Category Archives: Commissioning

Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

If you have a stroke on your way to the hereafter, your life expectancy is short, demand for services is high, and nobody listens to you, even if you can be understood.  Dumped is the right political word. Congratulations to the reporter on his understatement however, The real word, especially with regard to intensive physiotherapy, is abandoned. Dead patients don’t vote, and those near death don’t appear to count. Commissioners have a perverse incentive to save money, richer areas can have more physio as more patients go privately, and the post-coded, covert rationing lottery continues..

Image result for stroke cartoon

Jon Ungoed-Thomas in the Sunday Times reports: Stroke survivors ‘are dumped by the NHS’

Sufferers feel abandoned after leaving hospital and face waiting up to a year for the right treatment — or paying for it themselves

Stroke survivors are being left to languish at home with a “shocking” lack of support. Many say they feel abandoned by the NHS.
Juliet Bouverie, chief executive of the Stroke Association, said a new national plan was required to help the 1.2m stroke survivors in the UK. Some have to wait up to 12 months for psychological help.
“As a stroke survivor, your life and the life of your family is turned upside down,” she said. “Many stroke survivors say they feel abandoned, as if they have dropped off a cliff. The provision in some areas is shocking.”
About 100,000 people suffer a stroke every year in the UK; it is one of the country’s leading causes of death.
Andrew Marr, the broadcaster and journalist, who suffered a stroke in January 2013, said better support for stroke survivors — many of whom are of working age — could help them return more quickly to employment. He was back at work within six months, but largely because he paid for additional physiotherapy.

Stroke survivors can wait up to four months for speech therapy and up to a year for psychological support, according to data from the Royal College of Physicians. Stroke survivors say there is insufficient physiotherapy, a treatment which would ensure the best recovery.

Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner<img class=”Media-img” src=”//www.thetimes.co.uk/imageserver/image/methode%2Fsundaytimes%2Fprod%2Fweb%2Fbin%2Ffa4fb670-698c-11e7-8ef4-9d945f972597.jpg?crop=2250%2C1500%2C-0%2C-0″ alt=”Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner”>
Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work soonerDavid Cheskin/PA

A stroke strategy, launched in 2007, outlined a 10-year plan to overhaul stroke services and has seen significant improvement in acute treatment. The Stroke Association is calling for a new action plan to build on improvements and outline a new strategy for the rehabilitation of stroke victims.

Nathan Ridgard, 40, a self-employed businessman and a father-of-two from Harrogate, North Yorkshire, suffered a stroke on New Year’s Eve 2012. After being discharged from hospital, he said he was given some leaflets by the NHS on coping with a stroke, but struggled to read them because of his poor vision.

“I just felt I had been dumped out in the world,” he said. He received some NHS physiotherapy, but also paid for private sessions to supplement them. He has since made a good recovery.

Professor Tony Rudd, National Clinical Director for stroke at NHS England, said: “The quality of care and survival rates for stroke are now at record highs. We are working with the Royal College of Physicians and others local health service leaders to improve rehabilitation care for everyone who suffers a stroke.”

Image result for stroke cartoon

 

Reflections on the BMA conference in Bournemouth. A complete lack of trust..

Image result for BMA health cartoon

ARM 2017 in Bournemouth

The annual representative meeting (ARM) is the BMA’s main policy-making body. Around 500 doctors from across the profession and the UK gather to consider and debate key matters of interest to the medical profession.

I have never been to a BMA conference before. his conference from 25-19th June was an eye opener. The volume of business, and the number of people was daunting. Agenda items ranged from the political to the clinical. and some of us thought some issues would be best addressed by politicians. Throughout the meeting there was a complete lack of trust by doctors of government, dishonesty, and denial by politicians and administrators, and resulting anger and resentment in the body politic. This is spreading beyond the profession and the unrest following the Grenfell tower will be as nothing to the unrest as the health safety net is seen to fail.

BMA council chair Mark Porter – opening speech  – Health Service running on fumes

STPs(Stick Toffee Puddings , or Slash Trash and Privatise

Agenda Items on Monday of which I as speaking at 1:34 into the meeting

Dr Roger Burns speaks up abut West Wales. (https://pharmaphorum.com/news/millions-affected-nhs-cuts-doctors/#) in response to Motion 16 (I):

Recognises that greater medical involvement in the design and planning of health care is crucial in ensuring that improved patient services are properly designed and effectively implemented.

There were plenty of retired members present, of whom I am one. It looks as if the retired members are trusted to represent their younger and busier colleagues. What is need is a way to vote from a distance. Members need to log into the website and watch a webcam and be prepared to vote at an instant. This would allow members to check in and relate to any particular motion but ignore others.

There was a couple of motions with the implication of rationing, but without mentioning the word itself:

Motion 12 (v) “Calls for government and NHS lead bodies to have an open dialogue with the public and patients about what services the NHS should provide for the funding available, and what services should no longer be funded by the NHS.

New attendees need to be aware that they need a speedy induction if they are to take advantage of the opportunity to speak. New conference members, and those who vote against a motion are given preference. I spoke out about the reconfiguration of Wales Health Trusts. NHSreality is in favour of one NHS trust for 3 million people, and this would at least endure choice within Wales. I spoke against the motion on the grounds that it failed to mention rationing, and the need for the politicians to get on board with this concept before we can make sense of the health service, and bring the hearts and minds of the doctors on board. Sometimes “hard truths” need to be said. Napoleon did this with the French after their revolution. By offering to bring order he took away a little liberty. Lack of choice is a loss of liberty, but it may be worth it if standards of treatment for important and expensive problems rise.

All local BMA groups need to plan ahead of the ARM to present notices of motion. Clinical and social meetings are also needed, and could be combined with politics.. My suggestions to be considered for the future include:

Wales residents should be given choices within Wales. If this can only be facilitated by one Health Trust then we support this proposal.

All Wales staff should be offered exit interviews by the BMA, and if they wish, in conjunction with other organisations such as the Nurses and Midwives, and other professions. Since no credence would be given to a summarised internal HR report, external consultants should be charged with this task.

In West Wales infrastructure needs to be improved, especially for travel, but also to replace old buildings and plant.

Medical Publications should always inform the reader if the paper was rejected by another publisher. The on line information should then reveal why rejection occurred.

All Wales BMA members should be offered the option of group/mutual medical insurance

and for local debate: A decision not to build a new hospital at Whitland / Narberth in 1996 is to be regretted.

Henry Bodkin in the Telegraph 27th June: Doctors call for abortion on demand as BMA votes to decriminalise terminations for first time ever 

Ann Furedi comments for BPAS: Why UK abortion laws should be scrapped – they are 50 years out of date 

Pharmforum comments on STPs on June 28th: Millions will be affected by STP health service cuts, say doctors

Hunt stayed silent over 700,000 lost letters to patients (The Telegraph)

Crowdfunding of Wheelchairs

UK falls behind in International league of doctor numbers (BMJ)

Government using GPs as scapegoats instead of taking responsibility for crisis in NHS

Margaret McCartney: Health inequality has to be political BMJ 2017;357:j2978

 

Image result for politics of health cartoon

BMA annual meeting: GPs working at unsafe levels should issue “black alert”-style warnings, says BMA (Wales sees steep rise in “at risk” surgeries.

Frances Gibb in the Times 27th June: Medical negligence payouts ‘unaffordable’

Doctors call for national rules on OTC prescribing (BMJ 25th March)

BBC2: Hospital – How do you cost life? 

Kat Lay in the Times 12th June: NHS blocks drug to help babies with spinal muscular atrophy

London commissioning group plans to restrict cataract surgery

Oliver \moody on 26th June: NHS urged to find money for cystic fibrosis drug

Kat Lay: ‘Overworked’ GPs demand to close their surgery doors

Image result for BMA health cartoon

 

 

 

 

 

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

Since the GP was excused from covering Out of Hours, the quality of continuity of care and palliative care has fallen. Care in the community (Hospice at home etc) is much more affordable, and sustainable than in patient care, especially in rural areas. It has to become normal to die at home..

Chris Smyth reports in the Times 14th June 2017: Doctors let dying patients waste their last days in A&E

Image result for home death cartoon

Tens of thousands of dying cancer patients spend their final year in and out of A&E because doctors are reluctant to tell them the end may be near.
Some are taken to hospital every other week in pain or struggling to breathe because of a lack of proper palliative care, analysis of NHS data shows.
Patients and their families wasted precious time in a “revolving door” of emergency treatment that was unlikely to extend their lives, said campaigners. They urged the health service to stop poor co-ordination between hospitals and local services.
One in ten hospital inpatients will die during their stay, but a review of services by the Royal College of Physicians last year found big variations, with only one in ten hospitals offering round-the-clock palliative care.
Researchers at Macmillan Cancer Support have looked at data on 316,000 patients with eight of the most common cancers, finding that 90 per cent had at least one emergency visit in the last year of their life.

More than 33 per cent had to be taken to hospital five times or more, equivalent to 22,000 patients a year, the charity found.
Five per cent, or 3,000 a year, had more than ten emergency visits, researchers will tell the Public Health England Cancer Data and Outcomes Conference in Manchester today.
This included nearly 200 patients a year visiting A&E more than 20 times.
Jane Maher, Macmillan’s chief medical officer, said that hospital staff were reluctant to tell patients that they may be dying.
“We haven’t really accepted as a society that people can both have cancer treatment hoping for the best and prepare for the end of life. Oncologists find it very difficult to have those ambiguous conversations,” she said.

GPs and district nurses can help with pain relief and contingency planning, while 24-hour support lines can help people cope with emergencies out of hours, but Professor Maher said that they would only be used if people had frank discussions and there was better co-ordination to stop them “falling through the cracks”.
Some studies have found that people who have aggressive treatment to prolong their lives die sooner than those given palliative care.
Jonathan Ellis of the charity Hospice UK, said: “Sadly, many people approaching the end of life are caught in a revolving door of repeat emergency visits to hospital . . . The lack of integration between health and social care services means that alternative options to hospital, such as community-based hospice and palliative care, are often overlooked.”

Simon Chapman, of the National Council for Palliative Care, said: “One of the core ways we should be looking at the NHS is the way it looks after people at the end of their lives.”

Case study
When Audrey Girling complained of a cough, doctors said she was just getting old. It was not until she was taken to hospital struggling to walk that she was found to have lung cancer, which had spread to the brain.

Mrs Girling, from Norwich, died within six months at the age of 80. Her daughter, Chris, said she and her sister were her carers until they could not cope any more. “In terms of actual care there was pretty much nothing,” she said. “We felt we were on our own.”

Mrs Girling was adamant that she wanted to die at home, but one Friday night she started fitting and her daughter phoned the ambulance. “She was so breathless that the GP had to beg the hospital to take her at A&E. There was no alternative and we were exhausted,” Ms Girling said.

She never left. Too ill to go home, Mrs Girling “just slowly deteriorated,” her daughter said. “It was quite drawn out. It was horrible. With the right end of life care, this would never have happened and her wish to die at home would have been possible.”

Image result for home death cartoon

Image result for home death cartoon

 

Leimyoscarcoma treatment options unfair…. in west Wales where choice is anathema.

I do not mind if something/some service is denied to everyone in the UK paying into the same mutual. What I do not like to hear is when someone in my town and post code is denied a treatment which is available in London. The National Sarcoma centre is at the Marsden, and there is a National Sarcoma Service. Unfortunately, unbeknown to the citizens and taxpayers of Pembrokeshire, until they suffer from sarcoma, is that this service is not available to them. This is what NHSreality calls COVERT rationing because one is not aware of it in advance. Net result is that money is raised, and this one patient gets “private” care. What about all the others in Wales? Local exclusion would be all very well for high volume low cost treatments, (this is not allowed) but is patently unjust for low volume high cost treatments. (allowed under the current “rules of the game”) Will the trust respond by saying they feel this is reasonable rationing? No way. They will use the words exclusion, restriction or prioritisation to justify their position. As a trust in special measures ( bankrupt and getting worse) it is not surprising they wish to save money… and the treatment may be poor value for money but this shows how unfair the situation is for those in West Wales, and it is repeated across many specialities and treatments.

Image result for unfair cartoon

BBC News reports today 23rd June 2017: Haverfordwest mum’s ‘roadblocks’ to SIRT cancer treatment

NHS Wales has been accused of “not being set up to deal with” certain types of cancer.

Anca Falconer, 36, from Pembrokeshire, was diagnosed with Leiomyosarcoma (LMS), a type of soft tissue sarcoma, just days after giving birth in 2010.

Her request for specialist treatment in England was refused.

The Welsh Health Specialised Services Committee said the success of Selective Internal Radiation Therapy (SIRT) “has not currently been established.”

Mrs Falconer, who lives in Haverfordwest, initially underwent extensive surgery and chemotherapy for her rare liver cancer, but it returned.

Her first request to the committee was rejected in 2013 on funding grounds, and her cancer consultant refused to submit another application, describing the efforts as being “futile”, and she was told she would have to find the money herself.

Fundraising efforts allowed her to receive the first round of SIRT, which involves injecting radioactive microbeads into the liver, at a cost of £10,000.

Mrs Falconer, who had been bedbound for about three months, said she felt transformed after the treatment.

“Within days I was able to stand up again. I can play with Mary and take her to school,” she said. “I had lost hope before.”

The second round of treatment costs £20,000 and is due by late August.

Mrs Falconer’s husband, Richard, 51, said NHS Wales was “not set up to deal with soft tissue sarcomas” with many of the specialist centres in England.

He added that he thought experts in Wales had “given up on his wife” four years ago and that she had received “nothing more than palliative care” and “roadblocks to all curative options that should have been on the table”.

Dr Sian Lewis, medical director for the Welsh Health Specialised Services Committee, said the “clinical effectiveness” of SIRT for the treatment of liver cancer “has not currently been established”.

She said it is only available to a limited number of patients in NHS England as part of a programme to assess its effectiveness.

The Welsh Government said NHS Wales will make a decision regarding the routine commissioning of SIRT when the results of the evaluation become available next year.

False hopes

Abertawe Bro Morgannwg University Health Board, which provided chemotherapy to Mrs Falconer, said if previous funding requests have been declined by the committee any subsequent submission has to contain “new clinical evidence”.

A statement from the health board said, while it could not comment on Mrs Falconer’s case, its “clinicians fully appreciate the distressing situation its patients are in”.

“It’s because of this they would never consider falsely getting a patient’s hopes up by resubmitting an already declined request when there is no new clinical evidence available.”

Hywel Dda University Health Board has also been asked to comment.

September 2016 – Mark Smith for Walesonline: Three Welsh health boards have been placed under additional Welsh Government scrutiny

Cardiff and Vale, ABMU and Hywel Dda are just one level short of ‘special measures’

Adrian O’Dowd in the BMJ 15th June 2017: Trusts boost ratings by engaging staff and including clinicians in management

Adrian Dowd in the BMJ 23rd June 2017 : The only way is up: the “special measures” trust that got back on its feet

Image result for unfair cartoon

 

The second eleven – The British political class is not up to the job

In the Economist June 10th, and talking about Brussels and Brexit negotiations, the writer Bagehot argues that career politicians do not have the experience for the job. This also applies to the Health Services in the UK. The dishonest language, denial, lack of leadership and low quality debate that threaten the health services apply to Europe. The lies on the bus… The politicians push commissioning onto GPs, rationing onto NICE, and try to pretend that they provide “Everything for everyone for ever“, but without ever saying what cannot be provided.

The second eleven – The British political class is not up to the job

IT HAS been impossible to watch the general election without being haunted by a single question-cum-exclamation: surely Britain can do better than this? The best performer in the campaign, Jeremy Corbyn, the Labour leader, is a 68-year-old crypto-communist who has never run anything except his own mouth. Theresa May, the Tory leader, tried to make the election all about herself and then demonstrated that there wasn’t much of a self to make it about. As for Tim Farron, the Liberal Democrats’ leader, he looked more like a schoolboy playing the part of a politician in an end-of-term play than a potential prime minister.

Complaining about the quality of your leaders is an ancient tradition: Gladstone’s older contemporaries no doubt moaned that he wasn’t a patch on Pitt the Elder. George Osborne, a former Tory chancellor, has had an enjoyable election skewering Mrs May from the editor’s chair at the Evening Standard, a London newspaper. But only four years ago that same organ was skewering Mr Osborne for his “omnishambles” Budget. And Britain’s leadership problems pale compared with those of America, where Donald Trump crashes from one disaster to another.

Yet sometimes decline really is decline. Both Mrs May and Mr Corbyn want to extend the already considerable powers of the government, Mr Corbyn massively so. And both promise to lead Britain out of the European Union, a fiendishly complicated operation. Unfortunately, both candidates have demonstrated that they are the flawed captains of flawed teams. Mrs May broke the first rule of politics: don’t kick your most faithful voters in the teeth for no reason. Mr Corbyn has stood out in part because his team is so mediocre. Diane Abbott, his shadow home secretary, stepped down the day before the election citing ill health, after a succession of disastrous interviews.

In 1922 Winston Churchill dubbed Bonar Law’s coalition government the “second eleven” because so many top players, including Lloyd George, refused to serve in it. Today both major parties are fielding their second elevens—Labour because of the rise of the far-left and the Tories because of Brexit. On the left, three-quarters of Labour MPs have concluded that Mr Corbyn is not fit to run their party, either personally or politically, scuppering their chances of a front-bench position. On the right, Brexit has hollowed out the party. Several prominent Remainers (including David Cameron and Mr Osborne) have retired, while several leading Leavers (such as Boris Johnson and Michael Gove) are seriously weakened. The Conservative Party chose Mrs May because she hadn’t expressed any strong opinions about the most important question of her time.

There are also deeper reasons. For most of the 20th century British politics has enjoyed an embarrassment of riches. Britain’s competing elites directed their most gifted offspring towards Parliament. The landed aristocracy sent Churchill and the Cecil clan. The business crowd offered Harold Macmillan and the Chamberlain dynasty. The trade unions put forward Ernest Bevin, Nye Bevan and James Callaghan. And the meritocratic elite sent intellectuals galore—so many, in fact, that the 1964-66 Labour cabinet contained seven people with first-class degrees from Oxbridge. (Mr Corbyn left school with two grade “E”s at A-level.)

There was plenty of dross among the gold, of course: Tory knights of the shires who didn’t care about much except badger culling and Labour trade-unionists who were only there for the beer. But the gold shone brightly. And it was well distributed between the major parties, with the Tories mobilising the forces of property and Labour the workers and intellectuals. Today it is as if Britain’s various elites have all decided, at exactly the same time, to stop sending their best people to Parliament.

It is harder to sell landed aristocrats to the people than it used to be. The trade unions are shadows of their former selves. But there is one big reason. Over the past 30 years politics has become a profession. Yesterday’s tribunes of the people, or at least of the people’s leading interest groups, have been replaced by professionals who make their livelihood out of politics. The trouble is, it turns out that politics is not a very attractive profession.

A sticky wicket

Most people crave two types of rewards: material (money and security) and psychological (esteem and fulfilment). Politicians don’t get much of any of this. They have seen their salaries fall relative to the sort of jobs that their university contemporaries go into, such as banking, consultancy and the law. They endure horrendous workloads: constituencies to nurse, speeches to make and, if they are ministers, huge departments to run. They live with the possibility of having the rug pulled from under their feet by electoral misfortune or personal scandal. And the public treats them with a mixture of suspicion and contempt. The proportion of Britons telling pollsters that they almost never trust the government has risen from one in ten in 1986 to one in three today. The biggest reward for putting up with all this is nebulous: the sense that you are part of the whirl while history is being made.

There are a few things that can be done to slow the decline. One is to give more respect to age and experience in selecting MPs. Parliament is over-stuffed with young former aides. Selection committees need to pay more attention to candidates who have already succeeded in other professions. A second is to broaden the talent pool. Margaret Thatcher used the House of Lords to bring in business people such as David Young. Gordon Brown did the same to try to create an administration of “all the talents”. The devolution of power to the cities may also provide another road to the top. If Britain embraces these and other ideas the electorate might face a more inspiring choice at the next election. But it is too late to do anything about the current mess: whoever wins the election, Britain will go into bat against Brussels with one of the weakest teams it has fielded in decades.

The comments and suggestions of “qualification” to be a politician by MBA are interesting.

 

The truth behind rurality: An increasing risk to individuals without access to a tertiary centre. Unethical rationing prevails.

The increased air pollution in the cities is countered by the lack of access to GP and specialist services in rural areas. The truth behind rurality is an increasing risk to individuals without access to a tertiary centre, Trusts have restricted choice.and this is particularly true in Wales where trusts such as Hywel Dda have restricted choice. Rationing by reducing choice options for certain post codes, but not for others, who pay the same tax, is unethical.

Image result for no choice cartoon

May Bulman in the Independent reports 18th March 2017: Beautiful Countryside hides the ugly truth…

The BMA news reports in Rural Health on 25th March 2017: Truth is hidden behind “picture postcard” image.

Poor health in rural areas is masked by “idyllic image” of the English Countryside, said local government and public health leaders in a joint report. Official statistics do not paint an accurate picture of people’s health outside cities., they warned. The report said that a sixth of areas with the worst health and deprivation in England are in rural areas; residents of rural areas are more likely to be over 65 than those in urban areas (23.5 v 16.3%); and rural residents are less likely to live within 4km of a GP surgery (80 v 98%) and 8km of a hospital (55 v 97%).

Have targets improved performance in the English NHS? | The BMJ – not in rural areas.

David Oliver reports in the BMJ: David Oliver: Challenges for rural hospitals—the same but different (BMJ 2017;357:j1731

The UK is densely populated. Even Scotland, with only 62 people per square kilometre, pales in sparseness next to Canada or Australia, whose densities are 3.2 and 2.6, respectively.1

Even so, our rural areas face distinct challenges, and the problems facing urban health systems are exacerbated in the countryside: less car ownership, worse public transport, longer travel times to GP surgeries. Practices are smaller and have more difficulty attracting GPs. The hospital is often a long round trip from patients’ homes. Distance makes access to moderate level urgent and ambulatory care crucial, as is rehabilitation or end of life care at or close to home, as well as family and social networks.23

Community hospitals, where they exist, can be used as a hub. GPs, paramedics, allied professionals, and nurse practitioners with enhanced skills and roles are invaluable.4

Rural areas aren’t homogeneous. Alongside bucolic idylls, much rural deprivation exists: social isolation, single occupier households, and unfit housing stock are more prevalent. Rural and coastal communities have a high proportion of older residents, compounded by “urban drift” in younger people.

It’s harder to attract a workforce to low paid caring jobs. Community practitioners and teams take longer travelling to and between patients’ homes. Funding formulas don’t reflect these additional costs, further disadvantaging rural areas.

And reconfiguration of health services based on urban models risks leaving whole regions without a hospital. Some specialised services clearly benefit from centralisation, but a smaller rural hospital should be able to do a great deal, including level 2 urgent care. In sparsely populated countries such as Australia, hospitals much smaller than the UK’s can provide a wide range of services.5

The lower patient volume and smaller peer group can make posts less attractive to subspecialists who want to maintain specialty interest and skills. Parallel rotas for acute, internal, and geriatric medicine, for example, may be unviable.6

There’s a pressing need for confident expert generalists happy to deal with most of what comes their way and for peripatetic hospital clinicians providing clinical support beyond the hospital’s walls. It’s especially hard to attract consultants to these roles, so substantive posts and rotas go unfilled.

Doctors tend to settle in the region where they complete specialist training, often with a family base in the town.7 Medical school places are disproportionately concentrated in big cities, limiting trainees’ exposure to rural medicine.89 Doctor-patient ratios and applications for training posts are higher in the metropolis.

If we want to ensure fair access to care in rural populations, tailored to their unique circumstances, we need plans to tackle these issues. And we have to start by recognising that their needs are the same but different.

Image result for no choice cartoon

Is choice an illusion in Wales? Not if patients pay to go privately.

Image result for no choice cartoon

 

 

Police investigate NHS waiting list ‘fiddle’

The epidemic of performance management in health has corrupted administrators, commissioners, and trust boards as well as doctors and nurses. The perverse incentives to fiddle the books are so strong that many are tempted. This is just the tip of an iceberg… Rationing differently by post-code encourages whatever behaviours can be got away with..

Image result for iceberg cartoon

Chris Smyth on June 5th reports: Police investigate NHS waiting list ‘fiddle’

Police are investigating allegations that an NHS hospital fiddled waiting times to meet targets.
NHS counterfraud agents are also looking into claims that bosses manipulated computer systems to hide the extent of long waits.
Dozens of patients are known to have been harmed, including one who suffered loss of sight, and hundreds are still waiting for surgery after more than a year.
Kettering General Hospital accepts that waiting lists were wrongly reported but insists this was an IT error rather than a deliberate cover-up. However, David Phelan, a former surgery man- ager at Kettering and now a governor of the hospital, said that officially reported waiting times were “based on a lie”.
Hospitals are told to make sure that 92 per cent of patients are given routine operations, such as hip replacements, within 18 weeks. Mr Phelan claims that bosses were so obsessed with hitting the target that they asked for databases to be programmed to exclude patients who had waited for more than a year and those who had not been in touch for six months.

He first noticed the anomalies in 2015. “They’ve bastardised the data so badly they actually don’t know what the waiting list is. They don’t know how many patients were affected,” he said.
Norman Lamb, the Lib Dem health spokesman, demanded a full inquiry. “There appears to be a rotten culture which has to be confronted,” he said.
Detectives have interviewed Mr Phelan and visited the hospital in response to the allegations but have yet to decide whether to open a formal inquiry. It is unclear whether the claims would be treated as fraud, misconduct in a public office or a data crime. “An allegation of potential misconduct at Kettering General Hospital has been made to Northamptonshire police and we are in the process of scoping that allegation,” a police spokesman said.
Fiona Wise, interim chief executive of Kettering General Hospital, said: “Naturally we will work with [the police and NHS Protect] to demonstrate how we have handled our waiting-time is- sues. The trust has openly and publicly admitted that we have had problems with our waiting-times data, systems and processes at that time and we have worked hard to address all of those issues and ensure that patients do not wait for too long. We have also categorically refuted any allegation that the trust has deliberately manipulated its waiting-list data.”