Monthly Archives: January 2017

For “prioritizing” read “rationing”. Billions needed to rescue unsafe NHS, doctors warn. The safety net is holed…

It is going to get worse and worse. The failure to care for the elderly and to fund the UK Health Services responsibly is evident. For prioritization read rationing: The safety net is holed… Those who fall through wont be voting on the future of their health service..

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Chris Smyth reports in The Times 31st Jan 2017: Billions needed to rescue unsafe NHS, doctors warn

Thousands of senior doctors have told the prime minister that the NHS is unsafe and failing patients.

Doctors are “handcuffed and paralysed” by the limits of a health service that does not have enough money to do what patients ask of it, they said in a letter to Theresa May.

“We have reached unacceptable levels of safety concerns for our patients within the NHS and simply cannot continue,” more than 2,000 consultants and GPs said in the letter, published in The BMJ.

They urged Mrs May to pump billions more into the service to bring spending up to the levels in France and Germany. The intervention has focused attention again on the deepening rift between Downing Street and the NHS following a public spat on spending with the head of the health service this month. Simon Stevens, chief executive of NHS England, told MPs that Britain spent 30 per cent less per person on health than Germany and accused Mrs May of stretching the truth by saying that she had given the NHS more money than it needed.

A government spokesman said: “We have invested £10 billion in the NHS’s own plan to transform services and improve standards of care and recently announced almost £900 million of extra funding for adult social care over the next two years.”

More patients forced on to mixed wards

Heart failure patients face same death rate as 1998 (Heart failure is very difficult to treat effectively to secure better long term outcomes)

‘Loneliness’ commission launched in memory of Jo Cox

NHS patients are demeaned by mixed sex wards – Jane Merrick Opines

Cashstrapped councils leave families to care for the elderly – Chris Smyth

Families will have to step in as more older patients are denied help with washing and dressing, councils have warned. A cash crisis will leave local authorities unable to meet their legal duties to older people under reforms introduced three years ago, they said.

Ministers need to admit that older people will be given only limited help as there is no more money available, according to the Local Government Association (LGA). It fears legal challenges from people who say councils are not meeting an obligation to ensure their dignity and wellbeing.

Cuts to council budgets have meant hundreds of thousands of older people lacking help with everyday tasks and NHS leaders have complained that hospitals are filling up with elderly patients who have been allowed to fall ill and cannot go home safely.

Izzi Seccombe, of the LGA, said that pledges to the elderly were “in grave danger of falling apart and failing, unless new funding is announced by government for adult social care”.

She said councils would increasingly have to prioritise the least mobile people who could not cope without carers at the expense of those whose lives are improved by extra help…..

TRAIN WreckProtest while you can – Dead patients don’t vote. Rationing in action…  (Feb 2015 – 2 years ago!)

Is it irony? NHS birthplace hospital ‘should be knocked down’

In a possibly unintentional play on words, the BBC report could be seen as a parody of the ideology of the UK Health Services which has not been revisited since Aneurin Bevan’s time.

cropped-05-04-11-steve-bell-on-th-0041.jpgChris Wood for BBC News reports 28th Jan 2017: NHS birthplace hospital ‘should be knocked down’

A building key to the formation of the NHS is a dangerous eyesore and should be knocked down if no use can be found for it, some residents have said.

Tredegar General Hospital shut in 2010 and the health board that owns it is trying to find “the best way forward”.

Blaenau Gwent AM Alun Davies called it a key part of local history and said it must be saved.

Aneurin Bevan was its management committee’s chairman in 1928 – 20 years before founding the NHS…..

…The hospital opened in 1904, with construction paid for by wages of local iron and coal workers.

Its creation was the vision of what became the medical aid society – which was considered far in advance of any similar initiative as it gave sick pay, medical benefits and funeral expenses to its 3,000 members.

Between 1915 and 1933, Walter Conway – considered a mentor to Bevan – was its secretary.

By the time he finished, it was supplying the medical needs of 95% of the local population, employing five doctors, two dentists, pharmacy dispensers and a nurse.

In a nod to how it inspired him, when he set up the NHS, Bevan said: “All I am doing is extending to the entire population of Britain the benefits we have had in Tredegar for a generation or more.

“We are going to Tredegarise you.”

Fifth of new medicines to be rationed – NHS cost-cutting raises fears for patient safety

There are some services which are much better than drugs and medications. NHSreality has always advocated more psychologists, and if we have to choose between drugs and people treatments we should opt for the latter, except in overt psychoses. It is reasonable rationing, but it is covert, and it will increase the health divide if the rich buy private provision. NHSreality feels it would be better, fairer, and more honest, to ration the high volume cheaper drugs than the low volume high cost ones.

Chris Smyth in The Times reports 19th Jan 2017: Fifth of new medicines to be rationed – NHS cost-cutting raises fears for patient safety

A fifth of new drugs will be rationed under tighter NHS cost-cutting plans, meaning that patients will suffer longer delays for medication.

Sufferers of cancer, diabetes and asthma could have to queue for treatment as health chiefs are handed powers to restrict access to medicines to save money, even if they have been ruled cost-effective by doctors.

Drug companies say that they will no longer launch drugs early in Britain if bureaucrats are given power to stop them from reaching patients for purely financial reasons. Campaigners warned that the plans would put Britain further behind the rest of Europe in offering cutting-edge therapies and more people would die while waiting for medicines.

At present patients have a legal right to be treated with drugs that have been ruled good value for money by the National Institute for Health and Care Excellence (Nice). Medicines that cost less than £30,000 for a year of good quality life are usually approved.

In the autumn The Times revealed plans to impose an extra affordability test on all medicines in an attempt to control NHS budgets that are under exceptional pressure. From April this year, even if Nice approves drugs, NHS England will be able to delay making them available or restrict who is eligible for treatment if the total cost to the health service is more than £20 million a year.

Analysis by Nice and the pharmaceutical industry shows that 20 per cent of newly approved drugs — expected to number about 12 a year — will fall into that category.

In recent years, for example, a cholesterol drug given to 160,000 people at risk of heart disease and a “breakthrough” prostate cancer treatment could have faced delays or restrictions. No drug to treat rarer diseases such as Duchenne muscular dystrophy would have been approved under the plans, the industry believes.

Phillip Anderson, of Prostate Cancer UK, demanded the scrapping of “catastrophic” changes that he said would mean patients dying while they waited for treatment to be made available. “A budget impact threshold has the potential to throw the brakes on the most effective new treatments and technologies just before they get to patients,” he said.

“It is unacceptable to put in place an open-ended ‘blank cheque’ for NHS England to request a very lengthy delay.”

Baroness Morgan of Drefelin, chief executive of Breast Cancer Now, said that the move would be devastating to cancer patients who were relying on new drugs to stay alive. “We are hugely concerned that the £20 million budget impact threshold would be a massive setback for access to new cancer drugs in England,” she said.

“With one in five new drugs set to be delayed by the proposed cap, we fear this country really could be left behind in access to the newest and best treatments.”

Patients can arrange to pay privately for drugs not available on the NHS but they must also meet staff costs and are told to go elsewhere to be treated.

NHS England says that the fifth of drugs caught by the new measure cost about £400 million a year compared with £125 million for new drugs below the threshold. Despite an existing £11 billion cap on the total NHS drugs bill, it argues that limiting who can receive new drugs will avoid the need to cut other services to pay for them.

The dispute comes after a rift over money opened up last week between Theresa May and Simon Stevens, the chief executive of NHS England. He publicly accused the prime minister of “stretching” the truth about NHS funding and “pretending” that cash shortages were not affecting patients.

Richard Torbett, of the Association of the British Pharmaceutical Industry, said that many patients would face delays of up to four years in getting common medicines. “Almost anything that’s in primary care — diabetes medicines, respiratory medicines, if there is anything for Alzheimer’s disease — would have a large number of patients even if the price is very low and it would trigger this new process,” he said.

Last year the NHS imposed caps on how many patients could be given transformative new drugs that can cure Hepatitis C to keep the annual cost to £200 million.

Mr Torbett said the industry was willing to negotiate phased introduction of medicines that would cost more than £100 million a year, but questioned the motivation for setting a £20 million figure. “For those really exceptional cases like Hepatitis C, where there’s an obvious challenge, then fair enough. But when it comes to one in five new medicines it starts to be another barrier for patients,” he said.

The change was partly motivated by fears that if a breakthrough dementia drug emerged, it could cost the NHS billions of pounds. George McNamara, of the Alzheimer’s Society, attacked the plan as a “short-sighted attempt to patch up a system that’s haemorrhaging cash”. It risked “cutting away the future hopes of people with dementia when they are most in need”.

He added: “There are potentially life-changing dementia drugs in the pipeline but they are likely to come in over the proposed threshold and the thought that they could still be rationed irrespective of whether they are cost-effective is really disturbing.”

NHS England declined to comment.

TREATMENTS UNDER THREAT
Prostate cancer
Abiraterone, used by an estimated 2,000 men.
Cost:
£43 million a year

Heart disease Ezetimibe, used by estimated 159,000 people.
Cost:
£52 million a year

Diabetes Lucentis, treats vision loss caused by diabetes, used by 1,200.
Cost:
£22 million a year

Skin cancer Pembrolizumab, thought to be used by just under 1,000 patients.
Cost:
£48 million a year

Source: ABPI

Mental health now area of most public concern within NHS

The Inefficient English Health Service is compared with the German one. Hypothecated Taxation with choice of provider?

We all know it’s going to get worse pending honest politicians willing to debate ideology with Mr Stevens and the Media. Meanwhile suggestions for better systems are being discussed in closet situations.. This suggestion is most welcome, and particularly in Wales where choice has disappeared, or Northern Ireland where abortion is so hard to access. The NHS crisis is spiralling out of control.. (Chris Ham in The Times 12 months ago) and The NHS desperately needs cash or it won’t survive, says former GP and Tory Health Minister Dan Poulter (The Sun 2w ago).

In The Times letters 30th Jan 2017: NHS EFFICIENCY

Sir, With the NHS under intolerable pressure, and many independent commentators ranking our system well below many others, we should examine what makes other systems fairer with better outcomes.

Many European countries have systems that are funded through hypothecated mandatory health insurance, but people ask, how does this differ from our own national insurance? The answer is that health insurance allows the insured to choose a provider, and the system reimburses that provider. With 70 per cent of healthcare costs being attributable to staff, reducing costs depends on using staff more efficiently.

In the UK, we have created the world’s biggest monopoly employer to provide 95 per cent of healthcare, and we feed that monopoly by largely barring all others providers regardless of their efficiency. As a consequence, the German healthcare system, which allows plural provision, employs many fewer staff for 80 million people that the NHS employs for 60 million.

The future of our healthcare system depends upon better use of limited resources. Cutting the number of hip operations (report, Jan 27) may save on the metal hip, but if all the staff remain in the expensive PFI building, little will be achieved.

Adam P Fitzpatrick Consultant cardiologist and electrophysiologist, Mottram-St-Andrew, Cheshire

An epidemic of nationwide bullying. In most dictatorships this precedes dissolution or breakdown….

Political collusion to neglect…? If the Regional Health services were companies they would be bust and run by the reciever

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

This mismanagement of the NHS amounts to neglect

It’s nonsense. A £22Bn “black hole”! Management by incompetence.. Even a ghost could do it better.

Denial extends to the generic management solution – “Troubleshooters will be sent into struggling NHS regions”

Health services pay structures. Inequity and long-term mis management. Strikes and comparisons with politicians…

“Appalling care” in Gloucestershire hospitals due to mismanagement, warns whistleblower

Candour and Transparency? – what a farce

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

General Practice is “a house of cards….”

Changing the rules of the game

Trying to defuse some of the invective against NHS managers.

 

 

Doctors are open to change – given time to think about implications

It is not just doctors who need time, but also politicians and patients and media. Unfortunately they do not have the time… It’s going to get worse..

The Sheffield Telegraph Reports: Doctors are open to change – given time to think about implications

Ninety per cent of NHS patient contacts are said to occur in primary care. GPs manage the tasks of being physician/healer, friend/advocate, resource-finder, and gatekeeper. That is why we value them although we know that different GPs will prefer some roles to others. But in 10 years time the GP and primary care systems may look very different. How will this be decided?
Many politicians, both national and local, seem unaware of how deeply the NHS crisis affects general practice. Indeed some consider that since Labour’s 2004 GP contract upped GPs’ pay and conditions and exempted them from routine out-of-hours duty, GPs have been sitting pretty, with many able to afford to go part time. That contract helped to improve GP recruitment, especially among women doctors, but it also contributed to the increasing difficulty of seeing the GP of one’s choice and led to a steady decline in public satisfaction in the NHS GP patient survey (though satisfaction remains high). However Downing Street’s suggestion that the crisis in NHS hospitals is down to GPs not offering a Sunday service smacks of ignorance and desperation. Recent trials (including in Sheffield) suggest lowish demand for Saturday afternoon surgeries and even less for Sundays. The truth is that we’ve actually been going to see our GPs much more often in the last 15 years and recent research suggests a 15 per cent increase in consultations between 2010/11 and 2014/15. GP numbers grew by only 4.75 per cent (much less than hospital doctors) and practice nurses by 2.85 per cent. Funding for primary care as a share of the NHS overall budget fell from 10.6 per cent in 2005/6 to 7.2 per cent this year but the costs of maintaining a practice and keeping to regulations have risen. Last year some practices, including those working in the most deprived areas, had their income reduced. The small increase offered by Hunt by 2020 will barely make up for this. Pressure on GPs and their staff is also fuelled by generally higher expectations, by having to keep up to date with new developments and technologies, by the erosion of other sources of patient support, particularly through cuts to local authority services and the benefit system, plus the administrative failures of Capita’s newly privatised support services. Overall GP job satisfaction is at its lowest since 2001. GPs are leaving the service or retiring. Few current GP trainees contemplate working full time. Practice staff are becoming harder to recruit. In Sheffield 30 per cent of practice nurses and other support staff are over 55 and the ratio per patient is the lowest in South Yorkshire. Good patient care is further complicated by difficulties in liaising with other services, including hospitals and social care. Last year’s Challenge Fund initiatives in Sheffield found that lack of liaison caused significant problems for both GPs and patients and a promising improvement scheme was abandoned because the private sector social care partner could not adjust its structure to meet the flexibility required. Most GPs in Sheffield are said to be genuinely enthusiastic for changing working practices to provide a better NHS service – provided they can find the time to think about it! Sheffield’s developing primary care strategy seeks radically to change the way we seek help for health problems, relying on our willingness to see other health care professionals rather than going first to the GP. It casts GPs both as medical generalists and clinical leaders for neighbourhoods. By getting services to work together, it hopes to help tackle demand for health care and significantly to reduce hospital admissions. We’ve heard such overly hopeful NHS-speak before, going back at least to 1996. Changes like this will only happen after an open and public renegotiation of the balance of the key elements of NHS care (including some transfer of funding from hospitals). No politician or party has yet felt confident about taking this on, not least because both efficacy and public acceptability have yet to be tested. Moreover, at the moment there just isn’t the right level or mix of staff. Some important local proposals depend on gaining transformation funding from NHS England. But much will depend on exactly how primary care is organised in the future. But more radical moves may be under way. The local Sustainability and Transformation Plan (STP) talks of running most local health care under an Accountable Care Organisation. This proposal is problematic in itself, but the ACO, probably hospital-centred, could easily decide to subcontract neighbourhood care not to GPs directly but to organisations which employ GPs – just like the contracts Virgin Care has elsewhere. So most if not all GPs would become salaried employees and indeed nationally 27 per cent already are. This would be a very different type of service. General practice matters to us all; its future needs discussion. The CCG and Sheffield Healthwatch need to take this on, as well as political parties. We need to join in too, as well as keeping up pressure on the Government to protect the NHS as a whole. Try joining your surgery’s patient participation group – and check it’s linked with the new CCG-sponsored network of similar groups.

SSONHS will also be supporting the national march for the NHS organised by Health Campaigns Together in London on March 4. Visit Our NHS and Sheffield Save Our NHS for details.

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Dont say we didn’t warn you… Nursing levels are going to get worse….

Chris Smyth reports in The Times 27th Jan 2017: Staff crisis grows as foreign nurses abandon the NHSDon’t say we didn’t warn you… Nursing levels have led to a locum bonanza, and are going to get worse…. We are undercapacity – whether it’s for your lawn or an operation…

European nurses are giving up on the NHS, with the number arriving to work in Britain down more than 90 per cent since the Brexit vote.

A total of 101 EU nurses registered last month, down from 1,304 in July, according to figures from the Nursing and Midwifery Council (NMC).

More European nurses are also leaving, prompting fears that Britain may be seeing the start of an exodus of the staff who have kept hospitals running in recent years.

Hospitals are already struggling to find enough qualified nurses, with tens of thousands of vacancies and many wards dangerously understaffed.

Hospitals turned to the EU after a damning report into the Mid Staffordshire scandal four years ago warned against cutting staff to save money. Recruiting missions were dispatched to Spain, Greece and other countries to increase the numbers of their citizens working in the NHS.

There are now 38,661 EU and European Economic Area (EEA) nurses registered to work in Britain, up from 16,798 in 2013.

However, since the referendum last June and with the introduction of tougher language tests last year, there has been a dramatic fall in new arrivals. In 2015-16 9,388 EU nurses came to work in Britain but the number arriving has fallen every month since July.

Janet Davies, chief executive of the Royal College of Nursing, said: “If this is the beginning of a long-term drop in the number of nurses coming to the UK from other parts of the EU, that’s a serious concern at a time when we’re already facing a crisis in nurse staffing numbers. With 24,000 nursing vacancies across the UK, the NHS simply could not cope without the contribution from EU nurses.

“We need a guarantee that EU nationals working in the NHS can remain. Without that, it will be much harder to retain and recruit staff from the EU, and patient care will suffer as a result.”

In December 318 EU staff left the nursing register, up from 177 last June, meaning 331 fewer working in Britain than in September.

Jackie Smith, chief executive of the NMC, said: “This is the first sign of a change following the EU referendum and it is our responsibility as the regulator to share these figures with the public.”

English language tests were toughened last year for newly arriving nurses. Only 453 application packs were requested last month compared with 3,697 in January 2016, the month before test requirements were raised.

Paul Myatt, of the hospitals’ group NHS Providers, said: “This is an early warning sign and needs to be monitored closely. There is already a high nursing vacancy rate in many parts of the country so if this drop-off continues over the next few months it would definitely be concerning.

“Members are saying to us that Brexit has created uncertainly for staff who are already here at the same time as trusts are finding that the EEA pool of nurses is increasingly depleted.”

Jeremy Hunt, the health secretary, told MPs earlier this week that it was a priority to guarantee the right of European NHS staff to work in Britain “forever”, but Theresa May has refused to offer assurances pending a deal on the status of Britons living in Europe.

Earlier this month official figures revealed that almost every NHS hospital has too few nurses on the wards, with warnings that patients were going unwashed, unfed and untreated because of a lack of staff. Analysis found that 96 per cent of 214 hospitals failed to meet their planned level of nurses during October day shifts, up from 85 per cent two years ago.

Efforts to replace them with home-grown nurses were dealt a blow last month when universities said applications for nursing degrees fell 20 per cent last year. Ministers scrapped bursaries and required nursing students to take out loans for their courses, arguing that this would lead to 10,000 more places.

Recruiting foreign nurses ‘frustrating and expensive’: British Nurses should cash in on the bonanza

How to cause disenchantment with those who are badly needed – Brexit will make things even worse for staffing levels..

Health services failure will make Brexit look cheap….

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

 

There is no rationing.. ? !!

The Telegraph 267th Jan 2017:

The Telegraph September 2016:
The Telegraph 9th Aug 2016:
The Express 12 days ago:
The Daily Mail:
The Standard 6 days ago:
The Times today:

Patients will be refused hip and knee replacements unless they are in so much pain that they cannot sleep or go about their daily lives, under the latest NHS rationing plans.

Health chiefs in the West Midlands are using a scoring system designed to assess patients’ illness to reduce hip operations by 12 per cent and knee replacements by 19 per cent. The move is intended to save £2.1 million a year.

Very obese patients would be refused surgery unless they could show that they had lost 10 per cent of their body weight or were in danger of losing their independence, the Health Service Journal revealed.

The Royal College of Surgeons (RCS) said yesterday that the “alarming” cost-cutting plans would inflict needless suffering on patients. It said that thousands of people were falling victim to arbitrary denial of treatment.

About 160,000 hip and knee replacements a year are carried out by the NHS in England and Wales and the figure is rising by about 8 per cent annually as the population ages. The prostheses replace joints worn by age or damaged by conditions such as arthritis.

Most patients are elderly but the number of replacements provided in people aged under 60 has increased by 76 per cent to 18,000 during the past decade. Better surgical results and more durable implants mean that joints can be replaced in younger people without the need for operations to be redone after 15 years. Doctors also say that younger patients are less willing to wait for surgery than in the past.

Stephen Cannon, vice-president of the RCS, said that the decision to restrict access to NHS care, based on arbitrary pain and disability thresholds, was alarming.

“It is another example of how the huge financial strains the NHS is under are directly affecting patients. It is right to look at alternatives to surgery but this decision should be based on surgical assessment, not financial pressures.”

He added that the savings estimate “overlooks the longer-term impact on patients of delayed treatment, prolonged pain and potentially higher costs of treatment. For example, patients affected by these changes may require additional pain relief medication and may still require surgery further down the line.”

Redditch and Bromsgrove, South Worcestershire, and Wyre Forest, the three local health groups implementing the plans, hope to avoid 350 operations a year. Paul Green, from Saga, said: “To suggest that it is acceptable for people to have to wait until they are unable to sleep before they are eligible for an operation is an outrage. How would these people feel if that was their mother or father or grandparent?”

Three years ago the RCS found that 44 per cent of local clinical commissioning groups required patients to be in various degrees of pain before surgery, against advice from the National Institute for Health and Care Excellence.

NHS Redditch and Bromsgrove Clinical Commissioning Group said: “The Oxford scoring system is a guidance for clinicians and they recognise that many patients will benefit from physiotherapy and weight loss before considering surgery. If a patient feels that they require this surgery but do not meet these criteria, there is a clear appeals system via individual funding requests.”