Monthly Archives: August 2018

If a placebo is recommended by NICE, and patients have to buy it, why not any thing less than 2 pints of beer and a packet of 20 fags?

I understand some trusts are still providing honey for wounds. If a comprehensive, free at the point of delivery, cradle to grave without reference to means health service is providing honey for one condition, why not for another? This is of course nonsense, and we simply need to be honest about rationing. Sugar paste is as good as honey for all medical conditions, and far cheaper. If a placebo is recommended by NICE, and patients have to buy it, why not any thing less than 2 pints of beer and a packet of 20 fags?

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The Lancashire Telegraph reported a nationally reported news item 23rd August: Treat coughs with honey not antibiotics, doctors and patients told.

Honey and over-the-counter remedies should be the go-to treatment for coughs rather than antibiotics, health officials have said.

Doctors will be told not to offer the drugs in most cases and to instead encourage patients to use self-care products, under new draft guidance from Public Health England (PHE) and the National Institute of Health and Care Excellence (Nice).

The advice is part of a growing effort by to tackle the problem of antibiotic resistance.

In most cases, acute coughs are caused by a cold or flu virus, or bronchitis, and will last for around three weeks, according to the guidance.

Antibiotics make little difference to symptoms and can have side-effects, it warns.

Patients are instead advised to try honey or cough medicines containing pelargonium, guaifenesin or dextromethorphan, which have been shown to have some benefit for cough symptoms, before contacting their doctor.

Antibiotics may be necessary treat coughs in patients with pre-existing conditions such as lung disease, immunosuppression or cystic fibrosis, or those at risk of further complications, the guidance states.

Dr Tessa Lewis, GP and chairwoman of the antimicrobial prescribing guidelines group, said: “If someone has a runny nose, sore throat and cough, we would expect the cough to settle over two to three weeks and antibiotics are not needed.

“People can check their symptoms on NHS Choices or NHS Direct Wales or ask their pharmacist for advice.

“If the cough is getting worse rather than better, or the person feels very unwell or breathless, then they would need to contact their GP.”

As many as one in five GP prescriptions for antibiotics may be inappropriate, according to research published by PHE earlier this year, and the body has warned that overuse of the drugs is threatening their long-term effectiveness.

Dr Susan Hopkins, from PHE, said: “Antibiotic resistance is a huge problem and we need to take action now to reduce antibiotic use.

“Taking antibiotics when you don’t need them puts you and your family at risk of developing infections which in turn cannot be easily treated.

“These new guidelines will support GPs to reduce antibiotic prescriptions and we encourage patients to take their GPs advice about self-care.”

A consultation on the draft guidance will close on September 20.

If a placebo is recommended by NICE, and patients have to buy it, why not any thing less than 2 pints of beer and a packet of 20 fags?

Interesting suggestion low cost for high volume treatments to be excluded… GPs will take no notice as their job is to put their patient “at the centre of their concern”.

Cough medicine is a waste of money: NHS recommends Honey … The Mirror

Honey for burnsNHS

Pouring granulated sugar on wounds ‘can heal them faster …

Why do some cavity wounds treated with honey or sugar

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The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

The safety net of the 4 health services is “free, comprehensive, cradle to grave, without reference to means”, but the safety net of social care is means tested, and only available in extreme poverty and with multiple conditions, and after a long delay in assessment, by which time the patient is often dead. The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care? Brexit costs can only make this worse… If we are going to ration lets do it  honestly. Commissioners should be allowed to alert their populations to what is not available in their post code.

William Eishler in Local Government news reported 17th Jan 2018: Funding system for continuing healthcare needs failing patients.

The system for funding health and care services is overly ‘complex’ and is ‘failing’ people with continuing healthcare needs, such as Alzheimer’s and multiple sclerosis, MPs say.

A new report by the Public Accounts Committee (PAC) warns that many people have their care compromised because no one makes them aware of the funding available or helps them to navigate the funding system……

Mark SMith for WalesonLine 23rd August 2018 reports: Families facing ‘excessive delays’ in reclaiming thousands for healthcare costs they should never have paid – Public Ombudsman for Wales has says 330 claims still need to be reviewed

Patients and their families who have incorrectly paid up to hundreds of thousands of pounds in healthcare costs are facing “excessive delays” in getting their money back, it has been revealed.

A new report from the Public Ombudsman for Wales has found that as many as 330 claims still need to be reviewed from people who feel they may entitled to a reimbursement.

The NHS has set up a funding programme, known as NHS Continuing Healthcare, which means people with a complex, ongoing illness can apply for an assessment.

For those eligible, all care needs outside hospital – including nursing home costs or help from a community nurse – are met by the NHS.

But for years, many families have been unaware about this programme and have resorted to selling their homes and making other major sacrifices to make ends meet….

Continuing Health Care funding needs to be rationed honestly, universally, and overtly. The only fair way is by a third party without the Perverce Incentive to refuse..

Continuing Health Care – the Lottery of how you die and how determined and educated your relatives are: Healthcare system is in need of a cure

Untrustworthy staff – continuing saga of data collection failure blights the Health Services potential. GPs cannot have had enough say and power in planning…

What models of funding are best for a healthy and just society? No other country has chosen our system, even after 70 years and our Olympic boasting. The public need to be led into realising why not.

Personal, continuing care….. is going the way of the dodo. Basingstoke represents the rest of the country.

Trials of personal budgets will have long term perverse outcomes in an ageing society. Health costs are rising, and geographic variations will become greater….

The “State of health and care in England” – is declining and worryingly underfunded…

A loss of personal continuing care. 700 practices in 5 years. Is the GP going the way of the Dodo in the past, or the Salmon in the future? We need to rediscover it’s value.

The Brexit catastrophe is only just beginning

Cancer care standards are threatened – Radiologist shortage ‘affecting cancer care’ in the UK

We all knew over 36 months ago that there was a shortage of radiologists. If it was going to get worse then, surely it will now as it takes a decade to train a Radiologist. We knew about the shortage because of the number of locums employed throughout the 4 health services. Radiologists are generic before they become specialised. In some ways they are similar to GPs, and they are should be at the heart of a decent diagnostic service….. With insufficient numbers, and grossly overworked, no wonder they see opportunities in other countries, or privately. After all, they are a “world commodity”, as we are all built the same.

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Radiology meltdown is no surprise. Which service next?  December 2017

and 3 years ago NHSreality opined: Cancer drugs fund is illogical. More money should be spent on radiology and radiotherapy.

Now Hugh Pym for the BBC News 22nd August reports: Radiologist shortage ‘affecting cancer care’ in the UK

A shortage of senior radiologists around the UK is causing delays for patients, and affecting cancer and other medical care.

Radiologists’ leaders say the situation is unacceptable and must be tackled by ministers.

Figures suggest their workload of reading and interpreting scans has increased by 30% between 2012 and 2017.

But the number of consultant radiologists in England has gone up by just 15% in that time.

The figures, given to the BBC by the Royal College of Radiologists, also suggest the number of these senior posts in Scotland, Wales and Northern Ireland has remained static over that period.

‘Brick wall’

Carol Johns is worried about her mother Maria, who is in constant pain because of swollen feet and ankles.

Over a six-month period there has been been a series of delays with scans and follow-up appointments, and Maria has still not been told the results or what the problem might be.

“You just can’t get through to people – it’s answer phones – you’re just banging your head against a brick wall most of the time.

“I just want to see some light at the end of the tunnel, really, to get her some treatment and hopefully get a bit more quality of life,” Carol said.

Dr Nicola Strickland, president of the Royal College of Radiologists said: “I can’t overestimate how worrying it is.

“I do really feel the entire service will collapse if something isn’t done about training more radiologists in the UK to fill all the vacant consultant posts, so we have to get imaging properly staffed – and right – and enough radiologists trained to make up this deficit.”

More trainees needed

The Royal College of Radiologists says NHS hospitals have increasingly had to outsource analysis of complex scans to private companies or pay for existing staff to do overtime.

The total annual bill for this across the UK has doubled over the five-year period to £116 million.

The vacancy rate for consultant posts in the UK has increased from 9% to over 10% in just two years, with Northern Ireland seeing the highest rate at more than 18%.

The Royal College says more trainee radiologists are needed – with extra funding required for training and a “concerted effort” to retain staff.

The workload has increased significantly with more sophisticated technology available.

Some doctors, known as interventional radiologists, carry out complex procedures using image guidance to facilitate precisely targeted therapy.

This includes treating cancer tumours and dealing with blocked veins using small catheters.

Treating a higher number of elderly patients with complex conditions has also added to the workload.

Radiologists argue that their work is central to much of what the NHS does, so staff shortages are having a serious impact on patients by prolonging waits.

International shortage

The new figures highlighting workforce shortages come the week after news that a Scottish health board has no interventional radiologists after the departure of the last remaining specialist in that field.

The NHS Highland health board said patients needing emergency care by these experts, which was usually provided at Raigmore Hospital in Inverness, would be sent to Aberdeen or Dundee.

The Scottish Cabinet Secretary for Health, Jeane Freeman, said there had been “an international shortage of radiologists affecting health services worldwide”.

But she said 50 specialist training places for clinical radiologists would be created over the next five years.

A Welsh Government spokesperson said it had nearly doubled the size of the radiology training programme in Wales.

“We have also created a new National Imaging Academy to provide state-of-the-art facilities for training more radiologists.”

A Department of Health and Social Care spokesperson said the number of clinical radiologists in England had gone up by 29% since 2010.

“We want to see numbers continue to rise and over the next three years we are also putting in place more training for doctors to specialise in clinical radiology.”

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NHS rationing under the radar

A reminder of the King’s Fund report from August 2016. The predictions by Ruth Robertson include post coded prioritisation, delays, treatment dilutions, withholding or substituting treatments, overspends, and a lack of data for monitoring exactly where the commissioners are!. She singles out Mental Health and District Nursing for particular dysfunction, and is open about the crisis in Primary and Social care. All of us know that, until “what is not available” is allowed to be discussed, that the “open discussion” is a nonsense. The Trusts under special measures in England are below, but most of those in Wales, and I suspect Scotland and N Ireland are in the same financial distress. Reality is not yet here, and “it’s going to get worse”. The King’s Fund promised a follow up report in 2017 but I am not sure which one it is or if it has been published yet..

NHS rationing under the radar:

After years of increasing deficits, that last year culminated in the NHS posting the largest overspend in its history, local health systems have been told to balance their books.

This intensifies the difficult decisions that commissioners and providers have been facing for some time, about how to prioritise limited funding and balance their budgets in the face of rising demand. While the NHS has always had to set priorities, with these unprecedented financial pressures it is inevitable that some organisations will be forced to restrict access to certain services or dilute quality of care as they seek to curtail spending. In some areas this is happening already.

On an individual level, this is like the bank cutting off the overdraft that you rely on when you have just started a family and your rent has gone up. You are forced to cut spending on non-essentials, but deciding what ‘the essentials’ are is tough.

NHS commissioners are starting to have honest conversations with their local populations about these tough choices…..

….Considering the wider impact of financial pressures on the health care system, it’s important to remember too that it’s not only patients who are affected. NHS staff often act as a buffer, working longer hours or more intensely to ensure the people they treat still receive a high-quality service. This can increase staff stress levels and lead to low morale, something that is particularly worrying given evidence that staff wellbeing can have a direct impact on patients’ experience of care.

The King’s Fund is currently researching how the slowdown in NHS funding since 2010 has affected patients’ access to high-quality care. The findings from this study, which will be published early next year, will provide valuable insight into the impact that financial pressures have had on NHS patients and staff. In the meantime the government should be honest with the public about what the NHS is realistically able to offer with its available funding.

Patients should not be looking forward to a “hard” Brexit. Make sure you have a good stock of medications..

The news is piling up on Brexit, and the majority of people now want another vote, even if they may not change their minds. Sarah Wollaston MP on YouTube/Sky News ‘Patients need to know the full consequences of Brexit’  Hugo Fry, chief executive of Sanofi facetiously suggests air-lifting flu vaccines, but since these are dubious value for money, this is laughable for medics. (Let us airlift flu vaccines after Brexit, says French drugs giant Sanofi – Sabah Meddings August 19th in the Times). Apart from going abroad, patients have little choice other than to obtain a good stock of repeat prescriptions. Going abroad could backfire as Brexit could be postponed or even cancelled if the politicians regain their “guts”. Each individual UK commissioning group may choose to ration differently…. A nightmare?

The Kings Fund did warn us in December 2017: Brexit: the implications for health and social care. 

Most of us want another chance to look at the evidence, rather than the false news, once the deal is on the table.

Henry Zeffman in the Times 20th August reports: No-deal Brexit could leave hospitals with drug shortage, say NHS chiefs

Hospitals are in danger of running out of drugs in a chaotic no-deal Brexit, NHS trusts have privately warned.

Ministers and health service bosses have been accused of failing to prepare adequately for the potential failure to strike a Brexit deal by NHS Providers, the association of NHS trusts.

Chris Hopson, the group’s chief executive, said that “in the event of a no-deal or hard Brexit”, on the first day outside the EU “the entire supply chain of pharmaceuticals could be adversely affected”. He added: “Public health and disease control co-ordination could also suffer and our efforts to reassure, retain and attract the European workforce on which the NHS relies could also be jeopardised.”….

Ben Gartside followed this up in the “Business Insider” 21st August with: A no-deal Brexit could prevent disease control and leave hospitals with drugs shortages

LONDON — Disease prevention would worsen and hospitals would risk running out of drugs under a no-deal Brexit, according to a leaked letter from NHS chiefs to ministers.

The letter was from NHS Providers, the association of NHS trusts, and accuses ministers of failing to prepare adequately for all possible Brexit outcomes.

Significantly, it warned that even a hard Brexit where the UK does strike a deal would risk damaging the UK’s healthcare sector significantly, given the risks to the certification of medicines or isotopes used in cancer treatments across the EU.

The letter warned that “from day one after the UK leaves the EU, the entire supply chain of pharmaceuticals could be adversely affected in the event of no deal or hard Brexit.”….

It continued: “Public health and disease control coordination could also suffer, and our efforts to reassure, retain and attract the European workforce on which the NHS relies could also be jeopardized.”

The letter was sent on Friday to Simon Stevens, chief executive of NHS England, and Ian Dalton, chief executive of NHS Improvement, with several ministers copied in.

An NHS England spokesperson told the BBC: “We will be working with our colleagues and partners across the NHS to ensure plans are well progressed and will provide the NHS with the support it needs.”

‘From what I can see patient care seems acceptable.’

A disingenuous report on closing A&E. Some lives will be saved in densely populated Trusts, but lives will also be lost..

What about choice? What if patients in rural and distant parts prefer to live shorter lives and have more convenient services? The whole basis of “mutuality” is being challenged by the current financial crisis. Does the utility value for the whole of West Wales trump the utility value for each individual part? There are four DGHs and three A&Es, and this is why we have a “trusted?” board to make decisions. But the people don’t trust them – do they?

This is a disingenuous report on closing A&E. Some lives will be saved in densely populated areas, but lives will also be lost..

TRUST: ‘Are you telling me that none of you knows what it means?’

Kat Lay reports august 20th: NHS saves 1,600 lives by sending ambulances on longer journeys

Controversial A&E reforms under which ambulances can bypass their nearest hospital have saved the lives of more than 1,600 patients since their introduction in 2012, according to research.

Designating some hospitals as major trauma centres concentrated expertise in dealing with emergencies such as gun and knife wounds, serious road traffic accidents or terrorist attacks.

However, it led to claims that other A&E departments had been downgraded, putting them at risk of closure.

The new research, from experts at the universities of Manchester, Leicester and Sheffield, calculated that an additional 1,656 people had survived major trauma injuries since 2012, when they would previously have died.

The reforms have also meant that patients are more likely to be treated by an experienced doctor at the roadside who, working alongside paramedics, can help to stabilise them before they get to hospital.

The odds of surviving a severe injury among patients reaching hospital alive have increased nearly a fifth since 2012, the researchers calculated. Patients have also spent fewer days in hospital.

Trauma is the most common cause of death for under-40s in England. According to National Audit Office estimates, there are 20,000 major trauma cases a year, with 5,400 deaths.

Researchers looked at data on more than 110,000 patients admitted to 35 hospitals between 2008 and last year. They found that results for major trauma patients were flat between 2008 and 2012 but improved rapidly after the introduction of major trauma networks.

Timothy Coats, professor of emergency medicine at the University of Leicester and a consultant in emergency medicine, said: “These findings demonstrate and support the importance of major trauma networks to urgent care with figures showing there were 90 more survivors in 2013 rising to an additional 595 in 2017. Over the course of the five years 1,656 people have survived major trauma injuries where before they would probably have died. It’s a fantastic achievement.”

He said that it could take up to ten years for this kind of system to reach its full potential, with the number of additional survivors greater than predicted by NHS England at this stage.

He added: “With changes to the way patients are treated from the moment doctors and paramedics get to them, with pre-hospital intubation, improved treatment for major bleeding and advances in emergency surgery techniques, there has also been a significant reduction from 31 per cent to 24 per cent in the number of patients needing critical care, and their length of stay on critical care wards reduced from four to three days on average.” The study is published in the online journal EClinicalMedicine.

Chris Moran, NHS England’s national clinical director for trauma care, said: “Patients suffering severe injury need to get to the right specialist centre staffed by experts, not simply the nearest hospital.

We are confident that we will continue to see further increases in survival rates for this group of patients.”

“Major trauma centres deal with the victims of stabbings and acid attacks as well as car and motorbike accidents. We have all seen the terrible increase in knife crime in our cities and there is no doubt that the new trauma system has saved many lives as these patients receive blood transfusion and specialist surgery much quicker than before.”

The changes were made after a 2007 report identified serious failings in the NHS’s care of trauma patients, which was poor in almost 60 per cent of cases.

It is a small risk (of fraud), but mainly notes missing is incompetence. Best keep a running file of your own notes.

The loss of many notes, both electronic and physical, is not surprising to a GP. The only safe way to keep a medical record in the modern world, is with a shared data-base that can be accessed at many locations. GPs have done this for decades, and my own practice since 1985. There is a small risk of fraud, but the main reason for the missing notes is incompetence. Disengagement with the local Trust is another reason, as staff have ceased to believe that any suggestions for improvements will be received and acted on. Just like there are no Exit interviews, the 4 UK health services KNOW that they are incapable of changing by themselves. So it’s going to get worse. More notes will be lost and more mistakes will be made. There is one action you as an individual and potential patient can take: ask for a copy if your medical record at every consultation, and keep a running file of your own notes.

The number of times my patients reported that “they couldn’t find my notes” was scary, and in the computer age this is unforgiveable. When I was defeated in asking for one GP data base in Pembrokeshire (1996!!) little could I have seen that some 22 years later there is no improvement, and the Hospital and Out of Hours records are disconnected. Too many Trusts are in crisis to think clearly abour what matters long term

Warwick Ashford in Computer Weekly reports 20th August 2018: NHS trusts lose nearly 10,000 patient records a year- Report calls for NHS trusts to work to abolish handwritten notes in hospitals to prevent loss of personal documents and to introduce a patient identity protocol

The University Hospital Birmingham tops the list of NHS trusts that have lost patient records in the past year, with 3,179 records reported missing or stolen, according to research by think-tank Parliament Street….

This was followed up in the Times by Kat Lay:  Fraud fears as hospitals lose thousands of patient records

NHS hospitals lost nearly 10,000 patient records last year, according to figures released under freedom of information laws.

The mislaid records, both paper and electronic, prompted concerns over the implications for patient safety and data security. Experts warned that sales of such records on the dark web and cases of identity fraud were on the rise, making better protection of patients’ data “urgent”.

Campaigners said that not having a full record available during a consultation could make it harder for doctors to make an accurate diagnosis or prescribe the correct medication, even though some records were eventually located. Only 68 hospitals released data on missing or lost patient records for the report by the Parliament Street think tank, meaning the scale of the problem is likely to be much bigger.

Barry Scott, of the cybersecurity firm Centrify, said: “These incidents underline the need to improve security procedures around the management of health records within the NHS. With sales of health records on the dark web and identity fraud on the rise, the need to protect the privacy of patients whilst moving towards secure digital systems is both urgent and essential. The health service remains a top target for hackers and whether their motive is to wreak havoc or steal identities, it’s critical that every single patient record is treated as a high priority by health trusts.”

Last year the WannaCry cyberattack affected 80 out of 236 hospital trusts across England, largely by exploiting out-of-date computer systems. Although the health service was not directly targeted, health chiefs said it “exposed a need to improve across all parts of the NHS”.

For the new report, hospitals were asked how many times patient records had been recorded as lost or stolen in the last financial year. In total, 9,132 records were reported missing. Responses included incidents where notes were missing at the time of an appointment, whether or not they were later found. One trust said a patient list had been stolen.

Only 16 of the 68 trusts said they had had no cases of lost or stolen patient data. The trust with the greatest number of misplaced records was University Hospitals Birmingham with 3,179. The second was Bolton NHS Trust with 2,163 and the third was University Hospitals Bristol with 1,105.

Joyce Robins, of the Patient Concern campaign group, said: “It is quite dreadful to think a doctor is going to come and treat you and has no records to do it with. It is just ludicrous.” She added that she worried people were becoming “blasé” about missing patient records.

Last year MPs said the NHS had “badly failed patients” after a scandal in which at least 708,000 pieces of correspondence were allowed to pile up in storerooms. The affected mail included blood test results, cancer screening appointments, medication changes and child protection notes.

Peter Walsh, chief executive of Action Against Medical Accidents, said: “Missing medical records represent a significant risk to patient safety. The move to electronic records should help. In theory any NHS service provider should be able to access the same record, but clearly the system isn’t reliable enough yet.”

The report also found that 94 per cent of NHS trusts still use handwritten notes for patient records despite often having software for keeping electronic records. It recommended that NHS trusts should work to abolish handwritten notes in hospitals and said it was “clear that much more needs to be done to protect the identity and integrity of patient documents”.