Monthly Archives: December 2016

Happy 2017: …politicians’ ‘persistent, blinkered denial’ – Say no to a post-truth health service

Mark Porter is the eloquent Chairman of the BMA and his robust attitude contrasts sharply with that of the RCGP. In the BMA News his new year message opines: “Say no to a post-truth health service” and the full message is emphatic, but does not recommend overt rationing. The RCGP new year message on 29th December is pathetic: “General practice running on ‘professionalism and goodwill’ to cope with winter pressures, says RCGP”.  Neither the BMA (tough) nor the RCGP (pathetic but honest ) is prepared to open the debate on the underlying ideology of our 4 health services. While this remains things will only get worse and more unequal.. Many in the professions feel there is a conspiracy to kill off the health services… actually it is ineptitude, and ‘persistent, blinkered denial’ .

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Doctors must resist a ‘post-truth’ health service, BMA council chair Mark Porter has warned in his New Year message to members.

Dr Porter writes that an approach that relegates the importance of facts and evidence is harmful to patient care and does nothing to address the long-term sustainability of the NHS.

He cites politicians’ ‘persistent, blinkered denial’ of the grave financial pressures facing hospitals and GPs. The BMA’s analysis of England’s 44 sustainability and transformation plans has uncovered a total of £26bn in cuts to health and social care over the next five years, and yet ministers speak only of efficiency savings or ‘bumps in the road’.

Dr Porter writes that, with social care under intense pressure, thousands of patients are suffering delayed transfers of care, which can threaten both their own health and the ability of hospitals to give them optimal treatment.

His New Year message finds similar pressures across the UK, such as in Northern Ireland, where GPs are considering submitting undated resignations.

An uncertain future for doctors

Dr Porter writes: ‘We need a Government that is willing to own its share of the challenges, not one that is obsessed with owning the headlines.’

He calls on the Government to take responsibility for the damage it has caused to doctors’ morale, and to the thousands of overseas-trained doctors facing an uncertain future after the EU referendum in June.

He points out the many consequences of an under-funded health service, such as the recent report of a five-fold increase in patients waiting for more than four hours after emergency admission.

‘The beds they are waiting for have been taken away in the name of cost cutting and efficiency. According to the OECD, the UK has fewer than half the beds of France and a third of Germany’s, per person – a difference in magnitude that cannot be explained away on definitions.’

 Neglected responsibility

One key area where the Government is neglecting its responsibility is in ‘providing a working environment for junior doctors in which they have confidence’. He says the Government’s decision to impose a contract in England that is opposed by a clear majority of junior doctors is a ‘self-defeating squandering of goodwill on an unprecedented scale’.

Recent surveys from the GMC and Royal College of Physicians had found junior doctors were left demoralised, sleep-deprived and forced to miss essential training.

He said junior doctors working under the contract should use the new system of exception reporting to raise any instance where their actual work varies from what they are scheduled, and paid, to do.

‘This has the potential to be a safeguard and an early warning system, and shock employers or the Government out of any delusions about working hours to which they may succumb. The more that junior doctors use it when their hours are in variance, and report those inconvenient truths, the more effective it will be.’…..

BMA News 13th December 2016 also tells the public: Collapsed hospital merger costs ‘eye-watering’ £10m. Such a sum would have delayed the inevitable in General Practice, but not stopped it happening. The health divide and health inequalities are rising, as those who can afford it go privately.

Neither the BMA nor the RCGP is prepared to open the debate on the underlying ideology. While this remains things will only get worse..




Is the NHS going to break in 2017? It is already – just that some may not know it

Nick Triggle for BBC news 29th December 2016 asks “Is the NHS going to break in 2017?”.

I have bad news for you: as far as most citizens are concerned, but also GPs, Nurses and Consultants, Paramedics, Physiotherapists and other disengaged staff, your local health system already broken. It is beyond the point of rescue because of the lack of sufficient staff to meet the oncoming tsunami of demographic survivors with multiple and complex problems. An unrepentant Michael Gove opines in the Guardian.. Meanwhile Rational Rationing is derided – because it is covert, post coded and divisive. Rationing of staff such as GPs and Doctors means access is becoming more problematic (RCGP Chairman, Helen Stokes-Lampard) , and this will encourage private General Practice and increase the health divide. Perverse outcomes as a result of perverse incentives….. Add to the demands the litigation costs , the dishonesty of politicians, and the problems are out of control..

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The past few months – if not the whole year – have seen a constant stream of warnings about impending Armageddon in the health service.

We have heard how the system has reached various levels of crisis from “tipping point” and “breaking point” to “on the brink of collapse”.

But is it really that bad? And if so, what can we expect in 2017?…

….The frightening thing for ministers – and in particular the Treasury – is just how much cash the NHS is swallowing. Over £130bn is spent on the health service across the UK. In England, the budget was increased by 4% in real terms this year.

But still it hasn’t got enough. Hospitals continue to rack up deficits. And while the NHS will undoubtedly still manage to balance its books by year end in March because of surpluses elsewhere, the prospects for the next financial year are much gloomier.

The 2017-18 year will see a much smaller rise in the budget – under 1% once inflation is taken into account.

That – to borrow a phrase from former Manchester United boss Sir Alex Ferguson – really will be squeaky bum time. Yes you can always argue the Treasury will step in and provide more funds, but no area of government spending has had as generous a settlement as the NHS. Tough questions will be asked and cuts will undoubtedly have to follow….

At a time when the population is ageing you would think more and more people would be getting help. But the opposite is true. The number of over-65s being helped has fallen by over a quarter in the past five years. This is seen as critical, because the cuts have been linked to the rising numbers of older people turning up at A&E. The care system and NHS are – it is argued – two sides of the same coin.

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The government has already tried to take action. Before Christmas, ministers announced that councils would be able to raise council tax more quickly than had been planned. But the jury is out on whether this will actually lead to that much more money being invested in services.

Brexit campaigner Michael Gove defends NHS funding pledge – Tory MP says £350m-a-week promise remains robust and renews argument that economic experts must be challenged

Sarah Boseley in the Guardian: Breast cancer drug rejected for NHS use on cost-benefit grounds

Senior GP Helen Stokes-Lampard voices fears for services ·

Anna Behrmann reports in the Express 18th December: NHS lines up £56billion of budget to pay for legal costs of negligence cases – THE NHS has set aside almost half of its entire budget to cover compensation payments and legal costs, it has emerged.

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Mr Hunt lives on hope rather than reality… Litigation is on the increase.. Will he become the hunted?

If he really believes the “Petersfield Herald” headline he is living in hope rather than reality. It was a fatal flaw to allow citizens to take their pensions as drawdown, rather than as annuities, if government wants individuals to be less reliant on state subsidy for their elderly care. Given that litigation is on the increase, and there is no “no-fault” compensation scheme,  operations are delayed to record levels, and the general staff crisis (retention and morale), things look set to get worse. Perhaps the Hunt will become the hunted..

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Hunt hopes for better NHS care reports on Xmas day:

HASLEMERE MP and Health Secretary Jeremy Hunt set out his position on key town concerns and his hopes for 2017 in an interview last Friday – including Surrey County Council’s “social care crisis” – following our report that Tory leader David Hodge had called on the county’s 11 Conservative MPs to lobby for far more central government funding to ensure the local authority can care for vulnerable residents.

Mr Hunt responded: “I know it is an exceptionally difficult situation and I have a great deal of sympathy for Surrey. Both David Hodge and his deputy leader Peter Martin have kept me fully informed of the precariousness of the situation.

“As Health Secretary, I am aware of the key issues facing the county. Whatever the pressures, we have to make sure we look after our most vulnerable residents.

“I appreciate the three per cent increase just announced by Communities Secretary Sajid Javid is a step in the right direction.

“But our Prime Minister Theresa May has said we need to make fundamental changes in the long term.

“People will need to save for their social care much as they do for their pension as many are finding social care a considerable expense in the last years of their lives.

“One of my hopes for 2017 is to find a solution to the social care issues in Surrey.”

Stroke patients face “fatal” delay

Waverley borough councillor Robert Knowles has condemned an “interim” NHS measure operation that will see people with suspected strokes taken to Frimley Park Hospital and St Peter’s Hospital, Chertsey, from January 9, as potentially “fatal” due to a toxic combination of slow ambulance response times and longer journeys.

Mr Hunt said: “Robert Knowles is a formidable campaigner. But in the bigger picture the NHS is saving more lives by improving stroke care by making services more centralised.

“It may take people a little longer to get there but they will get better treatment as consultants will be available 24/7 treating multiple stroke victims.

“It’s better for people in Haslemere to be treated in a hyper acute stroke unit and get the latest treatment around the clock.

“The issue is more about ambulance response times and the geographic area Haslemere is in, which is a particular problem for South East Coast Ambulance Service.

“It’s very important when this change goes ahead that people can have absolute confidence there will be priority for the most serious cases, of which stroke is one. It does depend on getting to a hospital quickly.”

‘Community hospital expansion on hold due to cuts’

Mr Hunt said: “There is increasing pressure on A&E departments and we need to make sure there are places to discharge people to.

“For people in the town, Haslemere Hospital is ideal and people discharged there are much more likely to recover more quickly.

“I think Haslemere Hospital has a bright future as it is very important for the community and it is fantastically convenient it has a GP surgery on site. It’s a model hospital.

“This is a challenging period for the NHS because there is so much additional demand.

“In the long term, NHS reforms will be agreed to enhance community care.”

Waverley’s Draft Local Plan to build 10,000 houses by 2032

Mr Hunt said: “I have mixed feelings about the increased housing target, as someone who grew up in a Surrey village.

“But I have changed my mind in recent years because I have met so many Haslemere residents whose children and grandchildren are unable to get on the housing ladder.

“We need more houses but it has to be done in a sustainable way with appropriate development in the infrastructure.

“If we don’t build more homes, much of the area will become impossible for our young people to live in and that would be a huge shame.

MP’s hopes for 2017

Mr Hunt said: “2016 has seen massive change both nationally and internationally with a new prime minister, a new relationship with Europe and a new American president.

“My hope is we resolve the things that really matter to our country and bring our country back together again afterwards.

“It’s important we implement what the British people decided but we need to do so in a way that maintains our position as the world’s greatest trading nation, open to ideas from all over the world.

“With my NHS hat on, I would like to thank my brilliant staff. Many in Haslemere are working over Chrsitmas and they have never worked harder than they do now because the pressure of an ageing population is increasing demand for NHS services.

“One of the things I hope for is to tackle better social isolation and the loneliness of people living on their own. We have some brilliant local voluntary organisations who work to do just that. We need to support them.”

Harry Kretchmer  for BBC news 23rd December reports: NHS claims lawyers ‘unacceptable’

The Daily Telegraph reports: Record number of cancelled urgent operations in NHS hospitals

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Health Services (England) dentistry “for sale”.

We all know dental care is becoming less and less equitable, and private care is dominant in many areas. Eagle Radio News reports 26th December 2016: Southern Dental tycoon launches fresh effort to sell NHS supplier

The tycoon behind the third biggest provider of NHS dental services has launched a fresh effort to sell his business months after abandoning an earlier auction.

Sky News understands that Dr Mazdak Eyrumlu, who founded Southern Dental a decade ago, has asked bankers at DC Advisory to find a buyer for the company, which he values at up to £100m…..

…”Our overall revenue mix of 74% NHS and 26% private has enabled us to grow our NHS commitment and at the same time maintain and grow our private income,” the company said.

“The group’s income continues to be principally from long-term fixed NHS contracts with NHS England.”

Private equity firms including Capvest and Graphite were among the parties with which Southern Dental held talks during its aborted auction in 2014.

A number of the UK’s biggest dentistry providers have attracted private investment over the last decade, including Oasis Healthcare, which was backed by the investment firm Bridgepoint before its recent sale, and its larger rival MyDentist, which is owned by Carlyle.

Southern Dental could not be reached for comment on Friday

If the NHS really is the envy of the world, why don’t countries copy it?

Mark Littlewood from the Institute of Economic Affairs asks 20th December in the Times: If the NHS really is the envy of the world, why don’t countries copy it?

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As Christmas wishes go, mine is pretty modest. Of course, a complete end to war, disease and famine across the globe would be wonderful. But if I can’t have that, maybe I can have something that should, in theory, be a little easier to achieve. I just want an open, grown-up and serious debate about whether we are absolutely sure that the NHS truly is the best healthcare system known to mankind.

I confess to being something of a sceptic. My gut instinct tends to be that we have at least as much to learn from the rest of the world as we do to teach it. So I would probably enter the discussion from a minority position.

Indeed, defenders of the status quo make some truly spectacular claims. According to David Cameron, the National Health Service is “one of the greatest achievements of the 20th century”. Aneira Thomas, the first person born under NHS care, insists it is the “envy of the world”, a sentiment apparently supported by 56 per cent of the UK population in opinion polls.

If these assertions are even half-true, they raise a rather awkward question. Why haven’t our European neighbours sought to replicate our cherished system? They have had 68 years to stare in wonder across the English Channel, turning an ever more fluorescent shade of green as their jealousy over the sheer brilliance of the NHS overwhelms them. Yet not one leading European country has taken our blueprint and copied it. Are these foreigners incredibly stupid, amazingly callous or just too bone idle to embrace a great idea when they see one? Alternatively, have they studied the facts and decided that they are much better off with the more market-orientated, less centralised healthcare policies each of them has chosen to adopt?

A glance at the statistics suggests that Johnny Foreigner isn’t as dim as some might think. Presumably, a useful starting point is to judge how good a system actually is at preventing people from dying.

If we could somehow replicate the survival rates from common forms of cancer that they manage to achieve in the Netherlands, nearly 10,000 fewer Brits would die each year. If we could get as good as the Germans, we would save about 13,000 lives annually. If we could somehow aspire to understanding whatever magic health formula the Belgians have stumbled upon, we could get that figure up to 14,000. That’s the equivalent of saving the entire population of Bolton every decade merely from improved cancer treatment. Looking at survival rates overall, the UK is about on a par with the Czech Republic and Slovenia, countries where average income is less than half of ours.

It is true that affluent western European countries tend to spend a little more than the UK on healthcare. But, crucially, they spend it in different ways. They run insurance-based systems and allow for competitive markets and even — horror of horrors — profit-making. The Dutch have no state-owned hospitals, no state hospital planning and no taxpayer subsidies to any hospital. In Germany, less than half of hospitals are run by the public sector. The Belgians even sometimes require a modest payment to see a GP. To different degrees, but across the board, competition in providing the best healthcare is encouraged.

Crucially, all these countries manage to guarantee universal healthcare coverage. The poor are not left without quality treatment. The fear that they might be seems to be behind much of the love for the National Health Service, but such concerns are misplaced. Through a mixture of means-tested subsidies and compensation schemes, the Europeans seem able to ensure that every citizen is properly covered.

Just because you want the state to guarantee access to something does not mean that the public sector needs to be the actual provider. We want to ensure everyone in Britain has access to food, but that doesn’t mean it is sensible to nationalise Tesco, Waitrose and Asda. Neither does our desire to ensure that all people can be clothed lead us to conclude that Marks & Spencer, Next and Debenhams should be amalgamated into a single company and then run by a Whitehall ministry. Yet we seem to have a blind spot when it comes to health, assuming that a gigantic government industry with 1.5 million employees is the best way to go.

The trick, of course, is to make sure that everyone is given the wherewithal to enable them to participate in the marketplace and then let the wondrous dynamics of competition weave their magic in providing high quality at an acceptable cost. In the healthcare arena, it is a trick that our continental neighbours are much better at performing than we are.

On an individual level, it is understandable that so many Brits feel warmth towards the NHS. Ourselves, and our loved ones, will very often visit a doctor or a surgeon with a health problem and find through the brilliance of medicine and the diligence of highly trained professionals that we are swiftly cured. Even if the worst happens, we console ourselves that medical experts gave it a really good shot. We don’t stop to ask whether the treatment would have been better if we lived in, say, Berlin or Rotterdam.

My Christmas wish is that we should start asking ourselves exactly that and in an unsentimental and clear-headed fashion. It might be comforting to kid ourselves that we have pioneered and maintained the greatest healthcare system on the planet, but that doesn’t make it remotely true. To believe that the centralised, state-run National Health Service is the best possible mechanism for curing the sick and keeping people alive is simply at odds with the facts.

Indeed, it’s about as far from reality as believing that a plump, bearded man on a reindeer-driven sleigh has left all those presents under the tree.

Mark Littlewood is director-general of the Institute of Economic Affairs

Sir, Mark Littlewood is to be congratulated for introducing a degree of reality into the debate about the NHS (“If the NHS is the envy of the world, why don’t any European countries copy it?”, Business, Dec 20). Is it really beyond our politicians to set aside party differences and establish a far-reaching and independent commission to examine the health and social care needs of the UK over the next 30 years? Such a commission should examine how care is successfully delivered and funded elsewhere, and ask searching questions as to whether we can reasonably expect the NHS and local government to match the best that is available, or if different delivery and funding solutions are needed.

Will Lifford

East Keswick, W Yorks

Sir, The elevation of our NHS to “holy cow” status is over-simplistic (letter, Dec 22). By the same token, Mark Littlewood’s article treats the NHS as a business, equating it to food supply and clothing. Surely the clue is in the title — it is a service not simply a business. That said, this is not the same as regarding it as a sacred cow. As a large, complex organisation there are doubtless areas that can be (and are being) improved without abandoning the principle of universal healthcare. Having this year been diagnosed for a second time with cancer I have been extremely grateful that during all this time, with five operations, six weeks as an in-patient, six weeks of radiotherapy and countless tests and clinics, I have never once had to worry once about my ability to pay for this excellent treatment.

By contrast, during my working career I lived abroad in a number of countries, notably the US, which did not have a comparable healthcare system, and where the ability to pay was a very real issue.

The time we should really worry is when the first question you are asked when visiting your GP is not “what is your date of birth?” but “what is the long number on your debit card?”.

John Young

Richmond, N Yorks

Sir, Mark Littlewood concludes that “To believe that the centralised, state-run National Health Service is the best possible mechanism for curing the sick and keeping people alive is simply at odds with the facts”, yet puts forward few facts to justify this assertion. The “factual evidence” he provides is a comparison of the extent of expected live expectancy in various countries after diagnosis and treatment for cancers. He notes that if the NHS could replicate the performance of the Netherlands, Germany and Belgium, death rates would fall and up to 14,000 fewer Britons would die each year. The UK, he says, “is about on a par with the Czech Republic and Slovenia, countries where average income is less than half ours”.

What he omits to say is that life expectancy as a whole is lower in Germany, Denmark and Belgium than in the UK; that these countries spend a higher proportion of their GDP on healthcare than the UK does; and that life expectancy in Slovenia and the Czech Republic is significantly lower than that achieved by Britons.

Alexander Johnston

Syston, Leics

Sir, Mark Littlewood asks questions that need answering, but J Wesley Harkcom (letter, Dec 22), along with many politicians, seems not to understand why the public are so loyal to the NHS. In 2014-15 the NHS gave superb care to my wife in her terminal illness, all the way through the ambulance service, Truro A&E, the neurological surgery unit at Derriford in Plymouth, the multiple services provided by Truro hospital, the neurological rehabilitation unit in Hayle, St Austell Hospital, Mevagissey surgery and the many Cornwall social services who, together with the NHS, enabled my wife to stay at home, enjoying life to a remarkable extent, until her death.

Anecdotal evidence suggests that our very good experience is common. This explains the public’s loyalty to the NHS. Misunderstandings get in the way of the sensible debate suggested by Mark Littlewood, who understands this loyalty.

Gerald Hingley

St Austell, Cornwall

At Christmas we should take a break from pessimism, just for one day. But the truth is out there..

National Inequality is becoming routine. NHSreality expects patients to have different rights of services in different areas of the country. The failing system in denial is the BIG issue for the new year. Have a Happy Unequal one. Philip Collins opines on 23rd December in The Times: Never forget that we live in the best of times – There has been much to mourn in 2016 but by almost every measure the world is becoming wealthier and fairer

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His health paragraph reads: “The world once again got healthier in 2016. A WHO report showed that, since 2000, global malaria deaths have declined by 60 per cent. Since their peak a decade ago, AIDS-related deaths have fallen by 45 per cent. The world is getting closer to cracking maternal mortality, which has fallen 44 per cent since 1990. Infant mortality has halved over the same period. Worldwide, people can expect an extra seven years of life compared to a relative born in 1990. Liberia was officially cleared of ebola in 2016, the last case of the deadly tropical virus in West Africa. The WHO announced that measles has been eradicated in all the Americas, from Canada to Chile. In April, the WHO said that polio could be wiped out within a year. The incidence of malaria is falling all over the world. In wealthy countries, colon cancer, dementia and heart disease are all waning.”….

and ends: “At Christmas we should take a break from pessimism, just for one day.”

In letters on 24th December:


Sir, In his article “Never forget that we live in the best of times” (Comment, Dec 23), Phil Collins omits to mention the bad news in disease control. The World Health Organisation reported a marked increase in cases of tuberculosis in 2016, particularly of drug-resistant strains. Few people realise that TB now kills more people than Aids and that almost half a million HIV/Aids sufferers actually die from TB annually. TB is clearly the forgotten plague that is creeping back at our peril.

Professor Peter Davies

Secretary TB Alert, Liverpool Heart and Chest Hospital

In letters December 18th:

Fears over access to cancer drug
AS A consultant oncologist and the chairman of Beating Bowel Cancer’s (BBC) medical board, I am deeply concerned that we are returning to the situation in the NHS where patients have to fundraise or use their own assets to pay for drugs (“AA Gill, giant of journalism, dies aged 62”, News, and “AA Gill faces up to his cancer”, Magazine, last week).

The Cancer Drugs Fund initially allowed patients in England with bowel cancer access to many of the new chemotherapies widely available in much of Europe and North America. These agents were then steadily removed. This is tragic, especially since patients in Wales and Scotland will have free access to some of them.

It cannot be acceptable that in a 21st-century NHS, patients must have to pay privately for a drug that can extend their life. The National Institute for Health and Care Excellence (Nice) is reviewing continued access to two bowel cancer drugs that are presently available. I do hope it listens to patients and oncologists in England and says yes.
Dr Mark Saunders, Consultant Oncologist, Chairman of BBC medical board

Mark Littlewood trumps all this with his article on December 20th 2016: If the NHS really is the envy of the world, why don’t countries copy it?

—- which deserves a separate posting.

Patients suffer in GP funding lottery. Ager and civil unrest to follow?

We all know that there is a funding lottery throughout the different UK Health Regions. It’s not just GP services, but cancer and waiting times/lists, psychiatry, infertility, terminations of pregnancy and many other areas. The author has missed the point: that this is endemic. Patients and their families do not know what is not available until they need it. Then it may be too late and since the politicians don’t care nothing will be done in the near future.. NHSreality predicts anger and civil unrest to come as the safety net fails..

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Chris Smyth reports in The Times 22nd December 2016: Patients suffer in GP funding lottery

Patients wait longer to see a doctor in many areas because some surgeries get a few pence for each registered patient while others receive thousands of pounds.

An “unjust” postcode lottery in funding for GP practices is forcing thousands of people to take appointments with nurses or go without extra services, such as home visits or diabetes checks, doctors and campaigners say.

Official figures analysed by The Times show a 93,000-fold variation in how much surgeries received last year for each person on their books, but the data give no clear reason why.

One practice in Romford, east London, was given £1.74 for each of its 2,608 patients last year as it merged with a neighbouring surgery. A mile away a second practice received £188 for each of 3,949 patients. Payments also varied regionally, from £240 in north Norfolk to £113 innorthwest Surrey. According to the analysis of data from NHS Digital, 731 practices got more than £200 a patient and 387 received less than £100. The average is £143.

At the extreme end of the scale, Shooters Hill Medical Centre in south London got £40,503 for its only registered patient in 2015-16, but the Leagrave Road Medical Practice in Bedfordshire received 43p for each of its 1,119 patients. Both have now closed. Shooters Hill treated many unregistered patients, including the homeless.

The variation has been condemned by patient groups but health chiefs are struggling to find a fairer allocation, amid fears that some surgeries could close if funding were changed.

Katherine Murphy, chief executive of the Patients Association, said: “There is no excuse for it. In parts of the country some patients will get a fantastic service from GPs but if they live 20 miles down the road the same service doesn’t exist. It’s an unjust system and the way it’s allocated needs to be looked at so that it’s not a postcode lottery.”

Most GP funding comes via a central formula that allocates extra money to surgeries with large numbers of elderly or deprived patients, or those that dispense medicines themselves. However, most of the variation does not seem to be explained by sicker patients and doctors say that discrepancies have built up over time as an unintended result of an arcane funding system.

…political “unsayables”. Behind closed doors nearly every politician admits that the current system for paying for health and social care is decades out of date.

Mayday Mayday – for the Health Services: Hospital faces charges over Caesarean tragedy. Dead patients dont vote.

Dead people don’t vote… End-of-life care ‘deeply concerning’

The NHS and reckless election promises. How about posthumous voting?

Child cancer results improving. In a “cradle to grave” Health Service we are not doing badly at cradles.. but we are doing badly as patients approach their grave.

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

NHS is heading for financial meltdown – but nobody seems to care!

Growing old without dignity – The middle classes and the ‘left behind’ will unite in anger if the government can’t devise a way to pay for social care

Nursing degree applications fall by a fifth – a two tier service is evolving by neglect.. State basic, and Private enhanced.

Most of the doctors feel that Nursing took the wrong course when they tried to push through the degree increments and “Agenda for change” demands in the first decade (2004) of the century. GPs as self employed businesses resisted most as our funding was not future proofed. Those who capitulated are regretting it now. Stephanie Jones-Berry reports in “Primary Health Care”.and Greg Hurst reports in The Times 17th December: Nursing degree applications fall by a fifth despite the Agenda for change”  This decline is a disaster for those of us in our sixties and seventies who hoped for the quality of nursing care our parents received. Continuous neglect, rationing of training places in medicine, and over borrowed nurses-in-training, and Agenda for change has led to government preferring to hire nurses and doctors from abroad, at cheap rates of pay, rather than train our own, with whom patients have cultural affinity and good communication.

A two tier service is evolving in Medical and Nursing care, by neglect: state basic, and private enhanced. It would be better this change was managed and overt..

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Applications for nursing degrees have fallen sharply since the government withdrew their funding via bursaries and forced students to pay for their courses with loans.

Universities said last night that applications for nursing, midwifery and allied health courses were down by about 20 per cent compared with this stage last year. In some institutions applications have halved.

Shortfalls in applications were worse in London and the southeast, among mature candidates and in specialist fields such as learning disability nursing, occupational therapy and podiatry. There are fears that some small courses may become too expensive to run if numbers dip too low.

It is too soon to judge if the fall will mean fewer student nurses starting in September next year but universities are considering contingency plans to avert a shortfall in nursing graduates, including accelerated two-year postgraduate nursing courses.

Vice-chancellors are planning a campaign with health bodies to encourage more people to train as nurses, which is likely to run well beyond the normal deadline for university course applications next month to encourage candidates to make late submissions or apply through clearing in the summer.

Some caution is needed with the figures as the Universities and Colleges Admissions Service says year-on-year comparisons are complicated this year because calendar dates mean we are two or three working days behind last year’s cycle, and university applications generally are running behind last year’s figures. But the drop in applications for nursing, midwifery and allied health subjects is twice that of other courses, according to a survey by the vice-chancellors’ body Universities UK (UUK).

Ministers claimed that ending the bursaries would create 10,000 more training places, as costs are met by students taking out loans rather than direct government funding. It would be an embarrassment if numbers fell.

Janet Davies, head of the Royal College of Nursing, said her organisation had consistently raised concerns to the government that its decision would result in a drop in applications. “Our advice fell on deaf ears. The government went ahead in gambling on the future of the nursing workforce,” she said.

Steve West, vice-chancellor of the University of the West of England and chairman of UUK’s health policy network, said that the numbers were down. “We want to ensure . . . we get the right message out that there are fantastic career opportunities in nursing.”

Vice-chancellors say that mature students are likely to find it harder to take on a student loan of £27,000 to fund their degree and worry that potential student nurses may not fully understand that they will only start repaying once they earn above £21,000.

A Department of Health spokesman said that it was too early in the application process to predict reliable trends, adding: “We are committed to increasing the number of training places for homegrown nurses, as well as making sure there are more routes into nursing including through apprenticeships.”

The RCN is concerned the effects on the future workforce will be exacerbated by Brexit and an ageing population.

To date many midwives and nurses have not been able to “demonstrate they can communicate effectively”. Communication and cultural barriers in health acknowledged. Litigation results..

In an undercapacity market who can blame the nurses or doctors? £190m is “comeuppance” for politicians. NHS nurse recruitment from EU ‘too aggressive’!

Not enough nurses or doctors? Or are we just inefficient? The situation is a disgrace and a scandal, and needs a war like atmosphere of honesty to address it…

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…

Not enough doctors – just keep lowering the bar & reducing the funding

A third of A&E doctors leaving NHS to work “in a non toxic environment” abroad


Will you be more likely to die with a male doctor? Patients less likely to die if doctor is female…

The report by Kate Gibbons in in The Times and other newspapers on 20th December 2016 is an interesting read, and it has statistical power. “Patients less likely to die if doctor is female” is reprinted below. The study needs to be reproduced in the UK’s 4 services, where junior doctors are mainly female, and see if it applies. Justification of the bias in selection would be retrospective, and some consolation to those on waiting lists. If they do get admitted they are at least more likely to return home.

Image result for female doctors cartoon

Yusuke Tsugawa was the original author in JAMA Internal Medicine October 13th 2016, and the article has free on line access. There were over 1.5 million patients analysed for nearly 60,000 physicians. The gender distribution of the physicians is not mentioned, but as they have graduate entry we can assume it is equal male to female, (unlike the UK where undergraduate entry results in 80% females).  The report is about internal medicine and there is a readmission rate of around 250K patients in 30 days. The potential total lives saved in the USA would be 32K if this is valid and reliable, and is accounted for by a difference of 4% in outcomes. It says nothing about quality of life, cost, or future care needs.

Elderly hospital patients treated by women doctors are less likely to die than those in the care of men, research has indicated.

A study found that people aged 65 and over who received hospital care from a male doctor had an increased risk of dying within 30 days.

Female doctors were less likely to flout national care guidelines and had better communication with patients.

The study, published in the journal JAMA Internal Medicine, was the first to examine how gender differences could affect mortality rates.

Analysis of more than a million patients aged 65 and over who had been in hospital for a variety of conditions, including diabetes, cancer and heart failure, found that those treated by a female doctor were on average 4 per cent less likely to die prematurely than those with a male doctor.

The researchers at Harvard University found that the differences were most significant for patients who had more severe conditions.

Yusuke Tsugawa, the study’s lead author, said: “The difference in mortality rates surprised us. The gender of the physician appears to be particularly significant for the sickest patients.”

Image result for female doctors cartoon


In a media led society, how do we tell the “hard truth” – Mr Fillon seems to have failed

A sensible pledge to “pledge to farm out minor health costs to private insurance “…… Readers might not think this is important but the lesson applies to the UK. Although we do not have layered insurance systems, we do have one universal system. In a media led society, how do we tell the “hard truths” such as on health. Rationing overtly is going to get harder, more punitive, more expensive and more regressive as the denial continues – Mr Fillon seems to have failed in persuading the French that they cannot have Everything for everyone for ever, and any ridicule would be better directed at the media and political opponents. Encouraging autonomy in minor health expenses is essential. The safety net should be there for the big, fearful, and expensive things..

In The Times 19th December Charles Bremner reports: Ridicule for Fillon after healthcare cuts retreat

François Fillon, the conservative favourite to win the French presidency, has been forced on the defensive after fumbling an attempt to retract a pledge to cut funding for basic healthcare.

The Republicans party candidate bowed to public outrage, deleted his pledge to farm out minor health costs to private insurance from his website and denied that he had ever made it.

“Never did I want to, or would I want to, ‘privatise health insurance’,” the former prime minister said. Until Tuesday, his campaign site said: “I propose focusing universal public insurance on serious and long-term illnesses, and focusing private insurance on the rest.”

The volte-face from the rural MP drew ridicule from his centre-left opponents and fuelled doubts about his credibility in a centre-right camp worried that his “Thatcherite” plans were alienating voters.“It’s hard to fathom just what he is saying at this stage,” said Marine Le Pen, the National Front candidate, who mocked Mr Fillon’s U-turn and said that his plans for cutting social security cover made her feel sick. “I hope it will pass quickly because I’m told digestive troubles are among the ‘small ailments’ that would no longer be covered.”

An Odoxa survey showed that nine out of ten respondents opposed cutting public spending on health.

“This programme is worrying, intimidating and confusing,” said Marisol Touraine, the health minister.

Mr Fillon has also been criticised for his support for President Putin.

Manuel Valls, the former prime minister, who is likely to become the Socialist candidate next month, said that Mr Fillon’s move was a cynical one. “Mr Fillon’s manifesto consists of less independence for France in the face of Russia and hard prospects for the French with the basics of our social model cast into doubt.”

Polls suggest that Mr Fillon is best placed to win the election against the far right and a fractured and discredited left-wing camp, but a survey yesterday showed that he was not liked by a majority of the public.

An Ifop poll for Le Journal du Dimanche suggested that 55 per cent believed that he would win the election but only 28 per cent wantedhim as president. His biggest support comes from the over-65s, who are 50 per cent behind him. Of the respondents, 62 per cent were worried by his promise to cut welfare cover.

Many voters, including many from Mr Fillon’s own party, described him as an out-of-touch, upper- middle-class country dweller who did not understand their problems.

Mr Fillon has spent the past two weeks trying to rally support from his former rivals, Alain Juppé and Nicolas Sarkozy, but they have not given him full backing. “The start of Fillon’s campaign has been a struggle. There’s no clear direction,” said one of Mr Juppé’s lieutenants. “The winning strategy can’t just consist of sitting on your favourite’s laurels.”

Natalie Huet reports on 19th December 2016: Lessons from François Fillon: How not to reform health insurance in France – François Fillon proposed dramatic reform for an overstretched health care system but has retreated bit by bit.

Jerome Chartier said ““One thing that got in the way is that we started to focus on details rather than on the most important … that social security is in deficit,””…

The Mailonline reports that the Fillon website was changed to delete the suggestion that healthcare insurance should be partly privatised.