Category Archives: Commissioning

Deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying, (de-)commissioning: it’s all “rationing”

It is deceitful verbal obfuscation. Prioritisation, limiting, restricting, reducing, cutting, delaying: it’s all rationing and it needs to be discussed openly and honestly as such. Until it is the professions will remain disengaged. Since there is no honesty in our politicians, the response of the professionals in the UK’s 4 health services is entirely predictable. Meanwhile the disparity in services for the rich (private) and the poor (state) will become greater.

Paul Frances for Kentonline 14th September 2017 reports: West Kent Clinical Commissioning Group forced to cut services

An on-going cash squeeze on NHS budgets could see further restrictions on non-urgent operations and other treatments for patients in west Kent, it has emerged.

The West Kent Clinical Commissioning Group (WKCCG) says “significant cost savings” are needed to balance the books and rationing additional services will have to be considered.

Earlier this year, the CCG – which serves 463,000 people – delayed non-urgent operations for four months to save £3.2m, affecting 1,700 patients….

Dennis Campbell in the Guardian 12th September reports: NHS waiting times ‘driving people to turn to private treatment’Report says private providers have seen 15 to 25% annual rise in ‘self-payers’ as patients resort to using savings or loans

Chris Smyth in the Times 14th September reports: Elderly patients with broken hips wait too long for treatment

Four in ten elderly patients who break their hips suffer delays in vital treatment that increase their risk of ending up in a care home, a report says.
Seven patients a day also break their hips while in a hospital bed and the number appears to be rising, with some hospitals failing to do enough to keep patients safe, the study found.
Broken hips are a common injury among frail elderly patients and dealing with the aftermath is estimated to cost the health service £2 billion a year.
While death rates from the condition are falling, analysis of records of 65,000 patients, almost all those admitted to NHS hospitals over a year, found thousands not getting the care they should.
Almost one in ten patients were still immobile four months after an injury with “enormous variation” in rehabilitation rates at hospitals, the National Hip Fracture Database reported.

Patients are meant to get standardised care, most importantly surgery within 36 hours and a prompt review by a geriatrician. However, the review found 40 per cent of patients were not getting the treatments they should. “It’s truly terrible not to have early surgery. If you have to get on a bedpan with a broken hip there’s no dignified way of doing that and people just unravel,” Antony Johansen, clinical lead for the project, said.
“If 40 per cent of patients are not receiving this care — usually because they miss out on just one or two elements — this could compromise their rehabilitation and recovery.”
He said that while some hospitals had 80 per cent of patients back in their own homes a few months after injury, elsewhere it was “a tiny little number”. Hospitals are paid extra for good care and Dr Johansen said that there was no good reason for poor treatment.
“With care of frail older people, doing it well is cheaper than doing it badly. I know if I fail to rehabilitate someone and they go into a care home that’s a bill of £70,000 for them or the taxpayer.”
The audit also found that 4.1 per cent of all fractures happen while older people are in hospital, up from 3.9 per cent last year. Accidents peak during staff changeover times, it said.
“Seven people every day are breaking their hip in hospital and the slight trend for that to go up is concerning,” Dr Johansen said. “It’s something we need to challenge. It’s very easy not to have enough staff on the ward or have staff doing paperwork rather than being with patients.”
While saying that hospitals should not be overcautious and confine patients to bed, he said that some hospitals had only one fracture for each 700 beds each year, while others have as many as one for every 16 beds.
Patients in England are also spending a day longer in hospital than last year, at an average of 21 days.
Caroline Abrahams, of Age UK, said: “We are dismayed that 40 per cent of those who go under the knife don’t benefit from the best practice available. She added: “The numbers of hip fractures in hospitals are unacceptably high.”
• Elderly patients face becoming sicker if they are rushed out of hospital in an NHS drive to empty beds, say local councils. Simon Stevens, chief executive of NHS England, has given hospitals six weeks to free up thousands of places after saying flu was likely to hit the UK harder than usual. The Local Government Association said the plan would backfire as patients were taken back to hospital at the busiest times.

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Let us charge patients for extra services, GPs urge – is this “decommissioning”?

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

We need to be talking de-commissioning and not commissioning….. Fewer doctors and higher occupancy mean more deaths – in Hospitals..

The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations



A summary of health rationing in the news this last week. Weak (cowardly) politicians have led the NHS to ruin

Just this last week we can see evidence of removal, restriction, limitation or prioritisation decisions made by CCGs or Trusts. In addition the administration are unable to keep up with the complaints and requests for information. I myself have a request on perinatal and maternal mortality pending which is over the 8 weeks at Hywel Dda Trust. There are so many fingers in the dam that there are no hands to repair ur security and health systems.. As for the elderly demented, they don’t vote and don’t seem to matter… An IPR report on Death Dying and Devolution explains clearly the post code and unfair rationing of resources. Weak (cowardly) politicians have led the NHS to ruin 

Mark Smith for Walesonline 6th September: Thousands of complaints against the Welsh NHS are not being handled quickly enough

Health boards claim it is sometimes impossible to respond within the 30-day timescale

Forty percent of Welsh NHS complaints miss target

Tom Knowles exposes the temporary nature of the employment currently offered. In the Times on 12th Septtember: Summer hiring spree for builders and NHS

Adele Couchman in Kentlive on 12th September reports:

The number of nurses specialising in dementia and other mental health problems in the elderly has been cut by a fifth since 2010, according to “incredibly concerning” figures.

Psychiatric nurses treating older people have been among the hardest hit by a reduction in mental health staffing despite government pledges to prioritise the rise in dementia, analysis of NHS data for The Times shows.

While the overall number of NHS nurses has risen slightly over the past seven years, this has been due to increases in acute hospital and maternity services, helped by a recruitment drive after the Mid Staffordshire scandal. Figures from NHS England show that the number of mental health nurses working for the health service fell by the equivalent of almost 5,000 full-time posts between May 2010 and May this year, a drop of more than 12 per cent.

Old age psychiatric nursing is among the worst hit specialisms, with 1,000 full-time posts gone since 2010, a fall of 22 per cent, to 3,541 posts.

Older patients often need more intense monitoring and are susceptible to problems with medication and side-effects. A nurse’s role also involves emotionally supporting patients’ families and helping patients stay independent for as long as possible.

Caroline Abrahams, charity director of Age UK, said: “An ageing population inevitably means we need more psychiatric nurses specialising in work with older people, so the fact their numbers have shrunk by a fifth over the last seven years is incredibly concerning.
“Historically, older people’s mental health needs have often gone undiagnosed and been overlooked and these depressing figures provide no cause for optimism that the situation will improve any time soon.” She called for urgent government action. With psychiatrists for the elderly also overstretched, doctors say they are increasingly reliant on specialist nurses to help manage the rising need for treatment.
More than 850,000 people in Britain have dementia, a figure which is expected to pass a million within seven years.
Hilda Hayo, head of Dementia UK, said that the charity’s specialist dementia nurses and helpline were picking up cases of families under increasing pressure as a result of the loss of nurses.
“These reductions are coming at a time when people live for longer but are not necessarily healthier — and dispersed families are unable to provide the support needed,” she said. “More families are going into crisis and having to make decisions which may result in earlier admission to hospital or a care facility due to the lack of community support.”
A Department of Health spokesman said: “This government is committed to improving care for those with mental health conditions, which is why we have started one of the biggest expansions of services in Europe.
“Our ambition is to create 21,000 new posts by 2021 by supporting those already in the profession to stay and giving incentives to those considering a career in mental health.”

Death Dying and Devolution

Weak (cowardly) politicians have led the NHS to ruin

Stephen Hawking is no idiot… he sees things getting worse and no way back. Hunt is rationing as much as he can get away with..

Stephen Hawking is used to scientific debate and the weighing of evidence. If he accuses Hunt of cherry picking he is really accusing him of rationing as much as he can get away with. Commissioning groups are all using the R word, but the politicians will not… No wonder the professionals are disengaged..

Nick Triggle in the BBC news website reports 19th August: Stephen Hawking: I’m worried about the future of the NHS

Stephen Hawking has said he is worried about the future of the NHS, in a speech critical of government policy and Health Secretary Jeremy Hunt.

The Cambridge University scientist, who publicly backed Labour in the election, accused Mr Hunt of “cherry-picking” evidence to support his policies.

The 75-year-old also said he was concerned about the involvement of the private sector in the NHS in England…..


On Saturday 19th August and report as Hunt responds and is reported in the Guardian: Jeremy Hunt accuses Stephen Hawking of ‘pernicious falsehood’ in NHS row

Health secretary reacts to physicist’s claim that the Conservatives are trying to implement US-style health insurance system

Jeremy Hunt has accused Stephen Hawking of a “pernicious” lie after the physicist said it seemed the Tories were steering the UK towards a US-style health insurance system.

Hours after the health secretary was criticised for claiming Hawking was wrong in the row about the government’s seven-day NHS plan, he leapt back into the fray with two tweets defending the Conservative party’s record on the health service.

Hunt was responding to criticism from the renowned 75-year-old physicist and author of A Brief History of Time ahead of a speech at the Royal Society of Medicine on Saturday.

In the speech, Hawking will accuse the health secretary of “cherrypicking” favourable evidence while suppressing contradictory research to suit his argument.

In a Guardian opinion piece published on Friday, Hawking also criticised the power of profit-seeking multinationals, which he said had contributed to the inequalities rife in the US healthcare system.

“We see the balance of power in the UK is with private healthcare companies, and the direction of change is towards a US-style insurance system,” he wrote.

The shadow health minister, Justin Madders, weighed in on the row: “It doesn’t take a genius to work out the Tories are wrecking the NHS.

“Professor Hawking has given us answers to many of the universe’s most challenging questions, and even he can’t work out why Jeremy Hunt is still in his job.”

Jeremy Corbyn, the Labour leader, said Hawking was a “brilliant scientist” with a “brilliant mind” and “brilliant thought process” who should be listened to.

The former Liberal Democrat leader Tim Farron said: “A renowned scientist such as Stephen Hawking questioning your evidence might normally be cause to think again, but sadly it looks as though Jeremy Hunt has joined the chorus of those who have had enough of experts. ……

Hospice stigma ‘forces 100,000 into earlier, more painful deaths’

NHSreality has argued consistently that in a cradle to grave and in-rationed health service, that hospice care should be fully funded. The reality is that Hospice Care is generally better and better funded , with more options (Living in Hospice or home based care) in richer areas. Commissioners should not be allowed to get away with this form of covert post code rationing, and ex chairmen and CEOs should speak out about the inconsistency..

Greg Hurst in the Times 19th August reports: Hospice stigma ‘forces 100,00 into earlier, more painful deaths’

Tens of thousands of patients miss out on expert end-of-life care each year because of an outdated stigma attached to hospices, a charity leader has said.
Many people with a terminal illness die sooner or without skilled pain relief or support because they are reluctant to approach a hospice or do so too late, according to the head of Hospice UK.
The organisation supports 220 hospices around the country, most of them charities, that provide care and support for about 200,000 dying people each year. They estimate that another 100,000 die from known conditions with an unmet need for hospice care.
Tracey Bleakley, the chief executive of Hospice UK, said much of this was due to misconceptions, although lack of funding and failure of GPs and consultants to refer patients were also factors….

….The hospice movement is celebrating 50 years since its founder, Dame Cicely Saunders, a nurse and doctor, opened the first voluntarily funded specialist centre for palliative care in south London. St Christopher’s has been emulated across the world.
The next stage for British hospices, Ms Bleakley said, is to extend their work into more care homes, sheltered housing and hospitals.
Hospices will increasingly send nurses who specialise in pain relief to terminally ill residents in care homes, sometimes working alongside GPs, she said, but also offer training to care workers and share their networks of volunteers to support residents and their families.
Similarly, more hospices are building links with hospitals. “If people are in hospital and they don’t want to be and don’t need to be, we can get them out,” said Ms Bleakley. “But if they do we can work with and support the hospital.
“It is about thinking that these are somebody’s last moments and thinking broader than what is killing them. It is about thinking what they want to achieve in their life.”

Now comes the winter of our discontent – and civil unrest may well follow the expansion of covert post code rationing

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

Children’s hospices struggling with funding crisis, report claims 

Hospices rely on volunteers while paying their bosses up to £160,000

Traditional In-patient Hospices are not viable in small populations

Doctors let dying patients waste their last days in Accident and Emergency

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.

Cancer care not good enough in eight out of ten (poorer) regions

“..a brutal and potentially fatal form of healthcare rationing”. It should be the politicians with “an inability to face the outside world” rather than the patients..

Tribunals urged after study finds ‘unacceptable’ variations in healthcare access

The unethical face of covert rationing is revealed in Scotland. We all pay the same taxes and should therefore have equal access to advanced and lifesaving technology. We should also have equal lack of access to the same services… where these are rationed. To do this fairly needs honesty and overt rather than covert rationing. 

Aberdeen Journals Ltd (Evening Express) reports 15th August 2017: Tribunals urged after study finds ‘unacceptable’ variations in healthcare access

Local health bodies should have to face a tribunal board if they have ” overly restrictive commissioning policies”, a new report suggests.
The recommendation comes after researchers found that there is “unacceptable” variation in access to care for patients across England.
After examining data concerning each of the 209 clinical commissioning groups (CCGs) across England in relation to certain treatments, researchers highlighted a number of variations in access to care and waiting times including:
:: Less than one patient (0.173) per 100,000 population in Southampton was referred for a computed tomography colonoscopy – a diagnostic tool for bowel cancer – compared with nearly 59 patients per 100,000 in Fareham and Gosport.
:: The authors found vast differences in the rate of stroke patients being admitted to a specialist unit with four hours of arrival at hospital – from 84.5% in Hillingdon to 21% in Wyre Forest.
:: In some regions, there were 207 hip replacements being performed for every 100,000 people living in that area, but in others the rate was just 54 per 100,000 population.
:: In urology and ophthalmology, the worst performing CCGs only hit the 18 referral to treatment time target about 80% of the time, the authors said. This means that one in every five patients from those regions get treatment in the required time frame.
The authors said that NHS England should establish a tribunal board to consider whether individual CCGs have overly restrictive commissioning policies which are contrary to national guidelines.
The report, by the Medical Technology Group (MTG) – a collaboration of pharmaceutical companies, patient groups, research charities and medical device manufacturers – also examined whether CCGs were falling behind on waiting times for patients.
After examining referral to treatment times, researcher s created league tables for CCGs for waiting times for a number of medical treatments such as pacemakers, cataract surgery, and hip and knee replacements.
They found that seven of the 10 “worst performers” at hitting the 18-week referral- to-treatment time target were actually rated as good or outstanding by NHS England.
The authors said: “CCGs currently go through an Ofsted-style assessment programme.
“Each CCG is given one of four ratings: inadequate, requires improvement, good, or outstanding.
“The MTG does not believe that these ratings are sufficient to give patients an overview of how their CCG is performing.
“The key factors for patients are gaining access to treatment and successful, quick recoveries. It is not clear from the current rating system that there is sufficient weighting given to these aspects of care.”
The authors suggested that p erformance against the 18-week wait should have a stronger impact on each CCGs’ ‘Headline Rating’.
Barbara Harpham, MTG chairwoman, said: “Delivering high-quality healthcare, no matter where you live, is one of the fundamental principles of the NHS. But budget cuts and rationing is having a huge impact on the service patients receive, and the outcome they can expect.
“There is an unprecedented strain on the health service and patients are not being given equal access to the treatment – and most importantly – the technology they need.”

An NHS England spokeswoman said: “Although this report by companies seeking to sell products to the NHS is largely a rehash of old and previously published data, the NHS RightCare programme is helping local areas identify which treatment differences are linked to local need, and which aren’t.
“But as the Academy of Medical Royal Colleges has pointed out through its Choosing Wisely initiative, over-treatment is often as much of an issue as under-treatment.”

Despite “adequate or average” funding, our waiting lists are much higher than average. Even communication is failing at a basic level…

Despite “adequate or average” funding, our waiting lists are much higher than average. Even communication is failing at a basic level, more in keeping with an African 3rd world country. The emperor has no clothes..

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Chris Smyth reports in the Times 10th August 2017: NHS funding matches most of Europe’s health spending

Britain is spending “about what might be expected” on the health service according to analysis which questions claims that the NHS is starved of cash compared with other countries.

Spending on health matches the average in other western European countries and those who call for more money for the NHS can no longer rely on the argument that Britain is spending less, economists said.

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However, to match higher spenders such as France and Germany, health funds would have to increase by £24 billion a year, conclude John Appleby, director of research at the Nuffield Trust, and Ben Gershlick, economics analyst at the Health Foundation, in The BMJ.

Concern that the NHS is short of money has increased as waiting lists and queues in A&E lengthen and treatments ranging from IVF to hip replacements are being rationed.

Those demanding more money have often used the same argument as Tony Blair, who justified a big increase in NHS funds in the 2000s on the basis that spending was below countries such as Spain and Portugal.

However, technical changes implemented this year to how international spending is measured mean more social care funds are now counted, raising Britain’s health spending to 9.9 per cent of GDP for 2014, instead of the 8.7 per cent previously estimated.

The £20 billion increase means Britain’s health spending is now about average for the OECD and 14 other mainly western European states who joined the EU before 2004 and comfortably above countries such as Spain, Portugal, Italy and Finland.

Professor Appleby and Mr Gershlick write in a blog: “The UK is spending what we would expect given its wealth . . . How much we should spend on healthcare is still a live and important debate, but the argument that we should spend more simply because we spend much less than the rest of Europe isn’t enough any more.”

Countries tend to spend more of their GDP on health as they get richer, with each $1,000 increase in wealth per head linked to a $120 increase in health funds. By the adjusted figures, the UK spends $3,675 a year per person on health, well above the $1,870 for each person in Greece, but the Netherlands spends a third more per head at $4,857.

Professor Appleby and Mr Gershlik stress that matching the average is not in itself an argument against more cash for the NHS. If voters want more comprehensive services that might require higher spending, they suggest.

Simon Stevens, head of NHS England, clashed with the government over health spending earlier this year, telling MPs Britain should be aiming higher than countries such as Mexico.

Henry Bodkin in the Telegraph 10th August reports: Waiting lists for routine NHS treatment such as hip and knee surgery longest for a decade 

Dennis Campbell in the Guardian: NHS patients waiting for hospital care top 4m for first time in a decade

BBC: Surgery waiting numbers highest in decade, says NHS England

BBC: Thousands of patient follow-up letters not sent to GPs

A nation choosing to have fewer children, and to import fewer workers for the health and social care services. It does not stack up.

We are a nation choosing to have fewer children, and to import fewer workers for running the health and social care services. It does not stack up.

Things have to get worse unless we export our elderly for warehousing abroad, or they are managed by robots.Image result for nuclear family cartoon

Fay Schopen reports in the Guardian that “IVF was stressful enough even before this new post code lottery. (NHSreality points out it’s not new and is only getting worse and more unfair as predicted)

Fay is paying for private care and pints out the two tier system which is the national effect of current policy.

Ironically, the Economist points out that fewer women in the west are choosing fertility. More and more have either one or no children. Is society getting compassion fatigue for those who choose to have large ffamilies?

The Rise in Childlessness is available in the Economist 27th July but also below.

Childlessness – Economist

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Change the Rationing of Infertility treatments from covert to overt: Schools should tell girls to try for a baby before 30, says fertility expert – and prospective professional be warned..

Patients suffer in GP funding lottery. Anger and civil unrest to follow?

You never knew it was “unavailable” until you needed it.. and then it’s too late

Women denied IVF as 80 per cent of NHS trusts ration fertility treatment

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