Monthly Archives: January 2020

Pensions and Health – all part of a European wide Ponzi scheme.

The Times leads with an interesting article on Pensions and Health.

We are taking away the future of our youngsters in more ways than leaving the EU. They are also funding our Pensions and our Health provision, and not from real money.

Pensions and Health in Europe. A Ponzi scheme. Times 30012020

If we cannot afford what we have now, how can we in the future?

Richard Smith was correct: we need a radical approach to reconfiguring health care. In my view this means we have to behave ethically. So covert and post code rationing are not in my plans. We need a national discussion with all parties being involved as it seems no party is bold enough to be honest.

Image result for honesty cartoon

Perverse incentives and results will mean new antibiotic development is slower than it need be..

The perverse incentives in the Pharma Industry extend to what they spend their money researching. In search of profit lifestyle drugs dominate, as these are long term prescriptions. Short term drug regimes for antibiotics are not high on their priority list.

SO new antibiotics will be led by the Welcome Trust, and the former Medical Research Institute which is now the Crick Institute. The Bill Gates foundation is also altruistic at the expense of profit, as is shown by their focus on population health and new vaccines for the developing world.

This is an opposing perverse incentive to that of the government, who restrict cancer drugs.

Times letters 30th Jan 2020: ANTIBIOTICS CRISIS
Sir, Tim Jinks (Thunderer, Jan 27 and letter, Jan 28) makes very clear the urgency of developing new classes of antibiotics. One factor determining Big Pharma’s attitude in this respect is that a successful antibiotic cures the condition for which it is prescribed, often in a matter of days. Thus the income from its prescription is limited. In contrast, common chronic diseases, such as Alzheimer’s and cancers, involve long-term prescription, and are more profitable. It is probable that only significant amounts of taxpayers’ money will adequately fund antibiotics research.
John Drewe

Former adviser to Ciba-Geigy Pharmaceuticals; London NW2

Two waiting lists for cancer patients needing new drugs. The insured and the uninsured….

 

Two waiting lists for cancer patients needing new drugs. The insured and the uninsured….

NHSreality has warned readers that there is a perverse incentive to delay the release of newly patented drugs; even for cancer. The pace of technological advance is faster than any government can afford. Hence France has decided to ration out dementia drugs, and to spend the money saved on looking after demented patients. Overt rationing of this type is sorely needed, and extends to other areas of health care. We can afford all the newest proven treatments IF we ration out the high volume low cost treatments, and encourage autonomy. There are now two waiting lists for cancer patients needing new drugs; the insured and the uninsured.

‘Your insurance doesn’t cover acts of God, like age related illness and accidents.’

Governments need to address the needs of populations ahead of those of individuals. They are right to ration, and all dispensations do this, BUT surely it is more ethical to ration overtly, so that people can plan for what is excluded, for them.

Prostate cancer has overtaken breast cancer to become the third deadliest type of the disease in Britain, but is it appropriate that less money goes into this disease as the victims are older? Most men with advancer prostate cancer do not receive chemotherapy: why not? (only one in four men with metastatic disease gets recommended chemotherapy BMJ 2020;368:m120 ) 

The only reason has to be RATIONING.

4th December 2019 in Science Business: Despite rapid innovation, UK patients wait up to 14 years for new cancer drugs.

Dennis Campbell in the Guardian 10th Jan 2019: Record 20,000 patients a month are suffering delays in seeing a consultant or starting therapies

Kaya Burgess reports in the Times 29th Jan 2020: Patients wait 14 years for groundbreaking cancer drugs.

Cancer patients are having to wait years for groundbreaking drugs because the approvals process has not fast-tracked them, a report has found.

Innovative drugs licensed between 2000 and 2016 took an average of 14.3 years to be available to NHS patients after patenting, according to a study by the Institute for Cancer Research (ICR). Conventional cancer drugs took 11.1 years.

The charity said the approvals process was too “risk averse”. Paul Workman, chief executive of the ICR, said the system was not keeping pace with advances in science. “Alarmingly, delays are longest for the most exciting, innovative treatments,” he added.

The government said the system had improved substantially since 2016.

Once a drug is licensed, the National Institute for Health and Care Excellence (Nice) assesses whether it is cost-effective for the NHS.

The ICR found that Nice had shortened the time between approval and the start of appraisal from 21 to 6.5 months but the appraisal process itself had sped up only from 16.7 to 16 months. “There was evidence that Nice had not been prioritising the most innovative treatments,” the ICR said.

Nice said it had worked with NHS England to “accelerate the evaluation and adoption” of cancer drugs since 2016 and had approved 75 per cent of cancer drugs since then, up from 47 per cent in 2012-13.

The Department of Health and Social Care said: “Three years ago we introduced the Cancer Drugs Fund, which is already delivering faster access to the most promising medicines.”

If you had CF would you think health and drugs were rationed, or not?

Call to end NHS rationing of HIV prevention drug PrEP

Drugs giants challenge NHS rationing plans in court. If the government wins the case should be appealed to the European Court before it no longer has the right to judge – after Brexit.

Fast-track plan cuts wait for newest drugs by years… will cost more in an unrationed service

Increasing the “Heath divide”? – Dementia victims to have drugs rationed. The “affordability test” is reasonable and sets a precedent at the high cost end..

Sensible rationing of dementia drugs – a lead from France

The cost of curing just one congenital disease…. The pace of advance of technology is faster than any government can afford

See the source image

Wales records worst ever A&E waiting times. Use the GPs…

It is my opinion that every GP should now have a contractual commitment to do emergency and out of hours care pro rata with their work commitment in practice. It is only by having experience at the hot end when patients attend that they can be dealt with efficiently.

This would be an unpopular measure, especially with those bringing up children. It would be temporary until we have regained enough doctors and staff to man the 4 health services. But in emergency times you sometimes need emergency solutions. To get the GPs into A&E will need money – lots of it, and their practices will suffer. So it may be extea paramedical staff are needed in GP surgeries.. 

ITV news 21st January reports: Wales records worst ever A&E waiting times

A&E departments in Wales have recorded their worst ever waiting times with just 72.1% of patients seen within four hours in December.

This figure is down significantly from the year before which saw 77.8% of patients seen within the target time.

The next worse-performing hospitals are Ysbyty Glan Clwyd at 52.5% and Royal Gwent at 53%.

The target set by the Welsh Government is for 95% of patients to be seen in that time.

6,656
patients waited more than 12 hours which is a record high.

Australia bekons

Many young doctors will be wondering where they can go to be trained, and looked after, properly, whilst in their formative years. You could do much worse than go to Australia.

GP-Australia Connect shared a post: WANTED DOWN UNDER ⇨ Series in which British families are given a look at life in Australia ahead of possible migration ⇨ Available on BBC iPlayer Link in comments box below #australia #health #careerdevelopment

The site is: “Health Jobs in Australia”.

The undervalued workforce. Option: reduce, resign, retire or emigrate. Its going to get worse still..

NHS for sale – property assets are the “family silver”. Staff may leave/emigrate/retire, and are doing so, but the property, once gone, is no use, and selling it just delays addressing the ideology.

Changing a culture of fear, bullying and gagging…… Start again with local pride….

The shortage of diagnostic and filtering skills is costing us dear. GPs retiring especially.

 

If it applies in England that the “poorest get the worst health care”, it does in all 4 health services.

There are perverse outcomes of the austerity years, but more as a result of the rationing of places in medical school over decades. Add to this the removal of nursing grants and subsidies, and less than ideal recruitment for all the para-medical specialities. The short term horizon of politicians has led to a situation where the miners of Tredegar once again get a worse service than the bankers of London. I wonder if any of our politicians have read it? We have to reconfigure the 4 health services.

Spin doctors? Richard Smith isn’t buying it. “The NHS doesn’t need more money, it needs a radical rethink”. 2020

Aneurin Bevan: In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear 1948

Dennis Campbell in the Guardian 23rd Jan 2020: England’s poorest ” get worse NHS care ” than wealthiest citizens

England’s poorest people get worse NHS care – Nuffield Trust
New QualityWatch analysis shows that people living in the most deprived areas of England experience worse NHS care. Read this scrolling story to find out how inequalities have changed over 10 years, and read this briefing for the low-down behind the numbers. The story was exclusively covered by the Guardian.

 

2016:What am I afraid of? More and more… Bringing back fear..

2017: Bringing back fear, and suffering. A return to 19th century inequalities.. How quickly politicians destroyed what was the best safety net in the world?

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

2018: Bringing back fear – in the media led society. Lets charge for screening tests and spend the money elsewhere.

2016: What is the true story behind NICE stopping “A&E safe staffing guidance” levels? Money and fear of civil unrest…

The thin edge of the wedge. Is private A&E going to thrive and become the shape of the future? Aneurin Bevan, what would you do?

 

 

Ways of reducing the bill for NHS negligence – The perverse incentives and outcomes …

Every doctor and student of medical systems needs to understand the perverse incentive. I define this as a “driver within a system that works against the overall objective of the system”. Claims for medical Negligence in our tort driven system are necessary to arrest or slow down the continuing decline in standards. Unfortunately Dr Barton is correct: the 4 health services have lawyers who are salaried and paid win or lose, and 80% of claims result in success! The argument for no fault compensation has been addressed properly in NZ and several other countries, and Australia appears to have found a half way house…

Image result for medical litigation cartoon

Times letters 24th Jan 2020: Ways of reducing the bill for NHS negligence

Sir, Your article “£4bn budget for legal fees in NHS negligence claims” (Jan 22) points out that the health service faces legal costs of £4.3 billion as part of a compensation bill for clinical negligence claims of £83 billion. The extent of this crisis cannot be overemphasised, as over the past three years the bill appears to have risen from £54 billion, according to the Department of Health. Apart from the usual platitudes about being careful, no one appears to be interested in addressing this parlous situation.

I previously worked for seven years in Australia, where this became a big problem and was addressed by an act of parliament transferring the liability risk away from the provider, unless it was ruled criminal negligence. This has led to a year-on-year fall of medical protection and indemnity fees for colleagues in Australia, while those in the UK have risen inexorably, providing yet another reason why doctors are giving up in droves and taking early retirement.

The start of a new government offers an ideal moment to address this festering sore on the NHS’s future.
Professor Angus Dalgleish

Foundation professor of oncology, University of London

Sir, As medical litigation costs spiral and threaten the future of the NHS, the case for a no-fault compensation system becomes overwhelming. At present, if a patient cannot prove medical negligence, they will receive no financial compensation — the decision sometimes having more to do with inadequate record-keeping than true clinical incompetence or negligence. As a result, two patients may have identical medical injuries but one will receive nothing whereas the other may be well compensated after perhaps years of litigation.

New Zealand has had a successful no-fault compensation scheme since 1974, with changes in 2005 ironing out some of its early anomalies, resulting in most claims being resolved in weeks rather than years. Litigation lawyers are the only people benefiting from the system in the UK.
Dr Andrew Quayle

Retired GP, Martock, Somerset

Sir, The cost of medical negligence (or accidents) is indeed high, but the possibility that the size of a giant claim might be reduced means that many cases end up in court because the legal fees justify an expensive defence. However, with court and legal costs of about £2,800 per day on top of barristers’ and solicitors’ fees it is often cheaper for an NHS Trust to settle a little case for a small sum than to defend it. While this is often done without an admission of liability it is open to abuse, because once word gets around it may generate frivolous or spurious “me too” claims that result in a payment of a few hundred pounds without many questions being asked. The system needs to address this as well as the top-end settlements.
Dr Andrew Bamji

Rye, E Sussex

Sir, NHS legal costs are inflated partly because of perverse incentives. NHS lawyers are paid win or lose, which encourages “deny, delay, defend” behaviour and promotes speculative defences. By contrast, claimant lawyers are generally paid “no win, no fee”; payment is by result, which imposes commercial prudence. This is amply borne out by NHS Resolution figures which show that compensation is paid in 80 per cent of cases where proceedings are issued. NHS lawyers should be paid by result and not rewarded for failure.
Dr Anthony Barton
Solicitor, Medical Negligence Team

Professional Liability Insurance : Market Global Report Jan 2020 – Fusion Science Academy

New York Telecast: Global Liability Insurance Market Status (2015-2019) and Forecast (2020-2024)

Image result for medical litigation cartoon

Lexicology: Wright Hassall LLP The most notable medical liability case in 2019

United Kingdom August 27 2019

The NHS is facing an existential crisis. The negotiations over junior doctors’ pay and conditions and widespread dissatisfaction among GPs, combined with a £2.45bn overspend by NHS Trusts, is impacting on patient care. The NHS is treating more patients than ever before, including a rapidly growing number of elderly people whose care, in many cases, is caught in a Mexican stand-off between the NHS and social services.

The NHS announced it has paid out more than £1.63 billion in damages for medical negligence in 2017/18; this is an increase from £1.08 billion in 2016/17 with the highest number of claims coming from emergency medicine. The number of claims made as a whole has decreased slightly (0.12%), but the cost to the NHS continues to increase.

The cases outlined below are some of our most notable and an indication of what can go wrong when the caring services come under pressure – and these are just the tip of the iceberg……

Image result for iceberg under water

Update 29th Jan Times letters 2020:

NHS LEGAL CLAIMS
Sir, I would be delighted to accept the challenge from Dr Anthony Barton that NHS lawyers should be paid by results (letter, Jan 24) so long as in return he accepts that claimant lawyers should pay NHS costs when they lose. This should include the more than 80 per cent of cases that never reach court, often because they were frivolous claims which were pursued regardless of commercial prudence. These nevertheless incur NHS legal costs and waste vast amounts of NHS staff time, which often leaves them inadequate time to care for their patients.
Martin Sheppard

Retired NHS consultant
Haverfordwest, Pembrokeshire