Monthly Archives: March 2017

NHS confusing public by using ‘gobbledygook’

In keeping with the BMA in Wales, Nick Triggle reports that “NHS confusing public by using ‘gobbledygook'” in the Times 28th March 2017.

The BMA Wales response to the Welsh Government was that we wanted “a clearer and more honest language” to be used in health. Needless to say this has not happened, and indeed NHSreality does not blame the Welsh politicians. The recommendation for “honest language”, along with “Exit Interviews” was buried deep within the BMA response ( Our health, our health service BMA response) to that part of the Green Paper , and did not appear in any bullet point summary. The rules of the game, for Commissioners (de-commissioners) will ensure that the language barrier remains. Therefore we need to change the rules. Both language and outcomes are going to get worse.. until we agree there has to be a cost.

Imagine the scene. Up and down the country, local NHS leaders are crowded into meeting rooms discussing information transfers and ambulatory care, when someone jumps up and shouts “I’ve had enough of sticky toffee puddings”.

Confused? You’re not the only one. The language being used by the health service is simply gobbledygook, says the Plain English Campaign (PEC).

Steve Jenner, the campaign’s spokesman, said the health service was riddled with “jargon” when it comes to explaining anything from the closure of hospital services to major incidents.d he even believes the NHS may be doing this on purpose.

“If you use impenetrable language it means the public has no clue what is going on. I can’t help thinking that suits the NHS sometimes,” he said.

“What this jargon is describing is very important. It should be articulated very clearly.

“We expect doctors to clearly explain themselves. It should be the same for the NHS management,” he added.

Sticky toffee puddings or important NHS plans?

STPs – dubbed sticky toffee puddings by some in the health service – are among one of the most important developments in the health service in recent years.

But you would never guess from the official name – sustainability and transformation plans.

However, the jargon goes further than that, according to the PEC. Look through most plans – there are 44 of them – and you will find some strange phrases.

Cambridgeshire and Peterborough’s documents, for example, talk about investing in “system-wide quality improvements” and developing a “shared understanding of all the interrelated issues”, while being able to learn “what it means to us as individuals and as organisations”.

Meanwhile, documents from North Central London shared the experience of one patient’s care that went wrong.

It says due to “hand-offs, inefficiencies and suboptimal advice and information transfers” the “patient’s pathway” went on for too long.

Another popular “pathway” is the ambulatory patient pathway. What does that mean? The patient can go home after being seen in hospital.

Is the NHS involved in a medieval battle?

Vanguards are a term used to describe the formation of a medieval army. But the NHS has also – ahem – deployed the term.

There are 50 vanguards that have been set up to test new ways of running services. They were created in 2015 and include schemes to get hospital doctors working in community clinics and to provide advice via video link-ups as well as the creation of super hubs in the community bringing together GPs, district nurses and council care teams.

You should not be surprised to hear evidence of what works best in the vanguard programmes will then be fed into the STP process.

But it’s not just in England where jargon can be found. Northern Ireland’s 10-year health strategy, published last autumn, promised to shift the focus from “treatment of periods of acute illness and reactive crisis approaches, towards a model underpinned by a more holistic approach to health and social care”.

Or, more simply, try to get people to live more healthily and give them better support to stop them needing hospital care.

Running hot or just busy?

Taps run hot, but so too, it seems, does the NHS. Commentators and health service managers have been using the phrase to describe just how busy hospitals and, in particular, A&Es were this winter.

It may be a bit of an odd phrase, but it is at least easier to understand than Operational Pressures Escalation Level Four.

That is the new name for a black alert – when hospitals get so busy they have to cancel non-emergency operations, divert ambulances and call in extra staff.

And guess what red alerts – the level down from black – were renamed? Yes, that’s right, Operational Pressures Escalation Level Three.

Guidance issued by NHS England last year ordered hospitals to use the new terminology when communicating with the public and media.

Not everyone obeyed. Newspaper coverage this winter was littered with reports of black and red alerts.

And what did NHS England make of this? They were unable to provide the BBC with a response.

The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

In Search of the Perfect Health System ( a new book reviewed )

The BMA response ( Our health, our health service BMA response) to that part of the Green Paper

 

 

Invidious options: to have to choose between fears is not necessary.

In Place of Fear (A Free Health Service 1952 Chapter 5 In Place of Fear), citizens are asked to choose between two fears: cancer or emergencies. Which is the greatest will be different for different individuals… As a 66 year old man my chances are greatest for Ischemic Heart Disease, but I have also had two cancers so I am at more risk of another than the average individual. As I get older I am at risk of a fracture, particularly fractured neck of femur, which in my case will be complex as I have had two hip replacements. There are strong arguments for individuals such as myself, living in a region (Wales) without choice, for moving near to a tertiary centre of excellence (teaching hospital). Does cancer care mean treatment as well as palliative and terminal care? The last two are mostly funded by charities… in the richer areas of the country. The life-years saved by A&E may be greater, but A&E deals with lower social classes who don’t vote… If the decision is left to patients we may not get the utilitarian result we need.. Hobson’s choice will of course be decided by administrators, as pithed politicians will sit on the fence. Given a choice, they must fund A&E properly (before cancers), but A&E is not where doctors compete to work… Such an invidious decision does not have to be made if we ration health care overtly. This is not as simple as the choices for an individual..

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Chris Smyth reports 30th March 2017: Patients must choose between A&E and cancer care, warns health chief

Patients must be told they cannot have routine operations quickly if they also want short waits for A&E, cancer care and other treatments, an NHS leader has said.

Simon Stevens, head of NHS England, is being urged to relax targets for waiting times as he prepares to lay out his reforms to the service today.

Niall Dickson, chief executive of the NHS Confederation, which represents all health service organisations, said that it was unrealistic to pretend that patients could have everything they had come to expect when money was so tight. “It’s not reasonable to say that all the current targets have to be met,” Mr Dickson told The Times.

“[Bosses] are on the one hand saying that mental health has to be a priority, elective care’s a priority, A&E’s a priority, cancer’s a priority and so on. Well, there’s got to be acknowledgement that some other things are not a priority.”

Mr Stevens is due to approve a structural upheaval of the NHS. It aims to better join up services around patients and to prevent illness. He has also signalled that he will spell out the financial pressures, threatening to resume a row with Theresa May over NHS funding.

Simon Stevens, head of NHS England, is being urged to relax targets for waiting times as he prepares to lay out his reforms to the service today.

Niall Dickson, chief executive of the NHS Confederation, which represents all health service organisations, said that it was unrealistic to pretend that patients could have everything they had come to expect when money was so tight. “It’s not reasonable to say that all the current targets have to be met,” Mr Dickson told The Times.

“[Bosses] are on the one hand saying that mental health has to be a priority, elective care’s a priority, A&E’s a priority, cancer’s a priority and so on. Well, there’s got to be acknowledgement that some other things are not a priority.”

Mr Stevens is due to approve a structural upheaval of the NHS. It aims to better join up services around patients and to prevent illness. He has also signalled that he will spell out the financial pressures, threatening to resume a row with Theresa May over NHS funding.

“If the money isn’t there you have to acknowledge that. It’s better to acknowledge that than to set up the system to fail,” Mr Dickson said. “It’s just unrealistic to expect the NHS to do everything and it’s unfair on patients and staff to pretend it can . . . It is disheartening, in any business, when a target is set that [staff] cannot deliver.”

The NHS is missing most of its main targets, including for A&E, routine operations, ambulance responses and cancer care. Jeremy Hunt, the health secretary, insisted this month that the target for 95 per cent of A&E patients to be seen within four hours must be met next year, despite January’s figure of 85.1 per cent being the worst on record.

Mr Dickson said: “If the government is absolutely set on, for example, A&E times and mental health, and I can see why they want to do that, then they should perhaps acknowledge that there are other areas where they could relax the targets a bit, which would allow the system to focus on those priority areas.”

Ministers have promised an extra £8 billion for the NHS by 2020 but Mr Dickson said that the “small amounts of additional money” fell well behind long-term average increases and left staff struggling to cope with rising demand from an ageing population.

He said that it was “absolutely right” to demand more savings but added: “We don’t think it’s reasonable to demand big financial savings on the one side, and on the other side expect no diminution of quality when demand is rising, without an admission that the NHS will have to prioritise some activities over others.”

Local health groups have been criticised for rationing services such as fertility treatments or barring the obese and smokers from surgery. Mr Dickson said that NHS England should back these decisions with “an honest admission that the service can’t do anything and that it’s reasonable to make decisions on the basis of priorities”.

•Only a quarter of people are satisfied with social care services, half as many as are satisfied with A&E, the least popular part of the NHS (Kat Lay writes). An annual report from the King’s Fund found that 63 per cent of people were satisfied with the NHS overall last year. Only 26 per cent were satisfied with local authority social care services, compared with 54 per cent who were happy with A&E

Pithed politicians collude in unsafe care, ministers told

Rationing in the NHS – The Nuffield Trust

Health professionals call for NHS Wales ‘vision’ by prospective parties. If you don’t have a choice in Wales, you can buy or game that choice….

When I am given the information (on survival), given the option, I will surely travel.

Chris Smyth reports 29th March 2017: Heart patients survive by dodging nearest hospital

This will not be good reading for those who are campaigning to keep local DGHs open, Ischaemic Heart Disease is a big killer, and is unexpected for many people. Despite the evidence from Denmark, and other sources, patients may prefer to die younger and have a local option for care. The problem is the limited resources, and utilitarianism. To fund the periphery adequately means fewer resources for the centre. When all the stakeholders are taken into account the centralisation of care is the only rational option. Although “Small is beautiful” for many low profile services, it is the giant mutual which brings the greatest dividends in health, technology, and survival. Ghandi’s Swardeshi is all very well…, but when I am given the information, and the choice, I will surely travel.

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Heart patients who are taken past a local hospital to a specialist unit are up to 45 per cent more likely to survive, a study has concluded. Even patients who had to travel long distances were better off in a hospital with high-tech treatments, according to research that boosts the case for centralising NHS care.

Doctors increasingly believe that concentrating complex care in fewer, specialist centres is better for patients but have struggled to make it happen amid protests about downgrading local hospitals. Danish researchers looked at data on 41,000 patients who suffered cardiac arrests outside hospitals.

Only 9 per cent were still alive 30 days later but the 29 per cent who went direct to a specialist heart centre were 11 per cent more likely to be among them. This rose to 45 per cent for those who had interventions to detect artery blockages and keep blood flowing. Distance to the specialist centre did not appear to affect chances of survival, researchers report in the European Heart Journal.
Centralisation, with fewer, high-volume, invasive heart centres, is essential

Tinne Tranberg, of Aarhus University Hospital, who led the study, said: “Among cardiac arrest patients admitted to hospital, those admitted directly to an invasive heart centre have a higher chance of surviving, regardless of the distance.” She added: “Centralisation, with fewer, high-volume, invasive heart centres, is essential for advanced care.”

Dr Tranberg said that Denmark’s experience would probably apply to the NHS, adding: “These results support a strategy that prioritises the establishment of an efficient pre-hospital organisation, over the establishment of multiple geographically distributed heart centres, and suggest that patients should be admitted directly to a few invasive heart centres for optimal care.”

Patients who received CPR from a bystander had a 10 per cent better chance of survival, while those whose cardiac arrest was witnessed by other people were 12 per cent more likely to survive. Survival was also higher among patients who collapsed in crowded areas, underlining the importance of immediate medical attention.

Instant specialist attention has been credited with saving the life of Fabrice Muamba, the footballer who suffered a cardiac arrest while playing for Bolton Wanderers against Tottenham Hotspur at White Hart Lane in 2012.

After expert help on the pitch, an ambulance took him to the London Chest Hospital six miles away, rather than to the North Middlesex University Hospital less than a mile away.

About 30,000 people suffer cardiac arrests outside hospital in Britain each year. Mike Knapton, associate medical director of the British Heart Foundation, said: “If you have an out of hospital cardiac arrest, your chances of survival improve if you are taken to a specialist heart centre. This isn’t the first time that research has pointed towards paramedics bypassing local hospitals and heading to one of the UK’s specialist heart centres. Paramedics make these specialised hospitals the first point of call, providing they are within a reasonable distance.”

PMI or private cover? Should GPs ask patients if they have private health insurance? Putting the patient in front of you at the centre of your concern – includes asking about attitudes to non state options..

Fundamental dishonesty. Let’s abandon our broken NHS and move on – The only solution to the health service’s problems is a continental-style insurance scheme

We need tiered rationing according to means… Drugs costing 8p a day could be  hit by ‘devastating’ NHS rationing plan.. What a good idea. 

Ghandi’s swadeshi – why not involve patients in this debate?

The UK Health services are facing a “dead end” – both literally and figuratively if we don’t accept rationing.

Britain’s Rubicon in the Brexit debate could also be one for the 4 Health Services. The trouble is that politicians are judged on 4-5 year cycles by a population who expect instant hedonism, and who don’t expect to wait for anything, and lacking honest leaders. The population also voted against proportional representation very recently: the one change which could have led to more long termism. Chris Smyth’s article (below) reveals how disconnected from reality the cancer charities, the RCGP and MacMillan nurses pretend to be – actually it’s not true since most monies for all three are not from taxation, but from gifts from the public. If we wish to ration fairly we need to think about ID cards and different scales of subsidy/co-payment, but before this we need short waiting lists (Wales is worst)…..  and will be getting even worse. Without quality those who can afford it will get better, faster treatment in a two tier service. And why should psychiatric patients suffer more than cancer from covert rationing – because they don’t influence elections? They have more life years ahead of them! Mr Stevens suggestions are rational, pragmatic and overt…lets have more, and avoid the “dead end” we are heading for.

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Britain’s Rubicon is the Times leader 28th March 2017, and the arguments against short-termism apply equally to health – Negotiators on all sides in the Brexit process that starts today must put short-termism aside and think of the future generations that will judge them.

Chris Smyth reports 28th March 2017: Cancer patients ‘will suffer in NHS war on waste’

Cancer patients will die in pain because of NHS cost-cutting plans, charities have warned.

Scrapping prescriptions for “low-value” medicines would also harm people with coeliac disease and those in chronic pain, the campaigners claimed.

Simon Stevens, the head of NHS England, outlined his proposals to cut waste in the health service yesterday when he said that common painkillers, gluten-free foods and travel vaccines should no longer be available on prescription when patients could buy such products for themselves. Medicines that have cheaper alternatives should also not be prescribed.

NHS bosses have identified ten products, costing £128 million a year, that they want doctors to stop prescribing, with further restrictions on other items being considered.

Suncream, cold remedies and heartburn treatment could be restricted under a review to cut £400 million of NHS spending.

“There’s £114 million being spent on medicines for upset tummies, haemorrhoids, travel sickness, indigestion. That’s even before you get on to the £22 million-plus on gluten-free that you can also now get at Morrisons, Lidl or Tesco,” Mr Stevens told the Daily Mail. “Part of what we are trying to do is make sure that we make enough headroom to spend money on the innovative new drugs by not wasting it on these kind of items.”

Helen Stokes-Lampard, chairwoman of the Royal College of General Practitioners, said doctors must not be banned from prescribing paracetamol in quantities not available over the counter or offering powerful sunscreen to people at risk of melanoma.

“If patients are in a position that they can afford to buy over-the-counter medicines and products, then we would encourage them to do so without a prescription, but this isn’t the case for everyone,” she said.

“Imposing blanket policies on GPs that don’t take into account demographic differences across the country or allowing flexibility for a patient’s individual circumstances risks alienating the most vulnerable in society.”

Rosie Loftus, chief medical officer at Macmillan Cancer Support, criticised the decision to single out fentanyl — a painkiller that costs the NHS £10 million a year — on the ground that morphine is cheaper.

“It is a drug often given to cancer patients to provide crucial pain relief at the end of their life. This move would signal a step back in how we manage people’s care when they’re dying,” she said. “We understand the financial pressure the NHS is under, but for some patients it might be the only or best medication that can help ease discomfort in their final days.”

Sarah Sleet, chief executive of Coeliac UK, attacked Mr Stevens for saying that people with the auto-immune disease could get their gluten-free foods at the supermarket.

“Budget and convenience stores, which are relied upon by the most vulnerable, such as the elderly, those with disabilities and on low incomes, have virtually no provision,” she said.

Identity Cards could help, addressing inequality in health, and helping younger families.. Bring back the guillotine for Mr Hunt?

What a pity that mental health stats are not universal and comparative. The limitations of the smaller mutuals (Wales Scotland and N Ireland) are exposed…. What can save the services?

A two tier primary care (General Practice) service is evolving, like in Dentistry, by neglect…

 Rationing by waiting, and insufficient staff. Wales is worst…

Betsi Cadwaladr waiting times ‘getting worse’ since Welsh Government stepped in to rescue health board

David Williamson for Walesonloine reports 23rd March 2017; Wales’ Health Secretary refused twice to guarantee that NHS services will not face cuts

If we go on like this the housing debt will be as nothing to the health debt in 10 years time.

There is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible..

If we go on like this the housing debt will be as nothing to the health debt in 10 years time.

Many of us start our lives with debt, usually on property, but this declines as we grow older. If we go on like we are in Health, the housing debt will be as nothing to the 4 UK Health Services debt in 10 years time.. The chancellor is rightly worried about debt, and the future looks bleak…(UK’s borrowing binge is worrying the Bank of England – Larry Elliott in the Guardian 27th March 2017) £50m for Hywel Dda board equates to approximately £156 per head today, and possibly £10,000 per head in 10 years. Expect more and more de-commissioning / covert rationing.

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Ministers refuse to bail out the Welsh Health Boards (Hywel Dda is the worst) – BBC News 28th March 2017

The boards are forecast to over spend by £146m this year.

In one case – Abertawe Bro Morgannwg University Health Board (ABMU) – the financial outlook is said to be “extremely challenging”.

The health board, which covers Swansea and Bridgend, said it was attempting to cut agency staff costs.

As well as ABMU there are overspends at Betsi Cadwaladr in north Wales, Cardiff and Vale board and Hywel Dda in mid and west Wales.

Betsi Cadwaladr’s deficit is now forecast to be £30m, Hywel Dda £49.9m, ABMU £35m and Cardiff and Vale £31m for the 2016-17 financial year.

The health boards will not face a bill to repay the money, but they will be expected to balance their books in the next financial year.

A spokesman for the Betsi Cadwaladr University Health Board said: “We have worked hard throughout the year, and worked closely with Welsh Government, to address our challenges, and we will continue to do so going forward.”

Stephen Foster, of Hywel Dda University Health Board, said: “This is not the financial situation that we would want to find ourselves in and we are putting together significant plans to turn it around.”


Analysis by BBC Wales political editor Nick Servini

These figures show a dramatic deterioration in the finances of four out of Wales’ seven health boards.

They have also prompted a hard-hitting response from the Welsh Government which, until this point, has been keen to stress how they approach problems together.

The tone resembles the approach of the man in charge of the English NHS, Jeremy Hunt, who has not been afraid of calling out heath trusts he believes are under-performing.

The Welsh Government has called for a significant improvement in the financial performance.

That will be easier said than done in the face of intense pressure on these organisations.

Walesonline and the Western Mail report 27th March 2017: Wales’ Health Secretary refused twice to guarantee that NHS services will not face cuts

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There is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible..

The Guardian has an “anonymous” opinion. I guess those close to the decision making action will know who it is. “The NHS sets leaders up to fail – and then recruits more in the same mould” on 27th March 2017.

NHSreality maintains that there is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible. There are no exit interviews of high turnover Trust Directors, and no feedback to Politicians – probably because they know they don’t want to hear it. Anonymous is one of the many disillusioned …. and a 1p hypothecated tax will change nothing. Lincolnshire will get nowhere with it’s request for suggestions because rationing overtly is excluded… Politicians with only one eye on health (the other in Brexit) will continue to be conned ….

It’s my job to support and develop senior NHS managers. And I’m deeply worried that we’re setting them up to fail – then recruiting more in the same mould.

I’m a former primary care trust director

Most of these leaders were hired to lead foundation trusts at a time when NHS providers were being encouraged to compete with other trusts for business; to invest in new services; to develop their own organisations at the expense of other providers. To make use of the freedoms granted to foundation trusts – including the ability to borrow money at commercial rates – they hired leaders with commercial, transactional and financial skills: hard-edged, competitive businesspeople who could expand their market share.

But then the environment changed. Trusts were – quite rightly – put under greater pressure to improve service quality and patient safety. And demand rose much more quickly than budgets, so the tariffs paid for trust services were cut year after year. Soon, many new services were struggling to repay the investments made in them. In a world of shrinking revenues, those skills in business growth suddenly looked out of place.

Meanwhile, health system leaders began pushing a new agenda – one built around collaboration between organisations, professionals and sectors. To protect healthcare nowadays we need people to work together, rather than to compete: the emphasis is on building services around the patients’ needs, rather than the providers’. The Sustainability and Transformation Plans and the Five Year Forward View create a need for leaders who have emotional intelligence; who are approachable and listen to their staff; who put the public’s needs above those of their trust; who can share power and responsibilities with other organisations. And in that context, the skills and approach of many NHS leaders look hopelessly outdated.

Too often, leaders are remote and isolated. Poor links between ward and board mean that board members often remain unaware of emerging problems. To deliver great care, you need your staff behind you – but we’ve spent years recruiting empire-building business leaders who have no feel for the kind of hands-on, visible leadership required.

; I now work as an executive coach, helping NHS executives to improve their skills. Many of my clients lead trusts whose leadership has been deemed “inadequate” or “requires improvement” by the Care Quality Commission – but few of them are genuinely bad leaders. The problem is that they were hired to do one job, and the requirement is now for something quite different. Yet they’re not being helped to change their approach, and when their trusts run into trouble they are being replaced with people likely to encounter exactly the same set of problems.

We end up with chief executives who find themselves receiving a lot of criticism, and being pushed out – creating huge damage to their careers and reputations. But it’s the system that’s let them down, not them letting down the system. Nobody’s given them the right advice or development or challenge, and the characteristics once seen as assets have become liabilities.

Unfortunately, trusts’ recruitment practices haven’t changed to reflect the need for a new kind of leader – so when these more commercial, transactional managers fail, trusts are too often replacing them with new figures cut from the same cloth. Many trust chairs are still stuck in an empire-building mindset; job descriptions focus on financial and operational experience; and recruiters are often cynical about the softer skills required for staff engagement and partnership working. So the trusts select new managers well-suited to facing the challenges of five years ago, and organisations head off towards a fresh set of failures.

What’s to be done? For a start, trusts need to refresh their recruitment practices – taking their cue from NHS Improvement’s new leadership framework, and shifting away from a narrow focus on technical competences towards a values-based approach. The solution is not simply to swap our existing leaders for a new set. The NHS cannot afford to lose a swath of senior managers. Many of these people could develop the skills we need, we just need to help them to do so. After all, we require doctors and nurses to refresh their skills regularly, revalidating their qualifications; and these days, the disciplines of management and leadership are changing just as fast as medical practice.

It’s hard for senior leaders and managers to reflect, train and change their approach. Most already work 60 hours a week, and seeking new skills is too often seen as a confession of weakness or incompetence. But this is a nettle we must grasp. For many of our senior leaders are ill-suited to the task in hand. If we are to serve the interests of NHS organisations, staff, leaders themselves and, above all, patients, we must reshape our leadership cadre – equipping it to understand and address the vast new financial and organisational challenges facing the NHS.

NHS faces ‘mission impossible’ to meet performance targets and budget savings, new analysis from health think-tank NHS Providers finds

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Record Level of claims Inflation – £1000 each taxpayer per annum: How to solve the indemnity crisis

NHSreality has often opined on the need for “No fault compensation” in the UK health services. Short termism ensures that the politicians take no notice – same as for rationing overtly.

Preeti Shukla for Pulse opines in Pulse 20th march 2017: How to solve the indemnity crisis

Blinded by love for a ‘seven-day NHS’, the Government first needs to tackle the issue of rising indemnity fees.

Here is the scale of crisis we are in. The overall NHS budget for 2015-16 was £116.4 billion. The NHS Litigation Authority (NHSLA) liabilities for current and future liabilities are around £28.6 billion costing £1,030 per English taxpayer.

According to the medical defence organisations (MDOs), inflation rate for clinical negligence claims is running at a record-high of 10%, meaning the size of claims is doubling every seven years. By a large margin, this is higher than inflation rates of any other goods or services in the UK. With very little hope of ceiling, this could make the NHS unsustainable.

The eye watering costs of indemnity premiums making GPs change their work patterns. The results of a survey I undertook, published in Pulse, reveal the gravity of the situation, with one in four OOH GPs reducing shifts because of indemnity costs.

Many believe that the GPs are omnipotent bunch of professionals who can triage, manage long-term conditions, reduce inpatient workload by keeping patients out of hospitals, and thus reduce the spiraling costs of the NHS. However, no consideration is given to how they will accommodate if the GPs can’t work to their wanted capacity because of indemnity. OOH services are worst hit and one in ten areas reported that on several occasions in 2016, they had to close OOH centres or run shifts without a GP as there was none available.

How can we address this issue?

The NHSE 2015-16 winter indemnity scheme added 15,000 extra OOH shifts and the scheme was continued in 2016-17. What NHS England seems to have forgotten is that the system now must cope with a winter that never seems to end. My assumption is that the withdrawal of winter indemnity scheme this coming year will lead to a catastrophic collapse of OOH services. Take for example, £100 million allocated for GP triage in A&E – a more practical and effective use of this money would be by reimbursing GPs for indemnity fee hikes for all OOH shifts. This sort of intervention will encourage more GPs to take the shifts and address the workforce crisis and patient demands simultaneously.

A toxic culture to promote litigation that exists is leading to a higher volume of claims like never seen before. The Personal Injuries Act 1948 advocates calculating compensation on the basis of private rather than NHS care and need to be repealed. This law is outdated now as we have the NHS that provides a world class service, so there is no imminent need for private care. MDOs should be allowed to buy local authority and NHS care packages rather than high cost private care packages.

Our secretary of state keeps talking about a ‘no blame culture’ but we need action, and not just empty words. We need efforts from the Government to protect the NHS and NHS employees from litigation as is done for vaccines in the Vaccine Damage Payment Scheme; and more so because doctors, nurses, hospitals and GP surgeries are all regulated by various regulatory bodies like the GMC, NMC and CQC hence any complaints about issues on performance and delivery are already being thoroughly scrutinised and appropriately addressed. Legislation in Germany and Denmark promotes sanction-free reporting of errors and provides indispensable protection for the healthcare professionals, thus enabling a better learning in safe environment.

This does not mean we reject the policies of compensation for negligence for the affected patients. However, there could be a direct system as it prevails for vaccine damages. Over the last decade, the payout made by the NHS has trebled to more than £1.3 billion a year, out of which more than £299 million constitutes legal fees. However, since 2001 only 3.2% claims had damages proved by the court of law. The rest were settled out of court. Could we have used this money for making our NHS safer and more efficient? Of course it could.

Capping of legal costs for small claims need to be done sooner rather than later. Currently there’s a consultation about a cap on legal costs for all such cases up to £25,000. In some incidents, the cost of legal fees has been significantly more than the compensation pay out, and this is completely ludicrous and unacceptable. A new revised law needs to be implemented urgently.

We need a ‘strong political will’ to bring in these reforms, not ‘sticking plasters’. We all (healthcare workforce, patient groups and the media) need to come together to solve this issue.

Dr Preeti Shukla is a GP in Blackburn and member of the GPC’s sessional GPs subcommittee