The NHS is under unprecedented pressure. Rising numbers of patients need hospital care – whether in an accident and emergency department, for cancer treatment or for planned operations and care, such as knee and hip replacements.
For each there are strict targets local services are expected to meet across the UK. But what are the chances of being seen in time where you live? Use our interactive tracker to find out.
Why for GPs and not other doctors? What is the governments attitude to “No fault compensation”? This is good news, but it looks like a reaction to the threat of losing General Practice as a speciality rather than a planned change in policy which could open up other opportunities. And its not just GPs who need cover. Hospital trusts and Regions are in deep financial do-do as their projected losses for litigation exceed annual budgets. Cleaning fluid included..
The health secretary will today announce plans for a new ‘state-backed’ indemnity scheme for GP practices that will see them paying a membership fee to have their fees covered.
As Pulse reported this week, Jeremy Hunt will tell delegates at today’s RCGP Conference in Liverpool that he is discussing plans to include the option of a new membership scheme into the 2018/19 GP contract.
Pulse understands that details around the cost of the scheme for practices and who it will cover are still being worked out.
It follows pressure from the profession and Pulse to tackle the problem of rising indemnity fees.
GP leaders gave the announcement a cautious welcome, but said more details on funding and who it will cover was needed.
Now this would be sensible rationing. The dispensing and container fees to the chemist are the main expense with Homeopathy, and few patients would rely on it for life threatening conditions. A private prescription seems sensible for those who believe in it enough, and of course it can be bought over the counter as it is entirely safe! Common sense rationing…
Sir, A sign in my local pharmacy asks patients to buy their own paracetamol, to save the NHS its much greater cost on prescription. If GPs are to prescribe homeopathic remedies, I hope to see a similar sign urging patients to obtain the same thing from the kitchen tap.
Sir, The only thing that Dr Fisher’s letter seems to show is that most patients get better or not despite their doctors, not because of them.
Alan Cohen, MBChB
Sir, The NHS ascribes any effect of homeopathic treatment to the placebo effect. I want to ask how it might be explained that, many years ago when my ten-year-old labrador became so stiff with arthritis that she could not jump into the car or rise from the slippery kitchen floor without help, the homeopathic remedy suggested by a friend enabled her to do both easily within a week. I gave her the pills until she died at 15, a grand age for a lab, and she remained reasonably active almost to the end of her life.
The Rev Mary Austin Droitwich, Worcs
Sir, Another way of expressing the contents of the letter from Dr Peter Fisher, editor-in-chief of Homeopathy, is that homopathic medication is simply cheaper than conventional medication (“NHS homeopathy”, Oct 3). This is because on the balance of probability a homeopathic medication contains not a single molecule of the supposedly active ingredient. Thus a tiny amount can go almost infinitely far — making it cheap to “treat” patients.
Dr Andrew Tay
The decision on assisted dying is to be welcomed, as is the news that diseases such as this could be edited out of society eventually using Crispr, but there is a cost, and patenting of the processes may mean costs are too high for many nations/systems. The news in the recent edition of the New Scientist is that a leukaemia gene can be edited for the price of $475,000 per patient. This blows NICE life – years valuation out of the water… But on the other hand, rich families will be able to afford the treatments… At last – common sense on the right to die with agreement of Dr and Family. But the cost implications of prevention, along with the ethical dilemmas and the religious rights objections, mean that helping the patient by “putting them at the centre of your concern”, will still be the main problem for doctors for decades to come. Even the insurers might object.
A judge has made a landmark ruling that legal permission will no longer be required by a court before life-supporting treatment is withdrawn from patients suffering from severely debilitating illnesses, lawyers say.
Mr Justice Peter Jackson ruled that a 50-year-old woman who had suffered from Huntington’s disease for more than 20 years should be allowed to die after a hearing in the Court of Protection, where judges analyse issues relating to people who lack the mental capacity to make decisions for themselves, in London.
The woman’s daughter plus doctors caring for her all agreed that life support treatment should end……
Sir, The crux of the debate on assisted suicide is whether it is possible to grant some people the right to assistance in suicide without exposing others to subtle, malicious pressure to exercise it.
In 2011 Lord Falconer’s commission stipulated that a safe assisted-suicide framework required, first, safeguards “to ensure that the choice of an assisted death could never become an obligation and that a person could not experience pressure from another person to choose an assisted death without the abuse being detected”. Second, there had to be provision of “the best end of life care available”, including staff who would fully investigate the circumstances and motivations of any person seeking an assisted death and alternative options for treatment and care”.
In her book about the treatment of the elderly, Not Dead Yet (2008), Baroness Neuberger reported that in the UK 500,000 elderly people were being abused, two-thirds by relatives or friends. The Stafford Hospital scandal revealed that abuse of vulnerable patients is not limited to amateurs but extends to healthcare professionals.
So, we have no reason to suppose that we can “ensure” the absence of undue pressure to opt for assisted suicide and the presence of compassionate staff. Indeed, there is good empirical reason to doubt that such things can ever be guaranteed.
Judging by his own commission’s criteria, then, Lord Falconer’s Assisted Dying bill is, while well meaning, dangerously imprudent.
judge in a specialist court has made a landmark decision that will affect the relatives of terminally-ill people, lawyers say.
Mr Justice Peter Jackson ruled that a 50-year-old woman who had suffered from Huntington’s disease for 20 years should be allowed to die after a hearing in the Court of Protection, where judges analyse issues relating to people who lack the mental capacity to make decisions for themselves, in London.
The woman’s daughter and her doctors all agreed that life support treatment should end.
Mr Justice Jackson said that judges should not be required to make rulings in similar cases, where relatives and doctors were in agreement and medical guidelines had been followed.
Mr Justice Jackson said he could understand why the woman’s mother and doctors had asked for a ruling. But, he said, in a written ruling : “In my view it was not necessary as a matter of law for this case to have been brought to court.”
He published the ruling on Wednesday and said the woman had now died.
Specialist lawyers at Irwin Mitchell had represented the woman’s mother. They described Mr Justice Jackson’s decision as a landmark.
Genetic engineers have eradicated disease-carrying DNA from human embryos in a breakthrough that heralds a new era in medicine.
The achievement could lay the groundwork for doctors to eliminate hundreds of inherited illnesses such as Huntington’s disease, cystic fibrosis and sickle-cell anaemia with a single, permanent change to a family’s bloodline.
While implanting altered embryos in the womb is against the law in the UK and many other countries, some scientists forecast that the technology will become acceptable if the benefits of preventing these conditions outweigh their practical and ethical problems.
There are about 10,000 diseases that are caused by individual mutations and could in theory be fixed with the treatment, which is known as germline gene editing because it involves using chemical scissors to snip harmful DNA out of an embryo’s genome.
Biologists in the US, China and South Korea used a powerful form of the technique called Crispr/Cas9 to cut out the gene that causes one of the most common of these conditions, hypertrophic cardiomyopathy (HCM), from sperm cells as they fertilised 52 eggs from a single healthy woman.
This incurable disease, which affects one in 500 people, thickens and stiffens the wall of the heart, sometimes leading to shortness of breath, palpitations or abnormal rhythms.
Findings published in the journal Nature show that scientists were able to get rid of the mutation that causes about 40 per cent of HCM cases by injecting a tailored version of Crispr/Cas9 into the woman’s eggs at the same time as they introduced the mutation-bearing sperm.
It is the first time that researchers have edited the genes of embryos and then seen them develop normally, partly because the embryos appear to be able to repair their DNA cleanly by using the egg’s genome as a template.
Attempts carried out in China over the past two years failed because they resulted in so-called mosaic embryos in which some cells had been fixed while others carried the gene.
There is a long way to go before the treatment can be used in IVF clinics. Ethical questions aside, the findings will need to be repeated in eggs from other women, while politicians and regulators will need further evidence that it is safe before they can consider legalising germline editing in the real world.
Even then, it will play second fiddle to pre-implantation genetic screening, where doctors examine the DNA of a couple’s embryos to see if any are free of mutations. In practice gene editing would be most useful for would-be parents who cannot produce enough healthy embryos, particularly if they carry dominant gene-linked disorders such as Huntington’s disease, HCM, Marfan syndrome and neurofibromatosis, which makes its carriers prone to cancers of the nervous system.
Peter Braude, emeritus professor of obstetrics and gynaecology at King’s College London, who was not involved in the study, said: “The possibility of germline genome editing has moved from future fantasy to the world of possibility, and the debate about its use, outside of fears about the safety of the technology, needs to catch up.”
Designer babies — the last taboo
Scientists heave a collective sigh when they hear the phrase “designer babies”. The words conjure up an elite race of children whose genes have been customised with methods that are as technically implausible as they are ethically fraught.
This is not what most experts fear. The real risk is that one of these days, in a fertility clinic beyond the intense scrutiny that attends every step of embryo research in most western countries, doctors will quietly slice an inherited disease out of a few embryos’ genomes and nine months later announce the birth of the world’s first gene-edited baby.
We know this because we have been here before. Last year John Zhang, a US doctor, used a different but scarcely less controversial technique known as mitochondrial replacement to create a “three-parent” baby in Mexico.
The global scientific establishment was appalled, particularly as the UK was still putting the finishing touches to a pioneering system for licensing this kind of experiment after more than a decade of thorough debate.
The trouble is that no matter how carefully we try to control the science, there will always be places where even the best-laid laws cannot reach. There is not much that experts can do to hold back their colleagues if they are determined to defy international convention, particularly if they are prepared to do so in countries whose regulations are vaguer or more permissive than those in Britain and the US.
This is true not only of gene editing but also of many ethical frontiers that are being challenged by the breakneck pace of biological discovery.
Sandy Starr, of the Progress Educational Trust, a biomedical charity, said the technology needed to be considered alongside projects such as the creation of animals that contain human cells and the generation of sperm and eggs in a dish.
“All of these are potentially exciting areas of research,” he said. “They all require careful regulation, and they certainly require the widest public and international debate before we consider permitting any clinical applications.
“Of course it’s always possible that someone unscrupulous will jump the gun, go jurisdiction-shopping, and travel somewhere to use an experimental medical technique in an unethical way. Even if they do, and even if they evade legal judgment, we can still subject them to our own moral judgment and find them wanting. Indeed, it becomes all the more important for us to do so.”
I am still asked “how should I choose my GP practice”, and I usually give a guarded reply which amounts to “It depends what functions/services you value most”. Continuity of care is a rarity these days, and with more and more part time GPs the problem will get worse. Patients are not “ill” on days that suit a Dr working 2-3 days a week. Children are ill suddenly, and so practices where partners offer a daily surgery, albeit with a different doctor, are valued. One thing to consider is whether there is an “individual list” system, or a “shared list” system. In the former it can be harder to see your doctor, but it may be worth waiting especially for older patients with chronic conditions. In the latter system patients are often fitted in quickly but usually see a different Dr each time if it is an emergency (as defined by the patient)! Mothers of young children usually prefer this type of system, but not always. Does the practice have an active Patient Participation Group?Other things to consider are whether the practice is a teaching practice, what the turnover of staff is, and whether they have a QPA (Quality Practice Award) which is in date. If you know a family who have had a death recently, the quality of any palliative or terminal care is pertinent, but remember “dead patients don’t vote“. Despite all this, and the Care Quality Commission report, most patients will still ask their neighbours…
It’s a pity that we don’t know the quality of care for comparison in the other 3 UK health regions, thus emphasising that there is no NHS. Rather than reporting the bad news, the Times could report that 90% of GP care is good quality, and ask “Are you lucky enough to be in a post code with good GP care and good choice?” as many areas have reduced choices, even in cancer care.
Seven million patients are treated at GP surgeries with serious safety problems, according to the first comprehensive review.
Inspectors urged patients to switch to better performing surgeries after finding that one in seven had issues with safety and one in ten was not good enough overall.
They uncovered “pockets of persistent poor care” including out-of-date medicines, a failure to follow up on test results, delayed cancer diagnoses and a lack of checks on the medical qualifications of staff.
Smaller surgeries were more likely to do badly, the review showed, with the worst half the size of the best. They have been ordered to end “professional isolation” by linking with neighbouring surgeries to share resources and expertise.
The Care Quality Commission (CQC) has finished inspecting all 7,365 GP practices that existed when it started its revamped regime three years ago. Nine in ten were good or outstanding, significantly better than hospitals or care homes. It initially found that one in three was not safe enough, forcing inspectors to take action including shutting dozens of surgeries. One in seven still had safety problems, however, covering seven million patients, with 13 per cent “requiring improvement” and 2 per cent, with almost a million patients, “inadequate” for safe care.
“Safety is the one clinical area that we worry about,” Steve Field, chief inspector of GPs, said. “You find surgeries where they have lots of [test] results that haven’t been acted on, they might have out-of-date medication, their fridges might be at the wrong temperature so the vaccines might not work. It’s really poor leadership.”
Professor Field recently had to intervene to replace out-of-date emergency adrenalin that could have led to the death of a patient, he revealed. He urged patients to use ratings on the CQC website to switch to a better surgery. “I was in a surgery two weeks ago where they said they’d had 300 patients move to them because they were rated outstanding,” he said.
The average “inadequate” practice has 5,770 patients compared with 10,126 for the average “outstanding” one. Professor Field said that smaller places often found it harder to stay up to date, manage services well and employ nurses to help patients with long-term conditions. He said that most should be linked to other family doctors and social services. “I suspect that if you’re a weak leader but a good clinician and you’re part of a larger group, the quality of care will be better,” he said.
Ministers have promised GPs £2.4 billion as they struggle with rising patient numbers and Professor Field said that this had to get through before a “winter crisis”. Richard Vautrey, chairman of the British Medical Association GP committee, said: “These positive results are undoubtedly down to the hard work of GPs and practice staff, but many are in an environment where they are increasingly struggling to deliver effective care.”
The union has clashed with Professor Field, insisting that his inspections were not fit for purpose. Dr Vautrey insisted that the process “remains overly bureaucratic and continues to result in GPs spending time filling in paperwork when they should be treating patients”.
Jeremy Hunt, the health secretary, said: “Nearly 90 per cent of GP surgeries in England have been rated as ‘good’ or ‘outstanding’ — and that is a huge achievement for GPs given the pressures on the front line.”
What do we know?
Every GP practice has an overall rating shown on the CQC website
Each practice is also given sub-ratings assessing whether it is safe, clinically effective, caring, responsive and well-led
The NHS GP patient survey assesses whether people would recommend their surgery, whether GPs give them enough time and whether they see the same doctor
There is little other official data on GPs
Patients can post ratings on websites such NHS Choices
The NHS has been ranked the number one health system in a comparison of 11 countries.
The UK health service was praised for its safety, affordability and efficiency, but fared less well on outcomes such as preventing early death and cancer survival.
The research by the Commonwealth Fund, a US think tank, looked at countries across the world, including the US, Canada, Australia, France and Germany.
The US came bottom.
It is the second time in a row that the UK has finished top.
Three years ago, when the survey was last done, the UK was also number one.
It comes despite the NHS being in the grip of the tightest financial squeeze in its history with lengthening waiting times.
The good and the bad
The NHS was praised for the safety of its care, the systems in place to prevent ill-health, such as vaccinations and screening, the speed at which people get help and that there was equitable access regardless of income.
Only in one of the five themes looked at did the NHS perform poorly compared with the other nations – health outcomes. This covers general health of the population, early deaths and cancer survival among other measures.
4 = New Zealand
4 = Norway
6 = Sweden
6 = Switzerland
England’s Health Secretary Jeremy Hunt said: “These outstanding results are a testament to the dedication of NHS staff, who despite pressure on the front line are delivering safer, more compassionate care than ever.
”Ranked the best healthcare system of 11 wealthy countries, the NHS has again showed why it is the single thing that makes us most proud to be British.”
But others pointed out that in terms of quality of care – as shown by the health outcomes – the findings were more damning.
Kate Andrews, of free-market think tank the Institute of Economic Affairs, said the NHS was “far from being the envy of the world”.
“The UK has one of the highest rates of avoidable deaths in western Europe, and tens of thousands of lives could be saved each year if NHS patients with serious conditions such as cancer were treated by social health insurance systems in neighbouring countries, such as Belgium and Germany.
“It is not just low-income earners who receive poor care, the NHS’s provision of care is equally poor for everybody, irrespective of income.”
Jemima Layzell had not heard of organ donation until two weeks before her death. When a family friend died in a car crash, however, the 13-year-old girl decided that she wanted to become a donor should the worst happen. Then, as she helped to prepare her mother’s birthday party, she collapsed with a fatal brain aneurysm.
It has now been revealed that her decision saved or transformed eight lives, the most by a single organ donor since the NHS was founded…..
Too many children die waiting for a donor organ, health officials have said.
Last year 470 people, including 14 aged 18 or less, died while on the transplant list or within a year of coming off the list, sometimes because they had become too ill for surgery, NHS Blood and Transplant (NHSBT) said.
Of those, 22 adults and ten children were hoping for a new heart.
The organisation urged people to take Organ Donation Week, which runs until Sunday, as an opportunity to tell their families their wishes as to being a donor.
One four-year-old girl was starting school with a new heart this week. The parents of Evie Doherty, of Colchester, praised the family of the organ donor, saying that they had made a “selfless decision at a terrible time” which had given their daughter the gift of life.
Figures from NHSBT show that 43 children under 16 years old had heart transplants last year. There were 383 heart transplants in total in 2016-17.
Anthony Clarkson, NHSBT’s associate medical director for organ donation, said: “It’s lovely to see Evie going to school thanks to an organ donor.
“Sadly, too many children still die waiting for a transplant. Please tell your family you want to donate this Organ Donation Week. A few words can make an extraordinary difference.”
As of August 25, there were 6,414 people on the transplant waiting list — of those, 36 were aged under 18. Typically, children on the list wait 463 days for a non-urgent heart transplant, and 70 days for an urgent heart transplant.
Organ transplants are a miracle of modern medicine. Ever more sophisticated surgical techniques and immunosuppressant drugs mean that organs from donors’ bodies save hundreds of lives a year. If England made one simple adjustment to the way it administers the donation system, it could save hundreds more.
At present, to be sure their organs will be used in the event of their deaths, would-be donors must sign up to a national register or tell family members to consent on their behalf, preferably both. This opt-in system requires people to think and talk about death, which many are reluctant to do. It is one of the reasons that England languishes near the bottom of the league table of developed countries for donors per capita. Hundreds die each year for want of a new organ.
The alternative is an opt-out system in which a deceased person is presumed to consent to donation unless he or she has specified otherwise. Wales introduced such a system last year: organ donation and transplants have since risen sharply, with only 6 per cent of the adult population opting out. The Department of Health says that it is “keeping a close eye” on developments to assess the case for following the Welsh example in England. Yet the case is already clear. It is the argument for delay that is unsustainable. This is one of those rare occasions when a cost-free, commonsense solution is available to an urgent problem. The task of policymakers is to seize it.
If more data were needed as a basis for action, the NHS has provided it to mark organ donation week, which runs until Friday. Last year 457 people in England died because they could not get a transplant and 460 organs suitable for transplant were not used for lack of consent. In addition, 875 people were taken off waiting lists for transplants and many subsequently died. More than 6,400 remain on these lists as consent is refused by family members of suitable donors at the rate of three a week, not because consent was withheld by the potential donors when they were alive, but because it was not actively given.
Without that consent families often hesitate and the window of opportunity closes. “A few words now can make an extraordinary difference,” the assistant director of organ donation at NHS Blood and Transplant says. This is true, and it is well established that knowing a loved one saved or transformed others’ lives by donating his or her organs can be of enormous comfort to the grieving. Yet a change to the law would make an even bigger difference.
Spain is the European country with the longest-running opt-out system and it leads the developed world in organ donation by a wide margin. Other European countries with similar systems, including France, Belgium, Ireland and Finland, all have between 70 and 120 per cent more donors per capita than England.
Theresa May gathered senior advisers yesterday to remind them that she wants to be remembered for more than Brexit, which is proceeding on the strength of a 52 per cent majority in last year’s referendum. According to the British Medical Association, a significantly higher proportion of the public — 66 per cent — would donate their organs after their death. This is a solid basis for an opt-out system, and the government should legislate to make it happen.