Monthly Archives: September 2019

Under the Knife – Watch the documentary 14-19th October

All 4 health services are under the knife. The BMJ fails to recognise that there is no NHS any longer.

Under the knife: five minutes with . . . Pamela Kleinot BMJ 2019;366:l5782

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The Documentary

“The documentary Under the Knife is about the undermining and privatisation of the NHS. It looks at what healthcare was like before the NHS, how the NHS came into being, and everything that has happened to it since then. It’s to help people understand what has been happening. I think the NHS is one of the greatest institutions humanity has ever made. I’m from South Africa and growing up there was very unequal access to healthcare. My father was a doctor at the largest state hospital in southern Africa and he would always tell me how great the NHS was.

“When I moved to England, I trained as a psychotherapist and group analyst and worked at Holloway Prison and the Women’s Therapy Centre. I then went to work for the NHS. When I started, there weren’t as many restrictions on how many patients you saw and the length of time you saw them. Then we saw the rise of targets and constant surveillance. I felt like I was working in a factory. I later became head of a mentalisation based therapy service for personality disorder in Newham, London, which was put under consultation. I fought tooth and nail to save the department with just a small team and it survived. But several months later we were told that the service was going to be put under consultation again. It had been such a tough and stressful process that I could not go through it again.

“The pressures you work under today in the NHS are enormous, but I believe it’s worth improving, it’s worth saving. That’s why I made this documentary. Even when I was working in the NHS, I didn’t realise what was happening. It was only when I began to research it that I saw the vested interests, how it’s used as a political football, and the lies and deception. There’s so much of that going on and that motivated me to start this project. I also feel Britain has been very good to me, and I wanted to give something back. Fighting for the NHS feels like the perfect way to do that.

“I took out a lot of loans, including remortgaging my property, to make this documentary. I did raise some money through crowdfunding, and I would have liked to raise all the money that way, but it was difficult and I didn’t want to delay it. I wanted to get this story out there. My hope is that it reaches people. I want it to reach the younger generation, who grew up with the NHS and don’t remember what it was like before. I want them to understand that people died because they could not afford to go to a doctor. Those were appalling times.

“The documentary is being screened between 14-19 October 2019 in 50 venues across England. These screenings are completely free, you just have to register on our website. And if people want to show the documentary—put on their own screenings in their home, at work, or in their local area—I’m very happy for them to do that. I just want as many people as possible to see it.”

Pamela is a former NHS psychotherapist and group analyst, and was the producer of Under the Knife. The website for the documentary—where you can sign up to see the film or ask to put on a local screening—is here undertheknifefilm.co.uk

 

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Why has it been left too late to be honest about health provision?

As standards fall, there is going to be an increasingly heated debate on why it was left so late to address the deficit in staff, quality of care, and social care. The lack of bed capacity was predicated on replacement care in the community, but it never happened in the scale needed. So a “Huge increase in hospital activity should be “wake-up call,” says acute medicine leader BMJ 2019;366:l5661 )

Adult critical care admissions to English hospitals have increased by 22% since 2011-12, new figures show.

A report from NHS Digital details the volume of inpatient, day case, and adult critical care activity in England in 2018-19, based on hospital episode statistics. It reveals the scale of the increase in hospital activity in England over the past decade….

PharmaTimes online reports 23rd September 2019: Hospital admissions increase 28% in ten years

The BMJ publishes a report which could be read as cynical by those in the profession: Healthcare for Everyone bmj.l5645.full

Bear in mind that the Economist is also suspicious that the founding principles of the UK Health Services are sustainable: Universal Health Care – The Economist

In the last week some of the headlines:

Jamie Buchan reports in the Courier 27th September 2019: Health chiefs launch “in depth review” of Bridge of Earn surgery closure.

Shrewsbury is a wonderful market town where only 0 years ago there would have been competition for each place as a GP.

Anviksha Patel reports 25 September 2019 “Patients to hold vigil for closing GP practice”

Protesters in Shrewsbury are holding a vigil on Friday to mark the closure of a ‘popular’ GP practice.

Whitehall Medical Practice is due to close its doors on Friday 27 September following the CCG not being able to find a bidder for the contract….

Watch out for novel and risky solutions such as reported by Andy Woodcock in the Independent 24th September 2019: Labour would fund state drug company to make medicines cheaper. This is all wriggleing on the hook of an unsustainable system.

UK is not the only country struggling to look after its elderly. Benjamin Krause reports 25th September 2019: IG Speaks On ‘Perverse’ VA Emergency Room Denial Incentives

The wording of the denial for funding after chest pains (which may have been a heart attack) is seminal. We are not told if the patient is a repeat attender, or a “heartsink”, but the wording is not expected. “The decision informed me that I was not a prudent layperson, and that a prudent layperson would not go to an emergency room with the symptoms I exhibited.”

How did Health Servicd staff vote in the referendum?

As far as I can find out from my contacts and friends most of the traditional 3 generation staff have voted for remain. They are aware of the added on cost from the reduced value of the £ Stirling, and the dependence of the 4 services on overseas trained doctors and nurses.

But perversely, those from non EU countries, and especially those with other relatives who aspire to come to the UK, might have voted “leave”.

After all, with fewer EU citizens allowed in, and a permanent under capacity in doctor and nurse training, where will the deficit come from.

It would be interesting to know the answer.

 

NHS “never event” blunders are 9 per week on average

Nine3 patients per week suffer NHS blunders. This was reported in the Times 16th September 2019 (not on line) and in the Mail which adds that @ 270 patients a year have operations on the wrong limb or organ. 

The Times report is below, but it surely applies only to England, and with the addition of the other 3 dispensations, which account for another 12 million people the figure might rise to over 300. Pity there is no NHS and no comparative figures. We also don’t know the comparable figures from the past for comparison. NHSreality believes that lack of teams and firms and continuity, lack of engagement, part time working, and reducing standards all contribute. How many are not reported as well?

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Hundreds of NHS patients have suffered from NHS blunders so serious that they should never happen, new data shows.

Some 629 “never events” – including operations on the wrong parts of the body and surgical tools being left inside patients occurred in NHS Hospitals between April last year and this july, the equivalent of nine patients per week.

Prof Derek Alderson, president of the royal college of surgeons, said such mistakes were “exceptionally traumatic for patients”, while the Patients Association described them as devastating.

The figures, obtained by the PA news agency are provisional. They revealed that several patients had procedures intended for someone else.

Barts Health NHS trust had the most errors, with 17, followed by Walsall Healthcare Trust with 13.

AN NHS spokesman said that such events were “thankfully extremely rare”, but had to be investigated and learnt from.

 

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Mid Staffordshire NHS trust fined for ‘avoidable and tragic death’ – we may all need an advocate..

Family advocates needed? Hospital patients at risk of falls as ‘thousands cannot reach walking sticks’..

“Serious risk of collapse”. The BMA represents the majority of consultants and GPs thoughts, and not the Royal College of GPs (RCGP). We ALL need to worry. Its going to get worse, until we face up to reality.

Time to exclude children from school until they are vaccinated? A justified illiberal action?

Is it time to exclude children until they are vaccinated? Could this be a justified illiberal action in view of it’s utility? The greatest good for the greatest number demands we take action. If we accept co-payments for those with sufficient means then the richest will gladly pay. We could also offer inducements for defaulting children prior to school entry… Tough love.

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Fiona McRae reports in The Times 26th September 2019: ‘Bold action’ needed as child jab rate falls for every major illness

The immunisation rate for every major childhood illness is falling for the first time on record, official figures have revealed.

Data released yesterday showed that the uptake in each of the 13 jabs routinely given to children under the age of five has dropped in the past year.

With fewer children being immunised against conditions from polio to meningitis and rates of protection against measles falling for the fifth year in a row, the health secretary has promised “bold action”.

Matt Hancock is taking advice on a range of options, including mandatory vaccination, something that already happens in nine other European countries, including Italy and France.

Warning that “devastating diseases can, and will, resurface”, he said: “Falling childhood vaccination rates are unacceptable. Everyone has a role to play in halting this decline. We need to be bold and I will not rule out action so that every child is properly protected.”

The figures, from Public Health England and NHS Digital, come amid concern about the influence of the antivaxx movement, which is spreading scare stories about the jabs online.

There are also fears that parents, many of whom will never have seen the effects of diseases such as polio, which can cause paralysis and even kill, are becoming complacent, turning to homeopathic remedies or deferring to religious concerns.

The number of babies given their first dose of MMR vaccine, which protects against measles, mumps and rubella (German measles), by their second birthday dropped from 91.2 per cent in 2017-18 to 90.3 per cent in 2018-19, well below the World Health Organisation target of 95 per cent.

Uptake of the five-in-one jab, which protects against diphtheria, whooping cough, tetanus, polio and Haemophilus influenzae type B (Hib) is at a ten-year low in children aged one.

The proportion of children given vaccines against rotavirus, which causes diarrhoea and sickness, also fell, as did coverage for the combined Hib/meningitis C vaccine, meningitis B vaccine and the pneumococcal conjugate vaccine (PCV), which protect against a range of illnesses including meningitis.

The decreases in vaccination rates ranged from 0.2 to 1.0 per cent.

Jonathan Ball, a virologist at Nottingham University, suspected that the drop was down to people forgetting how serious the infections could be.

“We all lead busy lives, and it might be tempting to put off a trip to the GP for convenience’s sake but the importance of getting our children vaccinated cannot be overstated,” he said.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, warned that the “destructive” anti-vaccination messages circulating online and on social media were “perpetuating toxic myths that are not backed by any evidence”.

“It is important for people to understand that the decision to vaccinate their child doesn’t just affect them, but society as a whole,” she added.

Others urged the NHS to make it easier for children to get immunised by putting on vaccination sessions at family-friendly times.

Mary Ramsay, head of immunisation at Public Health England, said: “No parent should be in any doubt of the devastating impact of these diseases.”

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The Nuffield Trust – Workforce conclusions. The overseas doctors we import will doubtless block the opportunities for our own in 1o years time… if we do train enough.

The Nuffield Trust admits that it has not addressed geographical considerations, but this is addressed by overcapacity. The fact that even this year only one in 10 applicants to medical school is successful speaks volumes. We need virtual medical schools, adverse selection so that rural and poverty stricken areas are allocated a fair share of doctors to train, and a “tie in” whereby doctors can be induced to stay where they are most needed. The overseas doctors we import will doubtless block the opportunities for our own in 1o years time… if we do train enough.

In Action for health: key areas for action in the health and social care workforce (21st March 2019), the Nuffield Trust summarises in Next Step and Conclusions:

The NHS Long-Term Plan recognises that over the past decade workforce growth has not kept up with the demands on the service and that the NHS now needs a comprehensive workforce plan to tackle staffing shortages, improve working lives and better utilise the talents and skills of the million plus people who work in the health service. Few disagree that the workforce is the make-or-break issue for the NHS over the coming years.
Over the past decade, day-to-day spending pressures have crowded out investment in the workforce. This must stop; this short-termism has not served patients, staff or taxpayers. The government has committed to a new pay deal for NHS staff and will be spending £20.5 billion more on NHS services by 2023/24. These are important and substantial first steps. But to tackle the current pressures in the workforce, much more action is needed, including more investment in training new staff and more support for the development and retention of existing staff. The health service cannot afford the government continuing to view education and training as an overhead cost to be minimised. There needs to be a fundamental shift in thinking to plan for ‘over-supply’ of key groups. If this were done and education and training budgets were increased, broadly back to the funding level in 2013/14, our analysis shows that the NHS has the chance to be self-sufficient – in nurses at least – in a decade’s time. But this won’t happen without investment, policy action and managerial focus now and sustained across the coming years.
In some other areas the management of staffing shortages requires even more radical action. The government has had a target to increase the number of GPs by 5,000 since 2016 (NHS England 2016). It is clear that this is not achievable. Over the next decade and across the NHS primary care will need to move to a wider team-based model in all parts of the country. Transforming primary care to a team model, shifting to train for over-supply, paying people competitive wages and investing in all staff so that they have rewarding jobs with terms and conditions which reflect modern life is critical to closing the staffing gap and delivering high-quality care.
But for the next five years we need to be realistic about what can be achieved – turning around the NHS’s staffing problems will not be quick. For the next few years the NHS can only maintain services by recruiting and retaining enough staff internationally. A positive culture and supportive immigration policy is essential alongside having NHS organisations that are ready to be good employers and help people settle. Even with this, the workforce constraints will inevitably shape and constrain the speed at which health services can be transformed and quality of care improved in areas such as cancer and mental
health.

There are no silver bullets for the workforce; addressing staff shortages requires consistent and concerted action across the system on pay, training, retention and job roles. While it is possible to point to individual policy failures in the past that have contributed to the current depth of the workforce shortages, the cause of our current problems goes deeper; workforce has not been a policy priority, responsibility for it is fragmented nationally and locally, the information the NHS needs to understand and plan its workforce is poor and the NHS has not invested in the leadership capability and skills needed to manage the workforce effectively. The NHS workforce implementation plan needs therefore to address not just specific policy areas but also the roles, responsibilities, skills and capabilities needed across the system for more effective workforce planning.
Finally, a key part of good workforce planning and policy needs to include thinking through how the NHS can work much more effectively with partners outside the strict confines of the health service. The past few years have clearly shown that good health depends not just on the NHS but also on the social care system; and an effective training pipeline of skilled staff requires strong partnership with further education institutions and universities, especially if we want to broaden the opportunities to ensure that the NHS has a diverse staff group that properly reflects the society it serves. There are a number of actions that can be taken to improve recruitment and retention in social care. However, workforce challenges in this sector partly have their basis in the poor pay, terms and conditions for social care workers. This can only be addressed by government, first through additional funding in the 2019 Spending Review, and in the longer term through comprehensive reform of adult social care funding.

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Its easy to say you will fund a treatment, but much harder to say what you won’t fund. How long will the English and Welsh hold out against the media led pressures? Emergency loans for Trusts merely delays the inevitable.

In the National Institute for Health and Care Excellence (NICE) website:

One QALY is equal to 1 year of life in perfect health. QALYs are calculated by estimating the years of life remaining for a patient following a particular treatment or intervention and weighting each year with a quality-of-life score (on a 0 to 1 scale).

In Wikipedia a QALY year is defined: Quality-adjusted Life Year

 

Quality-adjusted Life Year
The quality-adjusted life year or quality-adjusted life-year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health. If an individual’s health is below this maximum, QALYs are accrued at a rate of less than 1 per year. To be dead is associated with 0 QALYs. QALYs can be used to inform personal decisions, to evaluate programs, and to set priorities for future programs.

In “Carrying NICE over the threshold” ( 19th Feb 2015 ), Professor Karl Claxton suggests that paying more than £13,000 per QALY for technologies “does more harm than good” by displacing other more effective healthcare from the NHS.

In Scotland it appears that they are taking a lead in commissioning treatment that is very expensive, but effective in prolonging life, for Cystic Fibrosis sufferers. This induces perverse behaviour in families of sufferers, and, in addition, fails to point out what services will be weakened, or not funded, since the resources are limited.  . Cystic fibrosis: Father considers Scotland move to access new drug. BBC News 20th September 2019.  In the end it has to be politicians, with public consent, who agree how to ration. We can afford the CF treatment, but only if we ration high volume low cost treatments, or other more expensive treatments, out. Decisions like that in Scotland, without equivalent saving decisions will make the Health Service (s) worse, and the differences between the haves and the have nots worse. The main expense in the health services is spent on its greatest asset: staff. These are no longer feeling valued, and those that can are making hay as locums. This is an even greater burden to their health services than expensive treatments. Add to this the cost of infections (longer stays and expensive treatments) and litigation, and it is evident that England is correct in putting its population before its CF individuals. How long will they hold out against the media I wonder? Sepsis and Litigation are much larger problems. Emergency loans for Trusts merely defers the inevitable…

A father has spoken of his agonising dilemma about whether to leave England and move to Scotland so his daughter can access life-prolonging medication.

Dave Louden’s four-year-old daughter Ayda was diagnosed with cystic fibrosis shortly after she was born.

The family live in Carlisle, 10 miles (16km) from the Scottish border, where a new drug has become available.

However, despite the position in Scotland, NHS England said the drugs were not cost-effective.

Costing £100,000 per person per year, Orkambi and Symkevi improves lung health and life expectancy for sufferers of cystic fibrosis.

Patients in Scotland can access the drugs after the Scottish government agreed a “confidential discount” with the pharmaceutical company Vertex.

Cystic fibrosis affects about 10,400 people in the UK and causes fatal lung damage, with only around half of sufferers living to the age of 40.

Mr Louden said it was “heartbreaking” that his daughter could not get the treatment…..

‘Life-changing’ cystic fibrosis drug deal for Scotland is welcomed BBC 20th September

BBC News 16th September: Review launched into Aberdeen hospital project costs

BBC News 20th September: Hospitals relying on ’emergency’ loans

Huw Pym 19th September: How much does diabetes cost the NHS?

Jonathan Ames 14th September in the Times: Locum ruling will cost NHS millions

NHS long term plan to reduce toll of NHS Long Term Plan to reduce toll of “hidden killer” sepsis

Sarah Neville in the FT 7th September 2017:  Cost of NHS negligence claims quadruples to £1.6bn in decade – Soaring bill affects quality of care and increases financial pressure on trusts