A good result from Covid: Cold surgery goes to private hospitals at last

NHSreality has complained about the rejection of numerous government reports, and in particular the one on cold orthopaedic surgery. 

The fact that private hospitals are expecting a “surge” in business, is not surprising given that the 4 health services are the most prized of their state’s safety net. The health services were in desperate state before the crisis, and with normal work they will melt down. Sir Simon Stevens is the head of NHS England. As so often the media forgets about those of us in the peripheries deprived of both choice and quality.

Kat Lay in teh Times reports 29th June 2020: Private hospitals expect surge in cancer patients as NHS struggles

Private hospitals are bracing themselves for a “surge” in NHS cancer patients in August, amid calls for the Treasury to release funds for a new contract between the health service and the independent sector.

The NHS waiting list is expected to reach ten million by the end of the year, with experts saying that it will need to use private hospitals to tackle it.

There has been a drop in referrals from GP surgeries, and in diagnostic tests carried out, including for cancer, as patients put off seeking treatment over fears of contracting Covid-19.

Karol Sikora, chief medical officer at Rutherford Health, one of the largestcancer centre networks in the private sector, said: “We’re expecting a surge in cancer patients that are fully diagnosed to come probably at around August.

“That’s when the three private cancer services that exist, the private networks — and there’s 26 radiotherapy services in the private sector and about 65 places you can have private chemotherapy — they’ll kick back into action, and they’ll do NHS work.”….

….Sir Simon Stevens, head of the NHS, has praised staff for treating 50,000 cancer patients in March and April during the pandemic.

He said: “NHS staff have done everything in their power to make sure that the NHS can continue care for patients who needed treatment and this has happened, which is testament to their incredible hard work and dedication.

“We know people have been anxious about coming forward for checks during the pandemic but now is the time to get checked — it could save your life.”

Sir Simon said of a new specialist cancer hospital in Liverpool: “This hospital will provide world-class care to people with cancer across the region and it is timely as it will also help to support the NHS response to the pandemic by allowing vital tests and treatment to go ahead in a safe space.”

Reports commissioned by Government and others – but not acted on. A shame on all politicians for their short termism.

Too little, too late. The enquiry must ask why no notice was taken of these reports..

NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

Covid 19 ( Pathos or Tragedy ) : Where’s the strategy for testing?

When we look back in anger will we consider it pathos or tragedy that a sycophantic government has failed us?

Fiona Godlee, editor in chief of the BMJ 26th June opines: Covid 19: Where’s the strategy for testing? (BMJ 2020;369:m2518)

Editor’s Choice

Covid 19: Where’s the strategy for testing?

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2518 (Published 26 June 2020)Cite this as: BMJ 2020;369:m2518

Read our latest coverage of the coronavirus pandemic

It would be nice to be able to say otherwise, but the UK’s approach to testing in this covid-19 pandemic continues to be chaotic, centralised, commercialised, and driven by numerical targets rather than clear strategy. Allan Wilson, president of the Institute of Biomedical Sciences, has called this reactive and random approach the “wild west of testing.”1 Writing for BMJ Opinion this week, Chris Ham agrees. The system is far from “world beating,” and ministers must be prepared to acknowledge and learn from mistakes, he says.2

What makes matters worse is the ongoing lack of honesty. The government has exaggerated the performance of its much vaunted test, track, and trace system: most contacts were traced by local health teams, with only a minority by the national, privately contracted call centres.3 Some reasons for this are grimly outlined by one doctor who signed up to work in them.4

As for antibody testing,5 there are the same mistakes. Heralded by our political leaders as “game changing” and an “important milestone,” antibody testing is being ramped up, with healthcare trusts being asked to be ready to rapidly process thousands of tests a day. But a group of public health and clinical experts warn that this makes no sense6: these tests are not useful in diagnosis and can’t be relied on to decide whether someone has been infected or is now immune. The only current justification for such large scale testing is for research and public health surveillance, they say.

Also lacking is reliable information on test accuracy, says Jon Deeks, lead author of an imminent Cochrane review of covid-19 antibody tests and The BMJ’s chief statistician. The reported sensitivities and specificities are based on poor science or manufacturers’ marketing material, he says in our report.7 Nor have the tests been validated in real world situations. As for the costs, we know that £16m went on tests from China that proved inadequate, but we don’t know how much has been spent on contracts with Roche or Abbott, as these details have not been disclosed.

Tests are just one of many commercial opportunities that have opened up with this pandemic. Urgency tends to cut caution, allowing drugs and devices onto the market without adequate scrutiny, says our editorial this week.8 We want to thank all those who have signed the call for more independence from commercial interests in medical research, education, and practice, and we hope that others will add their signatures (bmj.com/commercial-influence). “During this fast moving and lethal pandemic, independent and trustworthy evidence, interventions, and guidance are more important than ever,” the editorial concludes.

As the government announced a relaxation of the 2 m rule on physical distancing,910 now is the time for a rapid, forward looking review of the UK’s preparedness for a second wave of covid-19. Healthcare leaders have made this call in an open letter to the UK’s political leaders.11 We must hope for less target driven chaos and more evidence based strategy in the months to come.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

 

Losing their grip… A generally poor performance from the 4 health services… and from central government.

Having lost their grip on the 4 health services before Covid19, the government and the 4 dispensations are performing badly during Covid. Comparisons of freedoms within other countries show how behind the curve we really are. It looks as if life expectancy will stop rising, and could even fall, Rationing has never been more obvious, but it will never be explicit! The feeling of National Security is a dam that could about to burst.. especially if there’s a second wave.

Bagehot in the Economist June 20th opines: Boris Johnson loses his grip  The prime minister’s poor management of the covid crisis is undermining his ability to govern

Britain’s chaotic departure from the European Exchange Rate Mechanism on “Black Wednesday” in 1992 destroyed John Major’s premiership and condemned the country to five years of agony, as the Tory government stumbled from crisis to crisis. The coronavirus debacle now threatens to do the same to Boris Johnson. He has a bigger majority than Sir John (87 compared with 23) and is more loved by Tories. But the corona crisis is much bigger than the ERM episode and will be harder to escape from.

Mr Johnson’s poor handling of the crisis has wrecked the government’s most important asset, its sense of authority. The government may already have lost the public: ratings for “being in charge of the situation” have been negative since May. It is beginning to lose its own party, too. Tory MPs have a litany of complaints about government policies. They especially dislike the insistence that strangers must stay two metres apart when other countries have settled on 1.5 metres or less, the back-tracking over reopening schools, the decision to quarantine those arriving from abroad for a fortnight, the abolition of virtual voting, which forces MPs to stand in a mile-long “conga line” to cast their votes, and the unruly streets, with up to 40 police officers injured in a fortnight of protests and counter-protests. Habitual critics of Mr Johnson ask: what did you expect? Others are “worse than despondent”, says one. “Despondent implies that you think that there might be a way out.”….

Mr Johnson’s authority, like that of the Roman emperors he studied at university, rested on fear and charisma. He struck fear into his colleagues by repeated shows of brutality, expelling half the Cabinet when he took over as prime minister, purging 21 mps who voted against the party and dispatching his chancellor, Sajid Javid. He also used his considerable political charisma to help win an audacious general election in December. Dominic Cummings, Mr Johnson’s key adviser, was central to this regime of fear and charisma, picking fights with all and sundry but also earning a reputation as a campaigning genius.

But fear and charisma only work so long as they are accompanied by competence. The backbenchers who once feared Mr Johnson and Mr Cummings are now more worried about the fury of their own constituents. There is talk of emperors without clothes and wizards behind the curtain. The ministers Mr Johnson demoted in his early months may now have a chance for revenge.

But righting the ship will be difficult. …..Britain’s poor performance is becoming painfully obvious as locked-down Britons watch images of continentals relaxing in cafés and returning to work.

If theres one aspect of society that must change, its how we die.

Few of us have a choice as to how we die. I feel guilty about the patients who wanted to fie at home, but for whom i failed to recognise their last illness, and admitted them to hospital when they should have remained at home. Choosing how and where we die has become a privilege of the few. They are either very determined or they are very lucky, or they are very rich. How often have we heard the pet lovers mantra: “You would not treat an animal like that”, and how often has a death been praised for its humanity? At the moment it is still “illegal” to assist death in any way….

Daniel Finkelstein in the Times 24th June 2020 reminds us that this is a societal choice: We don’t have to live with this way of dying – Denying the terminally ill help to end their lives will one day be considered as barbaric as refusing pain relief in childbirth

am going to tell you the story of Ian Douglas, who was diagnosed with multiple sclerosis in 1986 — the story of him and of his children, Anil and Anjuli. Because it’s also the story of millions of us. It is a story of unnecessary suffering and bad law. And one day, who knows, it could be the story of you.

I don’t believe it will be, though. I am an optimist. I’ve watched the way we’ve all behaved these past few months and I think we’re ready to change things. I think we are becoming more mature about death, more capable of talking about it and more self-confident. I think in every generation we have learnt to live better, and now we are going to learn how to die better, too.

So this article is about death, but it’s not about despair. It’s a bit about courage, a little about hope and a lot about a determination that the time has come to act.

Today brings the publication of Last Rights: The Case for Assisted Dying by Sarah Wootton and Lloyd Riley. It’s an eloquent argument for reform and when they sent me the text, I said I was happy to provide a foreword.

Until about 2008 Ian Douglas managed reasonably well. But that year his wife, Reena Bhavnani, died of breast cancer and Ian began, slowly at first, to struggle more with his illness. Having watched his wife die, he became determined that he would control his own death as far as possible.

This was a man who was mentally strong, a trade union researcher and a financial analyst. But with each relapse he could do less. By the end he couldn’t feed himself and sometimes he couldn’t get a glass of wine to his lips even when it was poured for him. His GP confirmed that his condition was terminal.

So he started to plan. He’d been obtaining marijuana and he got hold of opioids from the dark web. The first time he took an overdose, he didn’t take enough. He told his family that the resulting stomach pain was gastric flu. A week later he tried again, and failed again. But finally, the night before his 60th birthday, he took enough for it to be fatal.

The police arrived, of course. There were four squad cars. Anil and Anjuli, now adults, were interviewed with their father dead in the next room, and the police took their phones. And their dad’s phone and computer with his address book. They couldn’t talk to family or friends or even inform some of them of their father’s death. The police went through all of Ian’s possessions.

Later there were separate sit-down interviews with the children. Ian had taken great care to ensure they had no involvement but even that did not save them the ordeal of questioning.

Then silence. It took months for them to be confident that there wouldn’t be any follow-up. I’m able to write this story because they have only just found out for sure. Ian died in February last year.

Is this really how we want to do things? Because there is one last part of Ian’s story that is relevant. In his final note, left for those who might find him, he wrote: “I would like to put on record that had we more sympathetic assisted-dying laws in this country, in all probability I would still be alive today.”

If he had been certain that he would be helped to die by doctors when the time came, he would have been able to postpone his death. He acted when he did only because he was declining and he needed to be sure he could organise the whole thing himself.

We don’t have to live with this way of dying. The authors of Last Rights are surely correct when they say: “Denying people the option to relieve their own suffering at the end of life will [one day] be viewed as just as barbaric and nonsensical as withholding pain relief during childbirth.” Yet this was a policy once advocated by the church and many medical professionals until Queen Victoria demanded pain relief during the birth of Prince Leopold.

Suicide used to be illegal. It was until 1961, believe it or not. That is why we still talk about people “committing” suicide. We use the same word that we use for crime, because it was a crime.

It became obvious that it was inhuman to start criminal proceedings against those who tried and failed to kill themselves. How long before we do something about the similarly inhuman practice of having to interrogate relatives over the voluntary death of a loved relative who was terminally ill?

Everyone imagines that this will never be them, never be their relatives, because if they get ill like that the doctors will “know what to do”. Or they will be able to go to Dignitas or something.

In reality it isn’t like that. The doctors can’t start just bumping off their patients, and they don’t. And Ian couldn’t go to Dignitas because by the time he was close to the end, travelling was out of the question. And anyway he didn’t want to fly off. He wanted to die here.

So what should we do?

A few years back, when I was working in politics and Boris Johnson was writing a newspaper column, the two of us spent quite a long time discussing assisted dying. He was open to changes in the law but in the end I couldn’t quite persuade him.

He worried a lot that people would feel under pressure to hasten their deaths so as not to be a nuisance to their relatives.

But not long after this he began to change his mind, and it has been almost 15 years now since he agreed there was need for a new law, one with careful safeguards that allows someone overwhelmingly likely to die in the next six months to seek assistance from medical practitioners, following careful procedures and review. After all, far from hastening death, it would delay it. Ian’s life would have been longer.

This could be a landmark reform of his government. The moral case for it is compelling. And so is the political case. This is a policy that unites cultural conservatives and social liberals. It has done for years.

In January 1937 Gallup conducted the first opinion polls in this country. In answer to its second ever question, “Do you consider that doctors should be given power to end the life of a person incurably ill?”, 69 per cent of respondents said yes.

Now a change in the law, one that includes proper protections against abuse, is supported by a full 84 per cent. It is the settled will of the country and of its prime minister. It’s an idea whose time has come.

The current absense of law on assisted dying is divisive…. We need a national solution

Assisted dying reincarnated.. Patients need choice..

The neurosurgeon Henry Marsh on why assisted dying should be legalised

The Times letters 26th June: Its about choice, and avoiding doctors being responsible!

Sir, I am heartened by Daniel Finkelstein’s article. I have incurable cancer. Without a change in the law I am deprived of choice at the end of my life. I should be able to choose an assisted death so that in the last weeks of my life I can say: “Enough.”

I should be allowed to die before I have to endure weeks of protracted pain and deterioration. I will be dying anyway: I want the choice.
Christie Arntsen
Black Bourton, Oxon

Sir, I agree with Daniel Finkelstein. I hope that, in debating this subject, undue weight will not be given in the future, as it has been in the past, to the views of the medical profession. If sufficient safeguards are in place, it is surely an act of pure compassion to assist in the death of someone who is terminally ill and wants to end their suffering, but no doctor who had a conscientious objection would be required to take part. That aside, the views of doctors are surely no more compelling than the views of any other group of people. The decision is one for us all. The fact that assisted dying would be brought about by medical means does not make it a medical issue.
Richard Oerton
Cannington, Somerset

Sir, I read Daniel Finkelstein’s piece with mixed feelings. I felt sympathy for Ian Douglas and those close to him and their collective experiences. But I also recognised personal and professional dismay that it still seems to be expected that doctors will be responsible for helping patients to die.

I agree with campaigners for “assisted dying” that legislation is a matter for society to decide. But I do not agree that doctors should be expected to have a role in its provision other than to confirm diagnosis and clinical information as, in most of modern medicine, doctors are not qualified to make personal, family and social judgments that are inherent in such decisions. There are significant dangers of placing assisted suicide within medicine, not least that by doing so it is presented as a benevolent act and must be valid.

If “assisted dying” is a matter for society and not for doctors, it is society, through legal processes, that must take responsibility for it.
Dr Iain Lawrie
Consultant in palliative medicine, Manchester

Update 28th June letters 28th June in the Times:

ASSISTED DYING
Sir, I have no doubt that those arguing against the legalisation of assisted dying now (letters, Jun 25 & 26), will come to be seen in the same light as those who protested against the introduction of heart transplants as unnatural or ungodly. It is right to both save life when we can, and to limit the pain of dying for those terminally ill who so wish. At present, we can do the former but not the latter unless they commit suicide or covertly go abroad to die. It is time to give a better, safer and more regulated option.
Rabbi Dr Jonathan Romain
Maidenhead Synagogue

Sir, Daniel Finkelstein (Jun 24) repeats the well-worn arguments for legalising “assisted dying”. He overlooks the unfeasibility of framing and enforcing “proper protections against abuse” (no jurisdiction with permissive laws has anything close) or where his argument logically leads.

To pose but two of several obvious questions his article raises: if the law should allow physician-assisted suicide for those likely to die in six months’ time, why not for those who face years of suffering? And if a hastened death for suffering patients who can request it, why not for those who are unable to do so?
Professor John Keown
Kennedy Institute of Ethics, Georgetown University

Sir, In 1993, when my mother was 92, she suffered a stroke that left her paralysed. She could not utter a word, though could very clearly mouth “I want to die”. I was helpless. She was fed through her nose and given antibiotics when pneumonia set in. Three months later, when an elderly locum (with no career to lose) was on duty, my mother was given the means to die peacefully. I do not wish to end my life in such a barbaric way.
Enid Light
Henley-on-Thames, Oxon

Why are we so slow to realise that staff are a risk? We are currently dumbing down ….

Why are we so slow to realise that staff are a risk? With both MRSA and Covid we have made the same mistakes. I once wrote to our respected and now retied bacteriologist (  Microbiologists saved my life on more than one occasion ) about the issue of NOT testing staff for MRSA. I advocated that testing should occur regularly until there was evidence that it was not valuable, rather than the default position which is no testing until it is proven to be of value. Why did government not do the trial? . The Bacteriologists reply reply was convoluted and disingenuous, because he recognised that he might be identified, and that the risks to the Trust Risk assessment was significant, and that there might be legal implications. Doubtless he would have been punished for saying how he really thought.  There are so many reports that have been ignored, including one on antibiotics in animals, which would have helped the MRSA problem. 

Just as surgeons should be tested for MRSA, so should all staff, and equally for Covid. Relying on the staff being pro active and chasing a test if they have symptoms, the system should insist on regular testing, especially if the reliability is less than perfect. Rationing tests, which has occurred longer in Wales than in England, is indefensible. Procurement should be National.

Private hospitals are inactive at present, commissioned as “Covid or Fevers” hospitals. While they are out of action the inequality present normally in the UK, whereby the rich can avoid waiting lists, and retain choice, has evaporated. But we have done this by dumbing down rather than equalising up. 

The reality is plain to read in a simple letter… No testing for surgical consultant in Wales.

Truthfulness and Honesty with patients: Surgeons and Staff should be swabbed for superbugs – same as the patients

Health Services still ignoring the process of Evidence Based Medicine – lets save money and use common sense

NHS in England’s condition ‘deteriorating’ – The King’s Fund. John Appleby and Chris Ham tell us the “inconvenient truth” – but there will be no action until after the election.

Reports commissioned by Government and others – but not acted on. A shame on all politicians for their short termism.

Too little, too late. The enquiry must ask why no notice was taken of these reports..

We have still got the option to do things together, like drug manufacturing, procurement, and reversing devolution.

Brett Gibbons reports for Walesonline 24th June 2020: NHS workers should get regular Covid-19 tests in moves to stop waiting lists growing, Labour demands

Analysis shows a big increase in how long patients are having to wait for important diagnostic investigations creating delays in treatment

The reality is plain to read in a simple letter… No testing for surgical consultant in Wales.

Chris Wilson in the Times letters 23rd June 2020 tells it as it really is. If he would only be given an exit interview when he retires. 

The reality is that in Wales, part of the UK, but not part of the English Health Service, we had a different procurement for PPE, and a different procurement for swab testing, drugs etc. The result of trying to purchase for 3m people, a size much smaller than Manchester, is that we are less efficient and less competitive as our demand is for less. Why should a surgeon such as Mr Wilson not have regular testing? He is at high risk just because of where he works, and he could easily be a symptomless excreter. Are any politicians interested in the truth/reality?

The CORONAVIRUS TESTING
Sir, As an NHS surgeon I have worked for the past four months with patients from Covid-19 wards and in theatres, and not once during this time, despite my numerous inquiries and requests, have I been offered testing to see whether I may be carrying coronavirus. Instead I have been told that it is not hospital or public health policy to test asymptomatic staff, despite the higher prevalence of the virus among healthcare workers than in the general population. Yet before being allowed to provide medical cover for my local Championship football team as it resumes its season I have to be tested, with the results available within 24 hours, and tested again before every game.
Chris Wilson
Cardiff

The Truth is out there, but the small number of Post Mortems means it is often missed.

National Health Shambles – The truth is out there (in NHSreality)

Exit interviews, especially if done by outsiders, will tell health boards, politicians and the public the truth. There is no way to get sufficientt GP diagnosticians in time…

At Christmas we should take a break from pessimism, just for one day. But the truth is out there..

Will YOUR local trust be candid (honest and truthful) in a timely manner? No way….

Dementia cannot kill off any one UK Health Service if you exclude it, but understanding is essential to reconfigure..

It is so obvious that in a compassionate society we need to reconfigure the health services, and the social services. The perverse incentive to allocate all  possible conditions  to be classified as  social is so great. Fully funding the “Health Service” means that we don’t have enough money for the Social Service, which is means tested, but for which nobody prepares.

We could initiate laws that forced preparation, but they would be evaded.  Dementia cannot kill off any UK Health Service if you exclude it, but understanding is essential to reconfigure..  With a 40% rise predicted over the next 10 years, Belfast has led the way in this round of comment. But it will be quickly forgotten, as denial, especially by politicians, who will also suffer, becomes the norm, and the media move on again. If the odds are 30:1 we need to cover it..

The Alzheimers Society Jan 12th 2020: The Dementia Time Bomb

Victoria Ohara on 9th June in the Belfast Telegraph: Warning of dementia ‘time bomb’ as 60,000 people in Northern Ireland to suffer by 2051

James Ashworth in the Express says that the number of cases will double by 2050

The percentage of people suffering from dementia in Britain is set to increase from 1.6% to 2.7% by 2050, according to a report by Alzheimer Europe which reviewed 16 population studies

Giles Sheldrick reports 21st June in the Express: “Dementia crisis as £26bn “time bomb” threatens to sink the NHS. (As if it is not sicking already)

40% rise in Dementia cases in 10 years leads to “time bomb”. The Mail. 21st June.

A changing opportunity for the four UK health services.. Solution: avoiding paternalism, for rationing, and for financial probity.

Social care and the impact

of the pandemic – If social care and health care are to be funded the same way, then we can combine them.

Honest and pragmatic solutions to Social Care are ignored – by all parties. ( And the media )

A reminder of where we were .. before Covid…. Locality rationing in a honest way should be permitted by Parliament.

Some doctors in the profession still believe we can have Everything for everyone for ever for free, but they are only approximately 30% of the profession, and dwindling. The real question is whether we have a paternal state that rations covertly, and geographically by post code and depending on its Health Trust’s means. Or whether we ration overtly so that everyone knows what is not available…. and can plan accordingly. Before Covid we were in a terrible state. Now that all the doctors and nurses are heroes, we will be unwilling to contemplate the changes needed without strong leadership.

Nigel Barlow in “About Manchester” 2nd June 2020, which remember has a separate budget for health, and could be considered as a 5th Health Service alongside the 4 principalities, opines: Tough decisions for NHS will mean the public accepting previously unpalatable rationing of care. Which goes to show you can be honest when you have the understanding of the public. Locality rationing in a honest way should be permitted by Parliament.

On Friday 19th November 2019 Dennis Campbell reported in the Guardian  Revealed: NHS plans to ration 34 everyday tests and treatments

Cutbacks to procedures including scans and blood tests to affect millions in England

Millions of patients in England will be stopped from having an X-ray on their sore back, hernia repair surgery or scan of their knee to detect arthritis under controversial plans from NHS and doctors to ration “unnecessary” treatment.

The Guardian has seen a list of 34 diagnostic tests and treatments that in future patients will only be able to get in exceptional circumstances as part of a drive to save money and relieve the pressure on the NHS.

The sweeping changes they are set to propose include many forms of surgery, as well as ways of detecting illness including CT and MRI scans, and blood tests, for cancer, arthritis, back problems, kidney stones, sinus infections and depression. Three of the procedures have since been dropped from the list…….

…“As a result of this rationing, we know that patients who can afford to pay privately are doing so, while those who can’t are going without and suffering. This is exactly what having an NHS is supposed to prevent.”

The 50-page document is the result of months of detailed and until now secret discussions between four key medical and NHS bodies involved in the NHS’s evidence-based interventions programme, which aims to identify procedures that do not work.

They are NHS England; the Academy of Medical Royal Colleges (AOMRC), which represents the UK’s 220,000 doctors professionally; NHS Clinical Commissioners, which speaks for GP-led clinical commissioning groups; and the National Institute for Health and Care Excellence (Nice), which advises the government and NHS which treatments are effective and represent value for money.

They believe many of the interventions should be scrapped, or at most used very sparingly, because they could make patients anxious or even put them in danger. For example, they are suggesting that the prostate-specific antigen test, which is used to detect prostate cancer – the commonest form of cancer in men – is used much less often.

The document says: “Blood tests to check your prostate are not needed except for very specific cases. Blood tests can lead to further investigation that may also be unnecessary and can cause anxiety.”..

Prof Carrie MacEwan, chair of the AOMRC, defended the planned restrictions. “Medicine continually evolves and it’s right that we don’t carry out tests, treatments or procedures when the evidence tells us they are inappropriate or ineffective and which, in some cases, can do more harm than good.

“The list is drawn up by medical experts and senior specialist clinicians who have reviewed the latest evidence from around the world and it’s absolutely right we act on that evidence in the best interests of patients and so that we can focus our resources on things that we know do work,” she added.

And then letters on 3rd December in the Guardian opined:

NHS ‘rationing’ of procedures could be in patients’ best interests

Dr Helen Lucas, Dr Robin Davy and Gerald Maguire say there are good reasons for scaling back on some NHS tests, while Bella D’Arcy Reed is worried that some hospitals are to ration operations including gall bladder removal

I am surprised at the tone of righteous indignation that Denis Campbell uses in reporting the proposed rationalisation of tests and treatment within the NHS (Revealed: basic NHS tests to be rationed, 30 November). The examples he cites where restrictions will be introduced are a list of non-evidence-based practices which either do not help (at best) or actively harm (at worst).

Over-investigation and over-treatment of patients is a real and present problem, as the newly elected chair of Royal College of General Practitioners Council, Prof Martin Marshall, said in his first public statement, reported in your pages on 27 November. It is unethical both to expose patients to unsafe practice and to use NHS resources funding procedures for which there is no evidence.
Dr Helen Lucas
GP, London

Tough decisions for NHS will mean the public accepting previously unpalatable rationing of care.

The public will have to accept a reduced level of service from the NHS in a way that would have been deemed unpalatable just months ago as the service adjusts to a new way of working alongside Covid-19.

A discussion paper by the chief executive of the Nuffield Trust think tank warns that readjusting services to cope with the ever-present threat of infection will mean hospitals reducing the treatment they can provide due to added pressure on beds and staff, unless a fast and effective Covid test is rolled out.

Health care leaders will have to weigh up incredibly difficult choices that will leave people waiting longer and some services unavailable.

Health and the Covid crisis: If you appoint a team of inexperienced sycophants, this is the result.

Why oh why did we get into this position? We don’t have organised contact tracing, we don’t have linkage with GPs who deal with everyday symptoms and we have a team of  inexperienced sycophants following the Johnson “Pan Piper” into the mountain of economic decline as well as pandemic failure. Almost every IT initiative taken by government fails. The national note keeping is still incomplete and inadequate, recruitment website had to be completed by an in house new team because no recognised company would trust them not to change the spec, and now after great expense it is contracted out again! Any youngster, let alone IT expert could have told you apple was a hard nosed company who would never share codes, even in the public and pandemic interest.  So the app has failed, but in other countries apps work? Of course not. This is a distraction from the old fashioned methods that are needed, and there is still no effective and reliable test, so that there is no effective and reliable tracing plan. The economy is going over the edge. We now have to accept that old people will be best in lockdown, whilst the country tries its best to go back to work. In effect we are changing from a NZ (successful there because of low infection rates) to a Scandinavian / Sweden approach. We have no vaccine, and all attempts may fail. To commit to vaccine production before the science evidence shows that it works, exposes just how strained the politicians have become.

Oliver Wright in The Times 19th June 2020 reports: Coronavirus app failure leaves tracing plan in disarray

App to track Covid spread may never reach public4

A smartphone app to track the spread of Covid-19 may never be released, ministers admitted yesterday, as they abandoned a three-month attempt to create their own version of the technology.

Matt Hancock, the health secretary, announced that the government was scrapping its coronavirus contact-tracing app to focus on one developed with Apple and Google technology.

Mr Hancock said that in trials neither of the potential apps was accurate enough to be used by the public and he could not indicate when, or if, a usable version might be available. “The truth is that no app is better than a bad app,” a senior government source said.

Nick Gibb, the school standards minister, said that there was no point in rolling out a system that would subsequently fail. “We want to have ambitious plans to track and trace, and that’s what the app is about, but it has to be properly tested,” he told Sky News.

“There’s no point in rolling out a system that then fails because what you’re asking people to do when they’re contacted by the tracers is to self-isolate and you have to be able to trust the information.”

Ministers played down the setback but it will hamper efforts to lift social-distancing restrictions while controlling the spread of the virus.

Epidemiologists have calculated that the high asymptomatic transmission rates of coronavirus mean that manual contact tracing alone may not be enough to keep infection levels down as lockdown restrictions are eased.

Mr Hancock said that head-to-head testing of the NHS app against the version developed with the Apple and Google technology had revealed flaws in both versions. The NHS software registered about 75 per cent of nearby Android handsets but only 4 per cent of iPhones. By contrast, the Apple-Google model logged 99 per cent of both Android mobiles and iPhones but its distance calculations were weaker. Mr Hancock blamed Apple for the failure to make the government’s app more accurate, claiming that the company “won’t change their system”. He pledged to “join forces” with the two tech giants and “bring the best bits of both systems together”.

“We found that our app works well on Android devices but Apple software prevents iPhones being used effectively for contact tracing unless you are using Apple’s own technology,” he said. “Their app can’t measure distance well enough to a standard that we are satisfied with.”

Officials said that the Apple-Google model was unable to differentiate between a phone that was in someone’s hand three metres away from a phone that was in someone’s pocket one metre away. “That is a really important distinction if you’re going to use the app to determine whether or not you spend 14 days at home,” one official said.

In a sign of the breakdown in trust between the two sides sources at Apple said that it had not been informed of the announcement or consulted about the plan to work together. “We don’t know what they mean by this hybrid model. They haven’t spoken to us about it,” a source said.

The company also queried the claim that its model was less accurate at measuring distance than the government’s NHSX model. “It is difficult to understand what these claims are as they haven’t spoken to us. But the app has been downloaded by six million in 24 hours in Germany, the Italians have had it going since Monday, the Dutch government and Irish government have it, and there has been no issue about proximity detection.”

Contact-tracing apps work by logging when two people have been in close proximity to each other for a substantial period of time. If one of them is later found to have the disease, an alert can be sent to others they have recently been close to, telling them they should also get tested and/or self-isolate.

Mr Hancock said while he was “confident” that an app could eventually be made to work he refused to set a target and said that he would not be following other countries who have launched apps on Apple’s software. “The central point of test and trace is that when you are identified as at risk you then isolate, and asking people to isolate for two weeks is a big thing,” he said. “I would not recommend an app, unless I’m confident in it.”

The failure to make the NHS app work was welcomed by privacy campaigners, who complained that the government’s “centralised” approach gathered too much information about phone users. Apple itself declined to comment.

Meanwhile it has emerged that the “army” of 25,000 staff hired by the NHS to carry out manual contact tracing is doing just 11 per cent of the total work, with the vast majority completed by public health professionals.

Chris Smyth reports in the Times 19th June 2020: NHS to stock up on potential coronavirus vaccine

Joe Curtis in City AM reports 15th June: Astrazeneca to supply Europe with 400m doses of Oxford coronavirus vaccine

Update 21st June

The NHS coronavirus app was a vain attempt to take on Big Tech. No 10 was always going to lose that battle

Robert Colvile

On the face of it, the NHS app saga is another great British technology fiasco. When the coronavirus hit, Apple and Google — whose software powers 99.79% of the UK …

Why has the NHS tracing app been abandoned?

Tom Knowles

… still log each other’s details.Why didn’t the government adopt this model?The NHS wanted to use a centralised model in which someone tells their app that they …

Friday June 19 2020  |  The Times

A prostatically slow service …… multiple pathologies are best addressed by GPs

The “reality” is that elderly people with multiple pathologies are not going to be seen and treated as fast as they were beforehand. Actually the wait was often several months for a Prostatectomy, with a catheter in situ, even beforehand. Now any sensible person can expect a longer wait, and all the complications that occur from multiple indwelling catheters. There are short term trauma issues, but the main problems relate to the longer term. (Urotoday).

To now mainly GPs have rationed the access to secondary and tertiary care, but politicians do this as well, as Wales limits choice severely. The efficiency of GPs was emphasised by the Kings Fund recently. The GPs ability to live with uncertainty, and use time as a diagnostic tool is much valued by other countries, especially their Ministers of Health. Sir David Haslam is right…(see below)

‘ROLLS-ROYCE’ NHS
Sir, In his thought-provoking column asking, “What the NHS can learn from Rolls-Royce” (Jun 12), Ed Conway asks, “does it make sense to have generalist local doctors?” and proposes an increase in specialist care. Like all GPs, I recall many patients who had eight or more significant separate conditions. Indeed, in the UK there are more people with two or more long-term conditions than with just one. Ed Conway’s specialist focus would condemn such patients to a life of never-ending appointments with different doctors, which would be a time-consuming recipe for potentially disjointed care.

High-quality generalism, treating the whole person, has never been more important or more needed.
Sir David Haslam
Chairman, National Institute for Health and Care Excellence, 2013-19

Ed Conway: 12th June 2020 in the Times. What the NHS can learn from Rolls-Royce – Technology that allows manufacturers to fine-tune products could overhaul the health service

….Ways of working that have become entrenched over decades are being shaken off. Most obviously, GP appointments are happening remotely, and some of those habits may stick. That’s no bad thing given that primary care is one of the least efficient bits of the health system, too slow to process patients or detect problems before they become life-threatening.

More interesting still is what’s happening with data. A coherent patient records system is the tantalising goal of most NHS modernisation schemes, yet only 13 per cent of GP practices have fully digitised their paper records. Now, with doctors suddenly having to work from home and see patients remotely, digitised records suddenly make much more sense — to the doctors themselves, not only to some Whitehall pen-pusher.

This prompts deeper questions: does it make sense to have generalist local doctors, or should we create regional health centres where specialist GPs could remotely monitor patients with diabetes or other chronic conditions? That idea, by the way, summons up the kind of NHS Aneurin Bevan wanted in the first place before the GPs blocked it…..