Category Archives: Patient representatives

The benefits to the NHS of staying in the EU

No harm at this political juncture, or reminding NHSreality readers of The benefits to the NHS of staying in the EU (The Times letters 4th April 2016.

Sir, As health professionals and researchers we write to highlight the benefits of continued EU membership to the NHS, medical innovation and UK public health.

We have made enormous progress over the decades in international health research, health services innovation and public health. Much of this is built around shared policies and capacity across the EU. The future for European citizens’ health lies in teamwork.

EU trade deals will not privatise the NHS as negotiations now contain clear safeguards. Decisions on NHS privatisation are in UK government hands alone.

EU immigration is a net benefit to our NHS in terms of finances, staffing and exchanges. Medical tourism brings surplus funding.

Finally, leaving the EU will not provide a financial windfall for the NHS. The UK’s contribution to the EU budget is part of an agreement allowing access to the single market. If we pulled out, adverse economic consequences far larger than any nominal savings are widely anticipated. This jeopardises an already cash-strapped NHS.

Our health services, health-research collaborations and public-health protection are more robust within the EU. Leaving would damage the progress we have made together. Brexit should carry a health warning.

Professor Martin McKee CBE, Professor of European Public Health, London School of Hygiene and Tropical Medicine
Professor Sir Simon Wessely, Vice Dean, Academic Psychiatry, King’s College London Dr Mike Galsworthy, Programme Director, Scientists for EU
Lord Bernie Ribeiro FRCS, Past President, Royal College of Surgeons London
Lord Nigel Crisp, Former Chief Executive NHS, London
Baroness Elaine Murphy FRCPsych, Professor of Psychiatry, London
Lord Alderdice FRCPsych, Senior Research Fellow, Harris Manchester College, University of Oxford
Professor Dame Jill Macleod Clark, Professor of nursing, University of Southampton
Sir George Alberti, Visiting Professor, King’s College, London
Sir Harry Burns, Professor of Global Public Health, University of Strathclyde
Sir Iain Chalmers, Co-ordinator, James Lind Initiative, Oxford
Sir Ian Gilmore, Professor, University of Liverpool
Sir Richard Thompson, Immediate past-president, Royal College of Physicians, London
Sir Robin Murray, Professor of Psychiatric Research, King’s College, London
Sir Sam Everington, GP, London
Sir Cyril Chantler, Formerly Chairman of The King’s Fund and the UCL Partners academic health science network, London
Mr Carl Philpott, Honorary Consultant ENT Surgeon, University of East Anglia
Professor Dominic Harrison, Director of Public Health, Blackburn with Darwen
Dr Anna Batchelor, Consultant anaesthetist, Newcastle upon Tyne
Dr Arpana Verma, Director Centre for Epidemiology, University of Manchester
Dr Christine Robinson, Research Assistant, University of Manchester
Dr Christopher A Birt, Honorary Clinical Senior Lecturer in Public Health, University of Liverpool
Dr Clare Gerada MBE, Former Chairwoman, Royal College of General Practitioners London
Dr David L Cohen, Consultant Physician, Northwood
Dr David Nicholl, Clinical Lead for Neurology & Neurophysiology (writing in a personal capacity), Sandwell & West Birmingham NHS Trust
Dr David Wrigley, GP, Carnforth, Lancashire
Dr Dominic Hurst, Clinical Lecturer in Primary Dental Care, Queen Mary University of London
Dr Geeta Nargund, Medical Director, Create Fertility London
Dr Harry Rutter, Senior Clinical Research Fellow, London School of Hygiene and Tropical Medicine
Dr Henry McKee, GP, Belfast Trust
Dr Iona Heath, Retired general practitioner, London
Dr Jane Young, Consultant Radiologist and Head of London School of Radiology, Whittington Health
Dr Jennifer Mindell, Reader in Public Health, UCL, London
Dr John-Paul Lomas, Specialist Trainee in Anaesthetics, Manchester
Dr Kevin O’Kane, Consultant in Acute Medicine, Guy’s and St Thomas’ NHS Trust
Dr Leila Lessof OBE, Former Director of Public Health, London
Dr Linda Papadopoulos, Psychologist, London
Dr Michel Coleman, Professor of Epidemiology and Vital Statistics, London School of Hygiene and Tropical Medicine
Dr Nicola Shelton, Reader in Population Health, London
Dr Omar Bouamra, Medical Statistician, University of Manchester
Dr Richard Horton, Editor-in-Chief, The Lancet, Elsevier
Dr Roberta Jacobson OBE, Honorary Senior Lecturer, Institute of Health Equity, London
Dr S Vittal Katikireddi, Senior Clinical Research Fellow, University of Glasgow
Dr Suzy Lishman, President, The Royal College of Pathologists
George Davey Smith, Professor of Clinical Epidemiology, University of Bristol
Jan van der Meulen, Professor of Clinical Epidemiology, London School of Hygiene & Tropical Medicine
Mr Gary Clough, Research Assistant, University of Manchester
Mrs Louise Johnson, Well North Executive Co-ordinator, University of Manchester
Ms Clare Huish, Research support assistant, Manchester
Ms Rosalynde Lowe CBE, Former Chairwoman Queen’s Nursing Institute, London
Prof Alastair H Leyland, Professor of Population Health Statistics, University of Glasgow
Prof Frank Kee, Clinical Professor, Queen’s University Belfast
Prof Gerard Hastings OBE, Professor, Stirlng and the Open University
Prof Humphrey Hodgson FMed Sci, Emeritus Professor of Medicine , UCL
Prof John S Yudkin, Emeritus Professor of Medicine, University College London
Prof Jonathan Weber, Director, imperial College Academic Health Science Centre, Imperial College London
Prof Mark S Gilthorpe, Professor of Statistical Epidemiology, University of Leeds
Prof Trevor Powles CBE, Head Breast Cancer Cancer Centre, London
Professor Peter Kopelman, Emeritus Professor of Medicine (formerly Principal), St George’s, University of London
Prof Martin White, Programme Leader, Food Behaviours and Public Health, University of Cambridge
Prof Ray Powles CBE, Head, Haemato-oncology, Cancer Centre London
Prof Sir Mike Owen, Professor of Psychological Medicine, Cardiff University
Prof Tim Helliwell, Vice President for Learning, Royal College of Pathologists, Liverpool
Professor Adrian Renton, Director of Institute of Health and Human Development, London
Professor Aileen Clarke, Head of Division of Health Sciences, Warwick Medical School
Professor Allan H Young, Director, Centre for Affective Disorders, King’s College London
Professor Alwyn Smith CBE, Former President, UK Faculty of Public Health, Manchester
Professor Carol Dezateux, Professor of Epidemiology and Hon Consultant Paediatrician, London
Professor David Edwards, Professor of Paediatrics and Neonatal Medicine, Guy’s and St Thomas’ Hospital Trust
Professor Debbie A Lawlor, Professor of Epidemiology, University of Bristol, Bristol
Professor Derek Cook, Professor of Epidemiology, St George’s University of London
Professor Dorothy Bishop FRS, FBA, FMedSci, Professor of Developmental Neuropsychology, University of Oxford
Professor Gabriel Scally, Visiting Professor of Public Health, Bristol
Professor Jane Salvage, Nursing consultant, Lewes
Professor John Ashton CBE, Director of Public Health, Cumbria
Professor John Malcolm Harrington, Emeritus Professor of Occupational Medicine, Budleigh Salterton
Professor John Middleton, University of Wolverhampton, Wolverhampton
Professor KK Cheng, Director, Institute of Applied Health Research, University of Birmingham
Professor Liam Smeeth, Senior Clinical Research Fellow, London School of Hygiene and Tropical Medicine
Professor Lindsey Davies, Past president, UK Faculty of Public Health, London
Professor Martin Bobak, Professor or epidemiology, University College London
Professor Maurice Lessof, Former Professor of Medicine, Guy’s Hospital
Professor Patrick Saunders, Director, Carolan57 Ltd
Professor Peter Whincup, Professor of Epidemiology, St George’s, University of London
Professor Raymond Agius, Professor of Occupational and Environmental Medicine, University of Manchester
Professor Rod Griffiths CBE, Past President, Faculty of Public Health, London
Professor Rod Hay, Professor of Cutaneous Infection, King’s College NHS Trust London
Professor Rosalind Raine, Head of Department of Applied Health Research, UCL
Professor Rosalind Smyth CBE FMedSci, Director, UCL Institute of Child Health
Professor Simon Capewell, Chairman of Clinical Epidemiology, University of Liverpool
Professor Salman Rawaf, Professor of Public Health, Imperial College
Professor Shah Ebrahim, Hon. Professor of Public Health, London School of Hygiene Tropical Medicine
Professor Shanta Persaud, Professor of Diabetes & Endocrinology, King’s College London
Professor Simon Heller, Professor of Clinical Diabetes, University of Sheffield
Professor Sir Munir Pirmohamed, David Weatherall Chairman of Medicine and Consultant Physician, University of Liverpool
Professor Stephanie Amiel, Professor of Diabetic Medicine, King’s College London
Professor Trisha Greenhalgh OBE, Professor of Primary Care Health Sciences, University of Oxford
Dr Rachel Scantlebury, Public health registrar, London
Dr Verma Amar Nath, Retired General Medical Practitioner (NHS), Birmingham
Dr Ingrid Wolfe, Director, Children and Young People’s Health Partnership, Guy’s and St Thomas’ NHS Foundation Trust
Sir Eric Thomas, Former Vice Chancellor, University of Bristol
Lord Ara Darzi OM, Paul Hamlyn Professor of Surgery, Imperial College
Baroness Sheila Hollins, Former President Royal College of Psychiatrists, London
Lord Naren Patel, Former President Royal College of Obstetricians and Gynaecologists, Dundee
Professor Anna Gilmore, Professor of Public Health, University of Bath
Mrs Alexandra Johnson, CEO Joining Jack, Joining Jack, Wigan
Richard Fitzgerald, Consultant Radiologist, Royal Wolverhampton Hospitals NHS Trust
Anne Lennox, Chief Executive, Myotubular Trust
Professor Alison Woollard, Associate Professor, University of Oxford
Dr Simon Stockill, Medical Director, NHS Leeds West Clinical Commissioning Group
Professor Michael Laffan, Professor of Haemostasis and Thrombosis, London
Mr Daniel Mayhew BSc, Development Technician, Cambridge
Dr Martin Yuille, Reader, University of Manchester
Dr Alastair Cardno, Senior Lecturer in Psychiatry, University of Leeds
Ben Caplin, Senior Clinical Lecturer, UCL
Professor Chris Inglehearn, Ophthalmology, University of Leeds
Professor Matthew Hotopf, Director NIHR Biomedical Research Centre at the Maudsley, King’s College London
Dr Carolina Lopez, Consultant Radiologist, Bedford Hospital NHS Trust
Dr Chiara Marina Bettolo, Consultant Neurologist, Newcastle upon Tyne
Professor Peter Openshaw, Professor of Experimental Medicine, Imperial College London

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Missed appointments are a distraction. In the factory model there has to be a disincentive for poor quality (and to make a claim).

Recent news on missed appointments may be confusing the public. GPs are pleased to have a little reflective and organisational and administrative time when a patients does not attend. They may already be late, and then the time is merely used to catch up. In GP land, before GPs were excused from “emergencies”, all patients had to be seen before you went home. Not so today. In Hospital land, consultants have limited numbers, and GPs have followed suite. The least popular careers in the 4 health services are, guess what, emergency medicine. Victims of a career in A&E have to contend with long and difficult shifts, overdemand, and under capacity. The mopping up which GPs used to do has moved to A&E, and with less experienced doctors seeing the patients. Missed appointments are a distraction. In any factory  model ( mutual insurance system ) there has to be a disincentive for poor quality ( and to make a claim) .. Once we ration overtly, and probably introduce co-payments, morale in all areas will improve, recruitment will be better, and the “reality” of life will sink in to the public as a whole. Phil Collins in the Times opines that “..The factory model of healthcare is no longer appropriate in a nation made healthier by the success of the first seven decades of public healthcare.” But even he shies clear of the need for autonomy, responsibility for self, and for sticks as well as carrots to encourage good health. If missed appointments cost millions, most Drs don’t really care. It’s a distraction, a side issue. Politicians have yet to arrive for their reality appointment… (see below)

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BBC News 2nd January: Missed GP appointments ‘cost NHS England £216m’

July 2nd in the Times: Attlee ‘would be shocked by abuse of NHS’ – “The prime minister who created the NHS would be horrified that patients are abusing it by missing appointments”, his granddaughter has said.

Jo Roundell Greene, the granddaughter of Clement Attlee, said that when the health service was created people were “so grateful”, but some now took the system for granted.

We have to shut hospitals to save the nhs – Phil Collins opines in the Times 4th Jan 2019…    “…Public Health England, the government’s health agency, has been highlighting the threat from diabetes which, on current trends, could take up a fifth of the whole NHS budget by 2035.”

The Times letters to the Editor 2nd and 4th Jan 2018: Missed hospital appointments and the NHS

Sir, I challenge the supposition of the chief nursing officer for England that missed clinic appointments are so costly (“Timewasting patients are costing NHS £1bn a year”, Jan 2).

When, some years ago, we looked into the problem in my orthopaedic and fracture clinics, we found that most non-attenders had recovered, or no longer needed our treatment. Most were judged to have been given precautionary appointments by less experienced junior doctors.

In some areas patients are now sent mobile phone text reminders of their appointment, with plans to supplement this with a similar email policy. This and better supervision and training of young doctors should resolve the problem for most cases.

Reappointments need be sent only to those unable to decide for themselves, such as children, or the few deemed at serious risk should they miss their checkup.
Paul Moynagh
(Retired orthopaedic consultant surgeon)

Sir, The chief nursing officer tells us that patients who fail to attend their hospital outpatient appointments are costing the NHS nearly £1 billion annually. This is almost certainly nonsense. In almost all of my 25 years as an NHS consultant in ear, nose and throat surgery (which has a heavy outpatient workload), we would evaluate the missed appointments rate regularly and increase the planned numbers per clinic accordingly. This is standard practice across the service.
Prof Antony Narula
Wargrave, Berks

Sir, I feel we are not made sufficiently aware of the costs of NHS services we use. If the cost of each medication were printed on the package we may be persuaded to use it carefully.

I was horrified to be told by the pharmacist that my bottle of medicine cost £300. I now make sure that I don’t waste a single drop.
Elizabeth Bass

Shepton Mallet, Somerset

and on 4th Jan:

MISSED APPOINTMENTS
Sir, I cannot understand how missed appointments are costing the NHS £216 million (report, Jan 2). The so-called cost of an appointment is a notional figure; if the appointment does not happen, it costs nothing at worst and saves money at best. If a patient fails to show, not only can an overworked GP catch their breath (or catch up, because they will almost certainly have got behind) but they won’t have to do expensive tests or prescribe expensive drugs. So this £216 million is fake accounting.

What might be interesting is why appointments are missed. The patients may have got better; their mother-in-law may have been admitted to hospital as an emergency; or there was no one to take them to the surgery.
Dr Andrew Bamji

Rye, E Sussex

Sir, In my experience missed appointments can be due (in part at least) to the NHS’s own systems. For example, my wife was called by her consultant’s secretary to ask why she had not attended an appointment; she replied that she had not been given an appointment (the letter, which had a second-class stamp, arrived the next morning).

My daughter has had a number of similar experiences: once the letter dropped through the letterbox 30 minutes before the appointment was due. After another appointment she was called by a secretary at the hospital, who asked why she had failed to attend. My daughter replied that she had, in fact, attended. She was then asked to relate, in detail, what the doctor had said to her.
Malcolm Hayes

Southam, Warwickshire

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Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

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Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns

Haverfordwest

Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

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A Happy Brexmas to everyone as our leaders duck health and social care funding crisis.. The media failure, and political denial can only get worse..

Distracted by Brexit… There is plenty of evidence that Social Care is breaking down, and with the loss of the opportunity to import EU workers, the staffing issues will only get worse. Government in Westminster, following reports from Wales and Scotland, has promised a review of the funding of social care (and by implication, Health as the budgets are being combined), but they have failed to do this in their own time line which was before Christmas. A Happy Brexmas to everyone as our leaders duck health and social care funding crisis.. Even the IFS (Institute for fiscal studies) admits its a bust.. 

We have to earn profits as a nation to afford social care and health care, but the current account deficit is getting worse, despite the promise from Brexiteers that a lower pound would help exports. (Huge current account deficit is a worrying backdrop as Brexit nears – 

The media’s failure, and the political denial will get worse. NHSreality predicts that when the health and social care review is published, that it will try to pretend that we don not need to ration health care. It will ignore the fact that social care is means tested and health care is not, and it will allow post code blurring of the margins between these two. 

Paul Johnson in the Times 24th December opines in  Vital social care needs are ignored in obsession with short-term expediency  “….This is a long-term failure of government. It is a perhaps a sign of the fact that we have come to expect nothing better that I have seen little or nothing in the mainstream press in the past few weeks bemoaning yet another failure to deliver on a promise simply to publish a set of policy ideas for consultation. Perhaps we have just given up…” (Full text below)

Jan 2018: Parliamentary Review of Health and Social Care in Wales Final Report

The Nuffield Trust: Health & Social Care in the UK | Research Reports and Analysis

Charts and Infographics (Nufield Trust)

NHS deficits  (Nuffield Trust)

The Institute of Fiscal Studies reports 2018: A review of the Department of Health and Social Care’s Funding …

Jan 2018 in the Guardian – Delay in the Green Paper…

The Berwick report in 2013 criticised the lack of “compassion”, and it has got worse since then.

Vital social care needs are ignored in obsession with short-term expediency – 

The whole article is below:

Paul Johnson Vital care needs ignored

As Robertson Steel said in his valedictory piece, its all down to politicians and the “rules of the game”.

Dr Robertson Steel letter (exit interview) for Western Telegraph in Pembrokeshire

General News regarding the 4 UK Health Services in last 2 weeks.. Worse and worse…

Readers might well ask “What is the legal situation regarding rationing?” Well, as long as its called something else, prioritisation, restriction, limiting or excluding, trusts can, within certain limitations, ration health care. The risk of anarchic rationing by post code was exposed by NHSreality last week. (NHS rationing and the Law by Warwick Heale in Devon) The risk is getting higher….. and as each week draws nearer to Brexit day, UK citizens might wish to consider how they can reduce risk. Private insurance is all very well for “cold care” (Non urgent) but emergencies are unpredictable, A&E s are understaffed, and capacity is limited as well as funding. The safety net which was there when I qualified in 1974 is well and truly holed. I strived to find “good news”, and note the savings on syringes and gloves.. but this is child’s play compared to the waste elsewhere. The return of fear and the ultimate lottery in health care has arrived. The average citizen/punter will not recognise the problem until they or their next of kin are ill….. The current funding and the system for funding health overall is a political decision. The need for change is paramount, but in the Brexit limbo iceberg of today, no important changes are likely. Its going to get worse…

NHS rationing and the Law – by Warwick Heale in Devon

Gareth Iacobucci in the BMJ reports 16th September: GP exodus could force hundreds of practices to close in next five years, royal college warns

and on 2nd October David Oliver reports:  The crisis in care home supply

Mark Smith for Walesonline 22nd October reports: Welsh NHS boss quits and is moving to England to get better cancer care for her husband –  Prof Siobhan McClelland says she has lost faith in the Welsh NHS

and the Welsh Health Minister “rejects her claims” in the Mail

Michael McHugh 22nd October 2018 in the Belfast Telegraph: Cancer treatment in Northern Ireland receiving ‘sticking plaster’ approach, says campaigner – Co Down woman blasts care available to patients

and Northern Ireland health service facing resourcing crisis amid 1,800 vacancies – health chief Valerie Watts – An extra £100 million has been set aside to overhaul the system as part of the DUP’s confidence and supply agreement.

and MP’s ‘real concern’ at disparity in health service between Northern Ireland and UK

In BBC Scotland Glen Campbell reports 16th September: Health board says Brexit poses ‘very high’ risk of disruption after August : NHS Scotland works up ‘detailed’ no-deal Brexit plan

BBC News Holyrood Louise Wilson 22nd October: Statements on abuse, NHS and P1 assessments – Worse waiting lists, waiting times, cancer waits, and outcomes wompared to England.

ITV News reports something good: NHS saves £228m on syringes and disposable gloves!

and there are “not enough showers or toilets” in a Broke Trust.

Jamie Doward in the Observer Sunday 21st October: Ten NHS trusts ‘wasted £235m to hire private ambulances’ – Union anger over bill for outsourcing while service starved of cash

Dennis Campbell Sunday 21st October: NHS £20bn boost risks being spent to pay off debts, experts warn – PM urged to write off £12bn in hospital overspending or extra healthcare will be unaffordable

Martin Shipton for Walesonline 28th September: Welsh councils demand health cash is spent on schools and social care – Local authorities want the Welsh Government to give them some of the extra money that is coming to Wales as a result of NHS funding rises in England

Cathy Owen for Walesonline 18th September: Iceland is giving NHS staff free ice cream and pizza – Workers who have signed up to the supermarket’s Emergency Services Bonus Cardiff will benefit

David Williamson for Walesonline: GPs in Wales are getting a major pay hike – what the 4% deal means for staff  – Doctors are delighted but dentists are upset

Richard Youle 3oth September: Health board wants to ditch Welsh-only name because it thinks it’s putting people off working there – But it fears ending up being called Healthy McHealth Board, if it lets the public vote for a new name, following the Boaty McBoatface debacle

Mark Smith and Ruth Mozalski: Deaths of 26 babies being investigated by Cwm Taf health board

A review has found 43 maternity cases where there was an ‘adverse outcome’ since the start of 2016

Adam Hale 9th October: NHS managers ‘used names of U2 band members to cover £700,000 fraud’ – The trio allegedly helped secure payments for building work which had ‘major deficiencies’ and cost £1.4m to rectify

Strand News Service: Boy left brain damaged by ‘negligent care’ at Welsh hospital is awarded millions in compensation  – The boy, who is now eight, suffered ‘catastrophic injuries’ in the first few days of his life

Doncaster, which cannot attract doctors easily. is taking matters into it’s own hands: NHS Trust looks to Doncaster school for future staff (BBC News 19th October)

NHSreality wonders if it was a doctor who first saw the young man in Tonbridge Wells: Tunbridge Wells man died after misdiagnosis of sepsis symptoms (BBC News 18th October)

And in the Isle of Wight: Isle of Wight hospital trainee doctors ‘left alone’. – Hospital patients on the Isle of Wight suffered as a result of trainee doctors being left to make decisions they were not qualified to make, inspectors said.

BBC News 22nd October: King’s Lynn QE hospital head quits following ‘inadequate’ report

Dennis Campbell on 21st October in the Observer: NHS £20bn boost risks being spent to pay off debts, experts warn – PM urged to write off £12bn in hospital overspending or extra healthcare will be unaffordable

Are we to expect rationing by anarchy? Will we repeat the lessons of the past?

NHS rationing and the Law by Warwick Heale in Devon

 

Tayside bullying

Concerns raised with Tayside NHS over systematic bullying, MSPs are told. The Courier 20th September 2018. .

Allegations of “systematic bullying” at NHS Tayside and the stress-related suicide of a trainee doctor there prompted the resignation of the health board’s whistleblowing champion, MSPs were told.

Munwar Hussain was one of three non-executive directors of the troubled health board who quit in the wake of what was branded a “crisis of public confidence” there.

Labour health spokesman Anas Sarwar said Mr Hussain had been frustrated that concerns raised were “not being acted upon by managers”.

Mr Hussain was contacted by a former trainee doctor who said they “left the NHS due to issues of systematic bullying and negative cliques”, Mr Sarwar said.

There is a crisis of public confidence with NHS Tayside following a series of issues

Labour health spokesman Anas Sarwar

The Labour MSP continued: “There were claims that people were raising issues but these were not being acted upon by managers, including allegations in the email that a previous trainee took their own life and the stress was unbearable for some.

“A serious set of allegations including that a trainee took their own life due to stress.

“He (Mr Hussasin) goes on to say that he asked for this to be raised at a board meeting but was told that he could not.”

Mr Sarwar said Mr Hussain “eventually” raised concerns at a staff governance committee meeting but said he felt “this is viewed as an ongoing issue which is tolerated”.

It emerged at the weekend that Mr Hussain had decided to resign from NHS Tayside – along with colleagues Stephen Hay and Doug Cross – but he did not make public the reason for his decision.

Health Secretary Jeane Freeman told MSPs she was aware “other board members are considering their future plans”.

But she stressed she had “immediately followed up” the issues Mr Hussain raised with her.

These included concerns about “doctors in training” as well as senior management pay, the use of public funds, and CAMHS (Child and Adolescent Mental Health Services) issues, she said.

Mr Sarwar said he had seen the letter Mr Hussain sent to the Health Secretary, as he claimed: “There is a crisis of public confidence with NHS Tayside following a series of issues, including financial mismanagement leading to brokerage loans, raiding of the charity endowment fund, a chief executive and chair forced to resign.”

Ms Freeman conceded there were “undoubtedly challenges for NHS Tayside”, adding she “would not underestimate those in any respect”.

She insisted the “appropriate place” for Mr Hussain to have raised his concerns was at the staff governance committee meeting “and not in the wider public board meeting”.

And the Health Secretary said the board at NHS Tayside – which had a new chief executive and chairman appointed in April – were “responding appropriately in my opinion to the whistleblowing issues that have been raised with them”.

Ms Freeman pledged: “I will continue to monitor how the board deals with those and what the end result will be.”

Liberal Democrat health spokesman Alex Cole-Hamilton later pressed the Health Secretary on the “revelations” from Mr Sarwar.

The Lib Dem MSP asked: “On something this serious, on a failure of whistle-blowing systems this serious, can we really expect the board to mark it’s own homework on this?”

He argued it was “in our national interest” for the Health Secretary to “instruct a full, independent public inquiry” into whistle-blowing in NHS Tayside.

But Ms Freeman told him: “I do not believe that is necessary.”

She added: “We have a set of very serious claims by a member of NHS Tayside’s board which was communicated to me via email on September 3. That member then indicated his intention to resign following his period of ill health absence on September 11.

“The board has acted on these concerns. I have seen the actions they have taken prior to Mr Hussain being in touch with me and I have made a commitment I will keep a very close eye on how the matters progress.”

Orkambi and Yescarta are merely illustrating an ethical problem that will get bigger into the future… Political dishonesty and denial stall a solution.

It is self evident that we cannot afford everything. In health we only find this out when we need a non-funded treatment, such as Orkambi. There are other examples, such as Yescarta, Anticoagulant monitors etc. With drugs the perverse incentive is for authorities to decline them for as long as possible, so that they get as near to their patent expiry (12 years) as possible. Usually media pressure brings the state funding forward by a few years.. But in the intervening period the “health divide” means that only those who can afford it will get the new treatments. We could afford all these treatments once they were proven, if we agreed to ration out high volume low cost treatments. Indeed, for a disease like CF, the advent of CRISPR could ensure that fewer and fewer people need the drugs. This is the longer term solution, but shorter term our politicians need to ration honestly and overtly, large volume low cost products, so that those unfortunate enough to have an expensive disease can be treated. Even America is not covering Orkambi…

When will the debate on rationing take place ?

George Herd for BBC Wales: Cystic fibrosis mothers’ plea over ‘life-changing’ drug

Kimberly Roberts is the mum of three-year-old Ivy, who has cystic fibrosis – or CF – which is a genetic lung disease with no cure.

Along with her friend Alison Fare, who has two daughters with the condition, they want access to one of the most advanced treatments – the drug Orkambi.

But the manufacturer and NHS bosses have been locked in arguments over its £100,000-a-year price tag since 2015.

“Our children deserve to have it – deserve to live a healthy long life. Without that drug they won’t have one,” said Mrs Roberts, who lives near Conwy in north Wales.

Nice – the body which recommends whether a drug or treatment is available on the NHS – has said that the ongoing bills for the drug would be “considerably higher than what is normally considered a cost-effective use of NHS resources“….

Nice has said the cost for the drug would be “considerably higher than what is normally considered a cost-effective use of NHS resources“.

In July, NHS England made an offer of £500m for five years to have the treatment, with £1bn over 10 years.

But while that offer remains on the table – the deal has not been done.

Good News: Deal to freeze prices will allow NHS to use new drugs

First stem-cell therapy (for corneal epithelium) approved for medical use in Europe

Drug trails: how much obligation ha the state to support unproven treatments?

Anticoagulants to prevent clotting diseases.

Orkambi rationed for Cystic Fibrosis

Big pharma is taking the NHS to court this week – research is not “nationalised” for a reason..

More money needed… lets pour a little more into the holed bucket – and reduce the quality of care by rationing new treatments

Key cancer drugs to be axed from NHS fund – ITV News is updated by the Mail and Wales makes sensible decision..

The Times 29th August 2018: Yescarta cancer therapy ‘is too costly for NHS’

Kate Thomas for the NY Times 24th June 2018: A Drug Costs $272,000 a Year. Not So Fast, Says New York State. – New York’s Medicaid program says Orkambi, a new drug to treat cystic fibrosis, is not worth the price. The case is being closely watched around the country.

In PharmaTimes, Selina McKee, online 9th July 2018: Vertex, NHS England no closer to Orkambi settlement