Monthly Archives: June 2018

Challenge doctors over your treatment, NHS patients told. Choices need to be made, and a paternalistic doctor might be appropriate for some, but increasingly few.

One of the difficult discussions a GP can have is whether to raise the possibility of the “private” option with a patient. Some doctors leave it up to the patient to raise the issue, and some believe they should raise it if they feel the patient might be best served privately. What is the answer? In NHSreality opinion, all GPs and consultants should discuss the BRAN test… If a doctor’s first duty is to “put the patient at the centre of their concern”, he needs to point out that infections could be lower away from his DGH, and that survival rates are better in centres of excellence.

Should oncologists come out honestly about what is not available, but what they might like to give? Not without consulting with another Dr, preferably the GP.

 

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Kat Lay reports 15th June 2018: Challenge doctors over your treatment, NHS patients told

Patients will be told to challenge their doctors under guidance suggesting they should question the drugs and treatments they are offered.

Doctors and patients should follow what the Academy of Medical Royal Colleges has called the “Bran” test, which asks about the Benefits, Risks and Alternatives to a treatment, and what would happen if they did Nothing.

The academy, which represents 24 medical royal colleges and faculties, issued the guidance as part of a programme designed to reduce over-medication and decrease interventions of little or no value.

“This is all about enfranchising patients and giving them a sense of ownership of the way they are treated,” Professor Dame Sue Bailey, who leads the campaign, said. “Too often patients just accept what a doctor is telling them without question. We want to change that dynamic and make sure the decision about what treatment is taken up is only made when the patient is fully informed of all the consequences.

“Too often there’s pressure on both the patient and the doctor to do something, when doing nothing might often be the best course of action.”

The first part of its programme, published in 2015, encouraged the NHS to stop using 40 tests, treatments and procedures, including plaster for “buckle” wrist fractures in children. The latest tranche comes after NHS England said last year that it would no longer fund certain treatments including some dietary supplements and homeopathy.

The academy has now listed more than 50 further tests, treatments and procedures, which they said “may have little value or could be replaced with a simpler alternative”.

The list includes a recommendation to extend the length of contraceptive pill prescriptions to a year, to reduce visits to the GP, and simplifying advice on vitamin D supplementation to tell everyone to take them during the winter, not just the frail and elderly. It also says that doctors should not use drug treatments to manage behavioural and psychological problems in patients with dementia if they can be avoided, and talk to relatives and carers before a diagnosis, rather than just relying on a basic cognitive test.

Antibiotics in dying patients, the academy said, could be avoided because they “may not prolong life and can cause discomfort through side-effects”.

The advice is supported by Healthwatch, a watchdog. Imelda Redmond, its national director, said: “The campaign is all about encouraging meaningful conversation between doctors and patients, enabling people to have a greater say over their treatment and care while also ensuring precious NHS resources are used to their best effect.”

• A senior health service official said last night that four in ten GPs quit the NHS within five years of finishing their training. Ian Cumming, head of the NHS’s staffing body, said: “Forty per cent of all the people who completed training five years ago as GPs are not working in substantive GP employment or as long-term locums. They are doing short-term locums, they are doing other things.”

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Kat Lay in the Times reports 15th June 2018: NHS (England) must use extra funds to fight cancer

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions. If the people have a choice they will choose local, ahead of improved outcomes and travelling. As the population ages, and more people survive cancer, we will need more radiotherapy and oncology services. The shortage of Radiologists and Oncologists is so severe that the potential for improvement is threatened.

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The NHS will be expected to improve cancer survival rates and put a greater focus on maternity safety under a multimillion-pound funding package due to be announced within days.

Theresa May appeared poised to set plans to boost the NHS budget by more than 3 per cent after intensive meetings yesterday between No 10, the Treasury and the health team.

At a conference of health service managers in Manchester, Jeremy Hunt, the health secretary, said: “We need to make sure we unite the NHS and British people with a small set of bold ambitions as to how we want to transform our system. To get our cancer survival rate to the best in Europe; to transform our maternity safety so it is as good as Sweden; to truly integrate health and social care; to make sure we have waiting time standards for mental health that are as strong and powerful as the standard for physical health.”

He was still having “difficult” discussions with Mrs May and the Treasury over the precise details of a long-term funding plan, but an announcement is expected soon. NHS leaders say they need funding increases of 4 per cent a year, in line with assessments by think tanks. The Treasury is thought to be reluctant to provide that much.

Brexiteers want rises in health service spending to be funded by the so-called Brexit dividend — money available after Brexit that would have gone to the EU. They worry, however, that Philip Hammond, the chancellor, will suggest funding it through tax rises.

NHS sources fear that a “big picture” announcement could amount to a fudge because it will not spell out the exact funding increases on offer. That would mean health chiefs including Simon Stevens, chief executive of NHS England, waiting until November for the details.

There is also likely to be disappointment at a decision to keep social care funding, which is delivered through councils and is the subject of a forthcoming green paper, separate.

A report from the Institute for Public Policy Research, a left-wing think tank, has called for social care to be free of charge for people with substantial needs as part of a new long-term health funding settlement. Social care is currently means tested. Making it free would bring the care system into line with the NHS, where healthcare is free at the point of need.

Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Rationed – Start of cheaper technique for breast cancer is delayed in UK despite adoption elsewhere. GP commissioners should be demanding intra-operative radiotherapy.

Cancer drugs fund is illogical. More money should be spent on radiology and radiotherapy.

Cancer chief quits amid radiotherapy shortfall

Artifical Intelligence is no threat to doctors, but it’s potential needs to be managed. A shortage of Radiologists is more bad news for the future.

 

Artifical Intelligence is no threat to doctors, but it’s potential needs to be managed. A shortage of Radiologists is more bad news for the future.

All specialities depend on radiologists, and radiology. They, along with GPs have to have a deep knowledge of the whole human anatomy and physiology. Their skills are moving from diagnosis into treatment, as some tumours can be infarcted (have their blood supply cut off) at the same time as a diagnosis is made. Kidneys in particular lend themselves to this treatment. Artificial Intelligence is no threat to doctors, but it’s potential needs to be managed. A shortage of Radiologists is bad news for the future. The Economist confirms that in their view they will still be needed, but their skills will develop and change. Computers will become more and more useful for the reporting of routine, but more complex judgements have to be made by physicians. Radiologists are also the first physician to know of a bad diagnosis or prognosis, and therefore they are often “breaking bad news”. So their communication skills need to be good, as well as their radiological ones.

The Economist 7th June opined: From A&E to AI – Artificial intelligence will improve medical treatments – It will not imminently put medical experts out of work

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The whole article is below

Artificial intelligence will improve medical treatments

The RSNA News (Radiological Society of North America) points out the desperate shortage of radiologists in Scotland. Why is there such a “deepening gap in the workforce”, and what is a possible “big picture solution” that involves providing doctors form the UK rather than from 2nd and third world countries who can ill afford to lose them?

RSNA News June 2018

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Interview with Dr Ian Martin, Radiologist Withybush Hospital, Pembrokeshire 12th March 2013

 

 

 

Social care ‘close to collapse’ in most councils. The difference between public and private places, in the same homes, is “covert”, and needs to be routinely exposed.

Whilst Norway has a National Investment fund, which represents joint savings for unforeseen events, the UK has nothing. My pension is not funded from savings, or from my earnings, but from todays younger people in work. The reality of the shortfall for social care, and the difference between the bills paid by private customers as opposed to the state’s, are scandals. Families must ask for the difference between the private and the public funded places when their member first enters a home. Even if they still go ahead and are admitted, the truth is then out in the open. The difference between public and private places, in the same homes, is “covert”, and needs to be routinely exposed.

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Greg Hurst reports in the Times 12th June 2018: Social care ‘close to collapse’ in most councils

Three quarters of local authorities fear that their provision of residential homes and domiciliary care is close to collapse because of rising demand and reduced funding.

A survey found that 78 per cent were concerned that they may be unable to meet their duty to ensure a stable market for social care. Nearly half, 48 per cent, said that providers of home care, which are mainly private companies, had ceased to trade in their area in the past year and 44 councils said that companies had given up contracts because they were losing money.

The survey of 152 councils was by the Association of Directors of Adult Social Services. In addition to arranging adult care they have a duty to stimulate a diverse market for care provision.

The government announced a £2 billion boost for the care system last year. Jeremy Hunt, the health secretary, is to publish plans to reform social care next month.

Comment from the Times:

The welfare state model is going to have to change. People are going to have to save for their retirement (and no, NI is not going to do it for you) like they do other things such as a mortgage and not expect the state (that is other taxpayers) to provide support because you couldn’t be bothered providing for it yourself. Of course there will be means tested exceptions, that it what the state is there for, a social safety net for those in true need who didn’t have the option of preparing for retirement. Being profligate whilst working and expecting others to pick up your bill when retired, doesn’t count!

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NHS will help to find jobs for patients

Just because NHS England is going to do this, it does not mean the other 3 health services will do it. or that it will work. But it is good news, and the right way to think. The comment from the Times online which I have cut and pasted below summarises the “good news”. It will be interesting to see if the service lasts, and if the other Regions take it up.

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Kat Lay reports on the NHS England announcement 12th June in the Times: NHS will help to find jobs for patients

The NHS is to hire 300 employment coaches who will find patients jobs to keep them out of hospital.

Those in work tend to be in better health, visit their GP less and are less likely to need hospital treatment.

The specialists will help people with severe mental illness to seek work and hold down a job. They will offer assistance on CVs and interview techniques and are expected to work with 20,000 people by 2021. Pilot schemes running in Sussex, Bradford, Northampton and some London boroughs suggest that the coaches find work for at least a quarter of users. The scheme is being extended nationwide.

Claire Murdoch, NHS England national mental health director, said: “Tackling severe mental illness is not just about getting medication and treatment right but ensuring people can recover to live independently with their condition, including the reward and satisfaction of getting and keeping a job.”

NHS England is putting £10 million into the scheme over the next two years with further investment planned.

Coaches are urged to build relationships with employers to gain access to the “hidden” labour market of jobs that are never advertised. The specialists, whose support is not time-limited, then act as a link between a patient, their employer and their medical team.

A Centre for Mental Health review calculated that the scheme saved £6,000 per client over 18 months.

Far from being a waste of money this is long overdue. So often adolescents with special needs are let down by CAHMS and then as they mature, adult social services. What they need is an opportunity to contribute to society as they are able and in return receive both a fair wage and a sense of worth. At the moment all they hear is “limited resources”.

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England will lose more than 600 GP practices by 2022 without urgent investment, BMA analysis reveals

BMA News 8th June reports: England will lose more than 600 GP practices by 2022 without urgent investment, BMA analysis reveals

More than 600 GP practices in England will be lost in the next four years if investment is not increased, according to analysis by the British Medical Association.

The BMA has produced two projections based on the rate of practice closures and mergers over both the last six years, and between 2016 and 2017, which estimate that England is set to lose between 618 and 777 practices between now and 2022.

If these projections bear out, millions of patients will need to find a new practice.

According to NHS Digital1, there were 166 fewer practices in 2017 (7,361) compared to 2016 (7,527), while the total has fallen by 963 since 2010, when there were 8,324 practices in England.

While the fall in numbers is partly due to mergers, many will have closed or been forced to merge as the result of the….. continued pressures on general practice, following a decade of underinvestment.

The BMA is now urging the prime minister, as part of her pledge to produce a long-term funding plan for the NHS, to address the historic underfunding of general practice………..

 

NHS using 34‑year‑old equipment

The current crisis of capital  and lack of investment in plant, has left us all subject to old equipment, and inadequate images. Allied with poor purchasing power organisational skills, the health services need to replace their oldest equipment. X ray machines, for example, are much more efficient and use much less radiation and more sensitive plates than 30 years ago.

Chris Smyth reports 11th May 2018 in the Times: NHS using 34‑year‑old equipment

Patients are at risk because they are routinely being treated or diagnosed using equipment that is decades old, including scanners that are past their use-by date, Labour has claimed.

Diagnosis of cancer and other conditions is harder because hospitals have skimped on replacing vital machines, the party says. An x-ray machine from 1984 is being used at a hospital in Leeds, in Oxford staff are using a 1992 ultrasound scanner and an MRI scanner at the Royal Free in London should have been replaced in 2007, according to data from freedom of information requests.

Responses from 93 NHS trusts found that 892 x-ray machines were more than ten years old, including 139 that are beyond their replacement dates. There are 295 ultrasound machines still going after more than a decade, including 134 past replacement age.

Jon Ashworth, shadow health secretary, said: “Tory cuts to capital budgets mean we have among the lowest numbers of CT scanners and MRI scanners per head in the world.”

Theresa May has promised extra money for the health service, but Mr Ashworth said: “It will be a key test of any new funding settlement for the NHS in the coming weeks that it makes up for years of Tory cuts to capital budgets which have left hospitals unable to replace essential equipment and have put patients in danger.”

Phillippa Hentsch, of NHS Providers, said that money to maintain and develop equipment “has been used to prop up day-to-day NHS spending”.

The Department of Health said that the government had “announced £3.9 billion of new capital investment”.