Monthly Archives: August 2018

Health Secretary pledges to overhaul NHS IT system

The South Wales Argus reports that the secretary of health wishes to overhaul the IT systems. Presumably this is for England alone, as there is no NHS at this level of decision making.  Its interesting that slavery is meant to be disappearing, and the modern slave should be robots and computers. Instead of professionals being slaves to their terminals, we need a world where the computers actually help us…. When I was a GP the computer was essential. Losing it was like losing a right hand…. when it was down we offered a much inferior service. We computerised in 1985! The hospitals have no comprehensive notes even now, and when you are seen out of hours the team will have minimal information. It is a scandal that so little progress has been made in IT in any health jurisdiction.

Health and Social Care Secretary Matt Hancock has vowed to overhaul the NHS IT network, saying it would be unacceptable in any other 21st-century organisation.

The “bleary eyed” minister, who replaced Jeremy Hunt in July, said he saw first hand how staff were hindered by poor technology as he shadowed front-line staff during an overnight shift.

Mr Hancock reflected on his stint at Chelsea and Westminster hospital in a lengthy Facebook post, saying the IT has “so far to go” after he witnessed staff reverting to pen and paper.

“Staff were hindered by IT in a way that we simply wouldn’t accept in any other organisation in the 21st century. Tonight has motivated me more than ever to sort this out: interoperable data standards are on their way.”

The West Suffolk MP added: “Operating on a 24-hour basis like hospitals do, you can’t depend on an individual knowing all. Handover is everything.

“This, if anything, makes the importance of improving tech even greater.”

The minister, who wore scrubs, visited wards and sat in with London Ambulance Service paramedics, also praised the “dedication and camaraderie” of NHS staff, adding that the experience would stay with him for some time.

M

r Hancock’s visit was welcomed by acting Royal College of Nursing boss Donna Kinnair, who urged him to also examine the other “many areas of concern”.

She said: “We welcome the Secretary of State’s decision to see for himself the pressure that dedicated healthcare professionals in the NHS face every day and night and his recognition of their outstanding commitment.

“We are also encouraged that he understands that improvements in technology are long overdue and has already stated his commitment to delivering this.

“However, beneficial though the IT overhaul will be, much more still needs to be done to address the crisis that the NHS faces, and we urge him to not only focus on technology but on the other many areas of concern as well.”

Mr Hancock last month announced a £487 million funding package to create the “most advanced health system in the world”, and vowed to drive culture change, working with staff to embrace the latest technology and innovation.

In his first speech in the role, he told staff at West Suffolk Hospital in Bury St Edmunds: “Tech transformation is coming.

“The opportunities of this new technology, done right across the whole health and care system, are vast, so let’s work together to seize them.”

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The best and the worst hospitals in Wales

If you believe these superficial reports you might like to think whether you want to go to your local DGH in all circumstances? Do you have much choice? Waiting hours in A&E is going to become routine. Don’t forget money, a good book, drink and food, and possibly a camping stove if you have to go.

Walesonline reports on the comparisons by looking “at how long it would take if you need an ambulance, a visit to A&E or planned treatment in hospital.” (Mark Smith 22nd August)

 

 

 

 

 

So do you think the state can afford to care for you? Think again… Adults and children..

The state is unable to fund the future of social and dependency care with a projected 30% increase in demand in the next two decades. Although elderly people are living longer, they have to die of something, and before they do multiple pathologies and morbidities arise.

Ella Pickover on 29th August 2018 in the Independent reports: England ‘left behind’ in race to resolve social care funding problems, charity warns

Despite government consultations, official commissions, green and white papers and an act of parliament, England’s system of means-tested care funding is broadly unchanged, Age UK says

Age UK said an entire generation of elderly people had “lost out” after various proposed care reforms had been left to “gather dust”.

The comments came after a new report compared social care systems across the UK, Germany, France, Spain, Italy and Japan….

Peter Starkins of the Huffington Post 22nd August reports that “Ending free movement could cause a staffing crisis in Social Care”.

Jennifer Williams and her team for Manchester Evening News 29th August reports the dramatic increase of children needing care in many towns of the north of England: 

If you are organised and wish not to have your life prolonged unnecessarily, it seems that whether you tell your GP or the Local DGH its not enough. You also have to inform the ambulance service so that the paramedics don’t act outside your permission. Jennifer Cockerell  “Charity urges ambulance trusts ensure end of life care plans are met

Alex Matthews King in the Independent today- Social care crisis: Over-85s needing 24 hour care set to double by 2035, major study shows

Extending the retirement age will reduce the ‘informal and unpaid carer pool’ who have traditionally provided for older family members and heap pressure on social care, experts warn

 

 

 

Orkambi and Yescarta are merely illustrating an ethical problem that will get bigger into the future… Political dishonesty and denial stall a solution.

It is self evident that we cannot afford everything. In health we only find this out when we need a non-funded treatment, such as Orkambi. There are other examples, such as Yescarta, Anticoagulant monitors etc. With drugs the perverse incentive is for authorities to decline them for as long as possible, so that they get as near to their patent expiry (12 years) as possible. Usually media pressure brings the state funding forward by a few years.. But in the intervening period the “health divide” means that only those who can afford it will get the new treatments. We could afford all these treatments once they were proven, if we agreed to ration out high volume low cost treatments. Indeed, for a disease like CF, the advent of CRISPR could ensure that fewer and fewer people need the drugs. This is the longer term solution, but shorter term our politicians need to ration honestly and overtly, large volume low cost products, so that those unfortunate enough to have an expensive disease can be treated. Even America is not covering Orkambi…

When will the debate on rationing take place ?

George Herd for BBC Wales: Cystic fibrosis mothers’ plea over ‘life-changing’ drug

Kimberly Roberts is the mum of three-year-old Ivy, who has cystic fibrosis – or CF – which is a genetic lung disease with no cure.

Along with her friend Alison Fare, who has two daughters with the condition, they want access to one of the most advanced treatments – the drug Orkambi.

But the manufacturer and NHS bosses have been locked in arguments over its £100,000-a-year price tag since 2015.

“Our children deserve to have it – deserve to live a healthy long life. Without that drug they won’t have one,” said Mrs Roberts, who lives near Conwy in north Wales.

Nice – the body which recommends whether a drug or treatment is available on the NHS – has said that the ongoing bills for the drug would be “considerably higher than what is normally considered a cost-effective use of NHS resources“….

Nice has said the cost for the drug would be “considerably higher than what is normally considered a cost-effective use of NHS resources“.

In July, NHS England made an offer of £500m for five years to have the treatment, with £1bn over 10 years.

But while that offer remains on the table – the deal has not been done.

Good News: Deal to freeze prices will allow NHS to use new drugs

First stem-cell therapy (for corneal epithelium) approved for medical use in Europe

Drug trails: how much obligation ha the state to support unproven treatments?

Anticoagulants to prevent clotting diseases.

Orkambi rationed for Cystic Fibrosis

Big pharma is taking the NHS to court this week – research is not “nationalised” for a reason..

More money needed… lets pour a little more into the holed bucket – and reduce the quality of care by rationing new treatments

Key cancer drugs to be axed from NHS fund – ITV News is updated by the Mail and Wales makes sensible decision..

The Times 29th August 2018: Yescarta cancer therapy ‘is too costly for NHS’

Kate Thomas for the NY Times 24th June 2018: A Drug Costs $272,000 a Year. Not So Fast, Says New York State. – New York’s Medicaid program says Orkambi, a new drug to treat cystic fibrosis, is not worth the price. The case is being closely watched around the country.

In PharmaTimes, Selina McKee, online 9th July 2018: Vertex, NHS England no closer to Orkambi settlement

You will hear a lot more about BMAA. A population wide experiment is going on in West Wales.

My own county continues to be at “high risk” because the whole population is drinking and collecting BMAA in their neurological systems. Some of them will be susceptible. The WG environmental minister rejected the call for a nitrate vulnerable zone. She will live outside an area with high neurotoxins…… Some deaths in sheep and dogs have been due to immediate ingestion…. The world is aware, but Wales does nothing. Should doctors be asking for BMAA levels? Can they be measured in blood, or does this have to be from neurological samples, usually post mortem? Who would be prepared to fund the necessary research? Over time West Wales life expectancy and diagnostic rates of all neurological disease should be compared with Wales as a whole, and the UK, and with similar populations in Nitrate Vulnerable Zones where Blue Green Algae has been controlled and treated as the health hazard it deserves…

β-Methylamino-L-alanine, or BMAA, is a non-proteinogenic amino acid produced by cyanobacteria. BMAA is a neurotoxin and its potential role in various neurodegenerative disorders is the subject of scientific research. (Wikipedia) You will hear a lot more about this in the years ahead. 

BMAA is produced by cyanobacteria in marine, freshwater and terrestrial environments.[2][3] In cultured non-nitrogen-fixing cyanobacteria, BMAA production increases in nitrogen depleted medium.[4] BMAA has been found in aquatic organisms and in plants with cyanobacterial symbionts such as certain lichens, the floating fern Azolla, the leaf petioles of the tropical flowering plant Gunnera, cycads as well as in animals that eat the fleshy covering of cycad seeds, including flying foxes.[5][6][7][8]

High concentrations of BMAA are present in shark fins.[9] Because BMAA is a neurotoxin, consumption of shark fin soup and cartilage pills may therefore pose a health risk.[10] The toxin can be detected via several laboratory methods, including liquid chromatography, high-performance liquid chromatography, mass spectrometry, amino acid analyzer, capillary electrophoresis and NMR spectroscopy.[11]

BMAA can cross the blood–brain barrier in rats. It takes longer to get into the brain than into other organs, but once there, it is trapped in proteins, forming a reservoir for slow release over time.[12][13]

In the September 2013 edition of “The Conversation”

Toxic load: blue-green algae’s role in motor neuron disease and later Exposure to algae toxin increases the risk of Alzheimer

The implication of the circumstantial evidence and “associations” is that BMAA builds up in susceptible people.

Scientists have known for some time now that exposure to blue-green algae is linked to increased incidence of several neurodegenerative diseases. But the reason for the link has been a mystery until now. Research published in the journal PLOS ONE today may have the answer.

An algal toxin called BMAA has long been associated with the increased incidence of a motor neurone disease called amyotrophic lateral sclerosis (ALS). But for many years, the hypothesis suffered repeated blows as sceptics poked at the gaping hole in the theory – the lack of a plausible mechanism….

In UTS Newsroom: Breakthrough discovery links Blue Green algae with MND

In the Australian: Algal bloom linked to motor neurone disease

Dani Cooper in the ABC Science 26th September 2013: Motor neurone clue in blue-green algae

A toxin in blue-green algae could be taken up by the body’s proteins and trigger motor neurone disease, new research suggests.

Recent studies have identified a link between the consumption of food or water contaminated by blue-green algae and motor neurone disease.

Blue-green algae (cyanobacteria) produce a neurotoxic amino acid called β-methylamino-L-alanine, or BMAA, but how this chemical could damage the central nervous system has remained unclear.

In a paper published today in PLOS ONE, researchers from the University of Technology, Sydney (UTS) and the Institute of EthnoMedicine in the US, show BMAA has a similar structure to an amino acid, serine, that is used to build proteins.

First author Dr Rachael Dunlop, of UTS, says the similarities between serine and BMAA mean when the toxin is present in the system it can be mistaken for serine and incorporated into human proteins.

This damages the proteins and inhibits their function – over time causing cell death….

Risk of developing Motor neurone disease and possible link to contamination of the water supply, particularly in Pembrokeshire

 

Health service rationing: New figures for Mid Sussex

Sarah Page in the Mid Sussex Times reports 28th August 2018: Health Service rationing: New figures for Mid Sussex

Rationing of a range of NHS health treatments has remained unchanged across Mid Sussex, Horsham and Crawley – despite increased rationing in other parts of the country.
New figures released by local health chiefs show that there has been a slight increase in the numbers of people underoing life-changing cataract, knee and hip surgery in the district over the past year. The figures are in contrast to the rest of England which has seen a 45 per cent increase in the numbers of people being denied such operations. Currently, the Crawley, Horsham and Mid Sussex Clinical Commissioning Groups – which pays for NHS services – requires people needing such surgery to fulfil certain criteria before the ops can go ahead. If they do not meet the criteria, the patients’ GPs can request ‘exceptional funding’ from the commissioning groups to carry out the surgery.An investigation by the British Medical Journal has revealed a sharp rise nationally in rejected requests. They say nearly 1,700 patients were denied the surgery in England last year – 45 per cent more than the previous year. But it is a different picture locally. A spokesman for the Crawley, Horsham and Mid Sussex clinical commissioning groups said that no requests for exceptional funding for cataract ops, or knee or hip surgery had been made in the local area in 2016/17, nor 2017/18.Figures show that in 2016/17, a total of 1,933 cataract operations were carried out in the district which rose to 2,024 for 2017/18. The number of hip operations increased from 483 in 2016/17 to 529 in 2017/18. However, the number of knee operations fell slightly from 400 two years ago to 353 last year.Cataract, knee and hip operations remain among a list of procedures that are no longer routinely funded by the NHS in Crawley, Horsham and Mid Sussex.Other procedures also being limited include haemorrhoid removal, skin lesion treatment, female sterilisation, hysterectomies and treatment for varicose veins, among others. However, the commissioning groups say there is no ‘blanket ban.’The Crawley, Horsham and Mid Sussex groups – which have been placed in ‘special measures’ by NHS England after being rated ‘inadequate’ because of massive overspending – say they “do not have the resources to meet all these demands” and therefore have to make “difficult choices about which treatments/services represent the best use of finite resources.”

Read more at: https://www.midsussextimes.co.uk/news/health-service-rationing-new-figures-for-mid-sussex-1-8603196

Volunteers might delay the inevitable, but “hard truths” will eventually win out..

This leader is missing a vital point: that is that the 4 health services are not founded on a financial rock. Many retired people would “volunteer”, especially those who have specialist skills, if they felt that there was a long term future for the current arrangement. The basic philosophy is incorrect. By encouraging free health care as “Everything for everyone for ever” we encourage dependency and we discourage self sufficiency, which for the poorest means a bottle of paracetamol or some skin cream, and for the rich means buying faster treatment with lower complication rates in a two tier society. Voluntary action cannot save the health services (there is no NHS) but it might help delay the catharsis and bring closer the realisation that we have to change it. “Hard truths” are not considered the stuff that wins elections, but their time will come. Then there is confidentiality, legal responsibility and cover, all needing “no fault compensation”. And then the cultural change…. Is this suggestion another form of rationing?

Image result for volunteer cartoon

The Times leader Sunday 26th August: How little platoons can save the overmighty NHS

The National Health Service, 70 years old this summer, is the standard-bearer for Britain’s welfare state but also the cuckoo in the nest. It is a source of national pride, much loved and admired by the public, but also a source of exasperation. Its regular winter crises and its struggles with issues such as bed-blocking by older patients and the inability in some cases to offer even a half-decent service — figures last week showed that one patient waited more than 62 hours for an ambulance — raise questions about whether taxpayers are getting the service they pay for.

They are certainly paying for it. The NHS’s “birthday present” — additional spending of more than £20bn a year by the early 2020s — will add to the cost of an NHS that already accounts for nearly a third of all spending on public services, up from 10% in the early 1950s, and costs roughly 12 times in real terms what it did when it was founded.

The financing of the NHS has gone well beyond anything Lord Beveridge envisaged in his 1942 report which provided the blueprint for the postwar welfare state. The NHS — large, monolithic and one of the biggest employers in the world — has also moved beyond Beveridge in another way.

His 1942 report was one of three he wrote during that decade, the others being Full Employment in a Free Society in 1944 and Voluntary Action in 1948. Before the welfare state was established, much healthcare and support for the poor were provided by a network of voluntary organisations. The system was patchy and thus fell short of the universal care that was provided in 1948 and has expanded hugely since.

Beveridge was clear that the welfare state and voluntary action should be complementary, writing that “the state, in organising security, should not stifle incentive, opportunity, responsibility” and should “leave room and encouragement for voluntary action by each individual”.

Today, as Sir Tom Hughes-Hallett writes in News Review, some are putting that into practice. HelpForce, which he founded, is along with other charities providing volunteer support to the NHS and it is making a difference. Volunteers who ring patients to remind them of their appointments to attend memory clinics have lifted the attendance rate from 15% to 100%. Motorbike enthusiasts act as volunteer couriers, shipping around blood and other essential supplies.

It is making a difference, but it could go much further. Most people do not even know they can volunteer in an NHS hospital. But, as Hughes-Hallett puts it: “I can imagine a Britain where millions of people are proud to be the HelpForce — a Britain where giving back to the NHS and other public services is ingrained in our social fabric, where you can expect companionship and support through your entire time in the health system and where communities support nurses and doctors.”

It is an attractive proposition. David Cameron, the former prime minister, meant well when he launched his Big Society initiative in 2010. Allowing people to organise and provide for their communities would, he suggested, represent “the biggest, most dramatic redistribution of power from elites in Whitehall to the man and woman on the street”. Overcentralisation and bureaucracy had, he said, turned too many public sector workers into the “disillusioned, weary puppets of government targets”.

It is an ambition and a criticism that remain valid but Mr Cameron was, in most respects, the worst person to launch it. Coming hard on the heels of the start of George Osborne’s austerity programme, it looked to some like an attempt to get public services delivered on the cheap. And, perhaps more importantly, the key to building a bigger voluntary contribution should be from the ground up, not from the top of government down.

That experiment should not, however, be a source of discouragement. As the experience of HelpForce demonstrates, people want to volunteer and find it fulfilling. Figures from the National Council for Voluntary Organisations show that 35% of men and 39% of women do formal voluntary work at least once a year. More than a fifth of both sexes volunteer once a month or more. There is also a huge untapped resource of people who do not currently volunteer but would like to do so.

There is an optimistic vision here of voluntary action, working in tandem with state-provided public services, to provide the care that our ageing population needs; pensioner numbers are set to increase by 9m over the next 50 years. It is a vision that fits perfectly with the Beveridge vision of the welfare state. And it is one that we should embrace.

The blame game. The proliferation of compensation claims – needs a “no fault compensation” cure, possibly through a social insurance fund.

Patient complaints hit a ‘wall of silence’ from NHS – No fault compensation would help change the culture…

Image result for volunteer cartoon