Monthly Archives: February 2020

Madness: Robbing one trust to help another when both are going bust..

This news item may surprise non-medical readers, and taxpaying patients on the waiting list in Norfolk may well resent the loan to E Midlands! It cannot help that N&N is a PFI initiative costing the locals millions..

‘We’d love to help…but so many other calls on the public purse.’

Norfolk’s NHS to pay £5m to bail-out Midlands trusts –  12 February 2020 in the Eastern Daily Press – 

The NNUH's deficit is increasing every month. Image: Archant/Infogram

Norfolk’s NHS is set to spend millions bailing out a struggling group of health trusts outside of the county – despite financial reports from just days ago saying the payments would not happen

In May last year, health bosses were criticised over plans to fund a £5m bailout to beleaguered health trusts in the Midlands after a request from NHS England.

The payment would be part of a £25m bailout package from the five sustainability and transformation partnerships (STPs) – networks of health trusts – in the East of England.

The Norfolk and Waveney STP’s contribution would come from the county’s health bodies including the five CCGs, two of its three acute hospitals, ambulance service and mental health trust, and would go towards the Cambridgeshire and Peterborough STP which faced a £192m deficit.

READ MORE: ‘Taking food out of patients’ mouths’ – Norfolk health bosses criticised for bailout to Midlands trusts

The Norfolk and Waveney STP’s contribution would come from the county’s health bodies including the five CCGs, two of its three acute hospitals, ambulance service and mental health trust, and would go towards the Cambridgeshire and Peterborough STP which faced a £192m deficit.

NHS North Norfolk clinical commissioning group (NNCCG) governors were slammed at a meeting and accused of “taking the food out of patients’ mouths”.

But papers published ahead of a meeting of Great Yarmouth and Waveney joint health scrutiny stated: “The Norfolk and Waveney health system is now not expecting to meet the control total or provide financial support to the Cambridgeshire and Peterborough system as planned.”

The initial update on the system’s finances said the refusal to hand out cash was “due to the deterioration in the Norfolk and Norwich University Hospital (NNUH) and CCGs position”.

That came just days after it was revealed that the NNUH had failed to meet its financial targets, and would be denied £23.1m funding.

However, the STP now insists the payments will go ahead.

Chief CCG finance officer John Ingham said: “The NHS in Norfolk and Waveney agreed to support the NHS in Cambridgeshire and Peterborough, which faces even more cost pressure than here.

“This would entail a transfer of £5m from Norfolk and Waveney to the Cambridgeshire and Peterborough system, at the end of the year. The £5m comprises £4m from the CCGs and £1m from NHS trusts – excluding the NNUH.

“Recently, with cost pressures in the system rising, it looked as if the transfer from the CCGs would not be possible. However, since the paper was written, our forecast position has changed. Financial forecasts vary considerably from month to month, which is not unusual on a budget of £1.6billion which is why we believe £5m of support can go ahead as planned.”

READ MORE: Cash-strapped hospital punished for not hitting targets

However, the STP now insists the payments will go ahead.

Chief CCG finance officer John Ingham said: “The NHS in Norfolk and Waveney agreed to support the NHS in Cambridgeshire and Peterborough, which faces even more cost pressure than here.

“This would entail a transfer of £5m from Norfolk and Waveney to the Cambridgeshire and Peterborough system, at the end of the year. The £5m comprises £4m from the CCGs and £1m from NHS trusts – excluding the NNUH.

“Recently, with cost pressures in the system rising, it looked as if the transfer from the CCGs would not be possible. However, since the paper was written, our forecast position has changed. Financial forecasts vary considerably from month to month, which is not unusual on a budget of £1.6billion which is why we believe £5m of support can go ahead as planned.”

The demographic bomb – has already gone off, and is on a slow burn with increasing power.

The bomb has actually gone off, but its on a slow burn. Elderly people cannot expect the same care as younger people, but they can expect honesty about what is and what is not available. The power of the bomb will increase over time, until many elderly people just die, either on trolleys or waiting….

The New Chief Medical Officer warn us that we are sitting on a demographic time bomb. Sophie Borland reports in the Daily Mail 11th Feb 2020.

The NHS risks being overwhelmed by an old-age health crisis, the new Chief Medical Officer warns today.

Chris Whitty says drastic action is needed to cope with a surge in the number of patients aged over 65.

He points out that countryside districts and coastal towns with older populations are often poorly served by GPs, hospital clinics, ambulances and out-of-hours providers.

In his first interview since becoming England’s Chief Medical Officer in October, Professor Whitty proposes a series of radical solutions to our ageing crisis. Speaking to the Mail he explains how:

Professor Whitty has proposed a series of radical solutions to our ageing crisis
Professor Whitty has proposed a series of radical solutions to our ageing crisis

  • Doctors’ training will be reformed so they are able to better care for patients with several chronic conditions;
  • Medical schools will be located in rural and coastal areas to ensure more doctors serve these ageing communities;
  • Cervical cancer and many liver cancers will be eradicated in 60 years and other types will be much easier to treat; 
  • Ministers must avoid letting big tobacco firms lure children onto e-cigarettes;
  • Trendy cannabis products on sale on the high street may be unsafe. 

 Professor Whitty, 53, is the Government’s top health adviser and his brief stretches from planning the response to coronavirus to drawing up key medical policies. But one of his most pressing concerns is how to meet the needs of the growing numbers of older patients with multiple illnesses.

Eighteen per cent of the population is over 65 but by 2038 this figure is expected to reach 24 per cent, nearly one in four.

It is predicted to be 40 per cent in North Norfolk by then and 37 per cent in the Lake District.

Other ageing hotspots are expected to be Rother in East Sussex (41 per cent) East Lindsey in Lincolnshire (37 per cent).

Professor Whitty says: ‘The ageing of the population of rural areas will occur much faster and there will be a much higher concentration of people who are older who therefore have more health needs in the rural areas.

‘We have to think about this both for now and also accordingly for the future, this is a future issue.

‘If we did nothing on this we will get to a situation where the burden of disease for the country – the number of people who are actually suffering from lots of long-term medical conditions – will go up and service delivery will stay where it is. The gap between what people need and what people get will widen.

‘We have under-appreciated how much in the future this is going to be an issue. This is predictable and it’s solvable, provided we take a long run at it.’

Professor Whitty, who took over the role from Dame Sally Davies in October, stresses that the increase in over-65s will result in many more patients suffering from multiple long-term conditions.

These could include dementia, cancer, diabetes, cataracts, heart disease and osteoporosis – bone thinning – and some of this diseases will aggravate one another.

Patients can end up having five or six different hospital outpatient clinics for each illness which Professor Whitty says is ‘neither good medicine, nor is it convenient for patients’.

To end this, he wants to reform doctors’ training so they are more generalist than specialist.

He has been discussing the proposals with the Royal College of Physicians, the Royal College of Surgeons, the Academy of Medical Royal Colleges as well as NHS England.

He says: ‘We’re talking particularly about hospital doctors, we need to make sure they retain their generalist skills.’

Professor Whitty also wants medical schools to be set up in some of the rural and coastal locations where populations are ageing the quickest.

He hopes that this will eventually result in more doctors – hospital consultants and GPs – practising in the areas of greatest need.

‘One of the things we need to look at it how we can incentivise GPs and other doctors to want to work in these areas both for current and also future need,’ he adds.

‘There’s just a service delivery challenge that we need to think about and work out what methods we can use to address that. Some areas are more remote than others – providing services in the Lake District will be more problematic just because of the geography.

‘It’s sufficiently predictable and sufficiently far in the future that if we start doing things now, we can start to address it. If we wait until the problem has hit us, which it undoubtedly will, it will be a lot harder to sort out.’

“Dont repeat tobacco mistake over vaping!”

inisters must not let history ‘repeat itself’ by allowing children to get hooked on e-cigarettes, the Chief Medical Officer warned.

Professor Chris Whitty said that although the devices are ‘definitely safer’ than tobacco cigarettes, there remain question marks over their long-term harms.

And in a swipe at big tobacco firms – many of whom have moved into the e-cigarette market – he said he has ‘serious concerns’ about their ability ‘to addict people young’.

Several companies including British American Tobacco and Imperial Brands are investing heavily in vaping devices because tobacco smoking in the Western world is declining.

But some of their products appear to be brazenly marketed at children and popular e-cig flavourings include bubblegum, chocolate mint and butterscotch.

Professor Whitty told the Mail: ‘We need to make sure history does not repeat itself.

‘The test of whether a product is being targeted at children is if it starts to be increasingly used by children and that will lead to action. If e-cigarettes are increasing in children then we should assume that they are being marketed towards them or at least pushed on them in some way, and deal with that very, very strongly.’

Figures from NHS Digital last August showed 25 per cent of pupils aged 11 to 15 had used e-cigarettes, the same as in 2016.

But the figure had increased compared to 2014 when 22 per cent had tried them.

Professor Whitty said: ‘No-one would claim that e-cigarettes are safer than not smoking at all and so if you don’t smoke, don’t use an e-cigarette. He added that there is a ‘question mark’ about the long term effects of the flavours of some e-cigarettes.

‘If you’re just using them for a short period to come off cigarettes that isn’t such a concern, but obviously if they’re using them for long periods it can be, because we don’t know what the effect will be and we wont know for many years,’ he said. He also said he has ‘serious worries’ about tobacco firms’ ‘continuing ability’ to get youngsters hooked on ordinary cigarettes.

‘There are still children who are smoking and it’s not happening by accident. That’s an area we really need to look very seriously at.

‘The model of action for the cigarette industry is very straightforward. If you get people early, they get addicted to something which is going to kill them and then once they’re addicted, they say it’s all about choice.’ Professor Whitty is also looking at whether the thousands of cannabidiol (CBD) products on our high streets are safe amid concerns some may contain trace amounts of the the harmful tetrahydrocannabinol (THC).

Sales of the cannabis extract have doubled in the last two years. It is a legal substance derived from the marijuana plant and unlike the illegal THC – also obtained from the plant – doesn’t make you high.’

A Comparison of demographics and health spend between 1948 and today

Waiting times and Waiting Lists are a problem in all G8 countries. Comparisons are not meaningful. Demographics are outstripping all systems abilities to cope…..

Demographics – it seems as if rural areas are being occupied by more elderly. The implications for service delivery without rationing (overtly) are macabre.

Private: A denial of the demographics in planning: One in three now at risk as diabetes levels soar

Life Expectancy & Demographics

Prince Philip’s care… “No room at the Inn” for us. You will be lucky to get a trolley, let alone a bed. Trusting the system to “do the right thing” just wont work. You need an advocate….

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.

Image result for nhs trolley cartoon

Power politics and the contrarian policies of Right and Left. Time for a non partisan consensus…

Whilst the Conservative administration in England believes it needs to take power away from the administrators and doctors, the Welsh administrators thinks the opposite, and that closure decisions should be made by doctors! Boris is paying back an old friend? We need very badly a non partisan consensus on the health services, and their future in reality. The honest debate that Stevens asked for is being avoided by a PM who wishes to persist in covert rationing, denial, and dishonesty.

Chris Smyth reports 8th Feb in the Times: No 10 power grab for NHS sparks backlash over ‘turf war’ – Boris Johnson targets health service chief with plan to hand ministers control

Boris Johnson has been accused of starting a “turf war” with NHS bosses as it was revealed he will use a new law to exert more control over the health service.

Dominic Cummings, the prime minister’s chief aide, believes that at present the law gives Sir Simon Stevens, the head of NHS England, excessive freedom, making it hard for Downing Street to impose its will.

Legislation to be introduced this year will include powers for ministers to give orders to Sir Simon, who is meant to be operationally independent.

However, the move has sparked a furious backlash with Jonathan Ashworth, the shadow health secretary, accusing the prime minister of embarking on a new top-down reorganisation.

Mr Ashworth said: “Boris Johnson has promised he will get waiting lists down and build 40 brand new hospitals.

“Instead it looks like he’s about to embark on a top-down reorganisation and a turf war with NHS bosses.

“Ministers should fund the NHS and social care system properly and let frontline staff get on with their jobs with the support they need.”

The plans have also alarmed health chiefs, who fear the distraction of a reorganisation when they are struggling to stop waiting times lengthening.

The proposal has been brought forward amid concerns by No 10 that Sir Simon has too much power.

The government has begun monthly meetings with him and is demanding tangible reductions in waiting times after one of the worst winters on record for hospitals last year.

Mr Johnson fears that after winning an election by promising to support the health service, the government has limited control over it and needs “more levers to pull”.

The change will form part of a wider overhaul of NHS structures in which hospitals and GPs are subsumed into legally independent local care groups.

Officials insist that despite tensions over control of the health service, Mr Johnson is not trying to start a war with Sir Simon, with whom he has been friendly since they studied together at Oxford University.

The Times understands that soon after the election Downing Street told the Department of Health to be “more assertive” with NHS England, a body set up under controversial 2012 reforms to take charge of the day-to-day running of the health service. The most contentious part of those reforms, designed by Andrew Lansley, who was then the health secretary, was the introduction of internal competition.

Sir Simon is trying to unwind this and has asked ministers to change the law requiring care to be put out to competitive tender.

Mr Johnson’s 80-seat majority has given ministers the confidence to go further and the Queen’s Speech promised “legislation that will accelerate the long-term plan”. In a government briefing seen by The Times, Matt Hancock, the health secretary, is told: “The proposals NHS England brought forward were designed in a different parliament than the one we have now, with an underlying principle to avoid an extensive reorganisation. As a result, while they would entail a shift away from the market model enshrined by the 2012 Act towards a much more managed system, they do not deliver the fundamental reform of the 2012 Act that we and the system believe will be needed.”

By next year Sir Simon wants all areas of the country to be part of an “integrated care system” that plans collectively, and the laws would make these voluntary forums legal bodies with budgetary powers.

Ministers plan to use the legislation to give themselves greater power to tell Sir Simon what to do. The briefing talks about “creating a power of direction for the secretary of state over NHS England”, telling Mr Hancock that it would ensure that the organisation was “appropriately accountable to the secretary of state for health and social care and parliament for all aspects of NHS performance, finance and care transformation and that you have sufficient levers to direct and influence [it]”.

Sir Simon recognises that with Mr Johnson so dominant there is little point in protesting. Despite an insistence that the relationship with No 10 is good, there is nervousness within the health service about what the changes will mean in practice.

Integrated care is widely supported by health experts, who believe that linking hospital, GP and social care is crucial to dealing with an ageing population. However, Chris Hopson, chief executive of NHS Providers, which represents health service trusts, said: “A key current principle is that trust boards are responsible for the care delivered by the trust. We blur that clarity at our peril . . . Given the complexity and risk involved in the delivery of frontline healthcare services, it’s vital that lines of accountability are clear.”

Downing Street and NHS England refused to comment.

Internal NHS politics are about to collide with the Tory party (Chris Smyth writes).

The last time this happened was under Andrew Lansley’s 2012 reforms, which damaged the Tories’ credibility and were diluted at once.

Most in the NHS support Sir Simon Stevens’ vision for hospitals, GPs and others to work together, but the structures created by Lansley have made it harder to keep the elderly out of hospital.

In his ten-year plan, Sir Simon proposed changes to join up care. The Tory election win gives ministers the chance to go further and undo much more of the Lansley act.

Yet one key element of the Lansley act survives: NHS England, which made day-to-day running of the NHS the responsibility of an independent organisation at arms’ length from ministers. Sir Simon is too smooth a political operator for this to have led to many public stand-offs, but it makes No 10 unhappy that the most politically important public service does not obey its beck and call.

Boris Johnson knows that his long-term political survival depends on improving the health service. Yet NHS performance has been getting worse and while ministers take the blame, they can do little about it.

For Downing Street, taking advantage of an NHS bill to give themselves greater control is only logical.

Less clear is what the government wants to do differently. If Sir Simon cannot stop waits getting longer, is Dominic Cummings likely to do any better?

What nonsense from Mr Drakeford – Politician afraid to acknowledge the poor manpower planning, and his responsibility for the whole population. (Utilitarianism)

Inconvenient truth is NHS needs reforms

Boris Johnson in NHS power grab: PM plans new law to force …Daily Mail7 Feb 2020 – Boris Johnson is planning to bring in a new law that will take power away … NHS boss Sir Simon Stevens is paid a six-figure salary and was …

Hugh Pym for BBC News 14th Jan 2020: Is Downing Street turning up the heat on the NHS?

Steve Bird in the Telegraph 7th August 2019: How the future PM, Boris Johnson, and NHS boss, (England) Simon Stevens, formed an unlikely bond at Oxford

The election was caused by an impotent government, and health care is being managed by an impotent administration. An honest debate based on realistic expectations is beyond their ability.

Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

‘Honest debate’ needed over NHS crisis, says Gerada

Saving the NHS – Political parties are in denial over how to fund the growing pressure on the health service. We need an honest debate about new means of paying for it



Government plans to increase funding are missing the point.

The Huffington Post opines: Government plans to increase funding are missing the point. Philip Hunt reports: Austerity, workforce shortages, a social care crisis and a complete failure to factor in a growing older population – it’s little surprise the NHS is reeling, Lord Philip Hunt writes.

November 2019 saw the worst four-hour wait performance in A&E since figures were first collected, back in 2010. This has been matched by failures on key targets for cancer, GP appointments and hospital treatment waits. At the same time, rationing of medicines is on the increase – with failings being increasingly revealed in ambulance services, mental health support, and for people with learning disabilities.

Given all of this, it’s a huge tribute to NHS staff that so much care remains of a very high quality. But the calamitous drop in performance over the past decade is having an impact on patient safety as well as leading to longer waits.

Just before Christmas, the Norfolk and Norwich University Hospital advised staff to make the “least unsafe decision”, following a huge rise in admissions. It was

not an isolated incident. Indeed, 2020 has already seen the Royal Cornwall Hospital NHS Trust tell its staff to help reduce severe overcrowding by discharging patients – despite the obvious risks involved.

While many factors and pressures are at play, the alignment of austerity with workforce shortages, inadequacies of adult social care and a complete failure to factor in a growing older population, means it’s little surprise the NHS is reeling.

The lowest five-year period of funding growth occurred over the 2010/11 to 2014/15 period and the past five years have seen little improvement. Is it any wonder that the NHS is cash-strapped, in deficit and finding it very hard to invest the resources necessary to prevent hospital admissions? Latest estimates by the Health Foundation show a shortage of more than 100,000 staff, including 40,000 nurses.

All of this is happening when social care is in meltdown. By 2018, the House of Lords Economic Committee had reported that 1.4 million older people in England had an unmet care need. The number of older people and working-age adults requiring such care is increasing rapidly, yet public funding declined in real terms by 13% between 2009/10 and 2015/16.

What nonsense from Mr Drakeford…. Politician afraid to acknowledge the poor manpower planning, and his responsibility to the whole population..

Politicians should make the decisions about populations and their health. Doctors, apart from public health specialists, should “put their patient at the centre of their concern”. So when the BBC publishes 3rd Feb 2020: Royal Glamorgan: First minister criticises politicians on A&E plans they are never questioning Mark Drakeford’s comment:

“It is for doctors, not politicians, to decide the future of the Royal Glamorgan Hospital’s A&E department, Labour First Minister Mark Drakeford has said”.

This downgrading and closing of hospitals is driven by staff shortages. Its the same in Haverfordwest, Blackpool, Scarborough and all the peripheral and deprived areas without a teaching hospital and tertiary care. Mr Drakeford has relatively little power over the short term supply of doctors, but he could initiate the virtual medical school, and allow far more people to train. And that gives a long term solution. Meanwhile its going to get worse.. and worse.

Some good news on new medical schools. Lets hope the politicians seize the real opportunity for virtual medical schools living in local communities

There are just not enough geese to lay enough golden eggs. The cupboard is bare. We cannot be cloned.

There is a National shortage of GPs across all the 4 health dispensations. When the Department of Health primes reporters such as Chris Smyth, in the Times 7th Feb 2020, I am surprised by his naïve acceptance, seemingly without question. The bribes will not work as there is a 10-15 year shortage…A GP might move for 20K but he will not wish to move to a deprived area, and that is where the doctors are needed. SO what sort of perverse behaviours can we think of? Changing practice repeatedly and, like Monopoly, collecting £20k whenever you become a partner? There could even be a mutually beneficial merry-go-round…. There are just not enough geese to lay enough golden eggs. The cupboard is bare. We cannot be cloned.

Image result for health merrygoround cartoon

We could make it an obligation for all new doctors to work in deprived areas at first. ( Breaking EU convention human rights?) but would that deter some from applying? There were 11 applicants for every place up to recently, so it’s worth a thought.

Just as we could move our MPs to the midlands or S Yorkshire, the change would sort out those with real commitment. How many MPs are in the house because of the opportunity in London? Moving either house will test its members. Committing doctors to deprived areas for say 2 years, would test their altruism.

Bribes belittle the profession. They encourage distorted and perverse behaviours. In the long term deprived areas are best addressed by overcapacity. There is another distortion, and that is the temptation to go abroad, and that is best addressed by cultural change, making the doctors and staff feel valued, and an honest language, And Exit Interviews: what are they? Why not obtain from GPs?

Doctors to be given £20,000 for taking over local surgeries. Chris Smyth in the Times 7th Feb 2020.

Family doctors will be given £20,000 golden hellos for taking over local surgeries as the NHS struggles to deal with a GP crisis.

Care home residents have been promised weekly visits from surgery staff as part of government efforts to boost local care and keep elderly people out of hospital.

Thousands more pharmacists, physiotherapists and dieticians will be recruited as the NHS plans to boost an “army” of support staff to 26,000.

A shortage of GPs is one of the most pressing problems facing the NHS, with numbers falling even as the government has repeatedly promised more. Recently Boris Johnson pledged to boost numbers by 6,000.

Efforts to hire more have been hampered by younger doctors’ reluctance to become full-time owners of surgeries but, in an effort to tie them in for the long term, all new GP partners will be eligible for £20,000 bonuses plus help with training.

Under a deal struck yesterday between NHS England and the British Medical Association, £1.5 billion of a £4.5 billion pot allocated for primary care will be allocated to encourage GPs to stay in the NHS.

Sir Simon Stevens, NHS chief executive, said that the agreement was a “vote of confidence” in the GP system. “This agreement funds a major increase in general practice staff — including GPs, therapists and pharmacists — so that patients can get quicker appointments with a wide range of health professionals at their local surgery,” he said.

“These extra staff will be offering expanded services, including regular health checks for people living in care homes, action to boost vaccination uptake, earlier cancer detection and better support for people with learning disabilities.”

Health checks for new mothers and consistent medication reviews are also promised under contracts that pay GPs for providing them. Doctors will be encouraged to prescribe exercise and arts groups to expand “social prescribing”.

Richard Vautrey, of the BMA’s GP committee, said: “The significant investment in and focus on recruitment and retention, including payments to incentivise doctors to take up partnership roles and work in under-doctored areas, is a vote of confidence in the partnership model and a much-needed first step if we are to reverse the trend of falling GP numbers.

“An expanded healthcare team working in GP practices as well as increasingly closely with community colleagues across groups of practices, will mean patients have access to a wider range of staff, allowing GPs to see those who need them most more quickly.”

Matt Hancock, the health secretary, said: “This new contract is the first step to delivering our manifesto commitment to make it easier to get a GP appointment when you need it by delivering 50 million more appointments a year in general practice.”

2019: To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

2019: A GP in Milford Haven exposes the Inverse Care Law as applied by successive Governments, perversely and neglectfully..

2017: The decline of General Practice.. Bribes may be too late…

2017: The flock of geese that laid golden eggs has been culled. It takes years to rebuild, and the fox is at the door.

2016: The public will only miss what they had – when its gone. GP indemnity fees spiral out of control with 25% rise last year..

2015: Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

A new and very different type of NHS in England (BMJ 2011)

May 2011: BBC Panorama Report By Undercover Investigator

2012: Nuffield Trust Report on Rationing

2012 The Health and Social Care Bill 100 Voices on NHS Reforms

2013: Burnout forces almost 10% of GPs to take time off work as pressure on occupational health services grows

2013: Mid Staffs – Who, if Anyone, Will Be Accountable?

2013: The Demographic Time Bomb

A midwife at risk – of burnout and retribution. As are all her colleagues if they speak out..

For those used to watching “call the midwife” where there is time for a life as well as work, reading this book might bring you back to NHSreality. The fear of retribution is real… The author is at risk in our English, Scottish, Welsh or Northern Ireland health services. An honest exit interview would be really helpful, but not done by HR in any trust in the employ of the department of health…

Image result for midwife cartoon

Julia Llewellin-Smith reports 6th Feb 2020 on: The Secret Midwife interview: ‘It was a traumatic 15 years’ – Philippa George wrote a memoir about her time as a midwife after she was signed off for stress. Things need to change, she tells Julia Llewellyn Smith

Philippa George is recalling some of the weirder — and most heartbreaking — moments in her 15-year career as a midwife. “There was the time a woman in her twenties walked in accompanied by her grandma and dumped a Tesco ‘bag for life’ down on the reception desk,” she recalls. “We were, like, ‘What’s this?’ She said, ‘It’s the baby.’ ”

………Sitting in a café in central London, George, who works in a midwifery unit outside the capital, is exactly the person you would want at your side during labour: smiley, calm and empathetic. She went into midwifery straight from school and is adamant that it’s her vocation.

But her account of how her job has altered in the past few years makes for dispiriting reading. I would be uneasy recommending her book to pregnant friends, but women who have given birth in an NHS hospital may experience grim recognition at her accounts of constant short-staffing, which means that many women don’t receive the attention they need in labour and afterwards.

“I used to be able to give one-on-one care; now that’s a thing of the past…….

Now George’s main concern is that, having blown the whistle, management will uncover her identity. “I just don’t know what they might do if they found out about the book. I just don’t want to lose my job,” she says. “Even after everything that’s happened to me, I still think it’s the best in the world.”
The Secret Midwife is published by John Blake on February 6 at £16.99

The Secret Midwife – Full article can be downloaded here..

Inconvenient truth is NHS needs reforms

Image result for truth cartoon gagging

Image result for midwife cartoon gagging

Denial and reluctance – a cultural black hole is revealed, and is probably in every DGH.

When the problems surrounding the work of Ian Paterson, a consultant surgeon in the midlands emerged, there was hardly a surprised face amongst my colleagues. We know that standards are falling. We know there are far too few doctors and nurses to care for the future, and we know that it has to get worse before it gets better. We know that because of the inhuman pace at which the doctors work, they get jaded, and disengage from the managerial process.

Consultants failed to get involved in management many years ago, and GPs are seen as mavericks who only look after their own businesses: because they are self employed. Gps should be on health boards, but almost everywhere they have been excluded. Other countries have better consultant involvement, as many elect to serve their colleagues by getting involved. This is relatively rare in the UK, where managing doctors are seen as “going to the dark side”. This is the iceberg of denial and reluctance – a cultural black hole is revealed, and it is probably in every DGH

BBC News 4th Feb 2020: Ian Paterson: Surgeon wounded hundreds amid ‘culture of denial’

The Times leader 5th Feb 2020: An inquiry into a rogue surgeon has uncovered significant failings

It is devastating for a patient to receive a diagnosis of cancer and undergo invasive surgery. To learn retrospectively that the diagnosis was fraudulent and the surgery unnecessary is a trauma beyond words. It happened to hundreds of victims of the surgeon Ian Paterson, who carried out needless operations for breast cancer on women who did not have the disease. He was given a 20-year jail sentence in 2017 for wounding with intent.

Yesterday an inquiry chaired by the Right Rev Graham James, Bishop of Norwich, concluded that Paterson’s victims had been “let down, not only by Paterson himself but by a system that proved to be dysfunctional at every level”. It noted that many opportunities to stop him were missed. The report uncovers specific and grievous lapses in the system of healthcare that must be remedied.

Paterson worked at five hospitals in the West Midlands, of which three were in the National Health Service and two were run by the private healthcare company Spire. The inquiry found that between 1998 and 2011 Paterson operated on more than 6,600 patients at Spire and more than 4,400 at the NHS hospitals. Some of these were children. The most visible victims were more than 750 women whom he is thought to have wounded after giving bogus diagnoses.

Guilt lies with Paterson. The report refers to his lies and reckless flouting of rules. Yet patients were failed too by the reluctance of those in charge to investigate. The report notes that there are many layers of regulation in the health service but that these were inadequate to cope with “poor behaviour and a culture of avoidance and denial”.

Denial and a refusal to confront warning signs are a recurring theme in big institutions. An inquiry into the scandal in the 1990s at Bristol Royal Infirmary, where babies died at high rates after heart surgery, identified an “old boys’ culture” among doctors. More recently, the Church of England has been forced to acknowledge the institutional laxity that allowed Peter Ball, former Bishop of Gloucester, to sexually assault many young men. Subjecting such closed circles to scrutiny is vital to protecting vulnerable people.

Yet scrutiny is not enough if regulators fail in the task. The report recommends 15 reforms, of which two areas stand out. First, there is a problem with the private sector. Spire attempted to evade responsibility by saying that Paterson was not employed by them and was merely renting a room in their facilities. This system, known as “practising privileges”, needs reform, alongside the fact that in the private sector consultants are not required to share data with the NHS.

Second, medical indemnity is a mess. It is, contrary to common sense, not a system of insurance. Payouts are discretionary. The Medical Defence Union, which provides indemnity to medical practitioners, refused to pay out in the case of Paterson when it became clear that his actions were criminal. The system, by design, does not cover the very worst cases of malpractice. The union then declined to appear before the inquiry. As the report said, this needs to change.

The Paterson case recalls scandals in which an organisation defensively closed ranks, yet there is particular horror when the issue is medical malpractice. Such cases strike at the social contract under which patients trust in their treatment by medical experts. The gaps in healthcare identified by the report need to be plugged fast.

Golden goodbyes for NHS managers soar to £39m

So are the “people” the Health Services main resource? MPs should try a nursing sabbatical..

NHS Staff need to “Step up to the mark…. and stop bitching” – David Prior, chairman of the Care Quality Commission (CQC).

A new open (and Utilitarian) NHS? (a reminder from March 2013!)

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

An absence of political courage means the Health Services are dying..

Jeremy Hunt has enlisted a US professor to review the digital future of the NHS to keep it from falling into “elephant traps”

Heuristic (sub optimal) decision making – ignore part of the available information, basing decisions on only a few relevant predictors.


Update 7th Feb Times letters:

Sir, Your leading article (Feb 5) mentions the failure of the medical indemnity that the surgeon Ian Paterson paid towards. Many surgeons and physicians pay tens of thousands of pounds each year for this type of cover and most of us are members of one of the three big mutual associations (the Medical Defence Union, the Medical Protection Society and the Medical and Dental Defence Union of Scotland). Amazingly such schemes are not covered by existing insurance regulation and are entirely discretionary. Hence the patients were refused compensation by his insurer. The Department of Health published a consultation on this issue more than a year ago but no progress is visible; in the meantime everyone loses.
Tony Narula, FRCS
, Wargrave, Berks
Raj Persaud, FRCPsych, London W1

The skill of “doing nothing” is valuable, and is what makes the GPs so efficient.

The UK trains many doctors, especially Scotland, and some of them go abroad. We import some 30% of the doctor labour force. Wales trains many GPs. But we then have too few. We export them to England, and places where they aspire to bring up their families. Better infrastructure and education plays a great part in where doctors choose to live. With 80% of medical school places being allocated to female candidates, there is more incentive to stay near their home. Inner city and suburban schools provide most doctors for training. Whatever plan the government comes up with it needs to reverse these trends.. Inducements for doctors to work in poorer areas could be a lot greater….

Meanwhile we are promised a new brand of fast track doctor, who might have been a pharmacist or a paramedic beforehand. Lets hope they cut the mustard, and are asked to pass the same exams. NHSreality predicts that these people will not be able to live with uncertainty. Doing nothing for a short period of time allows diseases to take a natural course… The skill of “doing nothing” is valuable, and is what makes the GPs so efficient. If they cannot do this, and we know consultants find it hard, they will elongate the waiting lists for investigations. This will cause adverse outcomes, and those right enough will go privately. The perverse outcome of well intentioned but ill thought through change.

Read the damning nature of this joint report.. GP shortages …. Our very own post-code lottery.

Welsh NHS has ‘nothing to hide’, says health minister. Listen to Mr Drakeford…

Wriggling on the hook of Dr under capacity. Any solution, ethical or not, will be considered. On the other hand anyone who passes the final exams, however they learned, should be allowed to be a doctor.

Nurses and pharmacists to replace GPs for 1 in 4 visits

Cutting pharmacists may be possible in cities, but it will be very inconvenient in rural areas. Who is off their trolley?

Teetering on the edge? Living with uncertainty… something consultants are never trained for.. General practice is not a retirement home for hospital physicians (Let alone pharmacists and paramedics)


A deficient NHS bill for a sinking and near moribund service…

When 3 eminent people write  a letter to the Times letting the readers know that the NHS bill is “deficient”, they are putting it mildly. They really agree with Richard Smith (see below) and they are pointing out the “denial” of our politicians. These privileged people live mainly in London, and can get access to the free quality health care, or to all the private options, that exist in London. Choice is part of their lives, unlike the rest of us living in the shires. The 4 health dispensations re sinking – fast. The authors of this letter are experienced and eminent…. They are in charge of the “think tanks” that provide background research and evidence to the health services. They are unwilling to mention rationing, as is Richard Smith, but that is what is needed, and it has to be open. What would help is releasing the CEOs and Trust Board members to say what they feel in public, withiout losing their jobs, and to have exit interviews for all board members which should be done by an outside agency (not hospital HR) and feedback should be at intervals that allow depersonalisation of the comments.

Sir, Today MPs will pass a bill to enshrine in law promised funding for everyday NHS services in England. The investment is an important signal but it does not include areas of funding crucial to the government’s election promises to provide more hospitals, nurses and GP appointments. The bill does not cover investment in buildings and equipment. Yet capital spending in the NHS is well below comparable countries; for example, we have only a third as many MRI or CT scanners as Germany. The government has announced some money for hospital upgrades but it is not enough to address the NHS’s crumbling infrastructure or fund new technology to improve care.

The NHS is facing a workforce crisis but the bill does not cover education and training budgets that would help recruitment and retention. Nor does it offer any relief for the public health and social care services that help to keep people healthy and independent.
Dr Jennifer Dixon
, CEO, the Health Foundation; Nigel Edwards, CEO, the Nuffield Trust; Richard Murray, CEO, the King’s Fund

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