Monthly Archives: October 2019

£42m overspend by Betsi Cadwaladr in North Wales…… We might as well all move away to get quality medical care.

Its a medical and health market silly. In a market rare resources (Such as good locum doctors) command a high price. Lets hope Mr Philip Burns can deliver, but my suspicion he is just going to be the scapegoat for why the board has failed consistently. The board are not prepared to ration overtly, and indeed, the rules of the game say they cannot. In addition they have money they could well spend taken by the Welsh Government, who in turn set the “rules of the game”. This board cannot win, and they know it. The (presumably accumulated) deficit of £42m is so large that they don’t worry about a salary of £600K! Interesting that the Betsi Cadwaladr news site says nothing! 

I would do the turnaround for a lot less, but I would have to change the rules of the game. Co-payments and planned rationing… Mr Burns will get better quality of care in Spain than in Wales. Don’t blame him.

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Kay Burgess reports in the Times 29th October 2019: Expert paid £2,000 a day to help hospital save cash

A management consultant is being paid almost £2,000 a day to find ways to cut costs at a struggling NHS health board in a deal that allows him to work one day a week from his home in Spain.

The Betsi Cadwaladr University Health Board in north Wales has been in special measures for four years, recording a deficit of £41.3 million in June.

The board has employed an “interim recovery director” who will earn £360,990 over nine months, equating to £1,990 a day or £40,000 a month. He has been permitted to work from his home in Marbella on the Costa del Sol one day a week, it confirmed.

He was named as Philip Burns by Llyr Gruffydd, a Plaid Cymru member of the Welsh assembly, in the Senedd last week. Mr Burns, who is employed through the Hunter Healthcare consultancy, is paid more than the chief executive of the health board and the Welsh government’s health minister.

The figures on the pay received by Mr Burns and other consultants were revealed to Mr Gruffydd through a freedom of information request.

The health board confirmed that four other management consultants were earning large amounts for temporary contracts, ranging from £715 to £1,380 a day. The money was all paid to limited companies.

One money-saving measure proposed at the board has been to stop paying nurses for breaks taken during their 12-and-a-half-hour shifts. This would save £25,000 a month, just over half the salary paid to Mr Burns.

Mr Gruffydd said the health board had a £42 million deficit and one in nine of its nursing posts was vacant. “If we’re having to see costly consultants come in to run the show, then it suggests that senior management isn’t doing its job. Given that the health board is under the direct control of the Welsh government the buck stops with them,” he said.

The board said it did not pay any travel or accommodation costs for Mr Burns and that it was paying the market rate for his services. “Our priority is to deliver considerable improvements in unscheduled care, planned care and financial management and to achieve this, we are temporarily strengthening our existing capacity and expertise in these areas,” it said. A spokesman said that the appointment of a recovery director was recommended by the Welsh assembly’s public accounts committee.

Mr Burns could not be reached for comment. reports today: North Wales health board’s failure to change course on nurses rosters “wholly unacceptable” say union.

BBC News SE Wales 25th October: Nurse paid breaks row: Anger over £2000-a-day director

The Telegraph today: NHS manager allowed to work from Marbella on rates of £2000 per day…

North Wales Lives reports on the “market rate”.

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England follows Scotland in funding CF drug. Wales and NI cant afford it.

The drug for CF does not cure, but slows down the decline. It cost far more (normally)m than NICE recommends for each year of life gained (QALY) but presumably the “deal” struck means it is much cheaper. Since the price is secret, it is covert, and we cannot judge. What does seem to have occurred is that one Single Interest Pressure Group (SIPG) has succeeded where many others are unsuccessful. All trusts and regions should have policies on how they deal with SIPGs. Such policies will make the need for rationing clearer. We can afford the low volume and expensive items if we ration the high volume and cheaper items. Once again, although reported as a national decision, this is only for |England. Wales and NI cannot afford it, but then politically perhaps they cannot afford to refuse it. The perverse outcome if the situation remains the same, should be that CF patients move to England and Scotland.

October 25th in the Times: NHS agrees deal to fund cystic fibrosis lifeline drug

A life-saving cystic fibrosis drug is to be made available on the NHS after a deal with a private health company.

The drug Orkambi, which improves lung function, reduces breathing difficulties and can be given to children as young as two, should be available to patients on prescription within 30 days.

NHS England reached a deal with Vertex Pharmaceuticals, the drug’s manufacturer, after a row over the cost, which dragged on for more than three years. The company wanted to charge £100,000 per patient per year but a compromise was reached in a confidential deal. It is, according to the BBC, understood to involve significantly less than the sum originally asked for.

Two other drugs made by Vertex — Symkevi and Kalydeco — will also be made available as part of the deal, meaning that about 5,000 NHS patients will have full access to the drugs. Symkevi is restricted to over 12-year-olds, while Kalydeco can be used from 12 months.

Simon Stevens, the NHS chief executive, said that the deal was a “long hoped-for moment”. He added: “The UK has the second highest prevalence of cystic fibrosis of any country in the world, so today is an important and long hoped-for moment for children and adults living with cystic fibrosis.

“That fact also means that any drug company wanting to succeed commercially in this field needs to work constructively with the NHS.”

Matt Hancock, the health secretary, said that the decision was “great value for money for the NHS”.

Gemma Weir, 35, from Portsmouth, has campaigned to get the drug on the NHS for her six-year-old daughter Ivy for the past four years. She told The Times: “I’m completely ecstatic, as I can’t believe the government agreed to it. My daughter’s life expectancy has just doubled and she will no longer have to live with a horrible life expectancy hanging over her head.”

The drug is said to slow decline in lung function — the most common cause of death for people with cystic fibrosis, a life-shortening genetic condition that can cause fatal lung damage. Only about half of those with the condition live to the age of 32.

NHS England said that the deal was made possible by the company agreeing confidential commercial terms that constituted good value for British taxpayers.


At first I thought my hospital (and it’s trolleys) was worse, but now I know they are all bad.. We must be off our trolleys to have let it get this bad.

When I was the unfortunate recipient of “Emergency and Urgent Care” in my local casualty (That’s different from A&E as it excludes trauma) I thought my hospital was worse than others, but now I know they are all bad.. but perhaps some are worse than others. What is it that makes the non-rationed health service, universal and cradle to grave, with free access, treat elderly people as if they don’t matter? There are many answers and the culture needs changing. The first thing is to make the staff feel valued, and then they might change their attitudes… 

How many people know what the new terminologies include or exclude? What is the purpose of rationing if it remains covert? The only answer I can think of is that it encourages the persistence of denial…. by all of us. Public, politicians and media. 

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The Times did cover the story below, but not on line 25th October: Patient, 84, died after 6 hours on A&E trolley. You might hope that something had been learned or done since 2015 but no! ( Patient dies on trolley after six hour wait for A&E at new flagship hospital – Jeremy Watson, November 6th 2015 in the Times ) or going back further , on 28th November 2013 Tom Knowles reported: Nurses ‘forgot’ patient, 84, over weekend.

You now need an advocate if you are in a UK Health Service Hospital. Someone who will make a noise for you, stir the shit and be a nuisance if things don’t happen. Unfortunately this might impact on the rest of the patients under the care of too few staff. Even I, a retired GP, would have benefitted from an advocate in my recent admission. Some things happen (or don’t happen) when you are unconscious or affected by drugs.

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BBC News reported 23rd October. Coventry Hospital: Man, 84, died on trolley ‘after six-hour wait’

Donald Driver, 84, slid off a trolley and died minutes later at Coventry University Hospital. A daughter has spoken of her heartbreak after her elderly dad died after sliding off a hospital trolley he had been waiting on in a packed A&E for SIX hours.

The Mail followed it up 26th: NHS let Dad die in A&E after six hours on a trolley without seeing a doctor …

The London Economic: Pensioner dies after spending six hours in a queue of trolleys …

Plan your hospital advocate…. NHSreality warned you that it was happening near you. The problems of Mid Staffs and Sussex Mental Health services are endemic, and Christmas is not a time to be ill..

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100 doctors a year choose suicide. UK Health Services are missing 10,000 staff due to suicides and mental health issues

BBC News 26th October 2018: Shrewsbury Mum wants better care for doctors.

There are about he BBC’s Inside Out programme investigated suicide among doctors in England and found the NHS has a shortage of 10,000 staff.

Clare Gerada “”When they sign up to be a doctor in the first place they are signing up to give their working life to the care of others and we need to care for them.” The junior doctors don’t feel cared for.

Doctors and Suicide: Clare Gerada in the BJGP 2018

Carolyn Wickware in Pulse 3rd Septemebr 2018: Top GP issues mental health warning as 400 doctors die by suicide

Professor Clare Gerada has called on the Government to improve support available to doctors, amid data showing over 400 doctors died by suicide in just four years.

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Implicit rationing! Not a bad climb down from the Chief Executive NHS England

Despite the funding of a new cystic fibrosis drug, the UKs health services cannot afford to provide basic social and medical care. How long we all pretend that there is no rationing in a “cradle to grave”, free and universal health service is up to us. Yes, capital spend is important, but more important are the staff….. Whilst they are disengaged the problems will continue..

Nick Carling in the Health Service Journal reports the opinion of Simon Stevens, Stevens: Old capital process was ‘implicit rationing’ – Simon Stevens has described the process for approving vital infrastructure projects as “implicit rationing”.

Stevens criticises previous capital process He pledges to “bat very heavily” for mental health capital investment Simon …

Stevens: Hospitals should open more beds this winter than last

Health Service Journal8 Oct 2019
Simon Stevens has urged trust bosses to “think carefully” about how many beds they have open this winter

Stevens: New NHS beds should squeeze ‘inappropriate …

Health Service Journal10 Oct 2019
Simon Stevens has indicated that a “sometimes-inappropriate” level of private provision in mental health inpatient services should be squeezed …

Cystic fibrosis ‘wonder drug’ to be provided on the NHS after … hours ago
Simon Stevens, NHS chief executive, said it was “an important and long … Stevens said it is “good for our patients and fair to British taxpayers”.


The new Brexit deal: “higher costs and an emptier exchequer”, so more rationing, and only a skeleton of the old NHS left.

NHSreality has been warning that it was going to get worse. The people leading us to disaster are those most able and willing to go privately. If we get another chance to vote think carefully about remaining… for your health service’s sake. The new Brexit deal means “higher costs  and an emptier exchequer”, ( so more rationing  ed. ) opines Mark Dayan of the Nuffield Trust. Only a skelton of the former NHS is left.

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Health and hard Brexit: the impact of the new deal –  With Boris Johnson and EU leaders agreeing a new Brexit deal last week, Mark Dayan examines what it will mean for the NHS and social care.

….Earlier this year I warned that from the point of view of health and health care, there were drawbacks to “binning” the backstop. Now that we have new documents, we can go through the issues it raised one by one and see what has happened.

New rules

Northern Irish and Irish health services, including critical ambulance transfers, rely on staff, patients and supplies moving over an open border. Securing this was the point of the backstop: losing it was the most obvious downside of its excision.

The good news is that the revised Northern Irish protocol should still prevent a hard border. Rules for customs and for physical products will stay the same on both sides of the border, although a complicated system allows the UK to give rebates so that Northern Irish imports ultimately incur UK rather than EU tariffs. Keeping an open border removes some of the possible obstructions to the staff, patients and supplies that services on the island benefit from moving back and forth.

…The NHS is reliant on imported supplies – some types of which are overwhelmingly from the EU – and has relatively little interest in reworking trade deals, so this was broadly positive. But the new Irish protocol leaves us somewhere very different and the new declaration does not repeat this language. The Withdrawal Agreement Bill designed to implement the deal would actually set into law that goals for the future relationship should be in line with the looser arrangement in the declaration – although amendments in the House of Commons will aim to change this.

These shifts are likely to mean higher costs to the NHS to some extent, potentially to the tune of several hundred million pounds each year.

An emptier exchequer

A similar impact in other sectors would also likely mean an economy that grows more slowly, and so less tax revenue to support health and social care. Given the uncertainty in the trade arrangement, precision is difficult, but the UK in a Changing Europe estimates anywhere between £16 billion and £49 billion less to spend annually compared to staying in the EU.

Within the health and care sector, strong cases have been made for several billion pounds in extra annual funding for both NHS capital and an overhaul of the failing social care sector. But in such a straitened situation, finding that money would require some very tough decisions on tax or cuts to other public services.

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Genetic testing and treatment will undermine the 4 UK Health Services until we ration overtly.

The pace of the advances in technology is faster than any governments ability to keep up with ( making decisions on new treatments )The pace of the increase in cost of the new technologies is faster/higher than any government can afford.

The patenting of genetic treatments based on American laws is a dubious issue, but not many of the new treatments would never have been available so quickly without commercial intent. There is a reduction in cost as technologies age and become mainstream but this will not be for some time/years. Meanwhile genetic testing and treatment undermines the 4 UK Health Services until we ration overtly. The Times leader, ( See below) disappointingly fails to address the concerns around equity, cost, access etc … any nation, let alone a rich one like ours. If we ration high volume low cost treatments we can afford the new therapies – for everyone who needs them.

The Foundation for Economic Education 3rd June 2019 explains why a genetic treatment is so expensive…

by saying (subtitle) “Regulations serve to hinder access to treatment by making it prohibitively expensive. Drugs costing over $2 million are the latest symptom of the overregulation disease.

In the Independent 2nd April 2018 Sterghios Moschos reports that “Gene therapy is now available but could cost millions over a lifetime”.

If you were born with a rare form of blindness, there is now a treatment for you that may restore your eyesight. That’s because gene therapies became a clinical reality in 2017. Yet many people with rare diseases that could be treated in this way may never benefit from these therapies because they are too expensive for drug companies to develop, or too costly for the patient or health service to afford. Is witnessing a starry night worth an eye-watering $425,000 (£302,000) per eye?….

Emily Mullin on 24th October 2017 reports for the Technology Review (Biotech and Genetic Engineering) “Tracking the cost of gene therapies: Though expensive now, prices could get cheaper for more common diseases.”

James Paton for Bloomberg reports 24th April 2019 that: “Gene therapy was hailed as a revolution. Then came the bill…

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NHS reality has commented in the past: Societal debate on CRISPR should occur: but it won’t…… Of course there is a cost too, but that’s another matter. Lets just see if we can agree that CRISPR is desirable.

and observed that Gene tests ‘threaten core NHS principle’

In the Times a leader on Gene Therapy following a news article on the 21st October: DNA ‘word processor’ brings hope of cures for genetic dieases

The molecular tool allows researchers to target a single section of DNA among billions of letters in the genomes of living organisms and then, crucially and unlike other editing tools, change it in situ.

This could allow scientists to fix the mutations in embryos that lead to diseases such as cystic fibrosis and Tay-Sachs, and find better ways to treat conditions like sickle cell anaemia. In the shorter term it also holds out the promise of further simplifying laboratory work in genetic modification.

David Liu, from Harvard and MIT’s Broad Institute, said the work was a step on the path of achieving a “long standing aspiration in molecular life sciences, to be able to make any DNA change in any position of a living cell or organism, including potentially human patients with diseases.

The tool, known as Prime Editing, builds on a system known has Crispr Cas9 that in under a decade has revolutionised genetics. Crispr harnesses a feature discovered in the bacterial immune system….

Gene Editing – Times leader 21st October 2019