An “existential crisis”? – as civil unrest gets closer…

The meaning of peoples lives is important and includes a trustworthy health safety net…If NHSreality was able to speak sensibly and get an honest response from our political representatives we would ask for an open discussion on health to include three main requests aimed at addressing the disengaged culture, honesty, and standards. Commissioners cannot be blamed for the “rules of the game”, and it is natural for perverse incentives to occur in all systems, but they should be overt, and post code differences in safety net standards are not acceptable.

Image result for health punishment cartoon

  1. That the language of health be honest and include overt rationing. By this I mean that citizens are made aware, in advance, of what will not covered by their health service.
  2. That confidential exit interviews are offered to all Health Service staff by an independent outside body – reporting publicly in the general, and locally in the specific.
  3. That management powers be given to doctors to implement change, including the timing of meetings organised well in advance so that they can attend. This might well include the re-introduction of “firms” or “teams” when staffing levels allow (years ahead) (Hunt calls for NHS to be run by doctors and not managers – Fariha Karim December 1st). Doctors are avoiding managerial roles (BMJ 2017;356:j529) because they don’t believe they can follow the rules and win within this system.
    An “existential crisis”? – as civil unrest gets closer…
    6b792-stahlersafetynetChris Smyth reports 10th Feb 2017 in The Times: New NHS scandal is inevitable, Mid Staffs inquiry chief warns

The NHS faces an “existential crisis” and a repeat of the Mid Staffordshire hospital scandal is inevitable, the man who led the public inquiry into the trust’s failings has warned.

(.. existential crisis, is also a reference to Existentialism, but it is often used in a humorous or sarcastic way, to suggest that the person or people being described spend too much thinking about themselves and the meaning of their lives. )

Sir Robert Francis, QC, said the government could no longer pretend that the health service was coping. Pressure to cut costs would again lead to the neglect of patients, he added, and public confidence was at risk of collapse.

The warning comes in the midst of a winter crisis that has exposed a rift between NHS leaders and the government. Figures showed yesterday that waiting times in A&E units were at their worst for more than a decade and revealed missed targets on surgery, ambulance responses and cancer care.

Jeremy Hunt, the health secretary, described waits of up to 13 hours seen in parts of the country as “totally unacceptable” but said that the government’s plan would “take time to deliver”. He added that there were “no excuses” for cases where lack of social care places left elderly patients stuck in hospital for months.

Sir Robert said that the NHS was manifestly failing and dismissed savings plans as unrealistic.

His inquiry into the suffering of hundreds of patients at Stafford Hospital, published four years ago, concluded that bosses became obsessed with cutting costs and government targets at the expense of care. Frail elderly patients were left without food or water. It was one of the biggest scandals in the history of the NHS. Sir Robert told the Health Service Journal that ministers were again trying to ignore warnings.

“Politically, with a small ‘p’, the message is put out we are putting more money in the service than we ever did and it is the best health service around, but against that there is a frontline feeling that things have never been as bad as they are now and we can’t deal with the pressures,” he said.

Last month 60,000 people arriving at A&E had to wait four to 12 hours for a bed and a record 780 waited longer, according to data leaked to the BBC. Of 1.4 million A&E visits last month, 82 per cent were dealt with in four hours, below the target of 95 per cent, which has not been met nationally since summer 2015. Official figures on hospital performance in December also painted a bleak picture. By the end of last year, 376,877 patients had been waiting more than 18 weeks for surgery, 100,000 more than in 2015.

Theresa May responded by pointing to “record funding” and higher numbers of doctors and nurses. Sir Robert said: “We are told, ‘Oh, well we have got more nurses’ — no nursing director I have come across seems to agree with that and they can’t find them.”

In the interview, to be published today, he said: “Let’s make no bones about it, the NHS is facing an existential crisis . . . The service is running faster and faster to try and keep up and is failing, manifestly failing. The danger is that we reach a tipping point, we haven’t reached it yet, but there will come a point where public confidence in the service dissipates.”

Asked if the same mistakes that led to the Stafford hospital scandal could happen again, Sir Robert said: “I think it is inevitable.”

Last night Lord Carter of Coles, a government adviser on the NHS, admitted that hospitals were operating in a state of “war”. In a speech to the Royal College of Anaesthetists in London, he said that the health service was facing “a very, very difficult” time until 2020, adding: “Our hospitals are running so hot, and yet they haven’t broken. This is like being [in] a war actually and we should be extraordinarily proud of it. But you can’t continue on a war basis for ever, as we know.”

The Department of Health acknowledged that NHS staff were under pressure but said that, after the Stafford report, a record number of people were receiving harm-free care and that there would be “no return to the days of problems being swept under the carpet”.

In an interview with the BBC, Mr Hunt was challenged over conditions at Royal Blackburn Hospital, where some patients have been forced to wait up to 13 hours in A&E. He said: “It is incredibly frustrating for me. I am doing this job because I want NHS care to be the safest and best in the world. That kind of care is completely unacceptable. No one would want it for members of their own family.”

Presented with the case of Iris Sibley, 89, who has spent more than six months at Bristol Royal Infirmary waiting for a bed in a nursing home, he said it was “terrible for Mrs Sibley but it’s also very bad for the NHS”.

Mr Hunt said that other developed countries were struggling to care for an ageing population, adding: “It’s wrong to suggest to people that these profound challenges . . . are ones where there’s a silver bullet.

“We have a very good plan, it has the support of the NHS, [but] it will take time to deliver. In terms of immediate support, we’re doing what we can with extra financial support to the NHS this year.”

● Patients could be made to wait up to two years longer for new drugs after Britain’s expected departure from the EU’s pharmaceutical regulator, the government has been warned. Sir Alasdair Breckenridge, former chairman of the Medicines and Healthcare products Regulatory Agencies (MHRA), said companies would prioritise getting their drugs into the larger European and US markets and could be put off by Britain’s separate regulatory regime.

Jeremy Hunt, the health secretary, has said that Britain is expected to leave the European Medicines Agency. Departure is likely to mean that the regulator leaves its headquarters in London, where it employs about 800 people.

David Jeffreys, of the Association of the British Pharmaceutical Industry, said that British patients “may be getting medicines, 12, 18, 24 months later than they would if we remained in the European system”.

Doctors are avoiding management roles, says Hunt – BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j529 (Published 30 January 2017) Cite this as: BMJ 2017;356:j529

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This entry was posted in A Personal View, Gagging, Perverse Incentives, Post Code Lottery, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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