery will be damaged by an exodus of European staff following Brexit, leading hospitals have warned.

Some European doctors and nurses are already leaving the NHS, threatening specialist care that relies on them, hospitals say. A quarter of the doctors in some specialist hospitals come from the EU and because they have rare skills they cannot be replaced by British staff. NHS officials say that patients would be at risk if they left.

In a letter to The Times the Federation of Specialist Hospitals has urged the government to guarantee European staff that their future in the NHS is secure so that patients do not suffer.

The chief executives of Royal Brompton Hospital, which specialises in cancer care, Papworth Hospital, the leading heart transplant unit, Walton Centre, a major neurology hospital, and Moorfields Eye Hospital are those warning of the threat posed by the departure of EU staff.

“Our ability to provide exceptional care to patients hinges on recruiting and retaining the best clinical talent from the UK and further afield,” they write. “Crucially, this includes the European Union, where up to a quarter of doctors in a given specialist hospital trust may come from other member states, with even higher proportions for some clinical teams.

“In the wake of the EU referendum result our greatly valued European colleagues are understandably feeling uncertain about what the future holds for them in this country. Indeed, one or two have already left and, as things stand, more will be heading in the same direction with little return traffic.”

Rob Hurd, head of Royal National Orthopaedic Hospital, which treats complex hip and spine problems, said that with the NHS already under pressure “we don’t want this to be the thing that breaks us”.

Theresa May, however, has declined to offer guarantees, while uncertainty remains over the status of millions of Britons living in Europe.

• Patients are at risk because of European doctors’ poor English, the Royal College of Surgeons has warned. EU doctors attract a disproportionate number of complaints about their ability to speak English and must be subject to the same stringent tests as other foreign medics, the college says.

By the way… Sadly, NHS rationing was inevitable

An article/letter? by an un-named Dr in the Glasgow Herald (on press reader) is honest, but it misses the point that the rationing today is covert. It has to be overt and explicit, and known in advance, before it can be fair.

By the way… Sadly, NHS rationing was inevitable. Scottish Daily Mail – 16 Aug 2016

WHEN I became a junior doctor, the NHS was just 25 years old and we were all coming to terms with what it meant to provide free healthcare at the point of delivery.

I was becoming concerned about the growing waiting lists — a political hot potato at the time. But my father, an established anaesthetist who had worked as a battle surgeon before the creation of the NHS in 1948, warned me there would be further challenges ahead.

As he observed back then, there is only a certain amount of cake to go round, free service for all or not, so some form of rationing would be necessary.

In those days, demand for healthcare was managed by way of waiting lists. But my father warned me that, at some point, it would become politically unacceptable to have to wait for care and, once that day came, there would have to be more subtle ways of depriving the public of the care it had been promised.

One way is to make it harder for people to qualify for treatment.

And now we learn, not least from the Mail’s investigations, of the widespread restrictions on cataract operations — with three-quarters of NHS hospitals denying the surgery to all but the most visually impaired patients.

In a similar policy, joint replacement for knee arthritis is to be restricted in certain areas by tough selection criteria set by the local commissioners, while previously it was the decision of a specialist orthopaedic surgeon following referral by the patient’s GP.

The days when healthcare was governed by doctors functioning within a code of ethics are clearly over — the ministrations and cost-cutting antics of administrators and commissioning bodies are not informed by ethics.

Of course, care must be taken when spending public money on potentially expensive treatments, but the proper application of medical ethics must apply — we should strive to make decisions on the basis of individual medical need rather than blindly adhering to blanket rulings imposed from above.

And maybe now is the time to come clean, Mr Jeremy Hunt, and admit the mantra of free healthcare for all at the point of delivery is no longer something the nation can afford.

It is time to admit to rationing and accept that some will suffer — and not let it creep in by the back door.

Don’t get old and frail – if you can avoid it – in our covertly post-code rationed services

The UK Health Services are all different, by post code, and by design. Despite paying the same taxes citizens will get different services everywhere, Chris Smyth reports 16th August 2016: Dementia patients face a care lottery. We all know this but we don’t seem to care – until it’s our own nearest and dearest who suffer, have not planned with advanced directives, and are then semi- abandoned. Don’t get old and frail – if you can avoid it – in our covertly post-code rationed services.

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Dementia patients are facing a postcode lottery with figures showing that the quality of care varies wildly around the country.

Campaigners condemned patchy NHS services as official data high- lighted big variations in the number of emergency hospital admissions of people with the condition. They said it was unacceptable that patients had to gamble on whether they would get good care for an increasingly common illness.

In some areas, patients routinely go a year without having their condition reviewed while in others most people with dementia are denied their wish to die at home, according to data published today.

The NHS Dementia Atlas also shows that the rate of emergency hospital admissions of older people with the condition was 6,046 per 100,000 people in Bradford compared with 1,840 in Croydon, south London.

George McNamara, head of policy at the Alzheimer’s Society, said: “We must urgently explore why [the needs of] people with dementia are escalating to this point and what can be done in the community to prevent crisis admissions among this vulnerable group.”

He said that the variations in patient reviews were “extremely important” owing to the progressive nature of the condition. “The causes of variation need to be investigated to ensure care is never a gamble,” he added. Only 49 per cent of patients in Somerset have an annual review, compared with 86 per cent in northeast Lincolnshire.

East London fares worst for well-planned deaths, with barely a third of patients dying at home, which most people say they would prefer to do.

Caroline Abrahams, of Age UK, said: “This is an unacceptable postcode lottery of care. We must continue to improve access and quality of care for the growing number of us with dementia. In some areas help is really good but elsewhere services are frankly not up to scratch, with only a few people receiving at least an annual review of care.”

More than 850,000 people in Britain have dementia and the number is expected to exceed one million within a decade as the population ages. Jeremy Hunt, the health secretary, has pledged to make improving care a priority and argues that naming and shaming the worst performing areas will encourage them to improve. “By publishing current levels of care we are shining a spotlight on areas where there is still work to be done,” he said. “We still have much further to go to promise everyone that they will be able to live well with the condition. The impact of dementia tears at families and at our social fabric — that’s why making progress is a key government priority.”

This week people from the age of 40 will also start having dementia checks as GPs are told to encourage them to lose weight and exercise more. Assessments of people’s risk of dementia will be included in NHS health checks in a pilot scheme.

Charles Alessi, senior adviser to the programme, said: “Unlike cancer or heart disease, people are unaware that there are positive steps they can take to improve their health and reduce their risk of dementia.”

Carey Mulligan, has been signed up as the face of a campaign to urge businesses to train their staff to deal better with people who have dementia. The actress, 31, whose grandmother suffers from the condition, said: “I have experienced first-hand how devastating it can be.”

Live longer with dementia: Mr Hunt pillories the profession. Most doctors will be making “living wills” to avoid over-zealous care and prolonged demented lives…

Dementia – the truth comes out due to focus on prevalence rather than incidence. The ethics need further discussion.

Dementia carers feel brutalised: it’s a national and a systemic problem. Better to be honest about what we cannot afford..

Perverse Incentive? GPs to be paid £55 for each dementia diagnosis. “…an intellectual and ethical travesty.”

Image result for abandon the elderly cartoonUpdate 17th August. The BBC 16th August supplies comparative map for dementia care. “NHS dementia atlas reveals patchy care”.

Drug Procurement scandalously profligate and inadequate…

 With sufficient notice some simple drugs could be made by the nation, and there are Indian generic pharmaceutical manufacturers who would want to bid – but only if told with sufficient notice. And did we know it was happening – yes we were warned by the same Billy Kember: Alert on drug prices came two years ago. Drug Procurement, along with the rest, is scandalously profligate and inadequate…

Billy Kember in the Times 16th August reports on inefficient and derisory drug procurement management. “NHS failure on medicine prices costs public £125m”

NHS officials waved through medicine price rises of up to 600 per cent with no questions asked, according to a cache of emails seen by The Times.

Health staff queried the “large difference” in prices set by the British company AMCo — which has an effective monopoly over the supply of certain drugs — but merely asked for confirmation that the changes were correct. The new prices for 54 medicines alone cost the NHS an extra £125 million last year.

They included eye drops, which were raised by 243 per cent from £2.35 to £8.05, and an anticoagulant called phenindione, which rose by almost 200 per cent from £99.89 to £291.09 in May last year. Four months later the price of phenindione was put up again to £519.98 for a packet of 25mg tablets.

An investigation by The Times in June showed that entrepreneurs were buying the rights to old drugs and implementing price rises of up to 12,500 per cent, costing the NHS an extra £262 million a year. The Department of Health warned that “no pharma- ceutical company should be exploiting the NHS” and Jeremy Hunt, the health secretary, promised to act.

Hundreds of pages of emails released under freedom of information laws now reveal the extent of government complicity in the price-raising, while Mr Hunt has failed to stop the tactics.

The Health Services Procurement – inefficient and risky… Centralisation and management control is needed

Owen Smith warns of ‘secret Tory NHS privatisation’

The BBC reports 15th August 2016: Smith warns of ‘secret Tory NHS privatisation’ and it appears that there are other covert strategic decisions being taken ( Laura Donelly, 13th April 2015: Secret NHS plans overheard on the train – The Telegraph ). Without the open debate on the reality of post-code and covert rationing we face more and more unhappy people – and a strong possibility of civil unrest. Andrew Haldenby comments in The Times: “Owen Smith’s ideas would cause the NHS to collapse”.

Labour leadership contender Owen Smith has accused the government of having “a secret plan to privatise the NHS” in England.

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In a speech, Mr Smith said NHS spending on the private sector has doubled to £8.7bn during the six years the Conservatives have been in power.

The Department of Health said his analysis was “simply wrong”.

Meanwhile, leader Jeremy Corbyn has said he wants a “National Education Service” based on NHS principles.

In an interview with The Observer he said it would mean free education for all, “from cradle to grave”.

In other developments, the Labour leader has won the backing of a majority of local constituency Labour parties (CLP) in his re-election bid, securing 285 CLP nominations to Mr Smith’s 53.

It comes as the two contenders prepare to take part in a Labour leadership debate on the BBC’s Victoria Derbyshire programme on Wednesday.

Ahead of his speech on the campaign trail in Salford, Mr Smith said: “The NHS is our country’s most valued institution – and people will be shocked to hear that the Tories have been putting together a secret plan to privatise it.

“We all rightly contribute to the NHS through our taxes – but we must make sure that money is spent on doctors and nurses, and not lining the pockets of private sector shareholders.”

‘Less privatisation’

In his speech at the University of Salford, Mr Smith said government spending on private providers in the NHS had “doubled”.

He pointed out that the recently published Department of Health annual report showed that almost 8% of healthcare in England last year was bought from private sector providers – up from 4% in 2010.

He said the report said “there is very clear underutilisation of the private sector in the NHS and it set about putting in place a new work programme that would guarantee that more clinical services were being undertaken by private sector providers in the NHS”.

“I am opposed to it,” Mr Smith added, saying a “100% publicly funded NHS” would be “an absolute red line” if he was Labour leader.

“We need to see less privatisation in the NHS, not more.”

Analysis, BBC political correspondent Eleanor Garnier

Owen Smith has just over five weeks to win this leadership contest. And it’s clear he thinks being seen to be a socialist is essential for him to succeed.

He will hope this speech, focused on protecting the NHS from privatisation, will help in the battle to persuade the left wing of the Labour Party to back him.

And in attacking what he calls Jeremy Hunt and Theresa May’s privatisation agenda he wants to show he can more be effective than his rival Jeremy Corbyn at holding the government to account.

In response to a question from the BBC’s Alex Forsyth, he said there would always be some instances where the NHS had to rely on private providers, such as to make medicines, but he claimed the Conservatives were using them as “a Trojan horse to privatise the NHS”.

Last month leader Jeremy Corbyn took a swipe at Mr Smith for comments he made about private health providers increasing choice in the NHS when he worked as a lobbyist for drug company Pfizer.

In his speech, Mr Smith reiterated his pledge to increase NHS spending by 4% a year, paid for by tax rises including a wealth tax on the richest 1% in society.

A spokeswoman for the Department of Health said: “This analysis is simply wrong – this government was the first to ensure that doctors, not politicians, make decisions about who provides care.”

She added that the rate of growth in the use of the private sector was slower than when Labour was in power.

“We are committed to the values of the NHS and to delivering a safer seven day service. We are investing an extra £10bn a year by 2020 so the NHS can introduce its own plan for the future,” she said.

Meanwhile, Mr Corbyn has set out plans for a National Education Service to “put good education at the centre of our society” and ensure “nowhere and no-one is left behind”.

“It will mean that children get a good start in life and for the rest of their lives will have their horizons opened and not be restricted in their choices by the education they can afford, rather than the education they have a passion for,” he said.

Poor Paediatric workforce planning and career structures

Other countries have drop out rates, but the UK is particularly bad for Paediatrics and A&E medicine (Emergency departments). Comparisons to other countries are irrelevant when they recruit graduates to medical school compared to undergraduates in the UK. The dominance  of women at undergraduate recruitment, combined with their preference for paediatrics as an initial training path, means that too few complete and become competitors for consultant posts.

I am informed that the training is too long compared to other countries, and there is a focus on time served rather than experience or ability. There are also long hours in hospital just at a time when a woman might be planning / expecting to have a family. Paediatric workforce planning has been a disaster.

Add to this the fact that half of GP trainees miss out on a paediatric rotation, and readers will appreciate why the demand on paediatricians is so great. When there is so much competition for medical school places, this has happened because  of short term rationing of training places, as well as misguided manpower planning, poor training programmes (GPs could do 3 months Paediatrics) and a hierarchy which, once they reach the top, seem unable to change the route they had to take.

Time we cut our cloth to suit our means.

Martyn Halle and Robin Henry report in the Sunday Times 14th August 2016: Babies ‘at risk’ as NHS runs short of paediatricians

The country’s most senior paediatrician has warned that chronic staff shortages are putting children and newborn babies at risk.

Neena Modi, president of the Royal College of Paediatrics and Child Health (RCPCH), said: “We already have fewer paediatricians than comparable European countries. If we don’t act soon, we will fall even further behind and will struggle to find paediatricians to run some services.”

A report by the RCPCH to be published this week will show that more than half of paediatric units are understaffed and 89% of clinical directors fear their paediatric services will become unsustainable in the next six months.

Modi, who works at Guy’s and St Thomas’ hospital in London, said she feared the situation could get much worse as many of the services used by children were seen as a soft target for cuts.

She warned that the impact on children of 40% reductions in neonatal care and extra cuts of £7m to public health services in 2016-17 would be severe and could lead to rises in the rates of childhood obesity, sexually transmitted diseases and neo-natal deaths.

Among the services facing cuts are sexual health education and programmes to stop drug misuse and tackle obesity.

“These are key areas of public health where for relatively small investment we are getting good returns. The government really needs to listen to these concerns,” she said.

Modi said cuts to the Public Health England training budget had contributed to a 20% shortfall in the number of junior doctors needed to train to become the next generation of paediatric consultants.

The RCPCH study found that more than a quarter of general paediatric posts at senior trainee level were vacant. Dr Simon Clark, the RCPCH workforce officer, blamed the “imposition of the highly damaging new junior doctor contract” for a fall in morale and recruitment.

He said the RCPCH had made a number of immediate recommendations to tackle the problem in the short term but that in “the long term, more care should be delivered in the community by multi- disciplinary teams of paediatricians, GPs and nurses”.

His comments were echoed by Nigel Edwards, chief executive of the Nuffield Trust charity. “This is one among several examples of serious miscalculations in long-term planning of the NHS workforce,” he said.

“The simple fact is that we have not trained as many paediatricians as we need in the current system, given the rise of part-time working and the exacting standards we expect.”

Last week, Edwards warned that the next few years would see “widespread hospital closures” as the NHS sought to save tens of millions of pounds.The Department of Health said: “We’re helping the NHS cope with increased demand by recruiting more staff, with 9,100 extra doctors and 11,200 more nurses on our wards since May 2010.”

Meltdown. Living with increased risk in Maternity, Paediatrics and Neonatal Health…. and in Ambulances

Making rural hospitals sustainable – It is both quality hospital doctors and GPs we are short of… Please don’t be tempted to reduce standards..

Child health care: adequate training for all UK GPs is long overdue