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.

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

 

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Why won’t anyone in power talk about rationing? “We need to talk about NHS rationing”…

The downside of honesty must be greater than the upside – what an indictment of our media led society. Why are our leaders and administrators, trust chairmen and CEOs so afraid to speak out?

In Pulse 10th October 2017 David Turner opines: We need to talk about NHS rationing

A woman requesting breast reduction.

A child with severe behavioural problems in need of psychological assessment

A seventy year old brought to tears daily with knee pain, waiting for physiotherapy.

A new cancer drug costing thousands per month that has just received NICE approval.

What have these patients got in common? They all have a legitimate claim on the NHS pot of money for funding.

The recent announcement that NICE has approved nivolumab for treating patients with certain types of advanced lung cancer is fantastic news for those patients and will add valuable months to their lives.

There is, though, a rather large pachyderm in the room, which sooner or later needs to be faced. I’m afraid all of us – doctors, patients, managers and politicians – seem reluctant to address the rather obvious reality that NHS coffers are not infinite. Funds for healthcare are always going to be finite and even with the best political will in the world (and we certainly don’t have that at the moment) we cannot pay for everything.

Funding an expensive cancer treatment to give someone extra time on earth will impact on other aspects of healthcare. Increase funding to one area and others will suffer with reduced services and longer waiting lists.

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Do we say only disorders that can be fatal go to the front of the queue?

Many will say we should prioritise the most serious illnesses which can kill quickly such as heart disease or cancer. Nobody dies from osteoarthritis, but thousands suffers tremendous pain every day while waiting joint replacement surgery. It’s also not unheard of for people with mental illness to kill themselves while waiting to see a psychiatrist.

Name virtually any condition or disease and there will be individual sufferers and support groups making their case as to why more taxpayers’ money should be spent researching into or treating their disorder.

The reality is everyone’s health matters to them more than anything else and few people will be altruistic enough to say public money should be spent treating others before themselves and their loved ones.

I don’t claim to have the answers, but unless we start to talk more openly about the very real issue of rationing in the NHS we are just postponing some very serious questions for the future and they are not going to get any easier to answer.

Dr David Turner is a GP in west London

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Your GP notes and their contents are owned by the Secretary of State for Health in your Region. Not by you..

The Implications of the articles initiated by Kingsley Manning (Ex NHS England Digital Chief) are that patients are unaware of their note ownership. Some may prefer otherwise, but most people trust their administrators not to abuse the information database. Are they right? It might not be long before a drama is written detailing potential abuse of public databases (perverse incentives)… this would focus minds. Every patient is permitted to exclude his notes from distribution to a Regional database..

The Shropshire Star reports 1st Feb 2017: Ex-NHS Digital chief ‘pressured to pass immigrants data to May’s Home Office’ –  The former head of NHS Digital has said he was put under “immense pressure” by the Home Office under Theresa May to release data on immigrants despite questioning the legality.

Kingsley Manning said he was challenged for “daring” to question if there was a legal basis for handing over confidential patient data which would help the Home Office trace suspected illegal immigrants.

Last month, the Home Office published an agreement showing the basis by which information can be requested from NHS Digital.

But Mr Manning said the NHS body has been forced to hand over data that the Home Office would find useful since “at least” 2005, sometimes to junior officials who would just “ring up” and ask for it.

In an interview with the Health Service Journal (HSJ), Mr Manning said: “We said to the Home Office ‘We need to understand what the legal basis of this is’.

“The Home Office response was ‘How dare you even question our right to this information? This is data that belongs to the public. It is paid for by the taxpayer. We should use it for public policy’.”

When Mr Manning launched a review to establish a clear legal framework for the data- sharing, there was an “enormous reluctance from both the Home Office and the Department of Health to clarify any element of this process”, he said.

“The Home Office view was that tracing illegal immigrants was a manifesto commitment.

“If I didn’t agree to co-operate (with the sharing of patient data) they would simply take the issue to Downing Street.”

The new agreement announced last month has “maximised” Home Office powers “to the absolute limit”, MImage result for NHS abuse of data cartoonr Manning said.

He added: “All the Home Office has to say now is ‘We have lost track of this individual’, and NHS Digital will have to hand over confidential patient information, such as the patient’s name, gender, date of birth, last registered address and area details of their GP.

“There is no provision for transparency, no provision for oversight or scrutiny, and there is no role for the National Data Guardian.

“Nor is there any provision to alert patients to the possibility that information from their NHS patient record could be passed on to the Home Office.”

Mr Manning said he had become “deeply concerned” once he took the helm of the NHS body in 2013 that data had been handed over since at least 2005.
The Guardian: May pressured NHS to release data to track immigration offenders

For “prioritizing” read “rationing”. Billions needed to rescue unsafe NHS, doctors warn. The safety net is holed…

It is going to get worse and worse. The failure to care for the elderly and to fund the UK Health Services responsibly is evident. For prioritization read rationing: The safety net is holed… Those who fall through wont be voting on the future of their health service..

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Chris Smyth reports in The Times 31st Jan 2017: Billions needed to rescue unsafe NHS, doctors warn

Thousands of senior doctors have told the prime minister that the NHS is unsafe and failing patients.

Doctors are “handcuffed and paralysed” by the limits of a health service that does not have enough money to do what patients ask of it, they said in a letter to Theresa May.

“We have reached unacceptable levels of safety concerns for our patients within the NHS and simply cannot continue,” more than 2,000 consultants and GPs said in the letter, published in The BMJ.

They urged Mrs May to pump billions more into the service to bring spending up to the levels in France and Germany. The intervention has focused attention again on the deepening rift between Downing Street and the NHS following a public spat on spending with the head of the health service this month. Simon Stevens, chief executive of NHS England, told MPs that Britain spent 30 per cent less per person on health than Germany and accused Mrs May of stretching the truth by saying that she had given the NHS more money than it needed.

A government spokesman said: “We have invested £10 billion in the NHS’s own plan to transform services and improve standards of care and recently announced almost £900 million of extra funding for adult social care over the next two years.”

More patients forced on to mixed wards

Heart failure patients face same death rate as 1998 (Heart failure is very difficult to treat effectively to secure better long term outcomes)

‘Loneliness’ commission launched in memory of Jo Cox

NHS patients are demeaned by mixed sex wards – Jane Merrick Opines

Cashstrapped councils leave families to care for the elderly – Chris Smyth

Families will have to step in as more older patients are denied help with washing and dressing, councils have warned. A cash crisis will leave local authorities unable to meet their legal duties to older people under reforms introduced three years ago, they said.

Ministers need to admit that older people will be given only limited help as there is no more money available, according to the Local Government Association (LGA). It fears legal challenges from people who say councils are not meeting an obligation to ensure their dignity and wellbeing.

Cuts to council budgets have meant hundreds of thousands of older people lacking help with everyday tasks and NHS leaders have complained that hospitals are filling up with elderly patients who have been allowed to fall ill and cannot go home safely.

Izzi Seccombe, of the LGA, said that pledges to the elderly were “in grave danger of falling apart and failing, unless new funding is announced by government for adult social care”.

She said councils would increasingly have to prioritise the least mobile people who could not cope without carers at the expense of those whose lives are improved by extra help…..

TRAIN WreckProtest while you can – Dead patients don’t vote. Rationing in action…  (Feb 2015 – 2 years ago!)

If the NHS really is the envy of the world, why don’t countries copy it?

Mark Littlewood from the Institute of Economic Affairs asks 20th December in the Times: If the NHS really is the envy of the world, why don’t countries copy it?

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As Christmas wishes go, mine is pretty modest. Of course, a complete end to war, disease and famine across the globe would be wonderful. But if I can’t have that, maybe I can have something that should, in theory, be a little easier to achieve. I just want an open, grown-up and serious debate about whether we are absolutely sure that the NHS truly is the best healthcare system known to mankind.

I confess to being something of a sceptic. My gut instinct tends to be that we have at least as much to learn from the rest of the world as we do to teach it. So I would probably enter the discussion from a minority position.

Indeed, defenders of the status quo make some truly spectacular claims. According to David Cameron, the National Health Service is “one of the greatest achievements of the 20th century”. Aneira Thomas, the first person born under NHS care, insists it is the “envy of the world”, a sentiment apparently supported by 56 per cent of the UK population in opinion polls.

If these assertions are even half-true, they raise a rather awkward question. Why haven’t our European neighbours sought to replicate our cherished system? They have had 68 years to stare in wonder across the English Channel, turning an ever more fluorescent shade of green as their jealousy over the sheer brilliance of the NHS overwhelms them. Yet not one leading European country has taken our blueprint and copied it. Are these foreigners incredibly stupid, amazingly callous or just too bone idle to embrace a great idea when they see one? Alternatively, have they studied the facts and decided that they are much better off with the more market-orientated, less centralised healthcare policies each of them has chosen to adopt?

A glance at the statistics suggests that Johnny Foreigner isn’t as dim as some might think. Presumably, a useful starting point is to judge how good a system actually is at preventing people from dying.

If we could somehow replicate the survival rates from common forms of cancer that they manage to achieve in the Netherlands, nearly 10,000 fewer Brits would die each year. If we could get as good as the Germans, we would save about 13,000 lives annually. If we could somehow aspire to understanding whatever magic health formula the Belgians have stumbled upon, we could get that figure up to 14,000. That’s the equivalent of saving the entire population of Bolton every decade merely from improved cancer treatment. Looking at survival rates overall, the UK is about on a par with the Czech Republic and Slovenia, countries where average income is less than half of ours.

It is true that affluent western European countries tend to spend a little more than the UK on healthcare. But, crucially, they spend it in different ways. They run insurance-based systems and allow for competitive markets and even — horror of horrors — profit-making. The Dutch have no state-owned hospitals, no state hospital planning and no taxpayer subsidies to any hospital. In Germany, less than half of hospitals are run by the public sector. The Belgians even sometimes require a modest payment to see a GP. To different degrees, but across the board, competition in providing the best healthcare is encouraged.

Crucially, all these countries manage to guarantee universal healthcare coverage. The poor are not left without quality treatment. The fear that they might be seems to be behind much of the love for the National Health Service, but such concerns are misplaced. Through a mixture of means-tested subsidies and compensation schemes, the Europeans seem able to ensure that every citizen is properly covered.

Just because you want the state to guarantee access to something does not mean that the public sector needs to be the actual provider. We want to ensure everyone in Britain has access to food, but that doesn’t mean it is sensible to nationalise Tesco, Waitrose and Asda. Neither does our desire to ensure that all people can be clothed lead us to conclude that Marks & Spencer, Next and Debenhams should be amalgamated into a single company and then run by a Whitehall ministry. Yet we seem to have a blind spot when it comes to health, assuming that a gigantic government industry with 1.5 million employees is the best way to go.

The trick, of course, is to make sure that everyone is given the wherewithal to enable them to participate in the marketplace and then let the wondrous dynamics of competition weave their magic in providing high quality at an acceptable cost. In the healthcare arena, it is a trick that our continental neighbours are much better at performing than we are.

On an individual level, it is understandable that so many Brits feel warmth towards the NHS. Ourselves, and our loved ones, will very often visit a doctor or a surgeon with a health problem and find through the brilliance of medicine and the diligence of highly trained professionals that we are swiftly cured. Even if the worst happens, we console ourselves that medical experts gave it a really good shot. We don’t stop to ask whether the treatment would have been better if we lived in, say, Berlin or Rotterdam.

My Christmas wish is that we should start asking ourselves exactly that and in an unsentimental and clear-headed fashion. It might be comforting to kid ourselves that we have pioneered and maintained the greatest healthcare system on the planet, but that doesn’t make it remotely true. To believe that the centralised, state-run National Health Service is the best possible mechanism for curing the sick and keeping people alive is simply at odds with the facts.

Indeed, it’s about as far from reality as believing that a plump, bearded man on a reindeer-driven sleigh has left all those presents under the tree.

Mark Littlewood is director-general of the Institute of Economic Affairs

Sir, Mark Littlewood is to be congratulated for introducing a degree of reality into the debate about the NHS (“If the NHS is the envy of the world, why don’t any European countries copy it?”, Business, Dec 20). Is it really beyond our politicians to set aside party differences and establish a far-reaching and independent commission to examine the health and social care needs of the UK over the next 30 years? Such a commission should examine how care is successfully delivered and funded elsewhere, and ask searching questions as to whether we can reasonably expect the NHS and local government to match the best that is available, or if different delivery and funding solutions are needed.

Will Lifford

East Keswick, W Yorks

Sir, The elevation of our NHS to “holy cow” status is over-simplistic (letter, Dec 22). By the same token, Mark Littlewood’s article treats the NHS as a business, equating it to food supply and clothing. Surely the clue is in the title — it is a service not simply a business. That said, this is not the same as regarding it as a sacred cow. As a large, complex organisation there are doubtless areas that can be (and are being) improved without abandoning the principle of universal healthcare. Having this year been diagnosed for a second time with cancer I have been extremely grateful that during all this time, with five operations, six weeks as an in-patient, six weeks of radiotherapy and countless tests and clinics, I have never once had to worry once about my ability to pay for this excellent treatment.

By contrast, during my working career I lived abroad in a number of countries, notably the US, which did not have a comparable healthcare system, and where the ability to pay was a very real issue.

The time we should really worry is when the first question you are asked when visiting your GP is not “what is your date of birth?” but “what is the long number on your debit card?”.

John Young

Richmond, N Yorks

Sir, Mark Littlewood concludes that “To believe that the centralised, state-run National Health Service is the best possible mechanism for curing the sick and keeping people alive is simply at odds with the facts”, yet puts forward few facts to justify this assertion. The “factual evidence” he provides is a comparison of the extent of expected live expectancy in various countries after diagnosis and treatment for cancers. He notes that if the NHS could replicate the performance of the Netherlands, Germany and Belgium, death rates would fall and up to 14,000 fewer Britons would die each year. The UK, he says, “is about on a par with the Czech Republic and Slovenia, countries where average income is less than half ours”.

What he omits to say is that life expectancy as a whole is lower in Germany, Denmark and Belgium than in the UK; that these countries spend a higher proportion of their GDP on healthcare than the UK does; and that life expectancy in Slovenia and the Czech Republic is significantly lower than that achieved by Britons.

Alexander Johnston

Syston, Leics

Sir, Mark Littlewood asks questions that need answering, but J Wesley Harkcom (letter, Dec 22), along with many politicians, seems not to understand why the public are so loyal to the NHS. In 2014-15 the NHS gave superb care to my wife in her terminal illness, all the way through the ambulance service, Truro A&E, the neurological surgery unit at Derriford in Plymouth, the multiple services provided by Truro hospital, the neurological rehabilitation unit in Hayle, St Austell Hospital, Mevagissey surgery and the many Cornwall social services who, together with the NHS, enabled my wife to stay at home, enjoying life to a remarkable extent, until her death.

Anecdotal evidence suggests that our very good experience is common. This explains the public’s loyalty to the NHS. Misunderstandings get in the way of the sensible debate suggested by Mark Littlewood, who understands this loyalty.

Gerald Hingley

St Austell, Cornwall

Extensive’ care rationing is way forward for CCGs

Pulse is correct when reporting 2nd September Austerity? You ain’t seen nothing yet

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The waste of resources is revealed by the Telegraph 9th October: Taxpayer foots £1.5billion bill for legal cases against NHS in a year, figures reveal 

and Age based rationing is the conclusion of a trial based in USA and with large power based on 200,000 patients. Laura Donelly reports in the Telegraph 9th October: Women diagnosed with breast cancer after 70 twice as likely to die from it 

On 30th October the “Commissioning Review” for GPs and Health Trust managers reported: ‘Extensive’ care rationing is way forward for CCGs, says NHS Providers chief

The head of NHS Providers has said rationing access to care in an “extensive way” is one of six ways forward for the NHS as it is tasked to “deliver the impossible”.

In a letter sent earlier this month to Sarah Wollaston MP, chair of the health select committee, Chris Hopson calls for an inquiry into NHS issues surrounding missed performance targets, the “crisis in social care” and workforce shortages.

To solve the issues, Hopson said there are “a range of options” now open to political and NHS system leaders.

He said: “Providing additional funding is the most obvious. If, however, there is to be no more funding, the NHS must now make some quick, clear, choices on what gives, however unpalatable these choices may be.”

Hopson suggests six ways forward including “formally rationing access to care in a more extensive way”.

Earlier this month, two clinical commissioning groups came under fire for rationing services.

St Helens CCG rescinded plans to axe non-urgent referrals to local hospitals, while Vale of York CCG said they would review plans to ban surgery on obese patients and smokers following criticism.

Hopson says in the letter: “Somewhat understandably, these local decisions have met with opposition, not least because some are inconsistent with the overall NHS policy framework – a framework which prevents the NHS from making the changes that other public services, such as local government, have made when facing similar financial challenges.”

Hopson also suggested reducing the number of strategic priorities in the NHS, including seven-day services and mental health and cancer taskforce recommendations, which he says is leaving providers “inundated”.

The other option included relaxing performance targets, closing or reconfiguring services, extending co-payments or charges or reducing the size of the NHS workforce which, he said, “accounts for around 70% of the average trust budget”.

While Hopson expressed his support for the sustainability and transformation plans, “the problems the NHS faces are immediate”.

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Has NHS failure become the new norm? A short-sighted “boom and bust” approach to training staff means that the NHS is struggling to make the changes it needs to survive..

If I was a newly qualified doctor what would I be thinking? Would I stay working in an organisation that I could see failing and with lowering standards, and in a country turning inward on itself? Of course not… Increasing unemployment in graduates of all types is inevitable after Brexit as the appetite for risk reduces. (Reducing standards officially – across the board – intended delivery of incompetence? )

Nick Triggle for BBC News 21st June asks: Has NHS failure become the new norm?

With both the doctors’ and nurses’ annual conferences taking place in Belfast and Glasgow respectively, this would normally be a week when the state of the NHS takes top billing.

But not this year. The coverage is pretty muted. Of course, the EU referendum has something to do with that.

However, there is also a sense that something else is at play. After months of deadlock in the junior doctor dispute and a constant barrage of negative headlines about missed targets, there seems to be a certain weariness that has crept in when it comes to the debate around the state of the health service

It begs the question: has failure become the new norm? After all, week after week there seems to be fresh evidence of declining standards, but instead of provoking outrage there seems to be an acceptance that we should not expect as much as we used to.

The influential commentator Nigel Edwards, of the Nuffield Trust, highlighted this this recently, describing a “creeping sense of inevitability” that failure will happen.

The five worst months in A&E (in England)
Month Proportion of patients seen in four hours (target is 95%)
1. March 2016 87.3%
2. February 2016 87.8%
3. January 2016 88.7%
4. December 2014 89.9%
5. April 2016 90.0%

January, February and March each saw A&E units in England record new worst-ever monthly waiting times since the four-hour target was introduced in 2004.

The target has been met just once in the past 18 months with bosses at NHS England left to resort to the rather defeatist defence that while it is getting worse, it’s still better than many other countries.

Ambulances are struggling too, with a sharp deterioration in the number of life-threatening cases reached in the target time of eight minutes. Cancer targets and the 18-week goal for seeing patients needing routine operations have started to be missed too. Serious problems can be found in the health systems in Wales, Northern Ireland and Scotland too.

It is why Royal College of Nursing general secretary Janet Davies has this week been describing the situation facing the NHS as an “endless winter” and these kind of pressures the new norm.

But it is not only the targets that show the extent of the problems – inspectors are also finding worrying examples.

The Queen Alexandra Hospital in Portsmouth was recently criticised for the chaos that had engulfed it. The situation got so bad, inspectors said, that a tent had to be erected at the site of a motorway crash because ambulances were stuck at the hospital unable to unload their patients as A&E staff were over-run.

These are shocking stories, that are becoming all too familiar. Overall, out of the 182 ratings given to hospital, community, mental health and ambulance services under the new inspection regime, 121 have been inadequate or require improvement.

Ministers defend themselves by saying the NHS is coping admirably with the extra demands being placed on it.

Compared to six years ago 6,400 more people a day are being seen at A&E, 26,000 more people are being seen as outpatients and 16,000 more diagnostic tests are being carried out. That’s the workload of about a dozen new hospitals.

And they point out extra money is being invested. That is true. However, the fact remains the biggest chunk – £3.8bn – is being given this year, but two-thirds of that looks like it will have to go on paying off last year’s deficits.

The result? A feeling of gloom among both those who work in the health service and those who are treated by it.

Polling of more than 1,200 adults by the BMA ahead of their conference this week found that eight in 10 of them were worried about the future of the NHS.

An NHS Confederation survey of managers found over nine in 10 were not confident they could meet the savings targets being asked of them and only one in 10 nurses asked by the Royal College of Nursing thought the NHS was able to cope with the demands being placed on it.

Such defeatism leads to an expectation that standards will decline further – and when that happens the news value of the event diminishes.

Dr Mark Porter: If you’re having surgery, read the small print — your life may depend on it

Bowel surgery death rate warning – Too many patients are dying following emergency bowel surgery, experts who have done a comprehensive audit of care across England and Wales warn. 

The Times 3rd June 2016: Hospital delays leave thousands waiting outside in ambulances

The Times Scotland Aug 30th 2009: Thousands suffer botched operations

Martin Barrow on July 11th in The Times: Hundreds of patients suffer after serious mistakes during surgery

Chris Smyth reports twice today 11th July: Surgeon mistook fallopian tube for appendix

and Patients in danger as NHS is short of 28,000 nurses – A short-sighted “boom and bust” approach to training staff means that the NHS is struggling to make the changes it needs to survive

A shortage of 28,000 nurses threatens patient care and could derail the NHS survival plan, according to a report by the Health Foundation, a think tank.

Importing thousands of foreign nurses is only a short-term fix which would not solve a failure to plan for how many trained staff the health service needs, the report concludes.

It says that the short-sighted “boom and bust” approach to training staff means that the NHS is struggling to make the changes it needs to survive.

Simon Stevens, the chief executive of NHS England, is trying to make £22 billion of efficiency savings but so far only £1 billion has materialised. Today’s report says that up to £6.7 billion is meant to be saved by holding down pay, warning that this could backfire by hampering attempts to recruit or motivate staff.

Anita Charlesworth, director of research at the foundation, said: “The current approach to workforce policy needs to be overhauled so that staffing and funding are treated as two sides of the same coin. The recent decision for the UK to leave the EU will create additional challenges both in terms of finances and the ability to attract and retain valuable European staff.”

The National Audit Office found that 7.2 per cent of nursing posts were unfilled, equivalent to 28,000 staff. England is also short of 2,300 consultants and 2,500 junior doctors.

Many A&Es are failing now. As delays, standards, and staffing gets worse, more and more demand will come for private A&E and ambulances.