Monthly Archives: August 2017

Doctors are here to save our lives, not take their own

Imagine being a politician who doesn’t really care about doctors. She/he thinks they are overpaid anyway. Their time horizon is the next election, and they know nothing they say or do will influence the supply side in that time period. What they care about is their next term, and the vote in their locality. Be nice to everyone, and you usually keep your seat.. But make a difference to the national honesty on health, and you will lose it. Overworking is destroying General Practice, the profession and the doctor patient relationship. Places at Medical School need to be de-rationed. Where 2 out of 11 gain a place today, 10 out of 11 are capable and should be trained. If some go abroad or drop out so be it…

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Rachel Clark in the Mirror reports 8th August 2017: Doctors are here to save our lives, not take their own – I don’t know a single junior doctor who hasn’t at times felt utter despair at the burden of trying to keep patients safe in today’s overstretched and understaffed NHS

LAST week yet another junior doctor appeared to have taken his own life.

Colleagues found the man, in his 30s, dead at Musgrove Park Hospital where he worked in Taunton, Somerset.

While we know no details as yet of the circumstances of his death, we do know at least another three junior doctors have killed themselves in the last 18 months.

The first, Rose Polge , was barely six months out of medical school.

She took her own life when her workload became too much to bear. Rose committed suicide the day after Health Secretary Jeremy Hunt finally announced to Parliament that he was imposing his infamous contract on juniors.

As Rose’s mother put it: “Exhaustion due to long hours, despair at her future in medicine and the news of the imposition of the new contract were definite contributors to this awful and final decision.”
When it emerged Rose had been midway through a shift one Friday afternoon before vanishing, leaving a suicide note in her car that mentioned the Health Secretary, then walking into the sea, I felt sick with recognition.
I don’t know a single junior doctor who hasn’t at times felt utter despair at the burden of trying to keep patients safe in today’s overstretched and understaffed NHS.
There are times when, crouched in dark hospital corridors, I have wept with sheer exhaustion. I have seen colleagues become suicidal in the relentless struggle to try to give patients a half-decent service.
There is something spectacularly wrong with the NHS if those entrusted with saving lives end up taking their own. You would think that for the Department of Health, even one junior doctor suicide would be one too many. As it is, they seem to ignore the problem.
They are not even collecting national figures on how many junior doctors take their lives each year. It is as if they don’t care.

Could it be the real solution to the pressures on young doctors – ie. properly staffing their rotas – costs too much for the Treasury to contemplate?
And that austerity economics means more to this Government than doctors’ lives? We are short of about 6,000 doctors and 40,000 nurses.
Yet the amount the Government is willing to spend on health per head of population is falling for the first time in history.
For patients, this means NHS rationing. Already, Trusts are considering cutting hip and knee replacements and cataract surgery.
The misery this will unleash should make any Health Secretary feel mortified.
For frontline staff, the funding cuts herald ever more stressful working conditions. I’ve known doctors who have fled the NHS for Australia, quit medicine – or even taken their own lives.

Imagine spending six years slogging through exams at medical school only to find the job you dreamed of is too hellish to bear.

Imagine the shame of being the Secretary of State allowing that on your watch.

  • Rachel Clarke’s book Your Life In My Hands: A Junior Doctor’s Story is published by Metro Books.
  • Image result for overworked doctor cartoon

Samaritans (116 123) operates a 24-hour service available every day of the year. If you prefer to write down how you’re feeling, or if you’re worried about being overheard on the phone, you can email Samaritans at jo@samaritans.org

Tribunals urged after study finds ‘unacceptable’ variations in healthcare access

The unethical face of covert rationing is revealed in Scotland. We all pay the same taxes and should therefore have equal access to advanced and lifesaving technology. We should also have equal lack of access to the same services… where these are rationed. To do this fairly needs honesty and overt rather than covert rationing. 

Aberdeen Journals Ltd (Evening Express) reports 15th August 2017: Tribunals urged after study finds ‘unacceptable’ variations in healthcare access

Local health bodies should have to face a tribunal board if they have ” overly restrictive commissioning policies”, a new report suggests.
The recommendation comes after researchers found that there is “unacceptable” variation in access to care for patients across England.
After examining data concerning each of the 209 clinical commissioning groups (CCGs) across England in relation to certain treatments, researchers highlighted a number of variations in access to care and waiting times including:
:: Less than one patient (0.173) per 100,000 population in Southampton was referred for a computed tomography colonoscopy – a diagnostic tool for bowel cancer – compared with nearly 59 patients per 100,000 in Fareham and Gosport.
:: The authors found vast differences in the rate of stroke patients being admitted to a specialist unit with four hours of arrival at hospital – from 84.5% in Hillingdon to 21% in Wyre Forest.
:: In some regions, there were 207 hip replacements being performed for every 100,000 people living in that area, but in others the rate was just 54 per 100,000 population.
:: In urology and ophthalmology, the worst performing CCGs only hit the 18 referral to treatment time target about 80% of the time, the authors said. This means that one in every five patients from those regions get treatment in the required time frame.
The authors said that NHS England should establish a tribunal board to consider whether individual CCGs have overly restrictive commissioning policies which are contrary to national guidelines.
The report, by the Medical Technology Group (MTG) – a collaboration of pharmaceutical companies, patient groups, research charities and medical device manufacturers – also examined whether CCGs were falling behind on waiting times for patients.
After examining referral to treatment times, researcher s created league tables for CCGs for waiting times for a number of medical treatments such as pacemakers, cataract surgery, and hip and knee replacements.
They found that seven of the 10 “worst performers” at hitting the 18-week referral- to-treatment time target were actually rated as good or outstanding by NHS England.
The authors said: “CCGs currently go through an Ofsted-style assessment programme.
“Each CCG is given one of four ratings: inadequate, requires improvement, good, or outstanding.
“The MTG does not believe that these ratings are sufficient to give patients an overview of how their CCG is performing.
“The key factors for patients are gaining access to treatment and successful, quick recoveries. It is not clear from the current rating system that there is sufficient weighting given to these aspects of care.”
The authors suggested that p erformance against the 18-week wait should have a stronger impact on each CCGs’ ‘Headline Rating’.
Barbara Harpham, MTG chairwoman, said: “Delivering high-quality healthcare, no matter where you live, is one of the fundamental principles of the NHS. But budget cuts and rationing is having a huge impact on the service patients receive, and the outcome they can expect.
“There is an unprecedented strain on the health service and patients are not being given equal access to the treatment – and most importantly – the technology they need.”

An NHS England spokeswoman said: “Although this report by companies seeking to sell products to the NHS is largely a rehash of old and previously published data, the NHS RightCare programme is helping local areas identify which treatment differences are linked to local need, and which aren’t.
“But as the Academy of Medical Royal Colleges has pointed out through its Choosing Wisely initiative, over-treatment is often as much of an issue as under-treatment.”

Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

Mothers are having fewer children later. This makes them more high risk, and most sensible ones will have whatever form of delivery gives the best chance of a normal child. 

Born Free. Times leader 12th August 2017: Midwives are right to revisit received wisdom on what counts as a ‘normal’ birth

For an event so natural that none of us can avoid it, the business of childbirth has become an unfortunately ideological battleground. Since the 1960s advocates of “natural” birth have been pitted against defenders of medical intervention. The assumption, driven in part by advice from midwives, has been that a natural birth is somehow superior. In an interview with The Times today Cathy Warwick, chief executive of the Royal College of Midwives (RCM), acknowledges that her profession has got the emphasis wrong. There are great benefits to birth without interventions, but they should be pursued in a way that is sensitive to every woman’s situation, not as an article of faith.
For 12 years the RCM, midwives’ professional and representative body, has campaigned, as a matter of policy, for births where the mother enters and completes labour without medical intervention. Avoiding epidurals, forceps, artificially induced labour or a Caesarean section, the RCM argued, was better for mother and child. Yet that orthodoxy has been criticised, on two grounds. First, it can take a psychological toll on mothers. Those who ask for medical intervention because of their own anxieties or past experiences, are often left feeling as if they have failed. The RCM has sensibly decided to scale back the use of value-laden terms such as “normal birth” in favour of more neutral phrases like “physiological birth”.
The second, and more trenchant criticism of old habits is that they risk putting patients in danger. There is some evidence to support this charge. In 2015 an inquiry into a catalogue of unnecessary deaths in a Morecambe Bay hospital found that midwives’ pursuit of normal childbirth “at any cost” was, in part, behind the failures.
James Titcombe, who brought the scandal to national attention after the death of his son, has warned that the pressure for a delivery without medical intervention is rooted not in concern for patient safety, but in ideology. There have been concerns, too, about the role that midwives’ prejudices may have played in a string of deaths at Shrewsbury and Telford Trust.
None of this means that more intervention is always better, or even that it often is. There is value in a physiologically natural birth — the touch of a mother’s skin to her child’s in the moments after delivery helps to build a bond; a profusion of tubes, doctors and medical instruments does not. Caesarean sections come with well established risks. Mothers are vulnerable to the complications of any major surgery, and researchers have found some evidence that babies born this way are more likely to suffer from asthma and obesity in later life.

However, parents are well able to understand these risks and come to a considered view on what is best for them. The dangers are greatest, in any event, when interventions are emergency measures, taken after the failure of a “normal” birth. Better that midwives speak openly and neutrally about the benefits and risks of epidurals, inductions and Caesarean sections, well in advance, to avoid eleventh-hour panics.
Healthcare in Britain mostly compares favourably to that in other countries. Childbirth, however, is the exception. Britain has among the highest infant mortality rates in western Europe. That is all the more reason for midwives to eschew ideology and focus instead on what will work best for mothers and babies.

Mums, you have a 1:200 risk of stillbirth – what can you do about it?

The long term results of rationing midwives and doctors in training…

Rationed to dangerously low levels – “..Nine in 10 of the biggest NHS trusts are below safe staffing levels”.

The collusion of denial of rationing by politicians and administrators continues. Caroline Wheeler reports in The Sunday Times 13th August 2017: Nurse numbers dangerously low – Nine in 10 of the biggest NHS trusts are below safe staffing levels

This is the result of rationing places in nursing to save costs over a short time horizon (4 years or one term of office). The longer term loss of money due to inefficiencies and diminishing standards does not concern today’s politicians. In my own constituency the MP won by a few hundred votes, and is likely to lose the seat next time. An “honest debate” is what the public wants, but all parties are denying them… It does not help that Nurses are “graduates” as the caring side of personal care is excluded from their jobs as they get more senior. And now we are threatened with fewer immigrant nurses…So, it’s going to get worse.

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Nearly all England’s 50 biggest hospital trusts are failing to hire enough nurses to ensure patients are safe.
Nine in 10 of the trusts, which oversee 150 hospital sites, are not meeting their own safe staffing targets, according to analysis by the Royal College of Nursing (RCN).
The data also suggest nurses are being increasingly replaced by cheaper, unqualified healthcare assistants.
To cope with the shortage of nurses, more than half the largest hospitals (55%) brought more unregistered support staff onto shifts, the figures show. The situation is worse at night, with two thirds (67%) of hospitals using unregistered support staff — which critics claim will lead to higher patient mortality rates.
Janet Davies, chief executive and general secretary of the RCN, said patients can pay the “very highest price when the government encourages nursing on the cheap”.

She added: “Nurses have degrees and expert training and, to be blunt, the evidence shows patients stand a better chance of survival and recovery when there are more of them on the ward.”
A separate study of staffing in NHS hospitals, published in the online journal BMJ Open, found that in trusts where registered nurses had six or fewer patients to care for, the death rate was 20% lower than where they had more than 10.
Hospitals have had to publish staffing levels since April 2014 in response to the scandal at Stafford Hospital, where hundreds died from neglect.
The RCN analysis, which calculates the average fill-rate across the month, reveals the worst affected site was the Royal Blackburn Hospital, which had on duty only three quarters of the nurses needed.
According to the RCN there are 40,000 nurse vacancies. Brexit, low morale, the end of bursaries for tuition fees, and the public sector pay freeze have all been blamed.

The Department of Health said: “Just this month we announced an extra 10,000 places for nurses, midwives and allied health professionals by 2020, and there are over 12,500 more nurses on our wards since 2010.”

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Comments are legion at the Sunday Times. Here is one..

Stephen G Spencer letter by e-mail

With the culture of bullying so prevalent, pay held so that salaries today are worth less but nurses expenses like others have gone up, and a plainly mad Secretary of State and Department of Health that thought doing away with nurses training bursaries was a good idea, together with all those nurses from EU countries worried about the implications of Brexit for them and their families. No surprise at all. But quite worrying if you do have to go into hospital.

It is getting worse: Four million wait for surgery as NHS warns of winter crisis

Waiting lists are going to get worse. Until we agree that rationing is inevitable, and that it is more moral for it to be overt than covert, we will never address the real issues.
Once we agree to ration overtly, then we can discuss the “how”…

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Chris Smyth in The Times 11th August reports: Four million wait for surgery as NHS warns of winter crisis

More than four million people are on an NHS waiting list for surgery for the first time in a decade, and doctors warn that there is no end in sight to lengthening treatment delays.

One in 13 people in England are on a waiting list, with 373,000 on one for more than four months, up a fifth since last summer, official figures show. Hospitals said safe care was at risk this winter because they were already overstretched in the summer months.

Simon Stevens, head of NHS England, said in March that a target to give 92 per cent of patients needing a routine operation treatment within 18 weeks would be temporarily abandoned to fund other priorities. The target has not been met for more than a year and figures for June showed 3,831,207 on waiting lists, up more than 200,000 from the same month in 2016. Five hospital trusts, including the country’s biggest, did not report back and NHS England estimates that the true figure is “just over 4 million patients”.

Derek Alderson, president of the Royal College of Surgeons, said: “This is the real-life impact of an NHS under severe pressure. As our population increases and demand for the NHS grows, the waiting list will likely only get worse unless more action is taken.”

June’s waiting list is the highest known figure since August 2007 when the data was first collected and showed a waiting list of 4.2 million.

Richard  Murray of the King’s Fund think tank said: “These statistics show once again that it is unrealistic to expect the NHS to continue to be able to offer the same standards of care within the current budget.”

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Bed blocking is also up, with patients spending 178,441 nights stuck in hospital when they did not need to be there, compared with 173,122 in June 2016. NHS England said it was a sign of a crumbling elderly care system, with the number of delays formally attributable to social care up 20 per cent on last year.

Phillippa Hentsch of the hospitals’ group NHS Providers said: “Even at the height of summer, the NHS is working at full stretch. The lesson here is that there is simply not enough capacity in the system to assure patient safety in the coming winter.”

A target to treat 95 per cent of A&E patients within four hours is still being missed, with 90.3 per cent seen in this time, as is a target to start treatment for 85 per cent of cancer patients within two months of a GP referral.

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Chaand Nagpaul, head of the British Medical Association, said: “The government is now routinely missing its own targets across the health system. The NHS is clearly at breaking point, yet the government doesn’t appear to have an answer to this crisis.”

Jonathan Ashworth, the shadow health secretary, said: “A year of Theresa May’s mismanagement of the NHS has pushed services to the brink and left thousands more waiting in pain for routine operations. Standards for NHS patients are getting worse and worse as a direct result of Tory underfunding. The government urgently need to sort this out.”

NHS England pointed out that it was carrying out almost 50,000 more operations a month than last year as demand from an elderly population continues to rise. A spokesman said: “Last month 1.4 million patients started consultant-led treatment, and more than nine out of ten patients were waiting less than 18 weeks. We’re working hard to cut long waits.”

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NHS improvements lead to fewer deaths from heart failure

Chris Smyth reports in the Times 10th August 2017: NHS improvements lead to fewer deaths from heart failure

When it gets broken down I predict this improvement will be post coded…. with the rural areas doing worst.

Almost 500 lives a year are being saved by improvements in NHS care for heart failure, a review has found.
Too many people still die from the condition, however, and experts urged hospitals to make sure more get crucial treatment and see specialists promptly.
More than half a million people in Britain have heart failure, in which the heart struggles to empty and fill. It is most common in the elderly and accounts for one in 20 NHS hospital admissions.
Researchers at University College London found “modest but important improvements” as death rates in hospitals fell from 9.6 per cent in 2014-15 to 8.9 per cent now but added: “Mortality remains too high and there are large variations among hospitals.”
Sir Bruce Keogh, of NHS England, said: “This independent study shows that improvements to NHS heart failure services have had a significant positive impact . . . The progress highlighted today will be a spur for us to do even more to improve care.”

Despite “adequate or average” funding, our waiting lists are much higher than average. Even communication is failing at a basic level…

Despite “adequate or average” funding, our waiting lists are much higher than average. Even communication is failing at a basic level, more in keeping with an African 3rd world country. The emperor has no clothes..

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Chris Smyth reports in the Times 10th August 2017: NHS funding matches most of Europe’s health spending

Britain is spending “about what might be expected” on the health service according to analysis which questions claims that the NHS is starved of cash compared with other countries.

Spending on health matches the average in other western European countries and those who call for more money for the NHS can no longer rely on the argument that Britain is spending less, economists said.

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However, to match higher spenders such as France and Germany, health funds would have to increase by £24 billion a year, conclude John Appleby, director of research at the Nuffield Trust, and Ben Gershlick, economics analyst at the Health Foundation, in The BMJ.

Concern that the NHS is short of money has increased as waiting lists and queues in A&E lengthen and treatments ranging from IVF to hip replacements are being rationed.

Those demanding more money have often used the same argument as Tony Blair, who justified a big increase in NHS funds in the 2000s on the basis that spending was below countries such as Spain and Portugal.

However, technical changes implemented this year to how international spending is measured mean more social care funds are now counted, raising Britain’s health spending to 9.9 per cent of GDP for 2014, instead of the 8.7 per cent previously estimated.

The £20 billion increase means Britain’s health spending is now about average for the OECD and 14 other mainly western European states who joined the EU before 2004 and comfortably above countries such as Spain, Portugal, Italy and Finland.

Professor Appleby and Mr Gershlick write in a blog: “The UK is spending what we would expect given its wealth . . . How much we should spend on healthcare is still a live and important debate, but the argument that we should spend more simply because we spend much less than the rest of Europe isn’t enough any more.”

Countries tend to spend more of their GDP on health as they get richer, with each $1,000 increase in wealth per head linked to a $120 increase in health funds. By the adjusted figures, the UK spends $3,675 a year per person on health, well above the $1,870 for each person in Greece, but the Netherlands spends a third more per head at $4,857.

Professor Appleby and Mr Gershlik stress that matching the average is not in itself an argument against more cash for the NHS. If voters want more comprehensive services that might require higher spending, they suggest.

Simon Stevens, head of NHS England, clashed with the government over health spending earlier this year, telling MPs Britain should be aiming higher than countries such as Mexico.

Henry Bodkin in the Telegraph 10th August reports: Waiting lists for routine NHS treatment such as hip and knee surgery longest for a decade 

Dennis Campbell in the Guardian: NHS patients waiting for hospital care top 4m for first time in a decade

BBC: Surgery waiting numbers highest in decade, says NHS England

BBC: Thousands of patient follow-up letters not sent to GPs