Monthly Archives: September 2017

GP practices close in record numbers – Wrexham patients protest about GP staffing levels. This is only the beginning….

The problems in Wrexham are going to spread. BBC News today reports: Wrexham patients protest about GP staffing levels. The rationing of medical school places, midwifery places, physiotherapy places and nurse training places has led to severe under capacity. Patients will be asked to see nurses for “diagnosis”; something they are not trained for, and the result will be no living with uncertainty, or letting the natural course of disease run, over investigation and over referral to defend their litigation risk. We have the evidence here than we have destroyed the goose that laid the golden egg … Its NOT funny..

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…Since 2015, the health board has taken over the running of seven GP practices across north Wales after they terminated their NHS contracts…..

BBC News reported 7th April 2017: GP practices close in record numbers

Despite the poor recruitment 9 out of 10 GP surgeries are “outstanding”.

10th August 2017: North Wales’ GP shortage escalating crisis, medic warns – BBC News

Mark Smith on 29th February 2017: GP practice serving 8,000 patients terminates contract with its health board

26th January 2017: North East Wales GP shortage leaves Wrexham patients without out of …

GP shortage hits hospital out-of-hours service in Wrexham

Just to show how  unbelievably out of touch they are BBC News today reports: NHS reform can cut costs, says local council leader

Councils can show health boards how to cut costs, a local government leader has said.

A report has claimed protection of health funds could make libraries and leisure centres unaffordable.

First Minister Carwyn Jones said it was the “inevitable” consequence of Westminster cuts to Wales’ budget.

But Debbie Wilcox, leader of the Welsh Local Government Association, said councils had done “tremendously well” to protect front-line services.

A review by the Wales Governance Centre and Wales Public Services 2025 said about 56p in every pound spent by the Welsh Government on public services could go to the NHS within four years.

Mr Jones told BBC Radio Wales: “We know how important health is and we have got to the point where it takes most of our expenditure.

“But we have experienced austerity since 2010 and it is taking more of a decreasing budget.”

Speaking to BBC’s Good Morning Wales programme, he called on the UK government to support public services, saying finances were being “squeezed”.

Newport council leader Ms Wilcox said health boards could do more to reduce their spending.
“I think there has to be a question asked about further reform,” she said, pointing to management costs in the NHS.
“If the cuts keep coming, as this report has shown, local government is going to fall over.
“I think there is a responsibility on the NHS to sit down and talk to us and engage with us.
“We have made huge cuts. We have managed tremendously well. We can teach the NHS the ways in which to do that.
“We need to collaborate more and show them better ways of managing our limited resources.”

Finance Secretary Mark Drakeford will set the next budget on 3 October.
The NHS currently receives 48% of the Welsh Government’s revenue budget – up from 39% in 2009-10.
The two Cardiff University-based think tanks said under current UK government plans, the Welsh Government should expect another 3% cut to its budget for day-to-day spending by 2021-2022, on top of a 11.5% cut since 2010.
Welsh ministers have promised to protect the NHS, schools and adult social care, meaning local authorities take a bigger hit.
The share of the Welsh Government’s revenue budget the NHS receives could rise to 56%, if ministers find the money needed to keep up with a predicted growth in demand, the report has warned.
Cuts to Welsh councils have been smaller than in England, but spending on unprotected services – such as libraries, roads and culture – could reach 50% by 2021-2022, the study estimated.
It added: “There may not be a single tipping point but continued attrition would call into question whether the full range of services we have now is affordable.”

For the first time, Mr Drakeford has the option to raise some taxes.
But those powers are “likely to have only a limited impact” on spending during the next four years, the report said.
Ministers will have control over landfill tax and land transaction tax – formerly stamp duty – next year.
They will also get powers to vary income tax in 2019.
But Labour has promised there will be no changes to income tax, leaving spending heavily dependent on a shrinking block grant from the Treasury in London.
The Welsh government said the report illustrated the difficult budget decisions it faced.
“We have repeatedly called on the UK Government to end its unnecessary austerity agenda, which has resulted in ongoing real terms cuts to our budget since 2010,” a spokesman said.
But the Conservatives said the problems facing the Welsh NHS were “the product of nearly two decades of Labour mismanagement”.
Tory finance spokesman Nick Ramsay said: “Successive Labour administrations have singularly failed to get a handle on worsening public health, long-term workforce planning, and wasteful practices – all of which have been compounded by chronic underfunding.”

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

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Tax and control: of course drugs should be legalised. We would have more for cancer treatments…

Updated 25th May 2018: BMJ 2018;361:k2057  Drugs should be legalised, regulated, and taxed

Legalising the production, purity, distribution, and sale of drugs makes sense. By controlling the processes above the criminals will need to  stop or change into a different field. We as citizens stop spending on prevention and punishment in a system that produces more criminals in training schools (prisons). The savings from both prison and police can be spent on providing a better health service. Wales might even find the money for Cancer Cervix victims..

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Louis Emmanuel in the Times: Uruguay becomes first country to legalise cannabis sales over the counter

Valentine low in the Times reports the royal prince: Should drugs be legalised, asks Prince William

It is a debate that has divided society for decades, with libertarians, hippies and the state of Colorado on one side, and conservatives and anxious parents on the other. Now the Duke of Cambridge has raised the question: is it time for drugs to be legalised?
He spoke out as he visited a charity in east London that helps people with addictions.
Prince William, 35, told a group at the Spitalfields Crypt Trust in Shoreditch who had all been helped by the charity: “Can I ask you a very massive question — it’s a big one. There’s obviously a lot of pressure growing on areas about legalising drugs. What are your individual opinions on that?
“You seem like the key people to actually get a very good idea as to what the big dangers here are.”
Heather Blackburn, 49, from Hackney, said: “I think that it would be a good idea but the money is kind of wasted on drug laws that put people in prison . . . of the people I’ve known in recovery, 95 per cent have massive trauma and terrible stuff happen to them and using drugs to cope and then you get put in prison, you don’t get the facilities and actual help you need.

“ You get punished — which is not going to stop anyone taking drugs.”
William asked: “So there needs to be more of a social element to it?. . . So prison doesn’t tackle the root cause of why someone is taking drugs?” Ms Blackburn replied: “No, it just punishes.”
A royal aide said that while William had been careful not to proffer an opinion, “he has long taken a keen interest in the issue of homelessness and is not immune to the fact that addiction can play a big part in this”.
The aide added: “If there is a social issue then he believes it is important not to talk about it in the abstract but ask questions of and listen to those who are affected.”
A spokesman for Transform, the think tank pressing for a change in drug laws, said: “Transform is delighted that Prince William has the courage to ask one of the most crucial questions of our time . . . legalisation would better protect the most vulnerable people by putting government, not gangsters in control of the drug trade.”

The National Drugs problem: Stop Prohibition – even Mr Clegg might be getting there..

BBC Wales: Welsh women denied cervical cancer drug on NHS

Plymouth is in trouble, and meltdown. Is this the first city for whom the successive (dishonest) health ministers have failed? And thats not to mention the elderly needing care..

Plymouth Hoe gave us a national hero, and another is needed. This time it will be the first politician who persuades his party to be honest about the UKs 4 health services. It follows through into care of the elderly….

Plymouth is in trouble, and meltdown. Both GP retention and recruitment, and hospital juniors. Is this the first city for whom the successive health ministers have failed?

Charlotte Turner in GPonline 22nd August 2017 reports: Where the battle to save Plymouth’s GP surgeries will be won and lost

With surgeries closing their doors and providers handing back contracts, what does the future hold for our city’s GPs?

….It is not just Ocean Health who have experienced difficult times in Plymouth – Cumberland, Hyde Park, St Barnabas and Saltash Road GPs all shut on March 31 – the surgeries were being run up until that date also by Access Health Care, which stepped in last year after previous providers pulled out.
Freedom Health Centre will be shutting its doors on September 30 after the current provider resigned too.
The surgery, which has about 1,800 patients and deemed “not fit for modern healthcare” will stay open until that date.
Ernesettle, Mount Gould and Trelawney, which serve around 10,000 patients also need to find a new provider by March 2018 to ensure they stay open……

The Guardian 18th September 2017: Two junior doctors left to care for 436 patients on ‘very unsafe’ night shift

Anonymous tipoff to Plymouth Hospitals NHS Trust reveals pressure on staffing

NHSreality wants scapegoats – and suggests the successive ministers of health (for England). Allyson Pollock might agree..

The Times September 20th: Home care reduced for elderly despite extra £2bn

Many elderly and vulnerable people who receive care in their own homes are having levels of support cut because of funding pressures, despite ministers’ injection of extra money, social workers say.

Cuts include reducing home calls from 45 to 30 minutes, withdrawing help to wash at home or prepare hot meals and fewer visits to help them use the lavatory, according to a report.

Home care is also being more tightly defined in many areas, with local authorities refusing to pay for activities to help people go out and focusing on physical needs, it said.

The reports of squeezed budgets come despite the announcement by Philip Hammond, the chancellor, in March of an additional £2 billion over three years for adult social care.

A report by the Social Care Alliance said that the system was buckling under the strain of too few resources and rising demand, based on 469 responses from social workers to a survey conducted online by Community Care magazine.



90% of GP care is good quality. Are you lucky enough to be in a post code with good GP care and good choice?

I am still asked “how should I choose my GP practice”, and I usually give a guarded reply which amounts to “It depends what functions/services you value most”. Continuity of care is a rarity these days, and with more and more part time GPs the problem will get worse. Patients are not “ill” on days that suit a Dr working 2-3 days a week. Children are ill suddenly, and so practices where partners offer a daily surgery, albeit with a different doctor, are valued. One thing to consider is whether there is an “individual list” system, or a “shared list” system. In the former it can be harder to see your doctor, but it may be worth waiting especially for older patients with chronic conditions. In the latter system patients are often fitted in quickly but usually see a different Dr each time if it is an emergency (as defined by the patient)! Mothers of young children usually prefer this type of system, but not always. Does the practice have an active Patient Participation Group?Other things to consider are whether the practice is a teaching practice, what the turnover of staff is, and whether they have a QPA (Quality Practice Award) which is in date. If you know a family who have had a death recently, the quality of any palliative or terminal care is pertinent, but remember “dead patients don’t vote“. Despite all this, and the Care Quality Commission report, most patients will still ask their neighbours…

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It’s a pity that we don’t know the quality of care for comparison in the other 3 UK health regions, thus emphasising that there is no NHS. Rather than reporting the bad news, the Times could report that 90% of GP care is good quality, and ask “Are you lucky enough to be in a post code with good GP care and good choice?” as many areas have reduced choices, even in cancer care.

Chris Smyth in The Times reports 21st September 2017: 7m patients are urged to leave unsafe GP surgeries

Seven million patients are treated at GP surgeries with serious safety problems, according to the first comprehensive review.
Inspectors urged patients to switch to better performing surgeries after finding that one in seven had issues with safety and one in ten was not good enough overall.
They uncovered “pockets of persistent poor care” including out-of-date medicines, a failure to follow up on test results, delayed cancer diagnoses and a lack of checks on the medical qualifications of staff.
Smaller surgeries were more likely to do badly, the review showed, with the worst half the size of the best. They have been ordered to end “professional isolation” by linking with neighbouring surgeries to share resources and expertise.
The Care Quality Commission (CQC) has finished inspecting all 7,365 GP practices that existed when it started its revamped regime three years ago. Nine in ten were good or outstanding, significantly better than hospitals or care homes. It initially found that one in three was not safe enough, forcing inspectors to take action including shutting dozens of surgeries. One in seven still had safety problems, however, covering seven million patients, with 13 per cent “requiring improvement” and 2 per cent, with almost a million patients, “inadequate” for safe care.

“Safety is the one clinical area that we worry about,” Steve Field, chief inspector of GPs, said. “You find surgeries where they have lots of [test] results that haven’t been acted on, they might have out-of-date medication, their fridges might be at the wrong temperature so the vaccines might not work. It’s really poor leadership.”

Professor Field recently had to intervene to replace out-of-date emergency adrenalin that could have led to the death of a patient, he revealed. He urged patients to use ratings on the CQC website to switch to a better surgery. “I was in a surgery two weeks ago where they said they’d had 300 patients move to them because they were rated outstanding,” he said.

The average “inadequate” practice has 5,770 patients compared with 10,126 for the average “outstanding” one. Professor Field said that smaller places often found it harder to stay up to date, manage services well and employ nurses to help patients with long-term conditions. He said that most should be linked to other family doctors and social services. “I suspect that if you’re a weak leader but a good clinician and you’re part of a larger group, the quality of care will be better,” he said.

Ministers have promised GPs £2.4 billion as they struggle with rising patient numbers and Professor Field said that this had to get through before a “winter crisis”. Richard Vautrey, chairman of the British Medical Association GP committee, said: “These positive results are undoubtedly down to the hard work of GPs and practice staff, but many are in an environment where they are increasingly struggling to deliver effective care.”

The union has clashed with Professor Field, insisting that his inspections were not fit for purpose. Dr Vautrey insisted that the process “remains overly bureaucratic and continues to result in GPs spending time filling in paperwork when they should be treating patients”.

Jeremy Hunt, the health secretary, said: “Nearly 90 per cent of GP surgeries in England have been rated as ‘good’ or ‘outstanding’ — and that is a huge achievement for GPs given the pressures on the front line.”

What do we know?

  • Every GP practice has an overall rating shown on the CQC website
  • Each practice is also given sub-ratings assessing whether it is safe, clinically effective, caring, responsive and well-led
  • The NHS GP patient survey assesses whether people would recommend their surgery, whether GPs give them enough time and whether they see the same doctor
  • There is little other official data on GPs
  • Patients can post ratings on websites such NHS Choices

Dead people don’t vote… End-of-life care ‘deeply concerning’

The NHS and reckless election promises. How about posthumous voting?

NHSreality postings related to choosing a practice

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Pragmatic decisions need to be taken to insist on rationing… Are we are gullible enough to believe their lies?

All health systems are rationed. The political decision is whether to t=ration overtly (Most of the world0 or covertly (UK Health systems). Patients need not be in pain, and high cost treatments may be available if we accept that citizens have a need to provide the high volume and low cost treatments themselves. Rationing in this way will not offend big pharma or deny patients expensive cancer treatments. Rationing is not a possibility its a certainty. It’s just whether politicians continue to lie about it, and we are gullible enough to believe their lies.

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BBC News 4th July 2017: NHS ‘rationing leaves patients in pain’

The Telegraph reports 31st august 2017: NHS rationing bodies refuse to fund treatment which stalls breast cancer  

Foreign drug giants behind challenge to NHS rationing Jul 2017

Charities call for NHS to stop rationing critical care The Guardian 18th February 2017

Welsh women denied cervical cancer drug on NHS – BBC News

7 days ago – Women with terminal cervical cancer in Wales will not have the same access to a potentially life-prolonging drug available in England and …

Welsh cancer patient forced to move to England dies – BBC News  

31 May 2017 – Irfon Williams moved to England to receive the drug Cetuximab to treat his bowel cancer.

Is NHS rationing a possibility? BBC News in June

Money, money, money – it’s a familiar background theme across the NHS in England, but the volume is increasing.

Campaign funding promises have been made but whoever forms the next government will find some challenging financial issues highlighted in their ministerial red boxes.

This week, reports of a tightening of the financial thumb screws have emerged. There is talk of rationing and, as one source told me, “unpalatable things” being contemplated by hospital managers and local health commissioners.

Under what’s been billed as a “capped expenditure process”, NHS England and the regulator NHS Improvement are telling some trusts to stick within spending limits even if that means tough decisions on the provision of non-urgent care.

The new pressure on hospitals and local health commissioning groups in England comes after some trusts overshot agreed spending targets during the last financial year.

Spending control

Since the start of this year, from the beginning of April, it has become clear that the biggest over-spenders have been unable to agree their so-called “control totals”. They have now been told to take firmer action to keep a grip on spending.

The Health Service Journal (HSJ) reported that NHS officials have contacted health managers in 14 areas of England with a series of proposals for controlling budgets. These include extending waiting times for routine procedures and treatments, downgrading certain services and limiting the number of operations carried out by the private sector for the NHS.

HSJ first revealed the tougher spending regime in April, quoting from a letter sent to those local health leaders who could not agree their budgets.

They were asked to decide “from which areas further expenditure reductions will be made”, including reviewing the range of medicines prescribed.

Interestingly, the letter and subsequent dialogue has been with both commissioners, who can limit what they are prepared to pay for, and trusts who might save money by curbing the volume of non-urgent care provided to patients.

There was a clue to this tougher approach in the update to the NHS Five Year Forward View plan, published at the end of March. The finger is pointed at those organisations which had historically substantially overspent their “fair shares of NHS funding”.

Put a lid on it

They are accused of “living off bail-outs” taken from other services. They are then told to confront “difficult choices” and if necessary “scale back spending on locally unaffordable services”.

An NHS England spokesperson said no final decisions had been made and when final choices were made locally they would need to be approved nationally. But there was no denying the fact that in some areas hospital managers and commissioners were being told to go further than before to keep a lid on spending.

The background to this is that NHS England is receiving a much smaller budget increase this year than in 2016/17 which, though originally billed as a generous “frontloaded” settlement, appeared to only just cover what the service needed. Patient demand will continue to outstrip the money available with the financial pressure even more intense this year.

Those who see the NHS as a bottomless pit always requiring more money to be poured in will call for more efficiency savings before another bailout is contemplated. Those who argue that the NHS has been underfunded for some years, with the share of national income devoted to health lagging behind other leading economies, will say the only answer is higher levels of government funding.

It’s a familiar debate and one which won’t go away after polling day.

Not enough money

The three main health think tanks, The King’sFund, Nuffield Trust and the Health Foundation, wrote a joint letter this week arguing that no political party was offering enough extra spending to cope with the demographic and demand pressures on the NHS.

They estimated that an extra £20 billion annually would be needed by 2022 over and above the most generous manifesto pledge.

The think tanks argue that failure to provide sufficient funding will result in longer waiting times for patients and a decline in levels of care.

Recent reports indicate NHS chiefs are already planning for that to happen.

Surveys of the uninformed are less valuable than those of the staff: survey doctors and nurses please Kings Fund

The Kings Fund and the Guardian allege that the public want to “continue with the health service as it was originally set up….” The fact that there are 4 health services, and not one NHS, and that the surveys referred to are not biased towards those who understand is relevant. The argument is rather like allowing the whole population to vote on Brexit. The children will always vote for more Mars bars or Ice Creams… International comparisons of outcomes do not support the contention that the UK health services are the best, especially on outcomes. Life expectancy in different UK regions is about to become very different. The safety net is rotten to the core, morale is low and engagement is minimal. Hiding behind spurious surveys is immoral. Exit interviews and polls of Health Service staff would be more relevant. I did this in 1996 and the need to ration was appreciated. Give the questionnaire design to NHSreality and more realistic answers will be achieved.

It is impossible to have Everything for everyone for ever.

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So the article in the Guardian and the collection of articles in the Guardian is omitting the reality of the need to ration overtly. Pretending there is no need to ration means covertly and post code rationing.

In the Observer 17th September 2017: Two-thirds support higher taxes to maintain NHS funding

Amid growing concern about state of the health service, poll shows a willingness to contribute more

Two in three people are prepared to pay more tax in order to ensure the cash-strapped NHS has the money it needs to provide good care.

New polling for the King’s Fund thinktank found that two-thirds (66%) of the public are willing “to pay more taxes in order to maintain the level of spending needed” on the health service.

Only one in five (20%) would endorse cuts in spending on other services such as welfare and education so that the NHS could receive a boost to its budget. Even fewer – 10% – believe that the health service should reduce either its level of care or range of services to balance its books.

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“Clearly the [rising] volume of noise around the problems the NHS is facing, and the warnings from within the health sector around inadequate funding, are increasingly cutting through to the public in a significant way,” said Dan Wellings, a senior policy analyst at the King’s Fund.

“The fact that two-thirds of the public are saying that they would pay more tax to fund it shows the strength of feeling around NHS funding. This finding comes at a time of unprecedented levels of public concern about the NHS’s future; pessimism about that is at a record level.”

The poll also showed a huge majority, 77%, believed the NHS to be “crucial to British society” and that it must be properly maintained…..Growing evidence about the extent of staff shortages across the NHS is likely to be a key influence on public thinking, added Wellings, who until April was head of insight and feedback for NHS England.

What does the public think about the NHS? Kings Fund

Inconvenient truth is NHS needs reforms

Golden goodbyes for NHS managers soar to £39m

Its quite surprising that managers who will not get jobs outside the health service (except in health providers) are so “valued”. The doctors who move into management are considered to have “moved to the dark side”, as their colleagues appreciate that the philosophy is unsustainable and the hoops they are asked to jump through are mostly pointless. This applies in both Hospital and GP land. As referrals are “blocked” more taxpayers will have to go private…

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Nadeem Badshah in the Times 16th September 2017 reports: Golden goodbyes for NHS managers soar to £39m

Spending on golden goodbyes and voluntary redundancy deals has risen eight-fold in a year at the Department of Health, according to official figures.
A parliamentary answer reveals that more than 700 staff left the department in 2016/17 due to restructuring and cost-cutting programmes.
The figures, which cover the DoH and its agencies, showed that £39 million was spent in total, compared with £5 million the previous year.
Across the whole of the NHS, including the DoH, £153 million was spent on redundancies and “exits”, up from £141 million the year before.
Philip Dunne, the health minister, said that “voluntary exits” of DoH staff accounted for £31 million in a parliamentary answer published this week.

An additional £1.4 million was spent on compulsory redundancies, the Health Service Journal reported.

The remaining £6.6 million is thought to have been spent on voluntary redundancies at agencies including Public Health England and the Medicines and Healthcare Products Regulatory Agency. Ministers were criticised in March after revealing that 340 civil servants were to be recruited, despite the mass redundancies, largely to respond to Brexit.

Almost £2 billion had already been spent on NHS redundancies since 2010.

Official statistics released earlier this year showed that in the past three years more than 1,000 civil servants and senior NHS officials were awarded exit payments of more than £100,000, with 165 receiving at least £200,000.

Separate figures disclosed that more than 600 NHS quango bosses are now on six-figure salaries, with a doubling in the number earning more than the prime minister in just three years.

In 2010 the Conservatives pledged to reduce spending on NHS bureaucracy. A reorganisation of the health service reduced administrative costs, but has resulted in almost £2 billion being spent on redundancies.

The DoH said: “The department undertook a redesign and subsequent restructure to make sure it is best placed to meet current and future health and social care challenges. Redundancy and other departure costs were paid in accordance with the provisions of the civil service compensation scheme.”

Carolyn Wickware in Pulse 15th September reports: GPs told to refrain from referring as hospital declares early-season black alert

NHS managers still growing as GP posts fall

HSJ implies Managers and Directors are now at odds with Politicians over rationing..

It’s falling apart, and it’s going to get worse… for everyone except the top managers and politicians.

GPs (Commissioning Groups in England) spend vast sums on temporary managers – no its not happening in Scotland or Wales

NHS middle managers too comfortable to take top jobs “Kafkaesque regulation and rising patient expectations mean that managers and doctors opt for an easier life in less demanding roles”… political courage is needed.

Whistleblowing in the NHS – The need to regulate non-clinical hospital managers

Perverse behaviours by managers lead to covert and unfair systems for us all. Patients ‘bumped from cancer test waiting lists’

Trying to defuse some of the invective against NHS managers.