Monthly Archives: November 2019

The reality is that citizens no longer feel cared for … Lets give Liberals a chance.

Rich and poor should be treated alike, (for the major things) but a wealthy society needs to agree that richer people must pay for high volume low cost services and treatments. If we do not agree this then there will be a two tier society, exactly what Aneurin Bevan tried to avoid. In place of fear did not anticipate that the pace of technological advance would be faster than any government’s ability to pay. I live in a marginal seat, now without an A&E, and although health is devolved, the financing of health, the recruitment and retention of medics, is central government controlled. Conservatives should rightly be blamed for the neglect, but Labour take equal responsibility over the decades. Lets give the Liberals a chance. Big spending will only make a short term difference. It is the rules of the game that need to change… Bigger than money in the short term is staff recruitment and retention…. (See graphics below)

In ” our sons final days  “, “it was like he didn’t matter”. Sophie Hutchison reports for BBC News 25th November 2015.      

NHS investigators are to meet the family of a young, autistic man – left starving and desperately thirsty in hospital while waiting for a delayed operation.

Mark Stuart spent five days in agony and died following a catalogue of failings by NHS staff. His parents say they have been battling for answers for four years.

His parents feel guilty that they did not act strongly  as his advocates, trusting their local facility (Blackburn NHS Trust) to deliver. They were wrong…

Funnily enough that’s exactly how I felt when I attended our local A&E (Now renamed an “Emergency and Urgent Care” centre. I also trusted, as a retired professional, that standards would be sufficient to deal with me. I even sent my advocate (wife) home as I knew there would be some waiting. Little did I appreciate that I would be ignored, the same as Mark Stewart’s father.

Wales’ Health Services are failing, as are many of the DGHs in the poorest areas of the country, where recruitment poses the biggest problem.

There is a long history of under-investment in people and plant, and over management. This has occurred since Labour and Tony Blair, continued through Conservative and Coalition governments, and is unlikely to change whilst we have a politicised health service, and 4 devolved systems all managed differently.

Aneurin Bevan in “In Place of Fear A Free Health Service” ( 1952 Chapter 5 In Place of Fear )

encouraged a unified health care system. Bevan is against an insurance based system ”

The really objectionable feature is the creation of a two-standard health service, one below and one above the salt. It is merely the old British Poor Law system over again. Even if the service given is the same in both categories there will always be the suspicion in the mind of the patient that it is not so, and this again is not a healthy mental state.

The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.

He also says, with respect to size of “Approved Societies” ( Nowadays read devolved governments ) :

We had experience of this in Britain where certain of the Approved Societies under the old National Health Insurance recruited a disproportionate number of members from industries with a high degree of sickness and accident rate and affected by serious industrial depression. The result was that these Approved Societies were compelled to curtail benefits to their members, while other societies with a different industrial composition were able to distribute the full benefits. That situation consequently helped the strong and hurt the weak.

MANIFESTO FOR NHS – The Times letters 26th November 2019
Sir, Although it is good to see that the prime minister is making the NHS an election priority (“Johnson places NHS at heart of ‘critical’ election”, Nov 25), we should perhaps remember that the present state of the health service is the direct result of years of Conservative rule. In government the party has cut 15,000 beds (the equivalent of 30 district general hospitals); removed bursaries for student nurses; created a hostile environment for vital overseas staff; presided over an unacceptable increase in waiting times for cancer treatment and allowed trolley-bound patients to line our hospital corridors.

Mr Johnson should not be surprised if we view his promises to conjure up thousands of new nurses and doctors with some suspicion.
Dr Bob Bury

Ret’d consultant radiologist, Leeds

Chris Smyth and Ryan Watts in the Times 26th November: Struggling A&Es are a worry for Tories in dozens of marginals

and

Behind the manifesto: Parties promise big spending remedy for the sickly NHS – In the first of a series by Times correspondents on the manifestos Chris Smyth, Whitehall Editor, looks at health

……Perhaps a bigger problem, though, is staff. One NHS post in ten is vacant and Mr Murray says the success of any funding plan will “rest on the ability to recruit and retain enough workers”. The headline-grabbing promise in the Tory manifesto is a commitment to ensure that the NHS has 50,000 more nurses in five years than it has now.

NHS in six charts

Overseas visitors in 1952…. Aneurin Bevan’s argument still applies

NHSreality has many posts which include comment on overseas patients and nurses/doctors. Surely the benefit from the overseas doctors and nurses far outweighs the paltry cost of treating overseas visitors, with emergency needs, for free. I have sympathy with charging for planned use of health services for complex conditions in non UK residents. But this is a small percentage of the total costs.

In “In place of fear” Aneurin Bevan comments on overseas users of the health service:

This is the fifth chapter, In Place of Fear, of Nye Bevan’s book of essays, published in 1952.

“One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions to which I have referred. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen.

However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together. The cost of looking after the visitor who falls ill cannot amount to more than a negligible fraction of £399,000,000, the total cost of the Health Service. It is not difficult to arrive at an approximate estimate. All we have to do is look up the number of visitors to Great Britain during one year and assume they would make the same use of the Health Service as a similar number of Britishers. Divide the total cost of the Service by the population and you get the answer. I had the estimate taken out and it amounted to about £200,000 a year. Obviously this is an overestimate because people who go for holidays are not likely to need a doctor’s attention as much as others. However, there it is. for what it is worth and you will see it does not justify the fuss that has been made about it.”

Bribery and corruption. We have a media led society and its the media’s duty to expose this.

As the two political philosophies polarise our society, the moderate voice of reason remains unheard, but still trying to occupy the middle ground. We did not like Mrs Thatcher but a majority voted for her, and the same could be true for Jo Swinson. The reason for the election is being forgotten by the left, and Jo is naive in thinking to “stick to the knitting” of Brexit. The shame for me, as a member of the Liberal party, is that they have not got policies that attract majorities. So many active members are so keen to represent minorities that they fail to address the votes that really matter. At least we will address the longer term, which might help issues such as cancer survival. But honesty and transparency, in all parties, does not extend to challenging the fundamentals on which Aneurin Bevan’s original NHS was founded.

The Bribery implicit is the competitive inflationary promises on health and social care will lead to perverse outcomes, and then to corruption. The more that is promised short term, the longer it will take to make the decision to ensure that health systems in the UK are founded in reality, rather than pretence, denial, and covert rationing. We have a media led society and its the media’s duty to expose this.

Dominic Lawson opines 24th November 2019 in the Sunday Times: A fresh maternity care scandal exposes the folly of nationalising everything

…why has the Shrewsbury and Telford report escaped all discussion in the electoral debate? Perhaps because both Labour and Conservative, though light years apart on almost every other matter, are united in declaring that they “love our NHS”, which is — all together now — “the envy of the world”. These fallacies — the Conservatives for sure don’t “love” it and medical outcomes within the NHS are definitely not the envy of the world — compound the difficulties facing those failed by it. They are dealt with as so many Catholics were when complaining about abusive clerics: since the NHS has been described as “the nearest thing the British have to a religion”, it follows that the local hospital is the cathedral, its staff are the priests it is deemed a disgrace to question, and whistleblowers are heretics. The brilliant best of the NHS is despite and not because of its godlike status.

Doctors in private practice are no less reluctant to admit error, but their patients are more prepared to make a fuss when things go badly wrong. This is partly because the well-to-do are more confident than the poor in challenging authority, but also when something is seen as “free”, people are thankful for what they get, even if treated badly. Obviously, the NHS is not free: we are charged for it in our taxes (even those who don’t pay income tax are financing it every time they buy a good on which VAT or excise is charged). But it feels free; so it would be ungrateful to complain. And since the NHS is a monopoly provider for the uninsured, there’s no competitor available for dissatisfied users.

Yet this is the model the Labour Party plans to impose on as much economic activity as it can, even in industries that are not natural monopolies. Thus it pledges to make internet broadband a “free” service, nationalising not just BT Openreach, but also (at a price to be determined by a future Labour government) the businesses of rivals such as Virgin and TalkTalk. This proposal has been criticised chiefly on the grounds that Labour has grotesquely understated the cost to the taxpayer in funding such a “free” service. But the more significant point is that it is only through competition that the best outcomes are provided to the consumer (imagine the futility of complaining about your broadband service to its only legally recognised provider).

That most essential of all human needs — food — provides the clearest example. In the 1970s Jeremy Corbyn’s mentor Tony Benn had a nationalisation agenda that threatened to put supermarkets into public ownership. Yet it is ferocious competition among such firms that has, in the past half-century, helped bring the percentage of income spent by the average British family on food down from about 30% to little more than 10%. I treasure the unintended irony of the solitary entry for 13 November, 2007, in Benn’s last volume of diaries: “Went to Tesco’s and spent £31, but I did get a mass of food for it — it’s very cheap.” Cheap food for the workers! What brought that about? The market economy — exactly what Benn’s would-be imitators at the helm of the Labour Party of 2019 regard as the enemy of the poor.

When Corbyn was asked last year by the BBC’s Andrew Marr to acknowledge that it was only since the Chinese government allowed private enterprise to flourish that billions of its people for the first time experienced prosperity, the Labour leader countered that this overlooked the great benefits of Mao Tse-tung’s Great Leap Forward. That was the period in which its agriculture was forcibly collectivised, resulting in the starvation of up to 45m Chinese. This chilling observation tells us all we need to know about the philosophy of Corbyn and his shadow chancellor, John McDonnell — the latter has actually boasted of his intellectual debt to Mao’s Little Red Book.

There is nothing in our history to compare to the suffering of the Chinese people. But I have been re-reading the historian Dominic Sandbrook’s book on the 1970s to remind myself of the period before Margaret Thatcher buried British socialism — or so she thought — partly by making “secondary picketing” illegal (on the BBC Today programme McDonnell refused to rule out reversing this reform)……

UK’s poor performance on cancer survival ( BMJ 2019;367:l6122 )

Laura Donelly and Patrick Scott in The Telegraph 11th September 2019: Britain slumps to bottom of cancer survival league tables …

The Sunday Times today 24th November: Boris Johnson will woo voters today with plans to tackle the cost of living, build new homes, help the environment and boost the NHS

Apart from all the other giveaways, here are those on the English Health System.

£33.9bn boost to the NHS by 2023-24. The party is also pledging £3bn extra to 40 NHS trusts, which would result in six new hospitals and dozens of refurbishments
End hospital car parking charges for NHS staff on night shifts, as well as disabled and terminally ill patients
50m extra GP appointments to be made available.

and ● Three-point plan for adult social care — including £5bn in additional short-term funding
● Build a cross-party consensus on social care to come up with long-term proposals to address the issue
● Guarantee that no social care user would have to sell their home to meet their costs.

 

A curse on all their houses. Banal debates omit the really important questions. Entertainment has come before long term politics and unity..

For anyone who has watches the banal ITV debate (Boris v Jeremy)  and BBC question time leaders special I can only sympathise with the shallow nature of the questions, and the replies. They have omitted the really important questions. Entertainment has come before long term politics and unity. What a pity for those who gave their time to watch this display of denial. A curse on all their houses. They have all conspired to put patients and doctors lives at risk….

Here are some of the questions that NHSreality would like to have asked:

Brexit.

Do you feel that the Union of Great Britain and N Ireland is more or less likely to survive if we leave the EU?

Do you feel that continuing peace is more or less likely to continue if we leave the EU?

Do you feel that varied opportunities for work, particularly for younger people, are more or less likely if we leave the EU?

Do you believe the reports of the Economist, Governor of the Bank of England, World Bank, EU economists, all UK economists (bar one) and most politicians before the first referendum, when they indicate that prosperity and influence will diminish after leaving the EU?

Proportional Representation.

Please can you give your parties’ arguments against PR? Do these still apply?

If Proportional Representation is good enough for the devolved dispensations, why is it not good enough for the UK?

What form of PR would you advocate if we changed our system?

Do you think the vote should be extended to all those over 16, as in Scotland?

Identity

Since we have a virtual identity system with face recognition and other methods connected to central databases, and since we have a problem with identifying those eligible for state benefits, including health, would you support ID cards?

Could these ID cards lead to means related co-payments or taxes?

Tax

Would you support Land Rental Tax?

Do you think it could be at a level that allowed replacement of Estate Duty, Stamp Tax and reduction of Council Tax?

Health.

Do you feel that the 4 health services are sustainable under their present rules? Do you think that the pace of technological advance is faster than any government’s ability to pay? Given the demographics how would you change the rules?

If social care is means tested, then why not medical care? Or would you advocate the Scottish model of social care for England?

Is health care rationed covertly, so that nobody knows what is unavailable to them until they are denied it?

As far as health is concerned, has devolution worked in Wales and N Ireland?

Bearing in mind the excess of able applicants, for decades: Why are there so few doctors and nurses to meet the nations’ needs? Do you think this has anything to do with our political system and FPTP time horizons?

Usually when trying to fill the bath you put the plug in rather than turn the taps on more. We are now training more doctors, nurses and allied professionals than ever before. What are you going to do to change the culture  in the health service to stop the loss of the workforce soon after these individuals  qualify .

Bearing in mind that most purchases of equipment for the 4 health services are in dollars, and the costs have gone up 20% since the referendum, and this without trade barriers, do you believe leaving the EU will make our health as a nation better?

Education.

Bearing in mind job applications and competition for places at university, and interviews: Do you feel that all education is divisive? Is it more important to aim for excellence, or to reduce inequalities, when there is competition for resources and people? Do parents have the right to choose how to educate their children, and whether to spend their money on private tuition, sports activities, music etc?

Spin doctors – what the economist thinks about the conservatives health manifesto promises.

Northern Ireland health collapses. It would be kinder to bring in co-payments than to let more suffer.

Cloud cuckoo land….. The poor will remain slaves in a GIG economy.

Disgraceful leadership, and a longstanding culture of fear. Successive PMs of all colours are to blame. Spending money on bribing the electorate will bring only short term gains..

What the GP did best: used time as a diagnostic tool. The “failiing fiasco” of health care in the UK.

 

In the BMJs subsidiary magazine “Doctor” on 16th November the headline article is “On the cusp of collapse”. Overcrowding and Underfunding have left patients and doctors at risk……

Northern Ireland health collapses. It would be kinder to bring in co-payments than to let more suffer.

It looks as if the implosion of the different dispensations will begin in N Ireland where, without leadership and government for some years, the health budget and the recruitment are both broken. It would be kinder to bring in co-payments immediately… than to let more and more people suffer.

NHSreality appreciates that the 4 health services in the UK are all dependent on overseas staffing. We will need these people for a lot longer yet…

Claire McNeilly in the Belfast Telegraph 21st November 2019 reports: Nurses believe Northern Ireland health service is near to collapse, says frontline professional

Northern Ireland nurses are chronically stressed, suffering sleepless nights and pushed to the brink of exhaustion – with some even ending up crying in hospital sluice rooms.

The shocking revelation comes as the Royal College of Nursing (RCN) prepares for strike action, amid a dispute around staffing and pay, for the first time in its 103-year history.

Such an unprecedented move “goes against the grain of every single carer in the profession”, an experienced frontline nurse and RCN Northern Ireland board member told the Belfast Telegraph.

But Helen McNeilly said her colleagues – who number around 8,000 – have been pushed into making the difficult and highly contentious decision to down tools on December 18, after a two-week ‘work to rule’ period leading up to that date.

“Nurses are telling us there isn’t enough staff to deal with the ever-increasing number of patients that need to be treated… and they feel the whole system is close to collapse,” said Helen.

“Nurses are working 13-hour shifts without breaks, they’re stressed and they’re having sleepless nights worrying about work.

“Not only are they lucky if they get a 20-minute break during a shift that lasts from 7.30am until 8.30pm, many are then staying late to complete documentation and quite often that’s unclaimed overtime.

Cloud cuckoo land….. The poor will remain slaves in a GIG economy.

The lies around the health service are clear to all of us who have worked in and experienced the service today. Our current rulers are no different: their bribes are impossible. Ms Toynbee is correct. The denial and the collusion to deny the depth of the problem, and to acknowledge the “hard truths” around health, are preventing that essential debate. Rationing is a necessity in any health system. The future holds out genetic treatments and manipulations that will prevent disease, and enhance IQ and longevity. Without facing up to the problems of rationing overtly, the default position will be a two tier system, where the rich benefit most from the advanced treatments, and the poor remain slaves in a GIG economy. And, to cap it all,  without a proper funding basis, and without leadership, Northern Ireland health staff are threatening strike action.

Polly Toynbee in the Guardian opines: It’s Narnia on the wards: the NHS is in permanent winter crisis now.

The Boris Johnson show can always move on to another A&E. For the health service as a whole, there is no such easy option

….” Queuing – the old NHS rationing mechanism – is back with a vengeance. With immense effort and spending, long waiting lists were finally abolished by the Labour government, proving to the many naysayers that it can be done. Today’s latest figures show A&E waiting times in England are the worst since a target of a four-hour maximum delay was introduced in 2004.

Will there be an NHS crisis during this winter election? There already is, everywhere. It’s Narnia on the wards: permanent winter, as the pressure never lets up in the summer now, with performance figures rapidly worsening year after year. The condition of the NHS is already critical,…

Look at the ruination and depredations of this decade that need to be repaired, with 15,000 missing and desperately-needed beds and 100,000 missing clinicians and nurses. Nurse and doctor training places were cut sharply in George Osborne’s first budget. 

Then nursing bursaries went, haemorrhaging applicants. Even with visas for foreign medics liberated from the iron grip of the last years, new staff can’t be summoned up miraculously overnight. GPs are in critical shortage, with waiting times sorely felt by voters. Under a less pig-headed treasury, more money could instantly solve the pensions crisis that has seen waiting lists soar to 4.6 million as a third of senior doctors abandon extra shifts.

The structural damage done by the 2012 Health and Social Care Act is still under repair by the NHS chief executive, Simon Stevens, who is trying to pull back together into a unified service the fragments blown apart in a reform intended by the former Tory health secretary Andrew Lansley to lead to greater competition. That commissioning model still leaves postcode lotteries in provision, and money sent from the top for mental health has not been ringfenced, so it often gets diverted to other emergencies, leaving children’s mental health services especially bereft.

Mind, the mental health charity, revealed this month that vulnerable children, many with suicidal and self-harming thoughts, had 175,094 appointments cancelled in the last year, a 25% rise on the previous year. As for the crisis in social care, which leaves older people lingering on wards for much longer than they should, no one expects the Tory manifesto to dare to solve the long-term financing question, just to apply a little more cash Elastoplast to get them through the election.

Voters naturally tend to credit Labour as the safest pair of hands for running the NHS. The health service is voters’ second greatest concern after Brexit – which, contrary to that bogus Boris-bus promise, will deplete the Treasury’s ability to fund it. Month after month, worse figures will keep tumbling out the about the service. It wouldn’t take much to thrust overflowing A&Es to the top of TV news bulletins every night, because the NHS is in crisis already, with a long month still to go.

BBC N Ireland reports 20th December: Health and social service set date for industrial action

Gee Whiz – The potential for Genetic engineering from the Economist

Spin doctors – What the Conservatives say they will do. The Economist.

 

Disgraceful leadership, and a longstanding culture of fear. Successive PMs of all colours are to blame. Spending money on bribing the electorate will bring only short term gains..

In 2008 when the first inkling of a scandal at Shrewsbury and Telford arose, Gordon Brown was Prime Minister.  In 20113 and 2015 it was David Cameron. No political party is excused form the demise of the 4 UK health services. Thee situation in your average DHG has become so bad that the staff are often disengaged from their reality. In General Practice part time working has led to part time responsibility. Standards are falling, and these two hospitals are only the tip of a national iceberg. An election is an opportunity to have a new dispensation, but Wales, despite a completely failed self-governing elite, wants the election to be about their “Welsh health service”, with the worst results in the UK. All parties are aware of this failure, but the politics of Wales means that there is no debate on devolution, despite the small majority that bought it in. Prospective MPs, who spend most of their 4 dormant years denying that they have any influence on health (or education) are now claiming that their party will improve it. Denial means that the 15 year lead in is ignored. 

More and more people, for serious illnesses, or because there is no GP access, are having to attend A&E. The last place new doctors choose to work is A&E, (because of the shift work) and the first person patients see is a triage nurse, and then a novice junior, before they eventually meet someone who can make a diagnosis or initiate treatment. (Often many hours later).

The whole system is failing. Shewsbury and Telford is just a bellweather indicator, as was Morecombe 5 years earlier, for all the DGHs in the 4 UK health dispensations.

If we had started to recruit 10 years ago, ( P.M. was Mr Blair) we would just be starting to get a few extra. If we had started 15 years ago (Mr Blair took over from Mr Major) we would not have the staffing problems we have now. We would still however have the plant problems, with insufficient scanners, old hospitals with high infection rates, and the culture of fear. This latter is multi-faceted, but the main reason is the disengagement of physicians in hospital with management skills. In other countries ( Canada, USA, France, Germany, Holland ) the managerial beast has not been able to dominate like it has in the UK. The result has been false performance indicators, over management, and treating hospitals like a factory production line.

Midwifery, Doctor Training and Neonatal Care – all need improvement NHS reality 2015 (P.M. Mr Cameron)

Furness – the chronology of endemic denial. “Loving the NHS to Death” NHSreality 2013 (P.M Mr Cameron)

BBC News today 19th November: Shrewsbury and Telford Hospital: Babies and mums died ‘amid toxic culture’  (P.M. now is Mr Johnson, but 10 years ago it was Mr Brown)

Owain Clarke reports for the BBC 19 November 2019: General election 2019: Why the NHS is still an election issue in Wales

NHS 70: The health service in Wales – in 10 charts – Steve Duffy 2018

3 More of us are going to accident and emergency

A&E graphic

 

What the GP did best: used time as a diagnostic tool. The “failiing fiasco” of health care in the UK.

I was trained with and by the same teams as Nick Norwell whose letter points out the perverse incentives ever present in medicine. The dissonance is between over-treatment and investigation in the private system, or under-treatment and waiting lists in the state system. Elderly people are usually uninsurable, and so they have little choice. Thus they fall victim of any delay. The access to diagnostics is very important:

PET scans (positron emission tomography scans) are often done in conjunction with CT scans (computerized tomography scans) or MRI scans (magnetic resonance imaging scans). … An MRI scan can be used when your organ shape or blood vessels are in question, whereas PET scans will be used to see your body’s function.

But the relative number of these machines is very low in the UK, and often they are old and break down. There is not only a shortage of speedy access to imaging, but also a shortage of radiologists.

There will always be over-treatment, but what UK health service dependent patients are experiencing is slow, or under treatment, post code lottery of access, (even to private provision) and a failing fiasco of a broken down unfair system.

What better incentive to go privately if you know a delay could make your condition untreatable? Perhaps I need to drop the crusade? Legalising pot will be easier than reforming the (N) HS.

See the source image

INSURERS IN CHARGE – The Times 18th November 2019
Sir, The article on health insurers overruling consultants on the best treatment for patients (news, Nov 18) illustrates the fundamental problem with private practice in the NHS. In private health insurance, money (and profit) is king. In private practice money, if not king, is at least prince regent. The health insurers take the money and hope to do nothing, while private doctors take the money, and attempt to show patients that they are getting value for their money.

When I lived in France many expat Brits would tell me, with wide-eyed wonder, of the speed with which their various ailments were dealt with, surgically or otherwise, under the French mixed private/insurance/state-funded healthcare system.

As a retired doctor I could not help wondering how many ohttps://www.thetimes.co.uk/article/insurers-overrule-consultants-on-best-treatment-for-patients-5g0tdmdvtf those treatments were really necessary. I remembered the advice of one of my teachers at medical school: use time as a therapeutic tool. For all its faults, the NHS is good at doing this, albeit usually by default not design.
Nicholas Norwell
Newbury, Berks

The NHS does not have enough radiologists to keep patients safe, say three-in-four hospital imaging bosses  – Royal College of Radiologists

Andrew Ellson in the Times 18th November 2019: Insurers overrule consultants on best treatment for patients

Image result for failiing fiasco cartoon

Just because there are more GPs, it does not mean they work more hours!

The Wales GP information is available at GP-one – designed for General Practices in Wales. Just because  there are more GPs, it does not mean they work more hours! And the demographics mean we need more, with more time for more complex problems. There is an added problem in having a majority of female GPs and doctors, apart from their reduced hours, in that A&E, which involves shift work, is inadequately manned in all the peripheral DGHs. Not enough money, not enough doctors and nurses, not enough honesty, and too much denial. The collusion between the media and the politicians will perpetuate the problem: indeed its going to get much worse. The demand was not unprecedented. NHS reality has been warning about this under capacity for 7 years.

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

  • The number of general practitioners in Wales (excluding registrars, retainers and locums) was 1,964 at 30 September 2018, an increase of 38 (2.0%) since 2017.  There were 6.5 GP practitioners per 10,000 population in 2016
  • 2,986 total GPs (all Practitioners, Registrars and Retainers plus Locums registered to work) at September 2018, 50 more or 1.7% greater than 2017.
  • 230 GP Registrars at 30 September 2018, a decrease of nine since 2017
  • 14 GP Retainers at 30 September 2018, a decrease of three since 2017
  • There are fewer practices in Wales than a decade ago.  In 2016 the number of GP partnerships was 11.1 per cent lower than in 2006.  The number of patients per practitioner has fallen by 3.2 per cent since 2006 but patients per practice have consequently risen.
  • In 2013 there were 470 general practices in Wales, a decrease of 4 practices (0.8 per cent) on the previous year (2012). In 2014 there were 462 general practices in Wales, a decrease of 8 practices (1.7 per cent) on the previous year 2013. There were 441 general practices in Wales in 2016 a decrease of 13 practices (1.7 per cent) on last year.
  • There were 778 GP Locums in Wales at 30 September 2018.
  • The number of GP Practitioners approaching state retirement age is low, with over 90% of GP Practitioners under the age of 60. The number of GP practitioners aged 55 or over has remained steady in the last five years, with around 22.2 per cent of the GP practitioner workforce falling into this age band in 2016.
  • The percentage of GPs who are female has increased. In 2005 female GPs accounted for 34.7 per cent of the total, in 2013 they accounted for 46.6 per cent. In 2014 female GP practitioners accounted for nearly half (48.6 per cent) of the GP Practitioner workforce, an increase of 378 (63.3 per cent) since 2004.  In 2015 female GP practitioners accounted for over half (50.4 per cent) of the GP Practitioner workforce, and increase of 365 (56.9 per cent) since 2005.  Females accounted for only 32.9 per cent of the total in 2004. In 2016 female GP Practitioners accounted for over half (52.4 per cent) of the GP Practitioner workforce, and increase of 375 (54.9 per cent) since 2006.  Females accounted for only 36.1 per cent of the total in 2006.
  • The Guardian 17th November 2019: NHS bosses accused of gagging staff during election campaign and Gove ‘lying’ about EU citizens’ NHS rights to gain votes
  • The Guardian 18th November 2019: NHS running short of dozens of lifesaving medicines
  • Is the NHS facing unprecedented demand? BBC news
  • Poor state of Welsh health. The experiment with devolution has failed….
  • How to reduce quality of care further: A 32 hour week is less than 25% of the whole…
  • No “healing” the country or the 4 health services yet

Poor state of Welsh health. The experiment with devolution has failed….

Poor state of Welsh health Letter in the Sunday Times 17th December 2019
Labour has announced it will outspend the Tories on the NHS and reduce waiting times. Here in Wales the NHS has been devolved to the Labour–led Welsh assembly since 1999. Waiting-time targets for most elective surgery are twice those in England (36 weeks as opposed to 18) and even then are often exceeded.

The Welsh NHS also performs considerably worse in A&E waiting times, with some health boards even allowing 12-hour waits.
Eleanor London, Penarth, Vale of Glamorgan

Devolution of health to Wales was a mistake?

Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

The advantages of mutuality are being shunned. Purchasing power in small regions is little. Choices are disappearing.. Hammond is unlikely to help ..