Monthly Archives: August 2018

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”.


Potentially talented sports teenagers need protection – for their own health. Legislation is needed…

We have been reading about disgraced sportsmen for years, but politicians must remember that these people are “role models” for youngsters, whether we like it or not. The risk involved in becoming a professional sportsman, often involving parents signing a contract for a child in their teens, is invidious. Many of us feel this is tantamount to abuse.

Potentially talented sports teenagers need protection – for their own health. It is time for the state to do this – now. The chances of success at teenage level are VERY small, and a sensible family will discuss this and have other irons in the fire. A degree, or a professional qualification, or some HNDs seems essential, and since 95% of aspirants will drop out, protects their future.

What is the average IQ of professional sportsmen I wonder? No need to quote anecdotes of intelligent and degreed players (Steve Highway of Liverpool), but how about a study? Is the level of responsibility for average IQ (100) enough not to need a minder when off duty but at a meeting or during a test match?

The list of players who have made it but led themselves into trouble is a long one, but the list of those who never made it,  and then underperformed in the rest of their lives, is even longer.

We need new legislation to replace the current rules, and it needs to be with informed consent that a short contract is signed at 18y at the earliest. In the 4 health services, which are falling apart, the last thing we need to produce is mentally fragile youngsters. It is as disappointing to a potential professional footballer to be rejected as it is for a potential doctor. We need the doctors but 9:11 of applicants have been rejected up to now.

Sport is recreation, and that is how it should be for most of us. The tendency for young people to give up team sports if they are not in the top echelon is not healthy. Individual activities are taking over, such as surfing, and golf, but when professionals recruit to their “youth training programmes” parents need to give “informed consent”, and NHSreality feels this cannot be before age 18y. Before that age it should be a gentleman’s agreement between clubs and families, but a second string should always be available,

In addition to the problems of professional abuse, new youths are tempted and threatened by social media. At school level social media can do great harm, and parents face a minefield in trying to get access to on line bullying and other abuse. Sportsmen are no different, and many of them need minders both physically, and for their social media.

The student grant and loan, and fee payment schemes are leading to poverty and perverse behaviours. Although I suspect he overstates the case, it is worrying when a Councillor claims: Bristol is “full of perverts and disease riddles prostitutes from the local universities” claims local UKIP councillor on Ben Stokes case”,  (BristolLive)

The mental strain and the temptations are enormous, but the services are not there, either preventative or for treatment. 

Bearing in mind that this is a parenting problem, surely the law needs to be changed to help those families unable to protect themselves?  Following this an educational program on TV and radio similar to the AIDs programme might be much better value than having to treat the problems that arise from our denial.

You might argue that in a “robotic” age, when work is almost voluntary for many, that sport will be a natural outlet. I would agree, but the professional v amateur argument still holds. Sports that aim deliberately at damaging the brain are anathema to most doctors, (Boxing), and those that accidentally risk damage to the brain are becoming less and less acceptable (Rugby, American Football) to many sensible families. Should the longer term problems caused by these “games” be covered by insurance rather than the Health Services?

The Perverse Incentives of professional athletics led Flo Jo to take steroids, and she died young, and the combination of a cycle industry, a TV channel team, and professionalism was too much for Lance Armstrong.

Ben Stokes trial LIVE updates: England all rounder found not guilty of affray after late night bust up The Mirror 4 days ago

The list of rugby players includes:
Danny Cipriani,
Lawrence Daliagio
Mike Tindall
Jason Leonard
Manu Tuilagi
Olly Barclay
In the cricket world there has been:
Ian Botham
Mohammed Amir
Salman Butt
In Football:
George Best
and there are many more. In cycling and athletics, in Baseball and Ice Hockey.

Self-harming up by 70% among young teenage girls. Is social media responsible?

The potential risk for blackmail – think about your medical records when you are young. Are you ambitious to be famous?

Rugby and Dementia pugilistica…. an unfair cost on the health service

Should dementia from sports injuries and concusion be subject to “deserts based rationing”?

Should sports injuries all be covered by the UK Health Services? The brain damaging season of international rugby is about to begin.


IVF: NHS couples ‘face social rationing’ as providers struggle to fund it

NHSreality if actually “for” rationing, but we could afford all the infertility treatment that could be demanded if we rationed high volume and cheap services: perhaps those costing less that 2 pints of beer and a packet of 20 cigarettes? Figures for the other 4 health services in the UK are of course not available for comparison. They are certainly worse in Wales, but like most important issues after devolution, we cannot compare.

See the source image

BBC News reported 20th July: IVF: NHS couples ‘face social rationing’

The parents of the world’s first IVF baby – born 40 years ago next week – would not have got the procedure on the NHS in most of England today because of “social rationing”, a charity has said.

NHS IVF is unavailable to couples in many areas if either of them has children from a previous relationship…… Figures collated by campaign group Fertility Fairness show IVF provision at all 208 clinical commissioning groups (CCGs) across England.

They show eight out of 10 CCGs do not enable access to IVF if one of the couple has children from a previous relationship……Her father already had children from a previous relationship, which would render the treatment unavailable to the couple in many areas today, Fertility Network UK said.

Data chart

Aileen Feeney, chief executive of the charity, said: “If Louise Brown’s parents wanted to try NHS IVF today, they would be turned down by the vast majority of England’s clinical commissioning groups on social rationing grounds: although Mrs Brown was clinically infertile, Mr Brown had a child from a previous relationship.

ITV News reporter Lorna Shaddick reports 23rd July 2018: IVF treatment being rationed as providers struggle to fund it

Couples in the UK seeking fertility treatment are finding that their access varies dramatically, depending on where they live.

This week marks 40 years since the birth of the first test tube baby, Louise Brown, but if rules then had been what they are today, she may not have been born.

Couples in the UK face what campaigners call “social rationing” of fertility treatment on the NHS, meaning its availability to would-be parents varies dramatically depending on where they live.

It is up to each local NHS provider – the Clinical Commissioning Group – to decide which treatments to fund.

The charity Fertility Network UK says if Louise Brown’s parents were seeking IVF on the NHS today, they would be turned down by over 80% of England’s clinical commissioning groups, because her father already had a child from a previous relationship, one of many rules that make it more difficult for couples to get IVF.

The National Institute for Health and Care Excellence (NICE) guidelines say women under 40 who have been trying for more than two years to get pregnant should have access to three full cycles of IVF on the NHS – but crucially those are not binding.

IVF postcode lottery
Image: The availability of IVF depends on where people live

Campaign group Fertility Fairness says the number of CCGs in England meeting those guidelines has gone down, from 24% in 2013 to 12% in 2017, and only four offer what Fertility Network UK calls the “gold standard” of three full IVF cycles, even for couples who have children from previous relationships.

Aileen Feeney, the chief executive of Fertility Network UK, said: “We believe that there should be fair access.

“NICE guidelines are there because financially and medically they are the best way to achieve the outcome that you want.

“So, therefore, we believe that everywhere in the UK should be offering those in line with the NICE guidelines, so three full cycles of IVF.”

Emma Edey and her husband Lee say they are victims of these geographical differences.

Both have health problems that doctors agree would make natural conception difficult, but they live in north east Essex, one of seven areas in England where all NHS IVF treatment has been removed or suspended – and they cannot afford to pay for private treatment.

When Mrs Edey appealed to her local CCG last year, saying that her bowel disease means she is in “exceptional circumstances”, she was refused.

She said: “They’ve just completely taken away everything – all of both of our dreams.

“We just want to be given the opportunity to have what all our friends have got, to be able to celebrate Christmases and stuff like a family, as families do.

“And it doesn’t seem fair that my friends a few miles down the road can have it but I can’t.”

The cost of IVF varies but one cycle at a private clinic can come to more than £5,000.

NHS clinical commissioners told Sky News: “Unfortunately the NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.

“As a result there are some tough choices that have to be made, which we appreciate can be difficult for some patients.”

After more than two years of letters and phone calls to her MP, CCG and local hospital, Mrs Edey was told last month that her subsequent appeal has been upheld, and she can receive treatment.

But she says she’ll keep fighting for others in the same situation.

“I won’t stop,” she said.

See the source image



GPs could be forced to switch IT systems under new NHS Digital contract

The UK governments have not got a good record on the introduction of IT – anywhere. There is a tendency to go for too much, too quickly, and at too much cost. Some 20 years ago I proposed that all the GPs in West Wales used the same system. The knock on effects and health gains would have been immense. But I was thwarted, and we have not progressed. Out of Hours records are derisory, slow and unreliable. Information gained in one area (A&E for example) is  not shared electronically with another (GPs). NHSreality would have more faith if progress was in selected areas like the Isle of Wight, or Cornwall, or Pembrokeshire, before risking a national roll out. This could be good news… It would be better to use smaller groups, health board areas etc. 

Carolyn Wickware reports for Pulse 16th August 2018: GP practices may have to switch systems as NHS Digital embarks on a re-tendering process for patient record IT providers.

NHS Digital will launch a tender for a new panel of system providers in January, with the intention to have the new framework in place next summer.

But, in order to secure a spot on the panel, providers will need to show they can provide record systems for ‘multi-disciplinary settings’, and NHS Digital said this ‘may or may not’ be the systems currently used by practices.

Under the current GP Systems of Choice framework, which expires at the end of this year, practices can choose to use TPP SystmOne, EMIS Web, InPS Vision or Microtest Evolution.

GP leaders warned that attempts to overhaul GP IT systems ‘will be a huge undertaking’ and urged NHS Digital to ‘carefully consider the potential impact on practices’.

The current framework, which has been extended several times, has been in place since 2007.

All providers can bid to remain on the updated framework, however NHS Digital said they could lose their spot if they failed or refused to meet ‘new requirements’.

NHS Digital said the new Digital Care Services framework, worth £450m, aims to support ‘integrated care organisations’.

According to the prior information notice for the tender process, providers on the framework will be expected to provide ‘patient record systems for multi-disciplinary settings’, which ‘may or may not be general practice (GP) systems as currently accessed within the UK market’.

Martin Warden, NHS Digital’s director of digital transformation in general practice, said: ‘This is a step-change towards ensuring the continued relevance and resilience of primary care IT systems to meet evolving NHS needs.

‘The new framework will improve access to GP data for patients and the NHS, as well as enabling digitised workflows in and between care settings to support better patient care.’

He added that it will also ‘provide local organisations and other buyers with more choice through an online catalogue service’.

Dr Farah Jameel, BMA GP Committee executive team IT lead, said: ‘Any attempt to completely overhaul GP IT systems will be a huge undertaking, and those responsible must carefully consider the potential impact on practices and patients.

‘GPs and their teams must be fully consulted on these plans to ensure that they are rolled out with minimal disruption and the best interests of patients and practices as a priority.’

Requirements for NHS Digital’s new IT systems framework

  • Patient record systems for multi-disciplinary settings, which ‘may or may not be GP systems as currently accessed within the UK market’
  • GP systems ‘designed around the operation of a traditional general practice’
  • Digital services ‘integrating into the clinical desktop, such as document management, clinical decision support [and] e-Consultation’
  • Digital support services ‘supporting integrated service delivery’
  • Patient facing services including ‘appointment or practice communication apps’.

Source: NHS Digital

IT – the solution and a problem… Every patient deserves an examination. GPs must not be robots..

Do you have a right to forbid your notes to be filed electronically? We don’t know..

Bringing back fear, and suffering. A return to 19th century inequalities.. How quickly politicians destroyed what was the best safety net in the world?

The potential risk for blackmail – think about your medical records when you are young. Are you ambitious to be famous?

The Hacking reveals a collusion of anonymity for responsibility for rationing…


Successive increases in the health budgets in Wales have not helped….. Brexit will make it worse… We all seem agreed, so why not change direction?

Pouring more money into a bottomless well, or a holed bucket is what is occurring in Welsh health. There are seven Welsh Health Boards, in various states of economic degradation. There is no NHS, and so the Welsh Health Service has its own financial budget (Including NHS funding rules), its own litigation fund, its own waiting lists, and its own complication and death rates. These will eventually be compared with the other regions in the UK, and the WHO will report to show the differences after and since devolution. Wales is unsustainable as a devolved health service if the residents expect to have the same standards as England (why not, they pay the same taxes?) In addition, Wales is the region which voted most for Brexit, but according to the “Brexitometer” at the Pembrokeshire County Show the farming community are certainly thinking again. (This picture taken well before end of the show)

ITV news explored the Brexit outcomes for Wales: How will Brexit affect the Welsh NHS? | Wales – ITV News The third question askes if people think that Brexit will be good for the NHS. We all seem agreed, so why not change direction?

Meanwhile, the area of the UK with the greatest recruitment problems, has also got the greatest (pro rata) litigation problems. The money set aside for litigation in N Wales is extraordinary. This is part of a national concern, as staff shortages bite, and standards fall: Concern at ‘spiralling’ health complaints to ombudsman (BBC News today)

On 8th December 2015 David Deans in Walesonline reported on an increase of £278m to make a budget for 2016 of £7.1 billion. 

This was confirmed by the National Health (funding) Executive. But assessed at £260m

It is hard to get up-to-date information and the “NHS expenditure programme budgets” from the Welsh Government (WG) website does not help. Neither does the WG budgets website. (A work in progress!!) Neither is help offered by the WG beta website (again in development).

There are however, historic documents for download (.pdf) showing the change in expenditure year on year. (This is of course historic information, and not the budget)

Although prescriptions are free, 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.

Wales is already subsidised by England but The real cost of the English taxpayer subsidising NHS Wales – is twice the official figure

Outside of the cities, Cardiff and Swansea, there are really poor areas, and The agony of Damocles swaord hangs over West Wales..

Projected Litigation funding in N Wales is £90m, and the BBC 9 days ago said ” NHS Wales negligence bill alarming”,

Where recruitment is poor, morale is low and staff sickness, already the worst in the world for any organisation, is desperate. Jez Hemming in the Daily Post 6 days ago: What’s been making North Wales health staff so sick?

Shane Brennan reports 16th August on “super sized morgues” and  on the epidemic of obesity leading to higher death rates, as predicted by NHSreality.

This is not a surprise to GPs or NHSreality as Number of GPs in Wales hits lowest level in a decade

Cutting our hospitals could make sense, but there are many threats in doing this. The rules for Yorkshire do not apply in rural Wales. The fourth option for West Wales? Do we want “soft lies and gentle indifference”, until we realise the safety net is failing for us personally?

We are already subsidised by £1,500 per head, and now we have a running deficit: A bigger and bigger deficit in West Wales…… Now at £600 per head……

In Wales they really can waste money: £68m unveiled for health and care hubs

Cancer statistics broken down across Wales. What a pity we in Wales cannot compare to the rest of the UK, and EU.

Stroke patients in Wales ‘could die’ because thrombectomy not available Acute shortage in NHS of specialist doctors who undertake life-saving treatment means hospitals cannot provide it

Rationing by waiting, and insufficient staff. Wales is worst…

Wales is an unsustainable state: another good reason not to leave the EU. Graphics in support…

In Wales, as in many rural areas GPonline Nick Bostock reports: How small GP practices are being pushed towards extinction






Local Media may better expose the covert post code rationing which is present throughout the country

Local media may do what national media seems incapable of. Exposing the covert post code rationing which is present throughout the country, in all 4 different UK systems. Its only when you lottery number comes up, and you get ill, that you discover what may not be available for you. In psychiatric medicine this may be psychotherapy, in gynaecology it may be IVF, and in cancer treatment it may be proton beam therapy or a PET scan investigation.

Stuart Minting in Richmondshire Today 8th August 2018 in Yorkshire reports:  New Health Secretary to be pressed on state of North Yorkshire’s NHS services

The bleak financial outlook facing the NHS in North Yorkshire and concerns for patients’ services is set to be laid before the new Secretary of State for Health and Social Care.

The county’s health watchdog said it would press Matt Hancock for an immediate answer to questions as both his predecessor, Jeremy Hunt, and Prime Minister Theresa May had failed to respond to appeals for action.

Councillor Jim Clark, chairman of North Yorkshire’s Scrutiny of Health Committee, said he would write to Mr Hancock calling for urgent action as documents had revealed the deficit facing the clinical commissioning’ groups (CCGs) that control NHS funding was continuing to rise this year.

The committee has previously highlighted how groups commissioning NHS services in the county have for many years been unable to keep within their spending limits.

Despite concerted drives to cut spending, Hambleton, Richmondshire and Whitby, Harrogate, Vale of York and Scarborough and Ryedale CCGs racked up a £46m deficit last year and are expected to go £30m into the red this year.

The CCGs have been reported to the Health Secretary for acting unlawfully by exceeding last year’s budgets, while the committee has raised concerns over the “chronic shortage of NHS staff”.

In addition, the Hambleton group will have to draw up a financial recovery plan and notify health chiefs should it wish to make any senior appointments after being placed in special measures.

Cllr Clark said while the threat of longer waiting lists, more rationing of services and hospital bed closures loomed for North Yorkshire residents, the Government did not appear to have understood the urgent nature of the situation.

He said Mr Hancock would be pressed to get stringent financial controls put in place by NHS England to oversee any additional money given to address the deficit.

Cllr Clark said while it appeared while the CCGs were set to cut their costs by more collaborative working, it remained unclear if any extra Government funding would be used effectively and efficiently and if taxpayers would get value for money.

The retired accountant said: “I have had no response from the Prime Minister, but four out of five of our CCGs are still acting unlawfully and this has got to be addressed. They are building up a considerable deficit again this year.

“The NHS are spending more and more money on management consultations, but the problem is that they can’t recruit medical consultants.

“Hopefully, the new Secretary of State for Health and Social Care might get the seriousness of the situation.”

Nathan Hide in Leeds Live on line reports 7th July 2018: Revealed: Leeds patients denied necessary treatments

“There is something that would cure me, but I can’t have it unless I can afford it”

The Yorkshire Post 21st July reported on the rationing of IVF services.

and calls for “greater funding of IVF treatments”.


The perverse incentive to have a long waiting list… Rationing of health services in this way is immoral. It is a two tier system sponsored by the state.

Rationing of health services in this way is immoral. It is a two tier system sponsored by the state.

Hospitals are evidently charging for private operations that by-pass their waiting lists. According to the Mail this involves 2/3 of Hospitals in England (presumably).

Patients are being allowed to jump growing NHS queues by paying up to £15,000 for a hip replacement.

Hospitals are encouraging people to self-fund procedures that are either heavily rationed or have very long waiting times.

A Daily Mail investigation uncovered how two-thirds of hospitals allow patients to pay out of their pockets for hip and knee replacements and cataract surgery. It follows revelations that patients are having to wait for up to a year for surgery on the NHS.

Many hospitals offer all-inclusive packages that work out significantly cheaper than charging separate fees for the operating theatre time, the consultant and occupying a hospital bed.

Similarly patients wanting cataract surgery are charged a maximum of £5,125 at Derby Teaching Hospitals. The NHS typically pays just £800 for the procedure, though it involves a less advanced lens.

In return, patients are treated almost immediately

And last week the BMJ said 1,700 patients had been refused hip and knee operations even though their doctors had pleaded their cases.

But campaigners said it was ‘deeply worrying’ that patients were having to choose between finding the money themselves or enduring very long waits.

Caroline Abrahams, charity director at Age UK said: ‘It is deeply worrying that we’re apparently sleepwalking towards a situation in which if you want a routine operation such as a hip or knee replacement you either have to pay privately or wait a long time on the NHS. What about the many older people who cannot possibly afford to pay thousands and who are left in pain and distress for months on NHS waiting lists?’

Labour’s health spokesman Jonathan Ashworth MP said years of cuts have meant we have been left with ‘a two-tier NHS with quick surgery for those with cash while the majority are forced to wait longer and longer in pain’.

Rationing of health services in this way is immoral. It is a two tier system sponsored by the state.