Category Archives: Community Health Councils

What does the CHC offer us in Wales? They dont exist any longer in England.
Do we get an advantage from their existence? What do they cost?
Are they structured correctly – the CEO is appointed by the WG and may not feel able to speak out.

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.

Kat Lay in the Times reports 15th June 2018: NHS (England) must use extra funds to fight cancer

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. If the people have a choice they will choose local, ahead of improved outcomes and travelling. As the population ages, and more people survive cancer, we will need more radiotherapy and oncology services. The shortage of Radiologists and Oncologists is so severe that the potential for improvement is threatened.

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The NHS will be expected to improve cancer survival rates and put a greater focus on maternity safety under a multimillion-pound funding package due to be announced within days.

Theresa May appeared poised to set plans to boost the NHS budget by more than 3 per cent after intensive meetings yesterday between No 10, the Treasury and the health team.

At a conference of health service managers in Manchester, Jeremy Hunt, the health secretary, said: “We need to make sure we unite the NHS and British people with a small set of bold ambitions as to how we want to transform our system. To get our cancer survival rate to the best in Europe; to transform our maternity safety so it is as good as Sweden; to truly integrate health and social care; to make sure we have waiting time standards for mental health that are as strong and powerful as the standard for physical health.”

He was still having “difficult” discussions with Mrs May and the Treasury over the precise details of a long-term funding plan, but an announcement is expected soon. NHS leaders say they need funding increases of 4 per cent a year, in line with assessments by think tanks. The Treasury is thought to be reluctant to provide that much.

Brexiteers want rises in health service spending to be funded by the so-called Brexit dividend — money available after Brexit that would have gone to the EU. They worry, however, that Philip Hammond, the chancellor, will suggest funding it through tax rises.

NHS sources fear that a “big picture” announcement could amount to a fudge because it will not spell out the exact funding increases on offer. That would mean health chiefs including Simon Stevens, chief executive of NHS England, waiting until November for the details.

There is also likely to be disappointment at a decision to keep social care funding, which is delivered through councils and is the subject of a forthcoming green paper, separate.

A report from the Institute for Public Policy Research, a left-wing think tank, has called for social care to be free of charge for people with substantial needs as part of a new long-term health funding settlement. Social care is currently means tested. Making it free would bring the care system into line with the NHS, where healthcare is free at the point of need.

Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Rationed – Start of cheaper technique for breast cancer is delayed in UK despite adoption elsewhere. GP commissioners should be demanding intra-operative radiotherapy.

Cancer drugs fund is illogical. More money should be spent on radiology and radiotherapy.

Cancer chief quits amid radiotherapy shortfall

Artifical Intelligence is no threat to doctors, but it’s potential needs to be managed. A shortage of Radiologists is more bad news for the future.

 

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So, you did not think there was post code rationing of cancer care?

Kat Lay reports 12th March 2018 in the Times: “UK behind on cancer guidelines” (she means treatments)

It may be very sensible to refuse treatments for which there is a poor return, and serious side effects. The spending of state money has to be rationed, but NHSreality maintains that this should be overt, and universal for the low volume high cost treatments. Aneurin Bevan talked about In Place of Fear ( A Free Health Service 1952 Chapter 5 In Place of Fear ) but we are doing our best to bring back fear. There are four British health café systems, each rationing differently. In each we pay up under the same tax rules. The UK is also behind on introduction of new drugs – for good reason. Mark Littlewood doesn’t believe is deserves the taxpayer funding it gets! The Times also explains why and how more people are having to pay for cancer treatments which are excluded. Sarah Kate-Templeton reports on the current private income from treating cancers privately in 2017: £360m

British cancer guidance is less likely to recommend innovative drug treatments for patients than versions used in other parts of Europe, a study has found.

Researchers at King’s College London evaluated clinical practice guidelines issued by different national bodies, finding that UK examples were more likely to focus on surgery, and slower to pick up on new research.

Their study comes after several high-profile cases where patients have had to travel abroad for treatment.

The Home Office is considering allowing a medical cannabis trial to treat Alfie Dingley, a six-year-old boy with epilepsy, who travelled to the Netherlands to take a cannabis-based medication last September. Jessica Rich, one of two sisters with Batten disease, a genetic disorder that kills sufferers before they reach their teens, has to fly to Germany for treatment with a drug that Nice will not fund and Ashya King, now eight, was taken to the Czech Republic by his parents for proton therapy on a brain tumour, against the recommendation of doctors in Southampton in 2014. Earlier this month his family announced that scans showed he was free of cancer.

The study, published in Esmo Open BMJ, found recommendations in continental Europe tended to focus on the use of new chemotherapy agents or targeted treatment, while UK guidelines tended to focus on surgery, screening or radiotherapy.

Mark Baker, director of the centre for guidelines at Nice, insisted the research was “poorly undertaken” and misrepresented its guidance .

 

Imposter? Many of our own go abroad. With so many Drs from overseas, how many of them have “fake” degrees?

Without overseas staff, doctors midwives and nurses, the Health Services would collapse. Many of our own fo overseas. The majority of doctors from the Indian subcontinent have been trained at private medical schools, and although the state does train many, they are a minority. With the media exposing false and illicit degrees, the 4 health services in the UK need a healthy scepticism when examining the CVs of desperately needed staff. This includes midwives and nurses. As the Health Services implode further, Trusts may be so desperate that they really don’t mind imposter degrees servicing their citizens. The perverse incentive to appoint and examine the evidence later may be too great..

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Duncan Geddes in the Times 17th Jan 2018 reports: Fake degrees from Pakistan sold to doctors

A “diploma mill” in Pakistan has sold fake degrees to thousands of British workers and companies, including NHS doctors and a defence contractor, according to leaked documents.

Axact sold more than 3,000 qualifications in Britain over two years, including PhDs and medical doctorates, an investigation by BBC Radio 4’s File on Four found. The company has invented hundreds of universities online and uses fake news stories in an attempt to fool employers who check fake references on CVs.

Buyers of fake post-degree qualifications between 2013 and 2014 included NHS nurses, consultants and an ophthalmologist, according to the BBC. A British engineer based in Saudi Arabia spent almost half a million pounds on fake documents, it was claimed.

Dozens of websites selling fake degrees have been closed in recent years but the authorities struggle to keep up because they are usually based abroad. Pakistan opened an investigation into Axact nearly three years ago but the company continues to operate a global network from a call centre in Karachi.

In Britain the crackdown on bogus degree sellers is led by Higher Education Degree Datacheck. Its chief executive, Jane Rowley, said that only a fifth of British employers properly checked qualifications when hiring staff.

The BBC investigation claimed that the defence contractor FB Heliservices bought fake degrees for seven employees, including two helicopter pilots, between 2013 and 2015. Its parent company, Cobham, said disciplinary action had been taken.

The purchases were a “historic issue” and had no impact on safety or training, Cobham said.

Axact denies all wrongdoing.

Not enough doctors – just keep lowering the bar & reducing the funding

Making doctors stay….. in a neglected NHS. Letters in the Telegraph. Altruism destroyed early..

Thousands of fake degrees sold in UK – BBC – 4 days ago

Pakistan-based IT firm sold thousands of fake degrees to UK citizens … The Times of India 3 days ago

‘Diploma mill’ in Pakistan sells fake degrees to Brits | Daily Mail Online 3 days ago

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…

A day on the frontline. Numbers of NHS doctors registering to work overseas could reach unprecedented record

10% increase in vacancies. “Industrial scale” recruitment from overseas is a clear admission of recurrent cross party political failure.

Declining training standards prompt rescue action

 

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The Patients’ Association and the Charities should challenge, and define what is happening in the courts… Crawley: NHS “not rationing” hospital treatments and operations.

Denial in the Shires. Of course the Health Boards / Trusts / Commissioners cannot admit to the “R” word. They are “prioritising”, “restricting”, “reducing”, “limiting”, and “excluding”, different services for different people in different post-codes in different years. So no citizen can find out what, consistently, will NOT be available in his or her area of the country. Ask a retired consultant or GP or Nurse, or Physio in an exit interview whether Rationing is happening and they will almost all say yes. But there are no exit interviews… If policy does not conform with delivery, we have a collusion of denial. This is why the health service staff are disengaged. We need honesty in use of the English language before we can progress, so NHSreality calls for the Patients Association and the Charities together to challenge and define  what is happening in the courts… They may find GP commissioners, infuriated at the current “rules of the game“, help them in their case, and want to change them.

Joshua Powling reports for the Crawley Observer Friday 8th December: NHS “not rationing” hospital treatments and operations. 

Hospital operations and treatments for West Sussex patients are not being rationed, according to health chiefs.

Government reforms put clinical commissioning groups (CCGs), which are led by GPs, in charge of planning and buying healthcare from 2013, but all three organisations covering West Sussex are in special measures in part due to financial deficits.

The three CCGs are part of a new regional NHS initiative called clinically effective commissioning, which looks to standardise policies for when patients should undergo certain treatments and procedures.

According to a recent West Sussex Health and Social Care Committee (HASC) report, the aim of the project is to make sure commissioning decisions across the region are consistent, reflect best clinical practice, and represent the most sensible use of resources.

But last Friday James Walsh, vice-chairman of the HASC, asked: “What exactly is being proposed? Is this some form of rationing or delaying treatment?”

He explained that rather than dealing with statistics, they were talking about patients who had problems, many of which interfere with their daily lives.

Geraldine Hoban, accountable officer for the Horsham & Mid Sussex CCG and the Crawley CCG, explained the changes were bringing in more consistent thresholds for treatment.

She said: “We are not doing this for arbitrary reasons or to save money. This is based on up to date clinical evidence.”

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She added: “This is about people having procedures which we do not believe adds the clinical value they need.“It’s not rationing, it’s about adhering to the clinical evidence.”She went on to outline the ‘significant financial challenge’ facing the healthcare system in West Sussex, and how these changes were taking place before ‘we starting making some difficult decisions about difficult services’. They also found that previously some procedures had no formal policy, while in others such as orthopaedics activity the area was a significant outlier.

Other revisions were required were policies did not improve outcomes or patient experience. So far the clinically effective commissioning programme is split into three tranches. The first two have been reviewed by all the CCGs and updated where necessary in line with National Institute for Health and Care Excellence guidance.

Changing the rules of the game

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Doctors are recommending patients pay for non urgent operations… Inequality rules..

Alexandra Thompson reports for The Mail 4th December 2018: Doctors are recommending patients pay for non urgent operations…

Alzheimer Research reported 1st December 2018: NHS rationing reports are red flag for dementia treatment

Chris Smyth reports in The Times 4th December 2018: NHS ready to rule out more ‘poor‑value’ treatments (see below) This well written article highlights the health divide, and the risk of civil unrest.  The distraction of Brexit is starving the nation of other debates that are badly needed, and of new ideas to solve the unequal and unfair society that has led to the Brexit vote.

NHS Managers.net reports on the crisis in care of the elderly.

If you have a relative in a care-home this’ll interest you and if you don’t it should…  

Which? the consumer magazine people, have been busy researching.  Results published last week, that didn’t hit the headlines.  Given the system-wide difficulties with care of the elderly, this news should have pushed Brexit, Trump and all the other malarkey, off the front pages. Here’s a flavour: 

“More than half of care-home places in some parts of England are in facilities rated as ‘inadequate’ or requiring improvement” 

The report, based on the CQC’s own data, is a horrifying read.  In 45 local authority areas, a third or more, care places are in poor quality care-homes.

The situation is so bad that even newly planned and approved hospitals, such as in Basingstoke, cannot go ahead.  Planned £336m hospital for north Hampshire scrapped –

Chris Smyth reports in The Times 4th December 2018: NHS ready to rule out more ‘poor‑value’ treatments (see below)

T

he NHS could end shoulder surgery, hormone tests and other procedures which have been listed among poor-value treatments by health chiefs.

It is claimed rationing could save billions of pounds a year. Routine use of “low-value” medicines such as costly painkillers and homeopathy have already been stopped.

Senior doctors say that the plans would be justified if they avoid tighter rationing of more valuable treatment but warned against overzealous restrictions that could leave some patients languishing without care. Simon Stevens, the head of NHS England, is under pressure to find more savings as he steps up a public feud with ministers over funding. He argues that a £2.8 billion boost over three years promised in Philip Hammond’s budget is too little to do everything the government asks of the NHS.

At a board meeting last week, NHS England said that waiting lists for routine surgery would rise to protect cancer, mental health and GP care. Restrictions on the routine use of ineffective, unsafe or overpriced medicines were approved, as well as a crackdown on prescriptions for drugs that are available over the counter. The local health groups which began this work say that they want to go further and have started to pull together evidence on a much broader spread of treatments.

“There are a range of interventions that we shouldn’t be doing because they don’t work,” Julie Wood, chief executive of NHS Clinical Commissioners, which represents the groups in charge of buying care locally, told The Times. “We are now starting a piece of work to bring that all together and we hope there will be significant savings. We’re talking with NHS England about this on behalf of our members — we need to do it and it’s the right thing to do.”

The National Institute for Health and Care Excellence (Nice) has more than 1,000 treatments on its “do not do” list and Ms Wood plans to scour this for expensive procedures that could be cut.

Nice estimates that at least £129 million a year could be saved by following this list. For example £17 million could be saved by carrying out CT scans on more people with chest pain, avoiding the need for other more expensive interventions and tests.

The Academy of Medical Royal Colleges, which represents professional standards bodies for 220,000 doctors, has previously estimated that about £2 billion a year is wasted on useless medicines, operations and tests. Ms Wood also plans to review the academy’s recommendations.

Last month a Lancet study found that common shoulder surgery carried out 21,000 times a year was no better than a placebo. Other research found that costly robot surgery was little better than conventional keyhole methods.

Rachel Power, chief executive of the Patients Association, said that the rationing work could not be done behind closed doors. “The people best placed to say what has value to patients are patients . . . If it’s done badly, patients will lose out and there will be zero accountability for it.”

Poverty in the UK: a guide to facts and figures.

Definitions of Poverty and Social Exclusion

Tim Shipman reports in The Times 3rd December: Alan Milburn quits as Social Mobility commissioners achieve ‘zero’ and in the Mail: Alan Milburn quits, says no hope of fair Britain | Daily Mail Online

 

Those “five giants” are getting larger. The ghost of Beveridge haunts the country…

In the last decades, and especially in the devolved parts of the UK, the “five Giants” which Beveridge described have been growing. Post code unfairness in treatments and outcomes is a regular matter in the media, and the public have become immune – until they themselves fall victim.  Then it’s too late. Dead patients don’t vote, but their families do become cynical and restive… If readers wish to be reminded of the altruism which set up the original NHS read here: In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear Neglect, short termism, and denial are the cause. In a media led society this is such a shame, but reflects the poverty of debate on ideological issues.

The Telegraph thinks the “hard” Brexit deal will be expensive for the Health Services: £500m?

Nick Triggle, while welcoming the pay rises for NHS staff says: NHS pay rise: Are there strings attached?

NHSreality has already commented upon the rationing of hearing aids, and that the delay in proper treatment may be linked to dementia

The Mail is on about lack of evidence for masks, and rationing robotic treatments… and that Rationing is cutting lives short.

Andrew Grice for the Independent sums up the current situation and dilemma for the politicians: NHS England is rationing its services – Hammond’s Budget didn’t go far enough – The Budget’s gaping hole was on social care; it is close to collapse and putting ever-increasing pressure on hospitals through bed-blocking, but got no extra cash

A debate about rationing the care provided by the National Health Service will be launched tomorrow, when NHS England begins a conversation about what it can and cannot afford to do.

Although there will not be a hit list of cuts at this stage, the implications will be clear enough: the Government has not provided enough money to meet goals including the 18-week target for elective operations; cancer treatment; mental health; public health and obesity and for a creaking social care system. In short, something’s gotta give.

NHS England’s gloomy prognosis will come at a bad time for the Government. Theresa May has made mental health a personal priority. A green paper soon about expanding help for children will generate some headlines, but without money and staff there will be little or no difference on the frontline until 2021.

Similarly, ministers’ hopes that Budget headlines about a “£2.8bn boost for the NHS” would buy some political credit will prove short-lived when the continuing cash crisis is laid bare. Philip Hammond’s injection was less generous than it looked: £1.6bn for next year, well short of the £4bn a year prescribed by three independent think tanks – the King’s Fund, the Health Foundation and Nuffield Trust…..

The Local Government Association estimates a £1.3bn funding gap between what care providers need and what councils pay. Although May acknowledged the problem during this year’s election, she got her fingers burnt with her so-called “dementia tax” and the issue has now been kicked into the long grass. We won’t get a green paper until next summer. That is woeful, given the additional pressure the demographic timebomb will put on health and social care.

While the debate over NHS rationing is inevitable, we need a much wider one about the state’s priorities. The 2010 and 2015 elections were followed by a government-wide spending review. There’s no sign of one now – another example of the reduced capacity of a government consumed by Brexit.….

Appropriately enough, the new statesman celebrates the 75th anniversary of the Beveridge report: Slaying the Five Giants: the 75th anniversary of the Beveridge Report

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

The WHO will be reporting on the gross overall outcome comparators of different health systems and the next time they do, it will not be on the British “National Health System” but on the 4 Principalities in charge of their own health budgets. The long term rationing of medical school places, and the generalised under-capacity, mean that post code rationing is reality for a common and serious illness. More will follow. It’s going to get worse because none of the profession would have started from here. The BMA has been asking for more medical school places for years…. and only now are applications rising – we have to wait 10 years or more for most of the new entrants to be useful.

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Dennis Campbell in the Guardian reports 1st October 2017: 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

Stroke patients in Wales are being denied a life-saving pioneering treatment after the surgical team providing it had to be mothballed because of an acute NHS shortage of the specialist doctors who undertake the procedure.

Internal NHS emails obtained by the Guardian reveal that health service bosses in Wales are pleading with hospitals in England to perform mechanical thrombectomy on their patients to save them from disability and death.

And they show one senior doctor warning Welsh NHS officials that they have “not got a grip on the situation” and deserved to be “the laughing stock of the international neurovascular community”.

Doctors who specialise in stroke care are warning that the inability of the NHS in south Wales to offer patients what they say is a “game-changing” operation illustrates a chronic UK-wide lack of consultant interventional neuroradiologists (INRs).

They perform both thrombectomy and a similar emergency procedure, called endovascular coiling, on patients deemed at imminent risk of suffering a stroke.

However, there are just 70 consultant neuroradiologists working in the NHS across the four home countries – barely half the number the Royal College of Radiologists says is needed to cope with the rising demand for mechanical thrombectomy in particular.

That shortage means a number of hospitals are unable to provide the operation themselves and must send patients elsewhere.

University Hospitals Coventry and Warwickshire NHS Trust, which is struggling to fill several vacancies for INRs, has been sending stroke patients who need coiling 50 miles north to Royal Stoke University Hospital since January and sends mechanical thrombectomy cases 20 miles away to the Queen Elizabeth hospital in Birmingham.

The Stoke hospital, which in 2009 became the first in the NHS to offer mechanical thrombectomy on a 24/7 basis, has also been treating patients from six hospitals in the east and west Midlands, and north Wales, since 2010.

Patients from Middlesbrough who need emergency stroke treatment travel the 47 miles to Newcastle to have it rather than the town’s James Cook hospital, which cannot recruit enough INRs to offer its own local population that service.

Glasgow has also had recent problems offering mechanical thrombectomy to its citizens, some of whom have instead gone the 50 miles to Edinburgh for treatment.

The problems underline the NHS’s deepening staffing crisis, which hospital bosses claim is now a bigger issue day to day than lack of money. They also threaten NHS England’s ambitious plans to hugely increase the number of patients who undergo thrombectomy as part of its plan to reduce avoidable mortality.

During a thrombectomy doctors remove a blood clot from someone’s brain using a stent. That gives patients a much better chance of walking out of hospital unaided and disability-free rather than ending up with significant paralysis, or dying. Evidence suggests it is more effective for some stroke patients with a blood clot than solely undergoing thrombolysis – receiving clot-busting drugs – which is the traditional treatment.

Cardiff and Vale University Health Board launched Wales’s first clot-retrieval service, covering the bulk of the country’s 3 million population, last August. However, it had to stop functioning in May this year when one of the three doctors providing it retired, another got a new job and the third went on sick leave, and no replacements could be found.

Stroke specialists warn that patients from south Wales could die because they can no longer have a thrombectomy. Efforts by senior NHS officials in Wales to persuade hospitals in England to perform the procedure on patients from south Wales have so far failed to lead to any formal cross-border care agreements.

The NHS in Wales estimates that 500 people a year from the country would benefit from undergoing thrombectomy. Yet hospitals in England have made clear that they already have too many cases of their own, and too few beds and staff, to help on more than an occasional ad hoc basis.

In a testy email to Welsh NHS officials last month about the disappearance of the Cardiff service, Crispin Wigfield, the North Bristol NHS Trust’s stroke lead, told them: “At the risk of being blunt most frontline clinicians think that you have not got a grip on the situation and if it wasn’t so serious Wales would be the laughing stock of the international neurovascular community.”
His hospital at the time had no spare intensive care beds to be able to accommodate stroke sufferers from Wales, he told them.
In another email Dr David Rosser, the medical director of the Birmingham trust, told Welsh NHS officials that “we are, sadly, unable to support this [request for a cross-border thrombectomy] service as we do not have the capacity [to take extra patients].” He declined Welsh colleagues’ offer to pay for the opening of extra beds, explaining that his hospital was already “opening every bed we can get staff for”.
Doctors in south Wales can only seek help from a few English hospitals because doctors have ideally between four and six hours in which to perform a thrombectomy or the chances of a patient receiving real benefit fall significantly.
Twenty stroke patients from Wales have undergone coiling since May in hospitals in Birmingham, Bristol, Oxford, Plymouth and Southampton. The Cardiff service has recruited one new INR, but does not expect to resume offering thrombectomy for some time.

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

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Record numbers apply for Oxbridge and medicine