Monthly Archives: September 2016

In the National Interest we need to establish financial control…

Two recent news items reveal the denial of the inability to manage the finances in the 4 health services. The reality is that NHS England, Scotland, Ireland and Wales are all bust and broken, and the prospect of a realistic saving mechanism is remote. Keep hold of your Private Insurance Policy if you have it, especially where waiting lists are longest and choice is most limited. Look at the graph and imagine the situation in another decade.. Class resentment will be evident once the different life expectancies sink in.. (Is your lifespan more than a postcode lottery? – BBC News)

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Jonathan Morris reports 28th September 2016: NHS negligence claims hit £1.4bn

NHS trusts in England paid out more than £1.4bn in medical negligence claims last year compared to £583m in 2008, analysis shows.

The NHS Litigation Authority (NHSLA), which handles claims on behalf of trusts, said it was trying to reduce the costs.

It blamed big rises in claims and legal costs from claimants.

Lawyers said the costs would not exist if the NHS had not been negligent and accused it of delaying claims.

More on the clinical negligence claims story, plus more Devon and Cornwall news

The figures include defence and claimants’ legal costs which can vary depending on who wins or loses and emerged from analysis by the BBC of NHSLA data.

The NHSLA covers health trusts for claims by taking money from them every year based on what the expected payouts will be, so as payouts rise so do premiums.

The Times and The Independent report on the £46m which is paid to staff on suspension

We need no fault compensation, and caps on redundancy fees which are withheld if another job is made available within a year in the same organisation

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Patient complaints hit a ‘wall of silence’ from NHS – No fault compensation would help change the culture…

Litigation – The rising tsunami is swamping us all.. NHSreality lists all the posts on litigation in the two years of existence. NFC (No fault compensation) is essential.

Class resentment is coming..

Image result for rising tide cartoonUpdate 30th September: Boss resigns at troubled health trust (over improper re-employment)

Southern Health NHS Trust boss Katrina Percy resigns (and is re-employed in advisory role)

Henry Bodkin in the Telegraph reports 30th September 2016: Anti-GP ‘banter’ hindering recruitment into general practice, top doctor warns

 

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What’s the cost of care in your area? Find out using your post code..

What’s the cost of care in your area? From the BBC Website..

As we live longer, many of us will need support in our old age. But few of us know how much an hour of homecare costs, or the fees charged in residential and nursing homes, and whether the local council will help foot the bill.

This guide can help you understand the social care system for people aged 65 and over, as well as the costs involved, wherever you live in the UK.

Enter you Post code on the BBC website and be informed about what the state will finance for you in your area.

Where did the data for the project come from?

A variety of different sources were used. In England NHS Digital supplied the data on council-funded care home and nursing home places. The United Kingdom Homecare Association, devolved governments and healthcare analysts LaingBuisson were the sources for some of the figures relating to self-funded care, while BBC freedom of information requests to local councils have been used to find a lot of the other data.

How accurate are the figures for home care?

The figures showing the number of hours of care and the cost of that care are averages. As such they can only give an indication of the hours of care available as individual circumstances will vary.

How accurate are the figures for residential care and nursing homes?

The figures showing a weekly breakdown for residential care and nursing home care are averages. As such they can only offer an indication of the costs people may face, as individual circumstances can be very different from the average findings for the group as a whole, particularly if someone has complex care needs or dementia.

How were those figures calculated?

The figures that offer a weekly cost breakdown for residential care and nursing home care for England are taken from NHS Digital. Data from freedom of information requests was used for the rest of the UK. For England, the total amount of money contributed by each council’s population towards their care was calculated as a proportion of the total care budget. Once the proportion was worked out, it was then used to create a weekly figure in pounds and pence to show how much a council contributes to each person’s cost of care compared with the contributions paid by the people using the service. This figure was based on the unit cost information supplied by each council to NHS Digital. The same method was used for the rest of the UK, but the data was sourced from individual councils through freedom of information requests.

Why are some of the figures missing for my area?

Data has not been available in full for all the council areas in the UK. This is because much of the data has been collected through freedom of information requests and not all councils were able to reply.

Public relations advice on “making difficult decisions” from the Department of Health to Commissioners and Trust Boards

A new report “Making Difficult Decisions” has been launched by NHS Clinical Commissioners in collaboration with the University of Birmingham, and is heralded in The Times by the headline “How to close hospitals” (not on line), and is about how to broach hospital closures with the public. It says “active engagement, consultation and nurturing trustworthy relationships” are vital….. In retrospect, in Pembrokeshire which rejected a new build 7 years ago, a majority of the profession would support it now, seeing what the alternative has been. Would anything have been different if this report had been 10 years earlier?

Download Making Difficult Decisions PDF

Image result for difficult decision health cartoonIf rationing is accepted as a “policy” and a pragmatic need in view of the advance of science faster than our ability to pay, then we can start the discussion about the options for “how” to ration acceptably.

 

 

Unhappiness all over the 4 Health Services. Party conference collusion in denial.. Resignation letters from GPs?

There is ongoing and increasing unhappiness in the Health Services sector. Peter Carter in The Times believes “The BMA has shot itself in the foot over the doctors dispute” as “a loaded gun is more effective than a fired gun.”.

Despite the government (“Tories call for £400m investment in GP services” – Andrew Liddle 31st August 2016) promise of more funding, the report from Iona Twaddell in Pulse 28th September “GPs to be asked to submit undated mass resignation letters”, and in Belfast today: GPs in Northern Ireland urged to hand in resignation letters over ‘escalating crisis’ in primary care

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Neil Roberts reported on a further privatisation of services in June 2015: Capita awarded £400m GP support services privatisation deal and then they made a predicable mess of it: Tony Collins in Campaign for change reported 7 days ago: Capita and NHS England apologise after continuing problems on £330m contract

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Delayed and incorrect payments for a profession with low morale and a rapidly increasing overhead is not a recipe for goodwill. The minimum wage may be a good thing, but in businesses such as health where the main overhead is staff salaries and wages there will need to be a large increment to allow for increasing wages.

With all political parties in denial regarding Health, as evidenced by the statements from the main party conferences, (conservatives yet to come) the Liberals are unlikely to gain ground, despite their calls for lower class numbers, help for students, and call for another referendum. Many doctors are natural Liberal voters, but without an agenda for excellence in education and health they are unlikely to vote Liberal.

Will this Brexit offer get the Lib Dems back in game?

Chris Smyth reports 28th September 2016 in The Times that that “Nursing whistleblowers ‘will be told to keep quiet’ so they too are unhappy.

The patients are also unhappy. A new report “Making Difficult Decisions” has been launched by NHS Clinical Commissioners in collaboration with the University of Birmingham, and is heralded in The Times by the headline “How to close hospitals” (not on line), and is about how to broach hospital closures with the public. It says “active engagement, consultation and nurturing trustworthy relationships” are vital….. In retrospect, in Pembrokeshire which rejected a new build 7 years ago, a majority of the profession would support it now, seeing what the alternative has been. Would anything have been different if this report had been 10 years earlier?

Download Making Difficult Decisions PDF

JennyAm in the Stoke Sentinel asks 26th September 2016: Personally speaking (Tristram Hunt): ‘Who is accountable for health rationing?’, which shows a naïve denial and expectation of “Everything for everyone for ever”!

On 11th February 2015 the Health Department published “Culture change in the NHS”. Both we and they have a long way to go..

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‘Immoral doctors play system’ to see NHS patients in private

The way to stop Private Medicine is to provide an overcapacity of doctors, physiotherapists, dentists etc. The less the capacity (nationally) the more the Perverse Incentives to behave as described. When there is severe undercapacity, choice is only available privately… And of course the Post-Code lottery gets worse for those furthest from specialist care. Many consultants are now less than full time, allowing them to do more private care…

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When Gabrielle Swerling reports in the Times 21st September 2016: ‘Immoral doctors play system’ to see NHS patients in private

NHS consultants are “morally bankrupt” for dragging out appointments so that hospitals are forced to pay them to see patients privately to hit targets, claims an NHS manager.

The accusation came amid a row over plans to make NHS consultants reveal their private earnings to prevent conflicts of interest.

The Royal College of Surgeons has told its members not to be caught on the wrong side of an NHS drive towards greater transparency. “Patients rightly have a huge amount of trust in the medical profession and this guidance will help doctors to act appropriately,” said Clare Marx, the college president.

Lord Winston, the fertility pioneer, however, defended private medicine as medical colleagues promised “fierce resistance” to revealing their earnings.

The Times reported yesterday that NHS clinical staff would have to reveal details of income from private work under plans to ensure that they did not put personal interests before the NHS.

Sir Malcolm Grant, chairman of NHS England, said that private work could no longer go “under the radar”.

About half the 46,000 NHS consultants are thought to do private work.

An NHS manager in Greater Manchester said that consultants saw half as many patients in their NHS clinics as they saw in private, forcing managers who were under pressure to hit waiting targets to pay private rates.

“A lot of consultants will come and complain about not being able to see patients in a timely manner but will only do additional sessions at higher-enhanced rates via their private practice,” he said. “So they put pressure on management to pay them privately and that is morally bankrupt.”

In a letter to The Times, Lord Winston warns against seeing private work as a threat to the NHS. “When we were improving IVF, our private patients were academically important,” he writes. “Not only did their fees go to support NHS research, these patients were an important research resource for many advancing treatments.”

Chris Hopson, of NHS Providers, said: “We should have clear, consistent and effective approaches to managing conflicts of interest”.

•Patients are at risk because NHS wards are operating without enough doctors or nurses, according to a survey by the Royal College of Physicians. Seven in ten junior doctors say they work on permanently short-staffed wards, with more than half claiming that this has an “extremely serious impact on patients”. Andrew Goddard, of the college, said: “It is clear to all of us working in the NHS that we are at a point of no return.”

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Five million children failed to see a dentist in past year..

In many health care systems the access to a dentist is one of the key performance indicators. Prolonged lack of dental care can lead to heart disease and Rheumatic Fever may be going to stage a UK comeback in the next decade. Patients fail to book appointments at a dentist for many reasons, but chaotic lives lead to missing appointments, and the appointment system is designed for the people with organisation skills. Walk-in dental surgeries would be appreciated by some of these families, but is it worth it when most of them fail to recognise the damage in sweets and sweet drinks..? A universal tax on sugar would help… As it is in childhood that good dentition is laid down, those adults who cannot get an NHS dentist have to pay… What proportion of the country’s adults is now private? Rationing by undercapacity in dentists has led to a dangerous situation.. The way to control a profession is through overcapacity: same as medics.

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On September 24th 2016 the Times reported: Five million children failed to see a dentist in past year

More than four out of ten children have not visited a dentist in the past year and the figure is rising.

A total of 42.1 per cent of under-18s — almost five million children — did not visit an NHS dentist, up from 40 per cent the year before, data from NHS Digital shows.

From 2014 to 2016, 48.3 per cent of adults also did not go to a dentist.

NHS guidelines state that children should visit a dentist at least once every year. Adults might not need to go for up to two years.

More than four million teeth were extracted by NHS dentists in the past year. Among adults, there were 3.1 million extractions, with 917,346 performed on children. Extractions were most common in south Tyneside, with one for every six children and adults. At the other end of the scale was Richmond upon Thames, with one extraction on the NHS for every 39 people.

Geographic Distribution of Pediatric Dentists in Private Practice…

THE FUTURE OF DENTISTRYDental Economics

Dental Statistics and participation Scotland

NHS England General Survey Information 

….

8. The following graph (figure 1) shows the overall survey population breakdown of dental behaviour.
nhs-appointments-2013
1 Other reason includes: “I no longer have any natural teeth”, “I haven’t had time to visit a dentist”, “I’m on a waiting list for an NHS dentist”, “NHS dental care is too expensive”, “Another reason”.

9. Nationally, just under three fifths (58%) of all respondents stated they had visited an NHS dentist in the last two years. Of the remaining, 10% didn’t try to see an NHS dentist because they stated they “didn’t need to go” or “don’t like going” and 8% didn’t try because they prefer private dentistry.

10. The distribution of the different responses varied across the regions, suggesting there are specific areas with the different Regions to focus on to improve access to NHS dental services.

11. London has the highest proportion of those who have not tried to visit an NHS dental in the last 2 years for because they stated they “didn’t need to go” or “don’t like going (15% of all respondents), suggesting a lack of knowledge on oral health in this region is a particular issue.

12. South of England has the largest proportion of those who stayed with their dentists when they moved from NHS to private (at 9% of all respondents) and also the highest proportion who prefer private dentistry (with 11% of all South of England respondents).

13. North and Midlands and East of England have similar access trends, with a much higher use of NHS dental services than South of England and London (just over 60% of all respondents, compared to 54% of the South and 51% of London respondents). …

Open Wide – The system for dental care is letting patients down. Regulatory gaps need filling and dentists seem to agree..

Getting to see a Health Service physio – like getting to see a health service dentist

Dentistry now outside the Health Services for most of the nation

NHS Dentistry

How do politicians of all parties maintain that the NHS is free at the point of delivery? Dental care is certainly not..
Dentistry is full of perverse incentives

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Easier tests for Nurses. The irony of “never compromising” patient safety, whilst reducing standards…

If anyone was in doubt about the reduction of standards, here is evidence from the Nursing world. Equally damning evidence would be available from retiring consultants, if only they had exit interviews. The obsessive use of private providers is dumbing down the training of doctors. The irony in Linda Holland’s statement is self evident. Good communication, both in consulting with patients and in the written/computerised notes is essential in medicine. Rationing their pay, and the number of places, and insisting on degree academic courses, rather than practical skills based training for nurses is the cause.

Whilst Student nurses face tougher tests for course places – 31 May 2011:    in the Nursing Times the result has been a shortage. Now, to fill the gap Catherine Read reports in The Mirror: “English Language Test for Nurses is made easier as only 4% pass exam”.

In the Times (Not on line) the report reads “Easier test for nurses”.

The score needed to pass language tests for foreign nurses working in Brritish Hospitals has been lowered after only 8 out of 220 Filipina nurses passed at the Royal Wolverhampton NHS Trust. The Trust blamed the “painful” English test for an acute shortage of nurses. Under the new system more than half the nurses would have passed. Linda Holland, from the Trust, stressed “We will never compromise patient safety in any way”.

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