Monthly Archives: February 2018

“The NHS cannot save itself”. (Let alone it’s citizens)

Toni Saad for The Spectator 9th January reports “The NHS cannot save itself”. (Let alone it’s citizens)

Rationing did not end in the 1950s. The largest-scale rationing programme is still in existence: our beloved National Health Service. Its austere regime is part of our national life. We no longer queue for bread or sugar, but we most certainly do to see the doctor. We no longer wait in line at the butcher’s, but we do in A&E departments and on interminable lists for appointments and procedures. There are no books or coupons, but rationing it remains. Indeed, the government has announced it is withholding elective operations and routine appointments this month. Rationing by any other name would smell as sweet.

And, like our drawn-out post-war rationing, it is ours alone. Nowhere else in Europe must one wait until one’s knee is arthritic to the point of incapacity before a surgeon will set eyes on it. Are your unsightly and painful varicose veins making you miserable? Terribly sorry— come back if you develop an infection or an ulcer. You’re worried you have cancer? Would you mind waiting two weeks to have ten minutes of your GP’s time? This would be unthinkable to our European neighbours. Good thing we have a stiff upper lip.

You might say that rationing is necessary in a system like the NHS, and you’d be right. Some are bound miss out. And you might say that more funding is the solution. But this misses the point. Rationing and austerity are not a Nasty Party conspiracy to dismantle the NHS. The problem is the NHS itself. It is an unwieldy bureaucracy incapable of responding to demand, and has all its patients and workers at its mercy.

The Secretary of State for Health has the unenviable job of divvying up the pie across this vast system. That a government minister has the power to prevent thousands of operations from going ahead should tell us something is wrong. Patients are rightly up in arms, as are the earnest junior doctors, still reeling from the (mostly favourable) contract imposed upon them. Knowing nothing but the NHS has blinded them to the nature of the problem. Don’t they see that it is the very fact of the NHS which gives Mr Hunt the power to treat them en masse, cancel thousands of operations at the stroke of a pen, and do countless other things against which they rail? Mr Hunt is the popular scapegoat, but he has inherited a system which gives him and others great power to give, but also to take away.

Moreover, though we fawn over the NHS, in the ways that matter most (e.g. cancer mortality), it is giving us poor outcomes. On the international stage, we are holding the wooden spoon.  The NHS is not fit for purpose. But the solution to its problems lies outside of itself. It must look to other nations for inspiration, and cease the cycle of cuts and funding drives which treat only the symptoms of its malady. Its top-down approach is unresponsive to demand, makes beggars of all its users, and rations services in a way which would be intolerable to anyone else. And, yet, it is still taboo to talk seriously about the NHS. It is high time that politicians braved the subject. Serious alternatives to the NHS need to be put on the agenda.

Toni Saad is a final year medical student at Cardiff University

“No end to NHS crisis in sight, nurses warn”, and “Compensation payouts ‘could bankrupt NHS’

Elizabeth Burden, reports Feb 1st in the Times on line: Compensation payouts ‘could bankrupt NHS’

Clinical negligence payments must be capped or the NHS will be bankrupted, health service leaders have warned the justice secretary.

In a letter to David Gauke, senior members of the NHS Confederation, the British Medical Association and the Academy of Medical Royal Colleges called for limits on compensation paid to patients who suffered injuries through medical errors. The cost of such payouts has almost doubled since 2011, they said, and if all claims in progress were successful it would cost £65 billion.

The NHS leaders argued that compensation was channelling money from frontline services. Niall Dickson, chief executive of the NHS Confederation, told The Daily Telegraph: “We fully accept there must be reasonable compensation for patients harmed through clinical negligence. Yet this must be balanced against society’s ability to pay.”

The letter claimed that many doctors were having to practise defensive medicine, undertaking unnecessary tests for fear of being sued.

It came as the Royal College of Nursing announced yesterday that the NHS crisis would continue long after winter. The latest performance statistics show that eight hospitals had no free beds on some days last week.

Kat Lay reports 1st Feb 2018: Hospitals are left without any free beds amid worst NHS winter crisis (Originally no end to the crisis in sight)

The NHS is in the midst of its worst winter crisis, doctors in accident and emergency departments have warned, with many hospitals without even a single free bed.

One consultant said that he could not even make any more space in the department’s corridors for new patients to be admitted.

The warnings came as Jeremy Hunt, the health secretary, said: “We are moving into what is always the most challenging and stressful week of the year for the NHS.”

NHS figures show that some hospitals have had barely a single free bed since the middle of November, recording night after night of being “100 per cent” full.

On December 11, the busiest night to date, 18 large hospitals in 12 NHS trusts across England did not have a single spare bed.

Average bed occupancy for the winter so far is 93.8 per cent, compared with 92.1 per cent at the same stage last year. Experts say that anything above 85 per cent is unsafe because of the increased risk of dangerous infections and delays.

Only seven NHS hospital trusts out of 153 had average bed occupancy below 85 per cent last month, down from 17 the year before.

Taj Hassan, president of the Royal College of Emergency Medicine, said: “Last winter we said, ‘This is the worst in 15 years.’ But I think this winter it’s even worse.”

The lack of beds meant that “boarding” patients on trolleys was common, he said. “A ward might have 20 patients in 20 beds but it might be expected to take an extra two or three patients on trolleys placed in the middle of the ward or outside in the corridor.” He said it was the only way to let A&E departments function.

He said A&Es regularly had between 20 and 40 patients in that situation, adding: “In some cases I’ve heard of 50 patients in an emergency department waiting for a bed. We have to try to manage them as best we can, in cold, draughty corridors, while dealing with new emergency patients.”

Richard Fawcett, a consultant at one of the largest A&E units, tweeted on Saturday that patients at the Royal Stoke University Hospital had to wait 12 hours to see a doctor. He followed that with a message that the A&E had “run out of corridor space”, another casualty department had closed to ambulances and patients were having to wait in ambulances to be seen.

An NHS England spokesman said: “At this time of year hospitals are extremely busy but thanks to hardworking NHS staff and robust plans in place to cope with winter pressures, they are generally coping.

“The latest weekly figures show hospitals reporting bed occupancy levels of 90.9 per cent — down from 95.0 per cent the previous week.”

Other parts of the NHS were also under pressure. Yesterday Zoe Norris, a GP, said on Twitter that there were five-hour waits in walk-in centres, adding: “A doctor has just driven a patient to A&E because both the GP admission line and 999 were permanently engaged.”

In the northeast of England, nurses and doctors have been told that pressures on the ambulance service meant that they may need to go out to patients aged over 65 who have called 999, and act as “first responders”.

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

There is plenty of room for improvement. Whilst we have got good outcomes in Breast Cancer, the rare cancers                  and Prostate Cancer in men do worse.

Chris Smyth reports 3rd Feb 2018: NHS is crippled by top-down culture

Autocratic management is a leading cause of poor NHS care, according to the compiler of a European health service league table that ranks Britain 15th.

The UK trails Slovakia and Portugal while the best performers such as the Netherlands and Switzerland pull away, according to the Euro Health Consumer Index. Treatment is Britain is mediocre and there is an “absence of real excellence” in the NHS, the report concludes. Only Ireland does worse on accessibility measures such as availability of same-day GP appointments, access to specialists and waits for routine surgery.

The findings come after a global study this week found cancer survival in Britain still lagged well behind the best in the world.

Arne Björnberg, who compiles the Euro Health Consumer Index, said: “Cancer survival rates are one of the prime examples of NHS mediocrity.”

More money is needed to improve care, according to a study that finds a strong correlation between treatment results and how much countries spend on health.

However, Professor Björnberg said that the most urgent lesson the NHS could learn from other countries was about the corrosive effects of an “autocratic top-down management culture”. He said: “As a Scandinavian what strikes you when you visit the UK is British management is extremely autocratic. Managing 1.5 million using a top-down method doesn’t work very well. If you go and ask a secretary or a receptionist anything out of the routine in Scandinavia, the most negative response would be: ‘I’ll see what I can do’. But in the UK they will say: ‘I’ll have to talk to my manager’. Subordinate staff are not allowed to use their brains in the UK and managing a professional organisation like healthcare like that is not a good idea.”

The Netherlands has consistently topped the rankings, which some have attributed to a system of competing insurance companies. However, Professor Björnberg said that the main lesson to be learnt from the Dutch was not about market forces but the need to put doctors in charge and force them to take account of patients’ views.

“If you have intelligent people and make them talk to customers frequently, that is a good idea,” he said.

“You have 1.5 million intelligent and dedicated people working for [the NHS]. Liberate the medical profession and put politicians and amateurs at arm’s length.”

NHS bosses dismissed the findings, preferring an index compiled by the US-based Commonwealth Fund, which ranks Britain top of 11 global health systems. The NHS scores well on measures such as equal access, but ranks tenth at keeping people alive.

In Search of the Perfect Health System – a new book reviewed

 

Compared with 11 other countries UK ranked first – for it’s system and not for it’s outcomes

The Commonwealth Fund compares health systems. Unreality of MPs. ..

Performance relative to other countries. Commonwealth fund “mirror”.

Other countries have sensibly funded healthcare. (Scandinavia and NZ), & “the schemes used by most countries on the Continent are preferable to the NHS model.

Our state-run healthcare model makes winter crises inevitable: the healthcare crisis seen from abroad, and publicised in the City.

Waiting times matter -especially in Wales – to see your GP, for investigation, and diagnosis as well as treatment.

Sky News 2nd Feb: Prostate cancer now killing more people than breast cancer – While breast cancer has benefited from a screening programme and significant research, prostate cancer has been lagging behind.

Its good news: “More people dying from rarer cancers” so less are dying from the more common ones..

 

When doctors know the system is failing, should they tell their patients? Yes. From East Anglia to Pembrokeshire….

Norfolk is facing a double hit. The Trust is victim of a PFI, and the CCG is underperforming in respect to cost cutting. Services are threatened…. Warnings were given over many years and Geraldine Scott of the EDP (Eastern Daily Press) reported: Commissioners in West \Norfolk could be stripped of their powers if £10million deficit is not solved. Add to this the cost of litigation as per previous posting, and Norfolk is bust.  \\\\\\\\\\\\\\\\\\\\\\\politicians have tried to put rationing decisions at arms length from themselves, but now gross failure means they will have to take responsibility. Message is, for the moment, don’t get ill in East Anglia.  David Oliver is a writing journalist doctor and his comments are perceptive. “Should NHS doctors work in unsafe conditions?” and “Let the NHS be honest with the public”, by which he means doctors are not telling their patients the truth…despite the statutory duty of candour.

Gareth Iacobucci reports in the BMJ: CCG criticises NHS England after being ordered to cut GP funding (BMJ 2018;360:k247 )

The head of a financially stricken clinical commissioning group (CCG) has launched an outspoken attack on NHS England after the group was ordered to cut GP funding to balance its books.

In a starkly written letter to local GPs sent on 12 January that was leaked to The BMJ, Paul Williams, chair of West Norfolk CCG, said that the group faced a “dire” financial situation, warning of “very unpleasant consequences” from decisions it was being forced to take.

Williams said that the CCG had been ordered by NHS England to cut local enhanced services payments to general practices, which fund work outside the core GP contract such as minor injury consultations, wound care, and phlebotomy. He wrote that “it is highly likely that there will be some reduction or possibly even cessation of LES [local enhanced services] payments.”

The CCG’s overspend is expected to reach £10m by the end of this year. Williams said that the situation had escalated because of “unreasonable assumptions” about what the CCG could achieve within its available budget.

As a result of the group’s financial position Williams said that the CCG board had been summoned to face “a star chamber of NHS executives” that had ordered it to cut services or face being taken over by NHS England.

He wrote, “At the end of the meeting, we were left in no doubt that unless we immediately start reducing expenditure then NHSE [NHS England] would not hesitate to disempower the government body and current executives and send in managers under legal directions to turn things around. They would have little regard for the long term consequences of their actions, their prime imperative would be to simply save money.

“I know this will be very disappointing for primary care and will no doubt produce some financial pressure in some practices, but unfortunately the CCG are being forced down this route by NHSE.”

Ian Hume, medical secretary of the Norfolk and Waveney local medical committee, said that any loss of income from LES payments would be damaging to local practices and would fly in the face of NHS England’s national commitment to invest in primary care.

Hume said, “It would give completely the wrong signal to general practice, which needs to be part of the solution. To cut enhanced services or primary care budgets is counterproductive.

“There seems to be an inconsistency between the approach from NHS England’s regional office and NHS England nationally. Cutting money in one place may have an increased cost to the system elsewhere. There is an incongruity about the whole approach.”

In a subsequent statement supplied to The BMJ, West Norfolk CCG said that the letter set out “the worst case scenario.” A spokesperson said that the group would not cut any payments to practices this financial year but added, “The CCG will review all [local enhanced services payments] for 2018-19. We shall want to look at their effectiveness, to make sure that every pound we spend delivers maximum quality and value for money. If any are changed, core GP services will not be affected.

“We shall continue this efficiency drive across all areas of the NHS to deliver maximum efficiency and maximum quality of care and reduce the deficit we face.”

Andrew Pike, director of commissioning operations for NHS England’s East region, said, “The current financial position of the CCG is of concern. The CCG has a duty to the taxpayer as well as to patients to ensure it delivers the agreed financial plan for 2017-18. The CCG has been requested to improve its financial position this year.”

The storm is coming: All Regional Health Services are unsustainable. The PAC are telling us the truth..

Telling harsh truths about the NHS is a bitter but necessary pill

The finance officers tell the truth: “NHS cannot make £22bn cut sought by government”..- there is no way forward under current philosophy

Candour and Transparency? – what a farce

 

Half of last year’s UK Health spend is earmarked for compensation claims. Pithed politicians have consistently ignored this problem… Now it’s payback time..

NHSreality has pointed out the political negligence in ignoring the need for “no fault compensation”. The first report recommending this was printed @ 1970 and although accepted by both parties, Lord Pearson’s report was never implemented. The perverse incentive for short term gains was too great. Long term gains would be felt now, and for the last 25 years if we had acted then. But negligence claims are not the only way our 4 health services can waste our tax take: NHS forced to pay £1500 for £2 pot of moisturiser.  We may need reform, but pithed politicians will find this beyond them. The total budget for England alone is £127bn. (Kings Fund) So £65bn is one half of one year’s spend! It has doubled in the last 7 years, rising at 11.5% over the last 5 years, We can assume Scotland, Wales and N Ireland have similar ratios. Now the bill is escalating, and due to our adversarial justice system, it will eventually overtake the send on health care on an annual basis. The position could be improved if the chancellor reverses his decision on the rate of compensation calculated by the Ogden formula. This results from rationing over many years, and now we will get the payback…

Image result for incompetent politicians cartoon

Laura Donelly in the Telegraph 2nd January reports: Victims of medical negligence should receive less compensation or the NHS will face bankruptcy.

ictims of NHS blunders should receive smaller compensation payouts or the “staggering” costs of Britain’s negligence bills will bankrupt the health service, the Justice Secretary has been told.

Health service leaders have written to the Government, calling for cuts to payments for patients who suffer devastating injuries as a result of medical errors.

The controversial demand follows years of rising negligence payments, with current liability now at £65bn – a rise from £29 billion in 2014/15….

The BBC reports: Curb rising NHS negligence payouts, health leaders urge

Health leaders have written to Justice Secretary David Gauke urging him to reform the payout system for negligence claims against the NHS in England.

They say costs are spiralling, “unsustainable” and diverting vast amounts from frontline care.

The NHS Confederation, the British Medical Association and medical lawyers are among the signatories.

The Ministry of Justice has asked the advisory body the Civil Justice Council to look at ways to limit payments.

The annual cost of claims is said to have almost doubled since 2010.

According to the letter, the NHS in England spent £1.7bn on clinical negligence claims last year.

The letter says: “The rising cost of clinical negligence is unsustainable and means that vast amounts of resource which could be used more effectively have to be diverted elsewhere….