Aside from the fact that there is no NHS, Morten Morland: Weaponising the NHS appeals to me. Its one way to reduce management!
This was my first post afterwards: Midwifery in Crisis. A disgraceful reflection on the declining standards and tribalism across the health services. This is not confined to one trust but is endemic, and especially at unpopular and remote District General Hospitals.
In October NHSreality opined that Current health services management needs to go into administration… and in February reflected that Mr Hancock’s reforms are irrelevant to the longer term and bigger issues need to be addressed… Drs failed or were disbarred from involvement in management many years ago. Part of the reason was that they realised the system was broken – and their efforts would be futile. Wales and Scotland are free to differ – of course, as there is no NHS. If we are to have managed decline/rundown then we will need administrators as well as managers, but nobody in the health services admits to being an administrator! There is only one route out of management in the health services, and that is to retirement. Private industry has learned that most health service managers are only usefult to explain the “rules of the game” to their boards. Procurement is a disaster, and no lessons are learned from other countries’ systems! Heracles cleaned the Augean Stable with a revolutionary methodology…. diverting rivers. Nothing can be done in a short time about so many of the problems, such as having enough GPs, but the structure and rules can be changed so that the deficiency is corrected in the future. After all there are still no “exit interviews” (no honest feedback) and the cultural issues associated with the highest sickness and absenteeism rates in the world remain (BMJ May 2018). Covid has just added to this..
Figures show more than 8,000 health service penpushers are now paid at least £80,000 a year.
That includes 36 who rake in more than £250,000 – at least eight times more than a qualified nurse.
While 7,018 pick up between £80,000 and £129,999 a year, a further 1,071 are paid £130,000 to £199,999 and another 114 get between £200,000 and £249,999.
The number of staff on more than £250,000 has risen 50% in a year, to 36.
Calls to cull failing managers… but the rules of the game dictate their failure…
The revolving door of health service managers….. mismanagement is nothiong less than neglect.
September 2017: Golden goodbyes for NHS managers soar to £39m
April 2017: NHS managers still growing as GP posts fall & HSJ implies Managers and Directors are now at odds with Politicians over rationing..
Procurement and Profligacy. Too many cooks in the 4 different health services…
The HSE document on workforce planning 2015 -2025 is a joke. Read it and wonder how disconnected our politicians are from reality.
Denial is an interesting emotional block.
Denial BY GEORGE HERBERT
When my devotions could not pierce
Thy silent ears,
Then was my heart broken, as was my verse;
My breast was full of fears
And disorder.
My bent thoughts, like a brittle bow,
Did fly asunder:
Each took his way; some would to pleasures go,
Some to the wars and thunder
Of alarms.
“As good go anywhere,” they say,
“As to benumb
Both knees and heart, in crying night and day,
Come, come, my God, O come!
But no hearing.”
O that thou shouldst give dust a tongue
To cry to thee,
And then not hear it crying! All day long
My heart was in my knee,
But no hearing.
Therefore my soul lay out of sight,
Untuned, unstrung:
My feeble spirit, unable to look right,
Like a nipped blossom, hung
Discontented.
O cheer and tune my heartless breast,
Defer no time;
That so thy favors granting my request,
They and my mind may chime,
And mend my rhyme.
Whilst there is little industrial economy to keep open in Wales, the English society and services have been kept more open and less restricted than the other dispensations. The English econmy is the biggest and most important in the 4 Health Service areas, and so it is natural to close down those economies that produce less, and have more concentrated poverty, unemployment and close living. This explains the differences in the apporach of the 4 ministers of health. It emphasises and confirms to those who know, that there is no “National” health system any longer. Alex Therrian for BBC news 23rd December reports on “Social care: Immigration rules to be relaxed to recruit staff”, and this despite Brexit! The change could help all 4 health systems of the UK. The HSE document on workforce planning 2015 -2025 is a joke. Managed decline means more private care and more inequality -in standards and life expectancy..
Secretary of State for Health and Social Care (Englsnd), – The Rt Hon Sajid Javid MP
In Wales: Vaughan Gething was replaced as Wales’ health minister by Eluned Morgan in may 2021. In Scotland Humza Yousaf MSP is Cabinet Secretary for Health and Social Care
Fears if an overwhelmed NHS (Fears NHS could be overwhelmed by London Omicron surge – Chris Smyth in the Times) may be overstated, as is the reporting of absenteeism. But the reluctance of modern doctors to work in A&E as shift pattern medics into their old age is unsurprising ( Mark Smith for Wales on Line 21st December 2021 ) Ben Clover in the Health ServiceJournal 20th December reports “NHS in London ‘likely to be overwhelmed’ by early January, says leaked report”
In my own area there are severe recruitment problems for the forseeable future (decades) and with recruitment into Welsh speaking areas more difficult than to English speaking areas of Wales, one would have thought that any new build would be in Pembrokeshire, where there are more people, especially int he summer, and the distance to travel to tertiary care is further. Politics dictates otherwise. An announcement is expected soon, but in view of the Synod finances there may simply be a predictable procrastination.
In the letters section of the Guardian Madeleine Worrall on waiting for emergency surgery, and Helen Hills on the everyday anguish in care homes report “The NHS has already buckled under Covid – I know from painful experience2 17th December 2021. Indeed, social workers are paid little and hard to recruit:
And through all this the staff are expected to keep their compassion:
All over the country GP practices are closing. The total full time equivalent of doctors working has gone down rather than up since the governement promised to create over 5000 new GPs! (May 31st 2019 The Times Scotland Helen Puttick, Scottish Health Correspondent) This is just one of a multitiude fo reports from Local and National newspapers and websites on GP closures and shortages.
The effect of Brexit on Health and Living Standards will be in the final report from the Nuffield Trust later in 2022. Meanwhile this report looks at medicines and devices, international trade agreements, devolution, procurement, workforce and Northern Ireland. There is not much good to be said about any of the Brexit related changes. Add to this the threat of our being excluded from the European research programme and readers will understand how populism has affected us all and our futures – badly. (BBC News 21st December). This also impacts the quality of Medical Education.
Mark Dayan and many others reporting forThe Nuffield Trust: Going it alone: health and Brexit in the UK 20th December 2021
After nearly a year out of the Single Market and Customs Union, Brexit is still fuelling uncertainty in many aspects of health and social care. This report looks at six key areas that are being impacted, what has already happened and what NHS, government and business figures expect for the future.
The pdf report at Nuffield Trust
When the UK left the single market, it marked the end of the application of European law and institutions which underpinned many elements of health and health care in the UK. Regulations on medicines and devices, laws on the buying and selling of care, trade agreements, and rules on migration which had previously worked across most of a continent, were repatriated to the UK.
This report, an interim output from the Health and International Relations Monitor project funded by the Health Foundation, considers the impact of leaving the EU and changing international relations for health.
It considers changes in health across six key areas: medicines and devices, international trade agreements, devolution, procurement, workforce and Northern Ireland.
In the full report to be published in the Spring, we intend to examine two of the building blocks of health most affected by Brexit – workforce and living standards.
The Pareto Principle is what happens in outcomes of many systems. Becase the 4 health services suffer from the same effect I will add this to what remains “National” in the post questioning it still exists. In other systems the higher level of insurance or private care is encouraged for the rich, and creates a two tier system. Aneurin Bevan wanted to avoid this, and for the miners of Tredegar to have the same health prospects and outcomes as the bankers of London. It worked by being universal, and well funded whilst technology was slowly advancing. The pace of advance of tech has now led to a situation where no government can keep up without rationing. Its just a question of whether this is overt or covert rationing. Remember that there is no fine for DNAs, even in mentally competent people. The Times’ Kat Lay reports 21st December 2021: Just 10% of patients account for 40% of appointments with GPs
Forty per cent of GP appointments are taken by 10 per cent of their practice’s patients, research has found.
The study, published in the journal BMJ Open, looked at “frequent attenders” and their impact on doctors’ workloads. By analysing almost 1.7 billion consultations over two decades, researchers at Manchester University found that this group visited their doctor five times as often as other patients on a practice’s list.
Professor Evan Kontopantelis, the study’s co-author, said: “This is the first study to show that frequent attenders, the top 10 per cent of consulters, have largely and progressively contributed to increased workload in general practices over the last 20 years.”
In 2001 frequent attenders accounted for 36 per cent of in-person consultations at surgeries. By 2019, the latest year covered, it was 40 per cent. The study used anonymised data from 845 practices and 12.3 million patients, between April 2000 and March 2019.
At the start of that period frequent attenders saw their doctor 13 times a year on average, rising to 21 times at the end. When consultations with all types of practice staff were included, they went from 27 per year to 60.
For all patients, the averages went from five to eight a year for GP consultations and from 11 to 25 for all practice staff.
The study found that GPs were carrying out more consultations over the telephone and online but face-to-face appointments for frequent attenders continued to increase.
Aneez Esmail, a professor at Manchester University, another co-author, said: “Our findings show that frequent attenders account for an increasing proportion of face-to-face consultations with GPs and are responsible for nearly 40 per cent of consultations fairly constantly over time.”
Maria Panagioti, a fellow co-author, said that the findings could suggest a need for more multidisciplinary staff.
What is National About the Health Services in the UK? I have thought of 10 areas… (Added Pareto effect 21st December 2021)
Most of the population still trust doctors, especially experts in the public eye like Dr Whitty and Dr Vallence. However the movement to reject expertise is strong and getting stronger. Until the North Staffordshire by election i suspected that many of the public would still be persuaded that idiots, chancers and shallow thinkers could continue to rule us; after all they rejected the advice of the economists over Brexit: and were hoodwinked.. Most of the population now distrust politicians. Most of the medical profession hope he is mortally wounded, and that populism will die with the gambler PM.. Trust is essential. Without trust politicians have to go..
In the Times letters 18th December 2021:
TRUST IN WHITTY
Sir, How readily MPs who criticise Chris Whitty for doing his job (“Wait until after Christmas for verdict on further Covid curbs”, news, Dec 17) have forgotten that it was his idea to create the vaccine taskforce that kick-started our fight back against Covid-19 and has saved more than 100,000 lives in England. Professor Whitty has been criticised for giving a professional opinion, because he has not been elected to office. The reason his advice has had such resonance with the public is because of the vacuum at the heart of government.
Gordon Lethbridge
Sherborne, Dorset
Sir, I agree with those who say the British public is perfectly capable of making up its own mind about what it should do (letters, Dec 17). It has demonstrated this by opting to follow the advice of Chris Whitty. There are very high levels of trust in doctors, nurses and other health professionals.
Lord Crisp
Chief executive, NHS England and the Department of Health 2000-06Sir, It is not mathematically possible to stop the effects of the Omicron variant on the NHS or the economy with a vaccination campaign alone. It is simply too infectious. Additional measures are needed. To call them restrictions plays into the hands of those who rail against them. They are prudent precautions. In the case of masks and Covid passes they would open up the economy. If they had been in place now the restaurant industry would not be haemorrhaging customers at this important time. We would all have felt safe to go.
Dr Jeremy W Tankel
Medical Director, Salford Clinical Commissioning Group
Matthew Parris opines in the Times 18th December 2021: Tories have swallowed the poison of populism – Pandering to Ukippers delivered a temporary cheap thrill to the Conservative Party but it is now paying a heavy price
………….” The party has lost its bottom. Helen Morgan, the Lib Dem by-election candidate, will have hit the right nerve among rueful Tory supporters when, in her victory speech in the small hours of yesterday morning, she called recent Conservative governance “a nightly soap opera of calamity and chaos”. Populism will always yield that result because tummy-tickling can never be a recipe for sound government.
Since the European referendum campaign began, the Conservative Party has been poisoning itself, and the toxin is called populism. At first the experience was intoxicating, heady. Now the party’s getting the shakes. The cure will require more than the removal of one man.”
The Wound And The Doctor: Healing, Technology And Power In Modern Medicine by Glin Bennet 1987
Hywel Dda have produced their feedback report after consultation. If you fed into this process you may be interested to read and comment. The future of H/west depends on this decision ….
My comment, from NHSreality.wordpress.com is that there is no demographic data on the distribution of people, especially during the summer / tourist season which will almost certainly push the location towards Pembrokeshire rather than Carmarthen. There is also no talk of combining with Abertowe Board. The main driver omitted is recruitment, and without stating which services are paramount in the new build, i remain unconvinced that West Wales can recruit. Any new build needs radiotherapy, advanced nuclear medicine, and stent insertion / CABPG (coronary by-pass) in order to attract young ambitios doctors. In a world of undercapacity we are competing for a limited supply for the next 10 years.
NHS Highland expects to pay out £3.4 million in settlements in response to a review into bullying allegations at the health trust.
The review was commissioned by the Scottish government in 2018 after whistleblowers reported hundreds of complaints and described the culture at the Trust as “bullying”.
An independent review panel has so far assessed 150 complaints and is expected to pay the complainants more than £2 million in settlements. Two of the settlements came in between £60,000 and £95,000, and 61 were smaller pay-outs of between £5,000 and £15,000.
In a report to the Trust’s board meeting this week, it was revealed the final settlement is likely to be around £3.4 million.
The review was led by John Sturrock QC, who received submissions from 340 people across different departments and trusts at NHS Highland. More than 280 staff took part in face-to-face interviews or sent in written submissions.Two-thirds of these submissions involved experiences of bullying, the review found.
Employees reported raising concerns regarding patient safety, and the review concluded that “many described a culture of fear and protecting the organisation when issues are raised”.
It made a number of recommendations, including educating staff on the impact of bullying and providing an independent and confidential whistleblowing mechanism.
Brian Devlin, one of the whistleblowers and former director of corporate affairs, said it was “heartening” that the payouts were emerging as “the results of a healing process”.
But he told BBC Scotland that bullying persists at the health trust and he continued to have concerns.
NHS Highland responded that it did not tolerate bullying, describing its follow-up as a “unique and bespoke process, developed to support people in recovery”. This includes not only the financial payments but access to therapy and apologies.
Fiona Hogg, director of people and culture at NHS Highland, told the BBC: “The nature of the process is that it hears the participants’ perspective and account only, it doesn’t seek to allocate fault or blame, so it’s entirely different to internal processes and tribunals, which seek to establish that. It’s all about healing and what will best aid that process.”
NHSreality posts on bullying in the health services.
Without changing the “rules of the game” the task of integration is impossible. Health care is not means tested, but social care is. If two games players work to different rules they cannot play together…
NHSreality opines on changing the “rules of the game”. (Herbert Simon)
NHSreality posts on “Integrating Health and Social Care”.
NHS reality. An NHS soapbox. Speakers' corner for the NHS. 