The blood scandal “was criminal negligence”…

The problem of blood cross infections stemmed from a lack of donors. We still dont have enough, which is surprising when the “NHS is the nearest thing to religeon in the UK”. So we buy and import blood and blood products from abroad. Screening this blood is much safer now, but would it not be better if we had a surfeit from UK citizens? Artifical blood was mooted in 2015, but has got nowhere fast. Cancer cured patients are still excluded, and this is becoming a large percentage of a grateful population. Why not use them? Yes, criminal negligence but also little long term planning for a sustainable blood transfusion service.

INFECTED BLOOD SCANDAL – The Times letters 29th June 2022
Sir, Sir John Major is wrong: the infected blood scandal was not “incredibly bad luck” (report, Jun 28), it was criminal negligence. In the summer of 1982 I was in New York biding time until I caught a return flight. Seeing a medical trailer advertising $5 for a blood donation, I took advantage of the offer, as my pockets held only a few dimes and a ticket to the airport and I needed a coffee and a sandwich. There were no secure medical checks to ensure that I was not infected: I simply filled in a form saying I did not inject illicit substances. My fellow donors included some fairly rough characters whose blood I wouldn’t have touched by a country mile. No doubt some of their infected donations was added to the pool that the NHS purchased.
Andy Palmer
Mappowder, Dorset

Eleanor Hayward reports 27th June in the Times: John Major calls infected blood scandal bad luck – Survivors criticise former PM’s evidence to inquiry

2018: Do you carry a transplant donor card? Have you told your next of kin and children? Former cancer patients should not be excluded from being donors, of both blood and organs.

2021: Infected blood – deaths claim. What was the motivation for long term buying from abroad? and There is enough cross infection withon our overcapacity hospitals without importing it from outside the UK. We should have no need to import blood or blood products, and policy needs to be altered to ensure self sufficiency.

Relatives of registered organ donors block more than 100 transplants a year

2015: What is artificial blood and why is the UK going to trial it?

Self determination in palliative care? “It is easier for both doctors and patients to launch into a conversation about the treatments available and how they will be given and then begin the treatment”…. than to talk honestly.

It was predictable that Baroness Finlay would challenge Lord Carey of Clifton, the Archbishop of Canterbury. Sometimes reflection and experience can change ones mind, as it has for Lord Carey, but despite a majority in the profession doing the same, the Baroness remains adamant. Following these two letters is Richard Smith’s “Death and the bogus contract between doctors and patients” BMJ 2022; 377:o1415 now chair of the UK Health Alliance on Climate Change. Death and Climate Change seem to be two subjects that share different forms of denial. Sometimes a patient needs more than one doctor consulting him about a serious illness with a “no win” choice to be made. Oncologists consulting alone are not equipped to offer realistic choices to patients they are meeting for the first time. A palliative care doctor or a GP with a special interest might be appropriate.. or referral back to their GP for discussion about options. If “The Health and Care Act 2022 now requires the NHS to provide palliative care services.” and this is implemented, we might see some changes to the post code differentials. NHSreality asked for this 8 years ago. Richer areas may have hospices and poorer areas have often choose “hospice at home” as a pragmatic reality. Citizens may prefer the former, but patients often prefer the latter, and this form of care is certainly less capital intensive and demanding. How will government reconcile this dissonance? Hospice at home is educational and certainly not “bogus”. My search of the new act gets no hits for “palliative” or “terminal” care….

ASSISTED DYING 27th June 2022 in the Times
Sir, The Church of England is reportedly adamant that it will maintain its official policy on assisted dying at the General Synod next month (report Fariha Karim “Church of England vows not to support assisted dying law,” Jun 24). I would expect, therefore, that the church still strongly supports a royal commission on the topic, a stance adopted in 2014. This was backed at the time by senior clergy including the Archbishop of York, John Sentamu, during debates in the House of Lords on Lord Falconer of Thoroton’s Assisted Dying Bill. Since then, the argument for a review of our laws has strengthened.

With proposals for assisted dying legislation progressing in Scotland, Jersey and the Isle of Man and with states and nations across the Commonwealth and Europe continuing to legalise this option, it is only right that we reflect on what our present laws really mean for people at the end of their life and their families.

If the church were to revoke its support for an inquiry, it would raise serious questions about whether it is truly committed to fair and open debate. And in that spirit surely it is time for church leaders to listen to people in the pews who, like me, have changed their views as a result of seeing terrible suffering and indignity towards the end of the lives of those they know and love.
Lord Carey of Clifton
Archbishop of Canterbury, 1991–2002; Newbury
(The Times of Malts explores this further in “Who decides when a person should die?” 27th June 2022)

and in 2005 “Is political correctness undermining Christianity?

PRIORITY OF PALLIATIVE CARE The Times 28th June 2022
Sir, Lord Carey of Clifton (letter, Jun 27) overlooks the important advances in care of the dying, and still proposes death as a solution to medical problems. The Health and Care Act 2022 now requires the NHS to provide palliative care services. Until now, palliative care needs had to be met by charitable fundraising, leaving more than 300 people a day unable to access specialist palliative care. The Church of England leaders are calling for better care for all: they recognise the dangers of licensing doctors to provide lethal drugs (“Church vows not to bend on assisted dying law”, Jun 24). Such lethal cocktails are experimental and unevaluated. Campaigners’ proposals have not contained safeguards, only vague qualifying conditions, which are easily widened in scope to include serious conditions such as anorexia.

Palliative care doctors in Canada now report that patients are fearful they will be offered death rather than care. Neither physician-assisted suicide nor euthanasia has a place in modern medical care. People need high-quality care at all times, not fatal shortcuts.
Professor Baroness Finlay of Llandaff, director, Living and Dying Well;
Dr Claud Regnard, director, Keep Assisted Dying Out of Healthcare

Update 29th June : END-OF-LIFE CARE
Sir, I join Professor Baroness Findlay of Llandaff and Dr Claud Regnard (letter, Jun 28) in welcoming the requirement for the NHS to provide palliative care. However, I disagree with their conclusion that the fear of Canadian palliative care patients of being offered death rather than care is a basis for rejecting assisted dying. A patient’s fear is often very different from the reality; it behoves palliative care doctors to deal sensitively with that fear. Individuals should not be denied the right to decide their future when that future has become intolerable.
Dr Allison Wroe
Edinburgh

Death and the bogus contract between doctors and patients.
Perhaps medicine is best understood when it confronts death. “That distinguished thing,” as Henry James called it, highlights misunderstandings, confusions, and contradictions. Until the 16th century it was not an aim of doctors to try and hold back death. God, in all his and her various manifestations, decided when people should die. It was not for doctors to get in the way of death. Indeed, to try and do so would be to insult God. The Renaissance philosopher and scientist Francis Bacon (1561-1626) was the first to argue that it should be one of the tasks of doctors to battle with death. But it was not until the middle of the 20th century that medicine developed effective means to delay death. Since then, medical research has been much more concerned with diseases like cancer and cardiovascular disease that are major causes of death than with conditions like depression and musculoskeletal and skin diseases more associated with suffering than death. (I remember hearing an American psychiatrist argue that psychiatry made a strategic mistake in not emphasising more that severe mental health problems are an important cause of premature death.)
Death attracts more research funding than suffering. Ironically, the medical specialty most associated with death, palliative care, attracts only paltry research funding because it is concerned with accepting death not defeating it. Is medical research out to defeat death? Certainly, large sums are being invested in dramatically extending life if not in defeating death altogether. Much of this investment is on the West Coast of the US where all of life’s problems, including death, are seen as soluble with enough money and genius. Conventional medical research is not aiming explicitly at defeating death, but implicitly it seems to be: it is aiming at curing all diseases.
Medicine’s implicit mission to defeat death provides the context when a doctor meets a patient with a life-threatening disease. This is when the bogus contract between doctors and patients may be at its most pernicious. I’ve written several times about the bogus contract, and at its heart is patients thinking doctors to have greater powers than they actually possess and doctors being painfully aware of the limitations of their craft but being reluctant to be fully open about those limitations.1 For patients it’s wonderful to believe that doctors can fix most of their ills. For doctors the gap between what patients wish they could do and what they can do is uncomfortable, but doctors may worry that a full confession may limit their therapeutic power and perhaps their status and income. The media contribute to the bogus contact in that they prefer tales of what look like medical miracles to medical disasters.
When patients with life-threatening illnesses consult doctors, they hope, or may even believe, that the doctors will be able to hold off, or defeat death. The doctors make their assessment and let us suppose for this discussion that they think that there is a 10% chance that they can keep the patients alive for five years. The doctors know that the patients will suffer great discomfort during the treatment and have a 90% chance of dying within a few years or even months.
What should the doctors say? To the rational person, perhaps an economist, it seems simple: the doctors should present all the options with as much information as possible. If a patient says, “You do what you think best, doc,” the doctor should say, “I can’t do that. This is your life. You are a unique individual you must decide, probably after talking to family and friends.”
Such conversations are rare. These are emotionally-charged encounters with death watching both patients and doctors. Patients want to hear that doctors can cure them, quickly and with minimal pain and discomfort. The doctors know what the patients want to hear, but will know that cure is highly unlikely, probably impossible, and that the treatment will be prolonged and involve much discomfort. The doctors wish that they could do more and may be attracted by new treatments of uncertain benefit.
The conversation that needs to happen has been called “the difficult conversation,” although others prefer “the anticipatory or essential conversation.” We know that it often doesn’t happen, and the Lancet Commission on the Value of Death (which I cochaired) lists many reasons why the conversations don’t take place: busy clinics; fear of extinguishing hope or creating despair; difficulties finding the right language; the fix-it, protocol-driven culture of much of medicine; lack of clarity about whose job it is to start and hold the conversation; and perhaps even cowardice.2
It is easier for both doctors and patients to launch into a conversation about the treatments available and how they will be given and then begin the treatment. One result is that patients can be days or even hours from death without either the patients or their families aware that the patients are about to die. Another possibility is that the palliative care team is asked to come and hold the conversation that should have taken place weeks or month before.
The bogus contract where patients believe that doctors can do more than they can and doctors go along with the belief is highly—I might even say fatally—attractive to both patients and doctors. But ultimately it causes excess suffering for patients and infantilises them, while doctors are left with the discomfort of being evasive, dishonest, or cowardly. The bogus contract also explains why, as the Lancet Commission found, 10% of annual health expenditure is spent on the 1% who die in that year.2
It takes courage from both patients and doctors to move beyond the bogus contract in all of healthcare, but especially when death is close, but everybody—patients, doctors, other health professionals, citizens, and taxpayers—stand to benefit.
FootnotesCompeting interest: RS was a cochair of the Lancet Commission on the Value of Death, which argued for the demedicalisation of death and it becoming much more a partnership among patients, families, communities, and health professionals with health professionals as supporters rather than leaders.

Feb 2022: We’ve got death all wrong, say doctors. Too much health service money is spent on our last years on “treatments” and not enough on “caring”. Teamworking is key.. GPs or palliative care specialists should be present at oncology clinics.. and Palliative care and levelling up.. Needs wants and demands for care..

Sep 2021: The perverse incentives and the post code lottery in palliative care both need addressing..

Feb 2021: Palliative care: Experts call for major reforms as pandemic accelerates demand by 20 years

Nov 2020: Assisted dying and good palliative care are NOT mutually incompatible.

Feb 2018: Choice and self determination in palliative care. Those in charge of us think they know our “will” better than we do…

2016: Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

2016: GP workforce crisis set to undermine palliative care, BMA warns

2014: GPs should be encouraged to take on palliative and terminal care out of hours..

2014: Palliative and Terminal Care should be fully funded.

Local Government: Key provision of the Health and Care act 2022 – I see nothing in the LGA comments about palliative and terminal care.

David Oliver: A new legal duty to provide specialist palliative care BMJ 2022;377:o1146

The Times letters 2nd August: SURGICAL CHOICE
Sir, I welcome Mark Cheetham’s approach to collaboratively informing older people about their choices about prospective surgery (letter, Aug 1). Critical to the decision-making, though, should be where these patients will be cared for immediately after their operation, during rehabilitation and for the long term. This will significantly determine the success of the op. However, neither of the leadership contenders for prime minister, nor successive governments before them, have addressed this issue of cost and the acceptable provision of long-term care for older people. This is how operation numbers for older people are kept low and how censorship works in reality.
Christina Sell
Managing director, Arbour Companions and Care

A disastrous new contract is being used to whip, rather than stimulate and recruit, General Practitioners…

Consultation followed by negotiation! With a recruitment balance of 8:2 Females to Males in medicine as a whole, and even more scewed in General Practice, the new “imposed” contract in England is not going to help recruitment. Hopefully it might be different in the other dispensations, but recruitment there is even harder. Parents who both work, and who have young children, will resent this “interference” in their hitherto normal family life. A complete lack of realistic manpower planning has led to this situation, along with the short termism of our politics. While there were 11 applicants for every 2 places 10 years ago, there are now 3 for every 2. Why not appoint all and weed them out during training. The current impasse means that juniors are disillusioned with the BMA hierarchy and membership will fall. As things break down further politicians and civil servancts might like to reflect on the brief / job description that they gave for their “negotiator/interpreter”: Dr Nikki Kanani. (Appointed 2019) Her approach is partly resonsible for the breakdown, but this is also because of the BMA’s toxic culture.
Caitlin Tilley reported in Pulse 1st March 2022: GPs in England face imposed contract this year, says GPC negotiator A BMA GPC negotiator has said that the 2022/23 changes to the GP contract have been imposed without the agreement of the trade union. Under the changes, primary care networks will be required to provide a full range of services from 9am to 5pm, & on weekends, as part of General Medical Services…

On 3rd March Pulse reported:  GPC negotiator resigns to have ‘normal family life’ amid contract fallout

Caitlin Tilley reported in Pulse 4th March 2022 GPC negotiators were ‘consulted’ on new GP contract, says NHSE GP lead The BMA GP Committee’s negotiators were ‘consulted’ on the new GP contract changes for 2022/23, NHS England’s primary care medical director has said. NHS England this week announced the GP contract changes for 2022/23, which said that PCNs in England would need to offer routine services between 9am and 6pm on Saturdays/Weekends.

on 17th May Pulse reported: Calls for primary care director to resign. On 18th May The Standard reported: Hundreds of GPs call for NHS England executive to quit

On 6th June Pulse reported: BMA to vote on organising GP withdrawal from PCNs by 2023 and a day later the Independent reported: Half of GPs ‘plan on retiring aged 60 or before’ – “The Government has promised 6,000 more GPs by 2024 but are not on track to deliver this, but they cannot give up on it.” BMA GP committee workforce policy lead Dr Samira Anane … and the reason: Violence at health centres and GP surgeries ‘almost doubles in five years’

On 18th June the Telegraph reported: GPs threaten to strike over extended opening hours contract and MailonLine: GPs are threatening to STRIKE over contract that will force practices to offer face-to-face appointments on Saturdays and until 8pm on weekdays

On 22nd June Pulse reported that the RCGP was warning: RCGP demands action to avoid 19,000-strong ‘mass exodus’ of GPs and trainees

GP contract changes England 2022/23 – BMA

2021: Overview – Salaried GP model contract toolkit – BMA

CABINET STATEMENT – Written Statement: General Medical Services (GMS) Contract Reform for 2021-22 (Wales)

Policy Primary care services Scotland

Overwhelmed health service is broken, says leading medic in Northern Ireland

Pulse 22nd June:  Flagship overseas GP recruitment programme filled 124 positions out of 2k target

2nd June 2022: The ‘toxic’ BMA culture and how it affects grassroots GPs

Medical staff pension scheme is still exceptional. Threats to strike may harden the chancellor’s thinking…

In 2011 the govenment changed to pension calculation basis from CPI to RPI for most schemes. Not the NHS which still follows the CPI (NHSBSA) . THE Consumer Price Index (CPI) is a measure that examines the weighted average of prices of a basket of consumer goods and services, such as transportation, food, and medical care. It is calculated by taking price changes for each item in the predetermined basket of goods and averaging them. (Investopedia) “The Pensions Act 2011, in force from January 2012, replaced the Retail Prices Index (RPI) with the Consumer Prices Index (CPI) as the Government’s measure of inflation used for determining minimum inflation-proofing for deferred pensions and pensions in payment from occupational pension schemes.” Now the Mirror reports that the government wants the basis for the calculation of the RPI. (Thousands of pensioners warned they could lose BILLIONS under retirement changes – Sam Barker in the Mirror 23rd June 2022). “….. the Government wants to change how RPI is worked out, bringing it more in line with CPI.” Oliver Wright in the Times reports 23rd June 2022: State pension to rise 10% next year despite warnings on pay …”but the chancellor wishes to return to the system by which the annual state pension rises by inflation, average earnings or 2.5 per cent, depending on which is highest.” Rents are included in the CPI, because they are expenditures that are “consumed” in current period of time. But house prices are not, because they are expenditures on an asset to be consumed over many years. If you own a house, you will benefit from the rising prices–if and when you sell it.

What’s currently linked to RPI?

• Final salary pension payments
• Income from index-linked annuities
• Income from some index-linked bonds
• Regulated rail fare rises (and wage negotiations for rail workers)
• Mobile phone tariff price rises (the maximum rise allowed without triggering your right to leave the contract early)
• Vehicle excise duty (better known as car tax)
• Air passenger duty rises
• Tobacco and alcohol duty rises
• Interest on student loans

Two areas of interest are Medical Expenses (used in the CPI in USA) and House price inflation and the latter is usally excluded. If house prices were included in CPI, we would definitely have had inflation rather than deflation over the last decade, so the right action would have ben to increase the bank prime rate of interest, which would also have lowered house prices.. If Medical expenses in the UK were to rise (means tested co-payments?) , this too would add to the real inflation rate.

Many of the GPs now planning to resign (GPs planning to resign: “The intensity and complexity of our workload is escalating while numbers of fully qualified, full-time GPs are falling” RCGP chair.) have now maxed out their pension contributions at £1m, but they will still benefit from annual increase.

The Guardian 23rd June 2022 warns us all that NHS staff are thinking to strike:

The Independent Chris Massey opines 20th June 2022: NHS strikes are unprecedented but this year they have the potential to unite the UK against the Government – Public support for the NHS suggests that the Government will have a huge task trying to justify a below inflation increase

Hayley Dixon in the Telegraph 20th June 2022: NHS pay demands would gobble up £4.8bn from National Insurance rise – A number of the biggest health service unions are threatening strike action unless their salary requests are met

Why are house prices NOT included in CPI?

2019: Axe the pension caps that make the NHS sicker….how long will it be before the different Regions pay their doctors differently? & GP pension boost may halt exodus: why when “the NHS ….is the least national health service in the developed world, an insult to the memory of Aneurin Bevan.”?

2015: Unfunded and unreal public sector pensions – includes NHS staff

2013: Anger as NHS chief quits with £1.9 million pension. The man with no shame..

GPs planning to resign: “The intensity and complexity of our workload is escalating while numbers of fully qualified, full-time GPs are falling” RCGP chair.

National spending on General Practice has fallen as a proportion of GDP and has roughly stayed the same since i retired in 2012. Its no wonder so many more GPs are thinking to retire. The shape of their job has changed beyond recognition. Many of the graphs below are older, and more up to date figures are provided by the Nuffield Trust 2019, but the trend is the same. In 2016 there were 54000 and now there are less, and many more are part time. I suspect that those retiring shortly will have loved their former job, and are reluctant to stop: their pensiosn will be good ones, and the hastle of continuing is not worth it.

The total number of GPs has changed a little, but the proportion who are part time, mainly female, has risen exponentially.

This means that the number per 100,000 people appears reasonable.

The waiting list to see anyone has risen equally rapidly to the number of paert time GPs. It has risen much more since covid 19.

Eleanor Hayward reports 22nd June 2022: Surgeries struggle as 20,000 GPs plan to quit

Nearly 20,000 family doctors are set to leave the profession in a mass exodus, the Royal College of GPs has claimed.

Four in ten GPs said they intended to quit or retire over the next five years, blaming long working hours and unsafe levels of pressure.

The wave of resignations will exacerbate existing shortages that have left millions finding it almost impossible to get an appointment.

Two thirds of doctors surveyed by the college said that patients were at risk because they did not have time to assess them properly. Experts said that cancer symptoms could be missed.

There are almost 4,500 fewer full-time GPs in England than there were a decade ago, according to separate analysis by the Labour Party, while 301 practices have shut since the Conservatives pledged to hire 6,000 more GPs in their 2019 election manifesto.

GP surgeries said they were at breaking point because they cannot recruit enough doctors. Some are responsible for 2,500 patients. This has led to a vicious circle as the extra pressure on doctors means more are going part-time or leaving the profession entirely. Most GPs work three-day weeks.

The college surveyed 1,262 members about their career intentions, and 42 per cent said they would quit in the next five years. This equates to 18,950 GPs out of the workforce of 45,000 (35,800 full-time equivalents). Ten per cent said they were planning to leave in the next year, and 19 per cent said they were likely to leave within two years. Of those not planning to retire, 60 per cent cited stress, working hours and lack of job satisfaction as their reasons to quit.

The college has published a new plan called Fit for the Future, which calls on the government to take steps such as reducing bureaucracy. The college said investment in IT was needed to help patients book appointments. The college’s chairman, Professor Martin Marshall, said: “General practice is significantly understaffed, underfunded and overworked, and this is impacting on the care and services we’re able to deliver to patients. The intensity and complexity of our workload is escalating while numbers of fully qualified, full-time GPs are falling.”

Satisfaction with NHS GP services is at the lowest level since records began in 1983. Access problems have been exacerbated by a shift towards remote appointments, with 63 per cent of consultations held face-to-face compared with 80 per cent before the pandemic.

Reducing the prescription of a pill for each ill 20th June 2022 – Letters from the Times

There’s a post code lottery in prescriptions and prescribing. In Scotland and Wales prescriptions are free. The incentive to ask for a “freebie” when the prescritption charge is over £6 is high. Free precriptions discourage autonomy. They encourage dependency and a paternal state. The argument for abandoning them was financial in that the cost of administration outweighed the savings when so many persons were unemployed, disabled or elderly. They are progressive, in that they bring everyone to the same level, but at a greater cost. We do need to reduce unnecessary and unproven or borderline tratements. This can only be done by overt rationing. The Times letters: Reducing the prescription of a pill for each ill 20th June 2022

Sir, As a GP I agree that we need to reduce unnecessary prescribing (“Doctors increase side-effect risks with a pill for every ill”, Jun 17). However, significant cuts to other services, and long waiting lists, mean that GPs and patients often feel they have little choice but to resort to medication. Cuts to public health spending have led to the ending of many healthy living initiatives, such as exercise programmes and healthy eating courses. This has resulted in a lack of professional services for patients who may need extra support to make lifestyle changes, particularly the elderly and vulnerable, who may not be able to go to the gym alone or change their shopping and cooking habits.

Mental health services are so stretched that while patients and their GPs often agree that cognitive behavioural therapy would be beneficial, patients frequently have to wait months for assessment, with 20 per cent of patients waiting at least 18 weeks to even begin treatment. Patients are left with little choice but pharmacological management in the interim, or else face further months of depression, insomnia and psychological decline. Although GPs support reducing unnecessary prescribing, this will only be possible if there are adequate services and provision for alternative forms of treatment for these conditions.
Dr Selena Stellman
GP, Hammersmith and Fulham

Sir, In your list of common over-prescribed medicines and potential non-drug alternatives, you mention Sertraline. I have been taking this antidepressant for about a year, and for all that time have been on an NHS waiting list for cognitive behavioural therapy. Without the drug I dread to think how my condition might have deteriorated. Although I agree with some of Professor Sir Stephen Powis’s argument, the infrastructure needs to be in place to support such a change to non-drug treatments, which is not the case at present. Less pontification and more action is needed from England’s most senior doctor.
Jacque Smith
Coleford, Glos

Sir, I wonder if someone could help us feckless GPs know which stereotype to live up to: the doctor who dishes out drugs like Smarties or the one who peremptorily dismisses prescription requests, and the patients who make them, with the wave of a hand. Either approach would certainly be a lot quicker and easier than my technique of discussing the pros and cons of any significant medication with the patient and coming to a shared decision. I might even have time to see a few more patients.
Keith Hopcroft FRCGP
Wickham Bishops, Essex

Sir, The NHS seems unable to put into practice changes that would free up resources and avoid adverse effects on patients. Overprescribing and not stopping medications that are no longer needed was an issue in the 1990s. The prime reason is that it is easier and quicker for clinicians to give a pill than to discuss alternatives, and more difficult at medication reviews to stop a pill that a patient has been on for years. The Department of Health and politicians need to realise that primary care is the most important part of the NHS: if properly funded and developed it could relieve much of the pressure on the secondary health service.
Alan Meakin
Ret’d GP and primary care trust medical director, Ripley, Derbyshire

Murder Month is coming – and more patients will die because of our politics..

The Mail always likes to blame someone. Funded by right wing capital they are never going to mount a sustained challenge against the successive goverments, mostly conservative, who have declined to funf enough training places. The deficit in both Nurses and Doctors as well as all the other clinical attached staff is real and upon us now. The crisis is not theoretical but existential. And its going to get worse … Interestingly their index of posts claims face to face being less is a “good thing” To add insult to injury they report that 1000 GPs trained here may be asked to leave.. In an exposure of Operose, a contracter for GP services, which runs many practices, the BBC 13th June claims that unqualified staff are consulting, (Jacqui Wakefield: Operose Health: What I saw working undercover at a GP surgery) and that standards are low. NHSreality hates to say it, bit they may well get lower still. GP trainees are being appointed this August direct from overseas countries without any introduction to the culture of the UK. NHSreality claimed that “Murder Month” was mostly hospitsal based but now it may become GP based as well. The reason behind all this is our short term politics.. The fact is that those who recover are grateful, but those who die, like retiring staff, have no chance to give feedback. This is “selection bias” and denies the public the chance to really hear what is happenning, until its too late. (Morecombe Bay, and Shrewsbury/Telford)

Connor Boyd for MailonLine reports 8th June 2022: Fury at video that lays bare huge A&E waits ‘being fueled by GPs‘: Campaigners say desperate patients are turning to overwhelmed casualty units because they can’t get face-to-face appointments – as video shows nurse announcing 13-hour wait

NHSreality opines on the August changeover for Trainee doctors.

There is no plan – only inactivity and statemate. Gradual decline in state standards seems inevitable, in contrast to private…

NHSreality on selection bias

NHSreality on exit interviews (missing!) and feedback.

NHSreality on First Past the Post system

NHSreality posts on the one health minister who understood and wrote sensibly about the (then) “N”HS.

We destroy the “gatekeeper”role of GPs at our peril. Will consultants be instructed to give lower priority to GP referrals when compared to pharmacist ones as the overloaded system collapses?

Watch for the perverse behaviours and outcomes from this suggestion. Recent news coverage suggests that Pharmacists will be encouraged to refer for “suspected cancer”. This is all part of the wriggleing on the stick of undercapacity that NHSreality has warned about. Now that the gloves are off, and the future of General Practice is threatened by so many part-timers, and by a suggested salaried service, both of which make GPs less efficient, the government feels the time is right to “open the gates”, and punish GPs. This runs the risk of overloading the waiting lists. We know that referrals are more frequent as the assessor is less qualified. Diagnosis is an art, and the “geese that laid the golden egges” have been culled – systematically for years now. Responding in a knee jerk reaction to public unrest could mean that the service gets worse rather than beetter as it gets constipated with pharmaceutical referral overload. Perverse outcomes from such rule changes are common. Will consultants be instructed to give lower priority to GP referrals when compared to pharmacist ones? The outcome seems likely to enhance the two tier system: any of the 4 UK health systems, or private. London based MPs will of course have a real choice, and the rest of us will suffer. In Wales, with no choice to go outside our own Health Trust, and fewer private care options, it will mean private care centralises in bigger cities. In West Wales we are already using the private Orthopaedic Service at Werndale to near full capacity, paid for by the Synod. The unsustainable nature of our Health Services is evident to all, and it will deny our children the best health care if we “keep pouring money” into the curretn failing system. In the end we have to prioritise (See the Times letters below). We have to say what we won’t be able to cover, and this is really better called overt rationing.

Pulse on the demoralising effect of the Salaried Service option discussion.

The Independent: 50,000 nurses extra target will be missed party because of the “high rate of nurses leaving the profession” (Nursing Notes) and whistleblowing nurses need to be encouraged – and financially compensated. Instead the most experienced are leaving!

Sajid Javed comments on the pressures on nurses working in A&E departments

Pulse reports how GPs in government owned premises might be “punished” by higher charges.

Nuffiend Trust reports on Waiting lists differentials in England (Remember they are worse still in Wales)

The Hospitals (Plant) are now ageing and we need to reconsider how much hospital care could be redirected to the community, particularly death and dying. The Guardian warns us that they are “dangerous” but we dont take any notice!

Pulse: Pharmacies to refer…!!

February 2020: Wriggleing 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.

A&E “like a battle zone” with 9 hour wait

The Times letters 16th June: WAITING TO BE SEEN
Sir, On the same day you report that 4,410 people a day wait for more than six hours to be seen in A&E (“Thousand patients a day wait 12 hours or more”, Jun 14), and with many others unable to get a GP appointment owing to high demand, it seems inappropriate for a Menopause Mandate campaign to be launched asking for a champion in every surgery (report, Jun 14). The NHS must prioritise training and recruiting more staff in hospitals and GP surgeries so that more beds can be opened and the long waiting times and waiting lists reduced. I do not underestimate how difficult menopause symptoms can be but I am sure most women realise this cannot be an NHS priority at present.
Gillian Muncey
Ret’d GP practice manager, Steyning, W Sussex

Sir, As a GP myself I am unable to get an appointment for my teenager (who is in the middle of doing A-level exams and is suffering from debilitating symptoms needing assessment and treatment). What chance do the majority of the population have? The primary care crisis is here. Is anyone with the power to do something actually listening?
Dr Antonia Moore
Rochester, Kent

Succdessive failure of regulators and governments over teratogenic Sodium Valproate. Genetic mutations put children at risk..

NHSreality was slow to realise the implications of sodium valproate taken to control epilepsy, especially in children. Our first article was in May this year, when the first indications of a problem were noted in 2009 (ABC News). The nature of the risk should be calculable from the numbers of patients in the GP database. Anecdotal evidence gives the impression that the risk is high, but this may not be the case. We need to know the numbers – especailly for something that is relatively rare. At the same time there are lessons for drug regulators in that a longer term follow up has to be mandatory for any new innovative product that might be given to children. Shaun Lintern reports in the Times: Epilepsy drug that harms babies may damage their children too – The medicines watchdog says sodium valproate could trigger genetic changes that mean disabilities are passed on

An epilepsy drug that caused disabilities in thousands of babies after being prescribed to pregnant women could be more dangerous than previously thought. Sodium valproate could be triggering genetic changes that mean disabilities are being passed on to second and even third generations, according to the UK’s medicines regulator. The Medicines and Healthcare Products Regulatory Agency (MHRA) has also raised concerns that the drug can affect male sperm and fertility, and may be linked to miscarriages and stillbirths. Ministers are already under pressure after it emerged in April that valproate was still being prescribed to women without the legally required warnings. Six babies a month are being born after having been exposed to the drug, the MHRA has said. It can cause deformities, autism and learning disabilities.
Cat Smith, the Labour chairwoman of the all-party parliamentary group on sodium valproate, said: “This transgenerational risk is very concerning. There have been rumours that this was a possibility, but I had never heard it was accepted until last week by the MHRA. “This is going to be devastating for families who now face the prospect of their grandchildren being affected. “The harm from sodium valproate was caused by successive failures of regulators and governments, and this news means it could be an order of magnitude worse than we first thought. It underlines the need for the Treasury to step up to their responsibilities around financial redress to those families.”
Valproate, sold in the UK under the brand name Epilim, can be used in mental health services to treat bipolar disorders and migraines as well as epilepsy. Concerns about its safety have largely focused on pregnancy. Epilepsy can be dangerous for women and babies, and patients should not stop taking sodium valproate without talking to their doctor.Dave and Yvette Tout, from Exeter, believe their three-year-old grandson Zach could be displaying problems linked to the drug. Their son Andrew, 33, was diagnosed with foetal valproate syndrome at the age of seven, after Yvette, 64, took valproate while pregnant in the 1980s and was given no warnings. As a child, Andrew had difficulties speaking and learning language. He also has muscle weaknesses and had special needs support. His mother said: “Looking at Zach, I see Andrew growing up all over again. We worry he is following the same path.” Dave, 63, said: “I dread to think how many people this could affect. The medicines regulator needs to throw everything at this transgenerational risk, and if it is happening they must go back to all the families and check how many of those children have now had children themselves and whether they need support.”
Professor Peter Turnpenny, a consultant clinical geneticist at the Royal Devon University Healthcare NHS Foundation Trust, has been working with valproate-affected children for more than 25 years and helped develop the evidence proving its damaging effects. He said: “The main research at the moment has focused on animal models such as rodents and mice, and this is showing there may be a transgenerational effect. That doesn’t mean it will be the same in humans, but it should be enough to say we need to look at this with a properly funded study into a substantial human cohort.” Turnpenny said the history of valproate was a clear “system failure” that had affected thousands of families. In September 2021, 206 women under 54 were started on sodium valproate for the first time, a six per cent rise on the same month a year earlier. Guidelines say valproate should not be used in women of child-bearing age unless no other treatments are available.
Janet Williams, co-founder of the In-Fact charity for families harmed by valproate, said: “The transgenerational harm is an issue we first brought to the attention of the MHRA in 2017. The reluctance of the regulator to take meaningful action or even acknowledge it publicly has left us more than disappointed that yet another generation of children could be devastatingly disabled by valproate unnecessarily.”
In a letter to MPs, patient safety minister Maria Caulfield said she understood “the pain and suffering” of children affected by the drug and that the issue of financial redress was being reconsidered. She said that while prescriptions of valproate had fallen, the latest data suggested “little further progress has been made in the last year”.
An MHRA spokeswoman said: “As part of our ongoing review of the safety of sodium valproate, we have been carefully assessing all available data on its benefits and risks, and have sought independent advice from the government’s expert scientific body.”

2009 ABC News: Epilepsy Drug Impairs Baby’s Intelligence

2017: Epilepsy drug’s safety reviewed over pregnancy risk – BBC News & New evidence in France of harm from epilepsy drug valproate & 2018: Epilepsy drug’s safety reviewed over pregnancy risk – BBC News the UK alone have been left with disabilities since valproate was introduced in the 1970s. The medicines regulator said warnings had been updated as more information had… epilepsy drug valproate and Disabilities caused in babies by epilepsy drug a ‘scandal’

20/04/2017 · A drug given to pregnant women for epilepsy and bipolar disorder caused “serious malformations” in up to 4,100 children, a French study suggests. Mothers treated with valproate for epilepsy were up…
Disabilities caused in babies by epilepsy drug a ‘scandal’ – BBC News

May 3rd 2022: Sodium Valproate: a tragedy yet to be played out in full.. The GP research database might help..

Aug 2020: Cumberlege review exposes stubborn and dangerous flaws in healthcare. It is likely to be ignored…

April 2022: Epilepsy Research UK responds to valproate news coverage

Living in a “left behind” areas? Could we consider alternative models for health care? Diagnostic PET scans should be universally and speedily available.

The FT 4rd June 2022 seems to agree with me, that we in the “left behind” areas, could usefully and creatively consider alternative models for health care? If our rulers and politicians cannot afford or won’t give us a nearby hospital, is part of the solution to focus on Hospital at Home, and prevention more? Could this provide a different model of healthcare while we await the training of sufficient people – in 10-15 years; time?
It may mean more elderly people die before they would have in other dispensations, (England) but it might be a model of rationing that the community / population as a whole could buy into – as long as there is the longer term prospect of improvement and sufficient staff to man the hospital and community services of the future.
I hear stories of multiple scans, Ultrasound, CAT, MRI, and then PET on patients awaiting a complete diagnosis. We have too few PET scans and so thse we do have are overused, and have long waiting lists. Fortunately they are mobile. More PET scans would mean less demand for all the other tests that preceded them, and proved unnecessary after the PET, a more accurate diagnostic test assessment.
The figures show people in Wales will wait longer and die earlier than those in England anyway!

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