Monthly Archives: August 2017

Standards are worse than they were – Dozens of deaths after failings by ambulances and 999 call handlers

Kat Lay in The Times 31st August reports: Dozens of deaths after failings by ambulances and 999 call handlers

Almost two patients die a month on average after failings by the ambulance service, including delays or a failure to recognise the severity of symptoms, a review of coroners’ reports has found.
Coroners in England and Wales have written to ambulance services or call handlers 86 times since July 2013 warning them that they need to make changes to prevent future deaths.
Forty-eight of the warnings related to ambulance delays or problems with call handling, according to the review by Minh Alexander, a former whistleblower who now campaigns on patient safety. She said the volume of reports suggested a “significant decline in ambulance safety in recent years”.
She added: “Action is needed to rectify underfunding, related workforce and skill mix issues, and pressures on the whole NHS that spill on to ambulance services.”
Coroners have a duty to write a report under regulation 28 of the Coroners (Investigations) Regulations 2013 if it appears there is a risk of other deaths occurring in similar circumstances. Dr Alexander, a psychiatrist who raised concerns about patient deaths, produced her report by analysing section 28 reports published by the chief coroner.

A number of the reports highlight delays caused by slow handovers at A&E departments, echoing warnings from the National Audit Office earlier this year. In many cases the delay was not found to have caused the deaths but coroners were sufficiently concerned by what they heard at inquest to warn ambulance service bosses that delays could be fatal in the future.

In April, Gilva Tisshaw, assistant coroner for Brighton and Hove, wrote to South East Coast ambulance service following the death of Ronald William Bennett, warning of “serious delays in ambulances arriving at the scene of an incident as a consequence of ambulance crews being delayed at the accident and emergency department”.

There were also a number of cases involving call handlers without medical training and their computer programmes failing to recognise the severity of a situation.

In June, Elizabeth Earland, senior coroner for the Exeter and Great Devon district, wrote to South Western ambulance service after the death of Colin James Sluman, 68, who had a burst varicose vein. He called an ambulance at 1.36am, but bled to death before an ambulance arrived at 3.03am.

Dr Earland said the protocol followed by call handlers, on which they were “completely reliant”, did not recognise reports of dizziness in a patient on their own “as important triggers for a rapid response”.

An ambulance service spokeswoman said the trust had taken action to address the concerns.

Martin Flaherty, managing director of the Association of Ambulance Chief Executives, said ambulance services took coroners’ reports “extremely seriously” and would make changes in response where possible.

In 2016 English ambulances handled 10.7 million emergency calls.

Case study
Grant Benson, 21, died in a fire following a car accident in August 2014 after making a 999 call. Andrew Tweddle, senior coroner for County Durham and Darlington, wrote to the Yorkshire ambulance service after the event. He said: “It is clear from listening to the recording how frantic the driver became as the fire began and took hold.”

The car came off the road near Barnard Castle, County Durham, but the call handler at the ambulance service was based in Wakefield. She and two colleagues failed to pinpoint the crash location so an ambulance could be dispatched. The inquest heard that it was not possible to transfer responsibility for calls between emergency services, and one ambulance service could not send a vehicle from another. Emergency services attended only after a further call had been made by a passer-by.

A Yorkshire ambulance service spokeswoman said it had “taken steps to review local practice.

 

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A series of intellectually and ideologically bancrupt administrations has led us to a GP recruitment crisis.

Not to have enough staff to diagnose patients means nurses waste more resources, and refer more patients for more investigations. The efficient GP of yesteryear, “living with uncertainty” for a period of time, saving resources by allowing the natural course of disease to take place (in 80%) seems to be dying. The result has to be more and more rationing…. Most of us are irate at the rationing of medical school places over many years. Almost all rejected applicants could have done the job. Being a Dr is about determination and staying power as much as intellectual ability. Good Communication and Cultural awareness are also important, and the imported doctors will lack this. They will then block places for our own in the future, not to mention the immoral act of taking much needed doctors from poorer countries. In addition, after 40 years of building up an exam (MRCGP) to be proud of, the college of GPs is threatened with undermining by the pragmatic need for emergency recruitment. 

A series of intellectually and ideologically bankrupt administrations has led us to a GP recruitment crisis. The government are even planning to restrict (ration) referrals!

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Gill Plimmer for The Financial Times 31st August 2017 reports in headline: Search for doctors set to cost NHS £100m in agency fees- Recruiters to be paid £20,000 for each GP in drive to fulfil Hunt’s 7-day service pledge

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The National Health Service is planning to pay recruitment agencies up to £100m to find 5,000 doctors — about half of them from overseas — to plug mounting staffing gaps.The recruitment drive over the next three and a half years is intended to tackle a growing shortage of general practitioners in England, as well as fulfil a pledge by Jeremy Hunt, the health secretary, to make GPs available to the public seven days a week by 2020.The hiring is expected to start in the autumn and will enable recruitment agencies to secure about £20,000 in fees per GP, according to a contract notice published by NHS England this month.Up to eight agencies, which could include Hays, Reed, and Healthcare Locums, are due to be awarded the contracts to hire recruits collectively, with 2,000 to 3,000 of the 5,000 expected to come from overseas. The shortage of GPs in England has been caused by multiple factors, including doctors leaving the profession early because of an increasing workload linked to a rising population.The shortage predates Britain’s vote last year to leave the EU, but the Royal College of GPs said before the June general election that Brexit might exacerbate the shortfall.Gus Tugendhat, head of Tussell, a company that compiles data on public procurement, said the new recruitment contracts were the biggest tender for international hiring by the NHS since October 2014 and an example of the challenge facing the government’s post-Brexit policies.

“There is an inherent conflict between the need to hire international staff in order to maintain public services and the Brexit-related agenda of reducing immigration,” he added.“In future, if the government really is to improve its public services without relying on international recruitment, the NHS will have to invest more either in training UK nationals or in productivity-enhancing automation.”Arvind Madan, NHS England director of primary care, said most new GPs would continue to be trained in the UK but argued overseas doctors were essential to maintaining services. “The NHS has a proud history of ethically employing international medical professionals, with one in five GPs currently coming from overseas,” Dr Madan said. “This scheme will deliver new recruits to help improve services for patients and reduce some of the pressure on hard-working GPs across the country.”The hiring initiative follows a move by the government last year to increase GP funding in England by £2.4bn, to enable the recruitment of 5,000 doctors.The Royal College has warned some of the GPs working in England but born elsewhere in the EU could have to leave if their immigration status were not protected during the Brexit negotiations between the UK and Brussels.

 

It estimated about 2,000 of the 34,000 GPs in England are from other EU countries, and its chair, Helen Stokes-Lampard, said in May: “EU workers in general practice — and the NHS as a whole — play a vital role . . . Losing this skill and experience would be disastrous for the sustainability of our health service, and our ability to deliver the care our patients need.”A report by the National Audit Office, parliament’s spending watchdog, this year found that Health Education England, which is responsible for NHS staff training, filled 3,019 GP places out of a target of 3,250 in 2016-17. That was an increase from 2,769 in 2015-16.The NAO also warned that poor access to GPs during the working day could be fuelling pressure on hospitals’ accident and emergency units.Michelle Tempest, a partner at Candesic, a heathcare consultancy, said hiring GPs from overseas was an “expensive way of building a workforce”. “Training and retraining your own doctors is much cheaper and more efficient,” she added. The decision to pay up to £100m to recruitment agencies is likely to fuel concerns over the planned sale of NHS Professionals, a state-owned agency that oversees recruitment for a significant part of the NHS.The agency is estimated to save the NHS up to £70m a year by supplying staff more cheaply than private sector recruitment agencies.

Pulse opines 22nd August: An overseas GP recruitment drive is not enough

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Chris Smyth in the Times: £100m on table to hire enough doctors for the seven-day NHS

Recruiters will be paid up to £100 million to find enough doctors to plug staffing gaps in the NHS as the seven-day…

Kat Lay in the Times 31st August 2017: Plan to cut GP referrals ‘a safety risk’

The GP recruitment farce – Mr Hunt never said the 5000 would come from the UK!

NHS chief brands GP recruitment strategy ‘crazy’. Now that government has abandoned it, is General Practice is a key election issue

Choice is not all it is made out to be – without overcapacity including GP recruitment

Fresh concerns raised about GP recruitment after figures showed more than 40% rise in number of GPs over age of 55 in past decade

The government shows its misunderstanding of GPs – scapegoating the resentful and disengaged may lead to unintended consequences.

Health boards take over 42 doctor’s surgeries as GP shortage crisis deepens. It’s happening now. Implosion of your health services due to prolonged rationing by undercapacity, underprovision and denial.

A review into restoring pride in the NHS

The Times letters A review into restoring pride in the NHS in response to Paul Johnson. (25th August 2017)

Sir, Paul Johnson is correct to point out that we need to ask how the NHS can change for the better and to improve the way in which money is spent (“The NHS doesn’t deserve our hero worship”, Comment, Aug 25).
Nine out ten hospital trusts are in financial deficit because of increased staffing costs. There is a shortage of nurses and so they have to employ more staff (often from agencies) to comply with safety standards.
There is also a shortage of junior doctors, resulting in consultants having to act down to fill the gaps. Many doctors in training are leaving to work abroad to seek better conditions. GPs are retiring early to escape the relentless pressure and bureaucracy.
We need to retain our workforce by improving working conditions. We need to end the constant tide of blame which is heaped on those trying to provide a service.
The NHS is being asked to find £22 billion in efficiency savings while huge sums are being wasted through the present complex system of commissioning healthcare. By getting rid of this wasteful market approach, as in Scotland, and by ridding the NHS of the armies of management consultants, millions could be redirected to improve standards in primary and social care, disease prevention and hospital building.

The market sets different parts of the NHS against one another and leads to a fragmented approach rather than ensuring that all work together for the welfare of patients.

A return to a system in which healthcare is planned for a given population would ensure an integrated approach, improve care, restore professionalism, pride and satisfaction in working in the NHS.

Professor Robert Elkeles
Northwood, Middx

Sir, Paul Johnson’s realistic appraisal of the NHS needs to be understood in Westminster. The NHS has become a political football, with the government claiming how wonderful it is and the opposition putting all its failings down to the government.

The truth is that NHS England is too big to manage even if it did not have the politicians, nearly 2,000 civil servants, 29 quangos and assorted lobby groups. Given all that, it is amazing the NHS is as good as it is.

Norman Lamb, the Liberal Democrat shadow health minister, has called for a cross-party NHS strategic review. Lord Saatchi has, similarly, called for a royal commission. Mr Lamb’s petition rapidly gained 83,000 supporters before the last election closed it down. The NHS has always been a vote loser for the Conservatives. Surely they should recognise the benefits to them, as well as the UK, of taking it out of politics?

Tim Ambler
Cley next the Sea, Norfolk

Sir, On healthcare Paul Johnson says that “we spend a perfectly respectable amount: somewhat less than the French, Germans and Dutch, rather more than the Spanish and Italians”.

In fact the French, Germans and Dutch spend about 11 per cent of their GDP on healthcare against our 9 per cent.

However, the GDP per capita of Germany and the Netherlands is significantly higher than ours — about $42,000 and $45,000 respectively against our $40,000 — so their spending on healthcare turns out to be more like 25 per cent more than ours.

Gil Patrick
Bodmin, Cornwall

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The NHS doesn’t deserve our hero worship Paul Johnson

Politicians parrot the mantra that we have the world’s best healthcare but the facts say otherwise

If our politicians are to be believed we have the best armed forces in the world, the best firefighters, the most talented young people, the best farmers, the most effective democracy and so much more besides. How blessed are we to live in such a land of superlative achievements, such talented people, such enviable institutions.
Politicians the world over do the same, using cynical rhetorical devices to persuade some interest group or other that they are loved, or to reassure the public how wonderful everything is. But the one thing all British politicians fall over themselves to assert is that we have the best health service in the world. It seems almost impossible to mention the NHS without saying so. They then almost invariably go on to point out how dreadful the American system is by comparison.
This is dangerous. The evidence just does not support the contention that we have the best health service. Suggesting we run healthcare better than anyone else because we do it better than the Americans is rather like saying we have the best parliamentary democracy in the world because we do things better than the North Koreans. Other models are available.
Here is the first headline finding from the OECD’s most recent set of international comparisons: “While access to care is good, the quality of care in the United Kingdom is uneven and continues to lag behind that in many other OECD countries”. That is borne out across a wide range of measures. Overall life expectancy is no more than middling. We are in the bottom third of comparable countries for cancer survival rates and in the middle third for strokes and heart attacks. In an understatement of which we British might be proud, this Paris-based organisation concludes “the UK does not excel at providing high-quality acute care”.
This is not because we have healthcare professionals who are any less dedicated than those in other countries. We do not lack will, effort, compassion. And of course we do some things well. Survival rates from cancers, strokes and heart attacks are improving, albeit from a low base. Our performance on breast and cervical screening as well as vaccination is better than most. And on many measures of efficiency, such as spending on drugs and length of hospital stays, we perform well. Yet for all that dedication and compassion, for a wealthy nation we have no more than a fair to middling health system. Some bits are good, many much less so.

As recent work from the Nuffield Trust has shown, this is not because we spend much less than others on health. Across developed nations as a whole, and against wealthy EU nations, we spend a perfectly respectable amount: somewhat less than the French, Germans and Dutch, rather more than the Spanish and Italians.

Spending more would surely help, especially after seven years of financial drought. We will need to increase funding further, probably by a lot as the population ages, expectations increase and costs go on rising. But our relatively poor performance on outcomes is not just down to how much we spend. Where the money comes from, and how it is spent, also matters.

Almost all the money comes from general tax revenues. This does have the great advantage of ensuring an equality of access which is good, though by no means unique, by international standards. Though don’t forget it does not ensure anything approaching equality of outcome; the rich still live a lot longer than the poor.

Reliance on this single source can cause problems. Taxes can be hard to raise and the system can become monolithic. Systems paid for through social insurance, like those in Germany and the Netherlands, have their own problems but do seem to adapt more quickly, and they are at least as redistributive as our own system; higher earners pay higher rates and the poorest get into the system for free. They also allow health and social care funding to be brought relatively easily together. The Germans simply added a long-term care insurance fund to their health insurance system. That doesn’t get round the need to pay but it does avoid the huge inefficiencies and inequities created by our system of free, tax-funded healthcare alongside severely means-tested access to social care. We tend to forget this Cinderella element of our overall system when singing the praises of the NHS.

Our inability to do anything about it, exemplified by the aborted proposals on social care during the election, is just one part of the wider problem of the infantilisation of public debate. The whole system is inconceivably complex. However much we might want them, simple solutions are not available. You can’t just run healthcare from Whitehall any more than you can do the same for manufacturing industry. It is so big and complex that it forms a whole sector of the economy as much as it does a public service. Like any successful sector it needs to adapt and learn from the best in the world.

For that to happen we need to call out our political overlords when they shower us with drivel about how very lucky we are to live in the best of all possible worlds. Free universal healthcare is a precious thing indeed. To protect it we need to stop worshipping at the shrine of the NHS and stop demanding it be preserved in aspic. We need instead to ask how it can change for the better.

Paul Johnson is director fo the Institute for Fiscal Studies

Bicycles are dangerous, they are getting faster and now need to be insured. Why should the health service cover the costs of either road or cycle accidents?

Drivers are insured by law. So should cyclists be insured by law. If it became obligatory people who drove cars could bolt on a policy addition for their bikes. If they only ride bikes, and otherwise use public transport, they would have to have a separate policy. Long term injuries due to any form of road accident (cars and  bicycles) should be redressed by insurance claims. The cost should not be a burden on the state. There could be a reduction in premium for organ donors, especially those who ride motorbikes. There could be “family policies” attached to car drivers or independently. Why should the health service cover the costs of either road or cycle accidents?

Following the recent conviction of a cyclist for driving furiously and dangerously with no front brake, the letters in the Times 28th August are interesting. I have put the one I think addresses the issue in the long term, and in reality, first.

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LAWS FOR CYCLISTS

Sir, Cyclists should take a riding test to demonstrate their acquaintance with the Road Traffic Act and their fitness to be on the road. They should also be required to be insured, to subject their bicycle to an annual MoT test and to display a registered licence plate.

It would also be good if cyclists made a financial contribution to the upkeep of the roads and the construction of cycle-specific features through the road fund licence tax.

Alec Gallagher
Potton, Beds

Sir, The law already requires bicycles to be equipped with a bell, a reflector and front and rear lights at night (letter, Aug 25, and “Killer cyclist facing two years in jail”, News, Aug 24). However, it is the effective abandonment of road policing, relying instead on cameras — which some argue are sited to increase revenue rather than improve safety — that puts cyclists at risk, as well as those of us seeking to use the pavement safely.

Clive Fletcher-Wood
Bristol

Sir, Clearly cyclists should not be using bikes that do not comply with legal brake requirements, but pedestrians also have a duty to respect road users. The increasing problem of cyclists using pavements and pedestrians more intent on their phones than watching traffic will inevitably result in tragic cases.

Terry Freeman
Cheltenham

Sir, I too was knocked down by a reckless cyclist at the age of 44, and although I suffered severe brain damage which left me unable to work, I appreciate I’m lucky to have survived. I think the public need to be made aware of how much combined energy and weight a speeding cyclist is carrying, and the impact can be as traumatic as being hit by a car travelling at 30 mph.

Toni Beet
Walton-on-Thames, Surrey

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The paradox of the pharmaceutical industry. For most of us the quality of care, and of death is more important than more new therapies.

The paradox of the pharmaceutical industry is that they are not getting very far nowadays, and the cost of new product development, especially in countries with a time limited patent, is such that investment is reluctant. Some companies have indicated that UK Plc should invest (and take a share in the company?) and some have retrenched. Has pharmacy research reached its end? Will any new developments be affordable in a universal system? Unfair post code and ageist selection of exclusions is already happening, and new gene therapies may only be justified to a select few.. Treating populations does not involve investment in pharmaceutical companies. The risk must be taken by investors. For most of us the quality of care, and of death is more important than more new therapies. We cannot afford these new drugs, and yet we cannot afford to ignore them. Unless we ration low cost services overtly, new pharmacy will increase the social divide.

Michael Bow in the Evening Standard on 27th  July reports: Drug maker GSK to spend £275 million beefing up plants for Brexit boost 

and in the Telegraph on 23rd August Iain Withers reports: Britain’s drug makers call for public funds to help them catch global rivals 

and 26th August: Drugs giant AstraZeneca to expand largest UK site in boost ahead of Brexit

and How do you turn world-leading British science into medicines?

It may not be glamorous, but Stevenage is set to become a world-leading centre for gene therapies, the new wave of pioneering treatments that hold great promise for tackling illnesses such as cancer and rare diseases.

On the outskirts of the somewhat drab Hertfordshire town, a Government-backed drug development factory is springing up that covers an area the size of the pitch at Wembley Stadium. It will house start-ups dedicated to the fast-growing branch of gene medicine, which fights illnesses by modifying genetic code.

It’s an approach that is in its earliest stages, boasting only a handful of approved treatments globally, but in clinical trials has made breakthroughs in tackling conditions as varied as leukaemia and inherited blindness. The £55m facility, first announced in George Osborne’s 2014 Budget, is a Government play for a slice of this developing market.  Building work will complete within weeks and two biotech companies – Autolus and Cell Medica – have signed up for space, with several other firms in discussions.

It is exactly the kind of high-skill manufacturing the Government is desperate to promote and export, particularly ahead of Brexit. It is also likely to feature prominently when the Government’s industrial strategy is rebooted on Wednesday, with Sir John Bell, the immunologist and geneticist, set to launch the first report on how to boost the £60bn life sciences sector.

Ministers will have their work cut out as the UK has too often failed to translate medical breakthroughs into blockbusters made in Britain. An example is monoclonal antibodies, a common component of biological drugs discovered at Cambridge University in the Seventies.

It led to a Nobel Prize for the scientists involved and has since exploded into a field worth around £70bn globally today. Yet just 3,000 of the 100,000 people working in this area are in Britain. Over the past eight years the UK’s historic status as a major net exporter of medicines has been gradually dwindling.

Since 2009, every year bar one has seen a lowering of net exports of pharmaceutical products and medical devices, with the UK even becoming a net importer for the first time on record in 2014, according to UN trade data. So what barriers will industry and the Government have to overcome to make the UK a medicines manufacturing powerhouse once again?

Britain’s drug makers outlined a blueprint this week for doing just that, in a report entitled Manufacturing Vision for UK Pharma. In it they called on government to invest up to £140m to build a further three drug manufacturing “centres of excellence”, like the one in Stevenage. They also urged pharmaceutical firms to learn from their counterparts in the automotive and aerospace industries on how to partner with government and pool research and development efforts.

“It’s about trying to grow the medicine footprint in the UK,” says Andy Evans, chairman of the organisation behind the report, the Medicine Manufacturing Industry Partnership, and head of FTSE 100 giant AstraZeneca’s 3,500-strong Macclesfield drugs manufacturing site.

“These facilities will act as a bridge between the science and getting products to market,” Evans adds. He says public sector contribution is essential to “share risk” and to enable SMEs to access facilities.

Both the Government and industry will be hoping to replicate the UK’s early wins in gene therapy, a field now boasting 60 firms with £1bn investment behind them. Among them is Oxford BioMedica, a company that has developed a novel lentiviral delivery mechanism for modifying genes.

The AIM-listed firm’s market value has jumped by almost three quarters since June thanks to its partnership with Swiss conglomerate Novartis, which got provisional approval for a landmark gene therapy for leukaemia.  All of Oxford BioMedica’s operations remain in Oxford.

“We have looked extensively at other countries,” John Dawson, its chief executive, says. “But we are happy with what we’ve got. We’ve had a very good run of being supported by government.” That support has included millions of pounds of research grants.

Keith Thompson, chief executive of the Cell & Gene Therapy Catapult, the Government body behind the Stevenage facility, says: “We’re hoping that when companies grow out of using the facility and need a bigger place, they’ll simply build it down the road.”

Sceptics point out that a broader package of policies will be needed to compete with rival countries.

Dr Tobias Silberzahn, a partner at consultancy McKinsey & Company, said: “What’s the skill level, salary level, unrest potential, how do salaries develop, how is the tech scene, and what special incentives are offered from government?”

He adds: “If the UK wants to attract more drug manufacturing they need to look at their tax breaks and other financial incentives.”
Industry experts note policy has been moving in the right direction, with corporation tax falling and initiatives like the patent box scheme – offering a reduced tax rate on UK and European patented products – providing incentives. But all these considerations ignore the Brexit elephant in the room.

Last month, Pascal Soriot, AstraZeneca’s chief executive, said all its new capital investment was on hold due to the current uncertainty, although it is expected to commit to a “mid-size” project in Macclesfield. John Rountree, a consultant at Novasecta, which advises both UK and European firms, says his clients are generally putting capital spending on hold.

“With supply chains across different countries, if there are extra barriers and paperwork clearly that will be a deterrent.”

One company that remains a firm believer in UK drugmaking is GW Pharma. The company – which develops treatments derived from the cannabis plant to alleviate the symptoms of MS and epilepsy – grows, processes and purifies all its cannabis in the UK.

While the firm moved its listing from London to New York last year for funding reasons, Adam George, managing director, says: “We are proud to be a UK company, and we’re scaling up. We plan to create 70 jobs next year and to invest £50m in capital over the next three years.”

This bullishness is something the Government is hoping to foster more of.

Chris Smyth in the Times 29th August 2017: New drug heralds breakthrough in fight against heart disease

Yes, we have to ration services. Don’t deny it, but accept and discuss how.

Haroon Siddique in the Guardian 25th August reports: NHS accused of keeping secret its plans to cut services

Campaigners say freedom of information requests to NHS trusts and government have been turned down

Yes, we have to ration services. Don’t deny it, but accept and discuss how. Unfortunately short term time horizons mean politicians work out that they will lose more votes in honesty than they win.

The NHS has been accused of keeping the public in the dark about controversial plans to plug a £250m funding gap by rationing services.

The crowdfunded campaign group 38 Degrees submitted freedom of information (FOI) requests to the government, NHS leaders as well as trusts and clinical commissioning groups in the 13 areas affected but all except two refused to release details of planned changes.

Leaked proposals from three areas have already revealed plans including downgrading or closing A&Es and extending waiting times for operations, and 38 Degrees says the public is entitled to know what else is in store…..

…The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.

An NHS England spokesman accused 38 Degrees of “a rehash of months-old claims”. He added: “The NHS has always had to live within the budget that parliament allocates, and the usual requirements for public consultation on any suggested major service reconfigurations of course continue to apply. However, it’s grossly unfair if a small number of areas in effect take more than their fair share at the expense of other people’s hospital services, GP care and mental health clinics elsewhere in the country.”

Failing to care, lowering standards, excluding trained staff (Brexit), overworking all staff, and yet we still worship the Health Services.

It really is rationing time. we are failing to care, lowering standards, excluding trained staff (Brexit), overworking all staff, and yet we still worship the Health Services. Paul Johnson reports in the Times 25th August: The NHS doesn’t deserve our hero worship – Politicia ns parrot the mantra that we have the world’s best healthcare but the facts say otherwise

Most of the patients who die because of lack of nurses are elderly. Doctors and their families dread admission and know they need a bedside advocate. We are even encouraging the valuable carers and nurses to leave, and NHSreality has facetiously suggested that we may end up exporting our elderly. In Plymouth the GPs are collapsing and the new “Queen Alexandra Superhospital” has failed the CQC assessment. Helen Puttick on August 23rd Hospitals face inquiry into too-high mortality rates

Here is the first headline finding from the OECD’s most recent set of international comparisons: “While access to care is good, the quality of care in the United Kingdom is uneven and continues to lag behind that in many other OECD countries”. That is borne out across a wide range of measures. Overall life expectancy is no more than middling. We are in the bottom third of comparable countries for cancer survival rates and in the middle third for strokes and heart attacks. In an understatement of which we British might be proud, this Paris-based organisation concludes “the UK does not excel at providing high-quality acute care”.
This is not because we have healthcare professionals who are any less dedicated than those in other countries. We do not lack will, effort, compassion. And of course we do some things well. Survival rates from cancers, strokes and heart attacks are improving, albeit from a low base. Our performance on breast and cervical screening as well as vaccination is better than most. And on many measures of efficiency, such as spending on drugs and length of hospital stays, we perform well. Yet for all that dedication and compassion, for a wealthy nation we have no more than a fair to middling health system. Some bits are good, many much less so…..

As recent work from the Nuffield Trust has shown, this is not because we spend much less than others on health. Across developed nations as a whole, and against wealthy EU nations, we spend a perfectly respectable amount: somewhat less than the French, Germans and Dutch, rather more than the Spanish and Italians….

Chris Smyth reports 28th August that “Patients die because nurses are too busy”. 

 

Family advocates needed? Hospital patients at risk of falls as ‘thousands cannot reach walking sticks’..

Net migration falls as EU citizens quit Britain: More than a quarter of births in England and Wales last year, 28.2 per cent, were to mothers born outside the UK, the highest level on record.

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In the first six months of this year, almost 100,000 permanent residence cards were issued to EU citizens who have been in the UK for five years.

The ONS bulletin showed that the number of EU citizens leaving the UK increased by 33,000 year-on-year to 122,000, the highest outflow for nearly a decade. There was a rise of 17,000 in departures of migrants from the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia, the countries that joined the EU in 2004. There was also a 19,000 fall in the numbers arriving from the EU, although the ONS said that this was not “statistically significant”.

Total EU net migration was estimated at 127,000, a dip of 51,000 on the previous 12 months. The figure for migration from the rest of the world was also down, by 14,000 to 179,000, and included 87,000 students, according to the ONS.

Sir Vince Cable, the Liberal Democrat leader, said that the figures showed a “deeply worrying Brexodus of EU citizens who have made the UK their home”.

Some business leaders expressed alarm at the drop in numbers. A spokesman for the Institute of Directors said: “Given unemployment is currently at its lowest level ever, without the three million EU citizens living here the UK would have an acute labour shortage.”

Brandon Lewis, the immigration minister, called the figures “encouraging” but added: “There is still more work to do to bring net migration down further to sustainable levels.”

Migrants from the EEA pay about six times more in tax and national insurance contributions than they take out in benefits and tax credits, HMRC figures released yesterday showed.