Category Archives: Patient representatives

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

 

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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

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

The safety net of the 4 health services is “free, comprehensive, cradle to grave, without reference to means”, but the safety net of social care is means tested, and only available in extreme poverty and with multiple conditions, and after a long delay in assessment, by which time the patient is often dead. The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care? Brexit costs can only make this worse… If we are going to ration lets do it  honestly. Commissioners should be allowed to alert their populations to what is not available in their post code.

William Eishler in Local Government news reported 17th Jan 2018: Funding system for continuing healthcare needs failing patients.

The system for funding health and care services is overly ‘complex’ and is ‘failing’ people with continuing healthcare needs, such as Alzheimer’s and multiple sclerosis, MPs say.

A new report by the Public Accounts Committee (PAC) warns that many people have their care compromised because no one makes them aware of the funding available or helps them to navigate the funding system……

Mark SMith for WalesonLine 23rd August 2018 reports: Families facing ‘excessive delays’ in reclaiming thousands for healthcare costs they should never have paid – Public Ombudsman for Wales has says 330 claims still need to be reviewed

Patients and their families who have incorrectly paid up to hundreds of thousands of pounds in healthcare costs are facing “excessive delays” in getting their money back, it has been revealed.

A new report from the Public Ombudsman for Wales has found that as many as 330 claims still need to be reviewed from people who feel they may entitled to a reimbursement.

The NHS has set up a funding programme, known as NHS Continuing Healthcare, which means people with a complex, ongoing illness can apply for an assessment.

For those eligible, all care needs outside hospital – including nursing home costs or help from a community nurse – are met by the NHS.

But for years, many families have been unaware about this programme and have resorted to selling their homes and making other major sacrifices to make ends meet….

Continuing Health Care funding needs to be rationed honestly, universally, and overtly. The only fair way is by a third party without the Perverce Incentive to refuse..

Continuing Health Care – the Lottery of how you die and how determined and educated your relatives are: Healthcare system is in need of a cure

Untrustworthy staff – continuing saga of data collection failure blights the Health Services potential. GPs cannot have had enough say and power in planning…

What models of funding are best for a healthy and just society? No other country has chosen our system, even after 70 years and our Olympic boasting. The public need to be led into realising why not.

Personal, continuing care….. is going the way of the dodo. Basingstoke represents the rest of the country.

Trials of personal budgets will have long term perverse outcomes in an ageing society. Health costs are rising, and geographic variations will become greater….

The “State of health and care in England” – is declining and worryingly underfunded…

A loss of personal continuing care. 700 practices in 5 years. Is the GP going the way of the Dodo in the past, or the Salmon in the future? We need to rediscover it’s value.

The Brexit catastrophe is only just beginning

A disingenuous report on closing A&E. Some lives will be saved in densely populated Trusts, but lives will also be lost..

What about choice? What if patients in rural and distant parts prefer to live shorter lives and have more convenient services? The whole basis of “mutuality” is being challenged by the current financial crisis. Does the utility value for the whole of West Wales trump the utility value for each individual part? There are four DGHs and three A&Es, and this is why we have a “trusted?” board to make decisions. But the people don’t trust them – do they?

This is a disingenuous report on closing A&E. Some lives will be saved in densely populated areas, but lives will also be lost..

TRUST: ‘Are you telling me that none of you knows what it means?’

Kat Lay reports august 20th: NHS saves 1,600 lives by sending ambulances on longer journeys

Controversial A&E reforms under which ambulances can bypass their nearest hospital have saved the lives of more than 1,600 patients since their introduction in 2012, according to research.

Designating some hospitals as major trauma centres concentrated expertise in dealing with emergencies such as gun and knife wounds, serious road traffic accidents or terrorist attacks.

However, it led to claims that other A&E departments had been downgraded, putting them at risk of closure.

The new research, from experts at the universities of Manchester, Leicester and Sheffield, calculated that an additional 1,656 people had survived major trauma injuries since 2012, when they would previously have died.

The reforms have also meant that patients are more likely to be treated by an experienced doctor at the roadside who, working alongside paramedics, can help to stabilise them before they get to hospital.

The odds of surviving a severe injury among patients reaching hospital alive have increased nearly a fifth since 2012, the researchers calculated. Patients have also spent fewer days in hospital.

Trauma is the most common cause of death for under-40s in England. According to National Audit Office estimates, there are 20,000 major trauma cases a year, with 5,400 deaths.

Researchers looked at data on more than 110,000 patients admitted to 35 hospitals between 2008 and last year. They found that results for major trauma patients were flat between 2008 and 2012 but improved rapidly after the introduction of major trauma networks.

Timothy Coats, professor of emergency medicine at the University of Leicester and a consultant in emergency medicine, said: “These findings demonstrate and support the importance of major trauma networks to urgent care with figures showing there were 90 more survivors in 2013 rising to an additional 595 in 2017. Over the course of the five years 1,656 people have survived major trauma injuries where before they would probably have died. It’s a fantastic achievement.”

He said that it could take up to ten years for this kind of system to reach its full potential, with the number of additional survivors greater than predicted by NHS England at this stage.

He added: “With changes to the way patients are treated from the moment doctors and paramedics get to them, with pre-hospital intubation, improved treatment for major bleeding and advances in emergency surgery techniques, there has also been a significant reduction from 31 per cent to 24 per cent in the number of patients needing critical care, and their length of stay on critical care wards reduced from four to three days on average.” The study is published in the online journal EClinicalMedicine.

Chris Moran, NHS England’s national clinical director for trauma care, said: “Patients suffering severe injury need to get to the right specialist centre staffed by experts, not simply the nearest hospital.

We are confident that we will continue to see further increases in survival rates for this group of patients.”

“Major trauma centres deal with the victims of stabbings and acid attacks as well as car and motorbike accidents. We have all seen the terrible increase in knife crime in our cities and there is no doubt that the new trauma system has saved many lives as these patients receive blood transfusion and specialist surgery much quicker than before.”

The changes were made after a 2007 report identified serious failings in the NHS’s care of trauma patients, which was poor in almost 60 per cent of cases.

Successive increases in the health budgets in Wales have not helped….. Brexit will make it worse… We all seem agreed, so why not change direction?

Pouring more money into a bottomless well, or a holed bucket is what is occurring in Welsh health. There are seven Welsh Health Boards, in various states of economic degradation. There is no NHS, and so the Welsh Health Service has its own financial budget (Including NHS funding rules), its own litigation fund, its own waiting lists, and its own complication and death rates. These will eventually be compared with the other regions in the UK, and the WHO will report to show the differences after and since devolution. Wales is unsustainable as a devolved health service if the residents expect to have the same standards as England (why not, they pay the same taxes?) In addition, Wales is the region which voted most for Brexit, but according to the “Brexitometer” at the Pembrokeshire County Show the farming community are certainly thinking again. (This picture taken well before end of the show)

ITV news explored the Brexit outcomes for Wales: How will Brexit affect the Welsh NHS? | Wales – ITV News The third question askes if people think that Brexit will be good for the NHS. We all seem agreed, so why not change direction?

Meanwhile, the area of the UK with the greatest recruitment problems, has also got the greatest (pro rata) litigation problems. The money set aside for litigation in N Wales is extraordinary. This is part of a national concern, as staff shortages bite, and standards fall: Concern at ‘spiralling’ health complaints to ombudsman (BBC News today)

On 8th December 2015 David Deans in Walesonline reported on an increase of £278m to make a budget for 2016 of £7.1 billion. 

This was confirmed by the National Health (funding) Executive. But assessed at £260m

It is hard to get up-to-date information and the “NHS expenditure programme budgets” from the Welsh Government (WG) website does not help. Neither does the WG budgets website. (A work in progress!!) Neither is help offered by the WG beta website (again in development).

There are however, historic documents for download (.pdf) showing the change in expenditure year on year. (This is of course historic information, and not the budget)

Although prescriptions are free, Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Wales is already subsidised by England but The real cost of the English taxpayer subsidising NHS Wales – is twice the official figure

Outside of the cities, Cardiff and Swansea, there are really poor areas, and The agony of Damocles swaord hangs over West Wales..

Projected Litigation funding in N Wales is £90m, and the BBC 9 days ago said ” NHS Wales negligence bill alarming”,

Where recruitment is poor, morale is low and staff sickness, already the worst in the world for any organisation, is desperate. Jez Hemming in the Daily Post 6 days ago: What’s been making North Wales health staff so sick?

Shane Brennan reports 16th August on “super sized morgues” and  on the epidemic of obesity leading to higher death rates, as predicted by NHSreality.

This is not a surprise to GPs or NHSreality as Number of GPs in Wales hits lowest level in a decade

Cutting our hospitals could make sense, but there are many threats in doing this. The rules for Yorkshire do not apply in rural Wales. The fourth option for West Wales? Do we want “soft lies and gentle indifference”, until we realise the safety net is failing for us personally?

We are already subsidised by £1,500 per head, and now we have a running deficit: A bigger and bigger deficit in West Wales…… Now at £600 per head……

In Wales they really can waste money: £68m unveiled for health and care hubs

Cancer statistics broken down across Wales. What a pity we in Wales cannot compare to the rest of the UK, and EU.

Stroke patients in Wales ‘could die’ because thrombectomy not available Acute shortage in NHS of specialist doctors who undertake life-saving treatment means hospitals cannot provide it

Rationing by waiting, and insufficient staff. Wales is worst…

Wales is an unsustainable state: another good reason not to leave the EU. Graphics in support…

In Wales, as in many rural areas GPonline Nick Bostock reports: How small GP practices are being pushed towards extinction

 

 

 

 

 

Numbers “going privately” for surgery soaring as NHS rationing deepens.

The difference between rich and poor is increasing, and since health correlates with wealth, the health services in the can be seen to be failing..

A relative with a shoulder injury such that he could not move their arm, was informed after an X ray that there was “no injury”. He asked for and was put on a six week wait for an MRI. No wonder this fit young worker chose to pay, and the tendon and muscle injury was revealed so that physiotherapy, also private, could go ahead, and their ability to work was not impaired. Waiting six weeks for a full diagnosis and to start treatment could have led to long term disability. 

Now that even Emergency care is a choice between state and private, then perhaps the media will start to expose the reality. 

Laura Donelly on 11th August 2018 reports in the Telegraph: Numbers “going privately” for surgery soaring as NHS rationing deepens.

he number of patients paying for operations privately is soaring amid rising waiting lists and deepening rationing across the NHS, new figures show.

Private companies have seen a 53 per cent rise in the “self-pay” market in four years, the data reveals.

Analysts said the market for operations such as hip surgery and cataract operations was being fuelled by “very high waits for NHS diagnosis and treatment”.

In the last four years, the numbers waiting more than six months for such operations has tripled, with 445,360 such cases by the end of last year….

After the GP clinic closes down in Fairfield Hospital early next year, another private practice doctor could move into the space to treat the thousands of patients left behind.