Category Archives: Political Representatives and activists

Bradford staff: government breaking its promises….. This needs to be a nationwide rather than a local solution.

If we look at pensions as a promise of  future payment, and we assume that the English Health Service, along with the other 3 dispensations, has a “ponzi” scheme type of pension fund, then it is not surprising that Trusts and their boards of directors try to escape future commitments that they cannot fulfil. The whole of the former NHS (when we had one mutual) is funded on this basis, but by denial of the long term problems, politicians are forcing locally based solutions, inequity, and poverty in their workers old age. In effect they are breaking their promise… just as the Greeks had to …. The problem needs a nationwide solution so that the pain if felt equally. The earliest Trust sare those most likely to get away with it, and some already have. The result is post-code rationing by ethically and legally dubious means….  In any event, the whole state as well as health worker pension situation needs review….

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Unison website reports 8th July: Bradford hospital staff strike to stay in the NHS and picket lines will begin

BBC reported 14th August: Bradford Teaching Hospitals staff to strike over outsource plan

and Susie Beever of the Yorkshire Evening Post reported 1st August that there would be a two week strike over jobs 

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The History: Bradford Hospital has a track record. Simon Freemna in the Times 27th November 2004: Hospital’s rescuers charge £160,000 for the privilege

Sarah Kate-Templeton in the Times 2016: Safer births campaign: Shamed hospitals blame high stillbirth rate on the mothers

Rhys Blakeley in the Times 19th August 2019: Plea for state pension age of 75

 

Closure of many more surgeries…. And there’s an epidemic of dementia coming….

Popular cities like Bristol do not expect to be without GP cover. There have been many more since I last posted on GP closures. The Headline generated by Amanda Cameron in Bristol Live 2nd August reads: 

Health chiefs explain decision to close two GP surgeries in Bristol – The decision left 15,000 patients needing to sign up with another surgery within three months

The shortage of GPs is one thing, due to retirement, career changes, part time, and emigration (as well as early retirement due to stress and overwork), but the fact that we have a wave of demented patients coming in the next few years has not become real to the politicians. And it is not just doctors who are under stress. Midwives and nurses too… After all they will be up for re-election before that time, and may not win. The same explanation applies to the inertia om medical recruitment, acknowledgement of dementia, climate change and several other areas….. A first past the post system means we are all subject to short termism. Mending the 4 health services will take decades. So will addressing climate change… The pace of technology advance, especially following CRISPR, is faster than any government can afford. There is only one solution and that is to ration health care, with co-payments according to means. A quality service needs to have equal opportunity for all, and whilst “extras” such as private rooms or choice of specialist are reasonable in a two tier system, different outcomes and life expectancies are not. Will new tests (such as that for dementia) be available to all? In the end it is caring, continuity and trust  that matter rather than technology, especially when we are old.

You may wonder “Perhaps a new health secretary will change things”. No chance.

Scream, Jeremy Hunt, NHS, cartoon

“..Announcing the closure, the CCG said supporting patients to transfer to a neighbouring practice was the “best long-term solution”.

At a meeting of its primary care commissioning committee on July 30, it emerged that the CCG considered three options before deciding to close the Bishopston and Northville surgeries.

Those options included keeping both surgeries open, merging them with other practices, or closing them and sending patients elsewhere.

Following extensive consultation with patients, the CCG concluded that closing them would have “on balance, a neutral impact” on most patients.

Patients might also benefit from “improved provision of care” from practices offering a wider range of services, CCG papers show…..”

Owain Clarke for BBC News 31st July 2019: Cwm Taf maternity crisis: Midwife stress adds to staff problems

Rhys Blakely on June 13th reports in the Times: NHS creaking under the strain of record dementia diagnoses

The head of the NHS dementia strategy has warned that the service is struggling to keep up as cases of the degenerative condition surge.

NHS figures released yesterday showed that nearly 454,000 people aged 65 or over in England have formally had dementia diagnosed: a record. The number of diagnoses has increased by 7 per cent in the past three years…… Alistair Burns, the NHS national clinical director for dementia, said: “The NHS is having to run to keep up as dementia becomes a challenge for more and more families.”

BBC news today: Alzheimer’s blood test ‘one step closer’ ( By testing for amyloid )

Researchers say they can accurately identify people on track to develop Alzheimer’s disease before symptoms appear, which could help the progress of drug trials.

US scientists were able to use levels of a protein in the blood to help predict its build-up in the brain.

UK experts said the results were promising – and a step towards a reliable blood test for Alzheimer’s to speed up dementia research.

Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

The reality that Health and Social Care are not either of them free, has not sunk in to the politicians yet. We cannot have “Everything for everyone for ever” and for free, and in their denial, both houses thus conspire to avoid the important debate that Mr Stevens called for on 4th June 2014, almost exactly 5 years ago. If Social Care is means tested, why not Health Care? 

The unedifying spectacle of two potential leaders trying to bribe 160,000 older and richer people who happen to be their members, is the reality of todays politics. No wonder so many people dont vote. We need an honest party to speak “hard truths” to the nation. NHSreality believes the first party to do this, and be understood as honest and working for the overall good of us all, fairly, will eventually win a landslide. It will also win the hearts and minds of the medical professionals….. and they are trusted, and speak to many people daily.

Our political (moron) representatives need to permit commissioners and trust boards to ration overtly, so that their citizens know what is not available. Initially this will have to be by post code, but national guidelines from NICE would help. Eventually, for those services and treatments that none of us can afford, cancer and big operations for example, there can be a National Health Service again, and for cheap and cheerful, high volume low cost services, we can have local post code rationing if we still want it…

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BBC News reports 4th July: Social care: Hunt and Johnson urged to consider NHS-style free service

Public Service Executive reports: Peers call for NHS-style free social care system and an extra £8bn to tackle funding crisis

and the Guardian today also reports the Peers asking for an extra £80m for “vulnerable elderly people”. 

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?

New and higher taxes will never solve the problems of health and social care…

There is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

What principles should underpin the funding system for social care? Surely an ID card with tax status and means is now essential….

The reality of the post-code lottery and rationing of health and social care. It will just have to get worse before the “honest debate”…

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

Nov 2016 NHSreality: NHS funding and rationing: The debate (and the denial) intensifies… It’s going to get worse..

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this. (U tube 4th June 2014)

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The “Economist” acknowledges health rationing, but does not recognise that it is covert…. More and more anger to come.

How long will the UK citizens put up with untruths? How long will it take for the proper debate to begin? The Economist recognises rationing, Enoch Powell in “A new look at Medicine and Politics” recognised rationing in 1966. We cannot go on without knowing what (for us) will be unavailable. It is surely a human right to be able to plan for your own health, your family’s health, your death, and illnesses. No wonder citizens are getting more and more angry..

If we want to win the cooperation and hearts and minds of medical staff we need to find out the truth about what they think. BMA conferences full of retired and burnt out doctors may reject the “long term plan” but there is no link with the doctors at the coal face.

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Not only is devolution a failure (certainly in Wales) but the 4 different systems allow different language of obfuscation, different methods of rationing, and outcomes. The anger will be the same.

The East Anglian daily Times shows how angry and dissatisfied the citizens are becoming. If you multiply the figures up over 200 health staff are attacked daily in the UK.

NHS GPs Economist 0619 Whats up Doc June 2019

Enoch Powell 4 Supply and Demand – Rationing  Minister of health for 3 years 2nd Edition 1974

Toni Hazell 28th June in GP mag: Here are two potential problems with primary care networks.  Huge hurry, and who takes responsibility?

Andrew Papworth reports 30th June 2019 in the East ANglian Times : “NHS staff aren’t punchbags”: Shock as six workers a day attacked in Suffolk by patients.

BMA ARM: Doctors spurn NHS long term plan

NHS patients ‘face more treatment rationing since coalition restructuring’

Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

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Everyone as an opinion on their Health Service. Enoch Powell saw through its weaknesses in 1976.

The small book by Enoch Powell “Medicine and Politics 1975 and after” (his period was 3 years as Health Minister) should be obligatory reading for all doctors. He could less politely have said that the Emperor has no clothes. . Read a review by retired BMJ Editor Richard Smith. 

He tells us that of course the health care is rationed, and that this is deliberate but covert. He (page 37) discusses some methods of rationing, but since his day we have invented many more than the waiting lists and waiting times that he refers to.

Parkinson’s Law of Hospital Beds (page 43) “asserts that the number of patients always tends to equality with the number of beds available for them to lie in”. But he was not aware that clever administrators can use trolleys, but not count them as beds. Therefore more and new covert rationing….

Finally I wish to quote his last word on rationing:

“It is unfortunate that the nature and value of rationing by waiting and by ineligability in the NHS are not recognised, at least by the professions (and by implication the rest of the country). For these are the features that make it possible to avoid invidious discrimination in administering the service and, at the same time, secure a certain rational allocation of priorities. Instead, these features are treated as evidence of “inadequacy” and as blemishes that it lies within the power of politicians to remove, given the will.”

Richard Smith non-medical blogs on Enoch Powell’s book – The best book ever written about the politics of the NHS

The Socialist Health Association also summarises the book (A large part or almost all – I failed to spot omissions)

Poverty and Wealth, and pregnancy rates. Will the slave society mean that Middlesborough et al supply the future low paid workforce?

The Economist in an article on 20th April reports on the state of childbirth demographics, and the differences between rich and poor areas.  Surprisingly, Wales is improving compared to the North East and even in Breast Feeding, although the length of time this applies to is not recorded in the Guardian figures…. How many of the IVF conceptions (3% of all) are private and how many public? The health divide ….. The Economist says it explains: Why the middle-aged are replacing teenagers in maternity wards – The conception rate is rising for women over 40, even as it crashes among under-18s.

There are many interesting graphics below, and the Teenage Pregnancy Rates in England and Wales) are most interesting. They do not include Scotland and N Ireland. Presumably Scotland similar to Wales, and N Ireland will have many, and fewer terminations because of their archaic laws.

Since most pregnancies are “high risk” in older first timers, will this mean that midwifery led units disappear? They should. (The risks in having babies in rural areas – midwifery-led units questioned by consultant.)

Will the slave society mean that Middlesbrough et al supply the future low paid workforce?

Maybe Later baby – The Economist 20th April

…. The conception rates of the youngest and oldest mothers are now close to converging (see chart). Middle-aged maternity may soon be more common than teenage pregnancy.

Advances in health care help to explain the convergence. Although assisted conception accounts for only a small proportion of pregnancies, it is growing more popular and more successful. Between 1991 and 2016, birth rates from in vitro fertilisation treatment increased by more than 85%. In 2016 more than 20,000 babies were born following IVF (out of a total of 696,000 births that year). About three-fifths of women who use it are 35 or over. Demand is likely to increase as women learn of others whose treatment has been successful. Ms Fenelon was inspired by a magazine article about egg-freezing……
Patrick Butler in the Guardian 2018: New study finds 4.5 million UK children living in poverty

New measure by Social Metrics Commission aims to focus political attention on the issue

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The four GP dispensations / jurisdictions. Nothing “national” about GP contracts.

There is nothing “national” about the GP contracts around the UK. The only way to ensure adequate supply is to train enough. NHSreality believes we should aim at overcapacity to ensure both supply and financial control. The contracts seem to endorse “private practice” but at the same time stop GP premises being used at all for private activity. Will this include Insurance and DVLA medicals? We are all in the UK (just) and pay the same taxes, and yet we have dofferential, hidden, randomised post code rationing.

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The BMA in England has produced “A five-year framework for GP contract reform to implement The NHS Long Term Plan” but this does not apply to Scotland N Ireland and Wales, and indeed, it has not been agreed by NHS England in it’s entirety. Despite the lack of recruitment, loss and early retirement of GPs, the whole edifice is falling like a pack of cards.

Pulse commented on the headlines in January observing that this was the most significant reform since 2004. The comments on line are “looks like the exodus will continue” and “150K lloks like a lot but after tax and pension it’s a much more modest sum.” Another is “Well if you are close to the !%)K limit …. what will happen is GPs will simply stop doing NHS work”.

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In Northern Ireland the HSC (Health and Social Care) Board rules.

In Wales the GPone website from the Welsh Government supplies their details. In Wales agreement has not been reached on the litigation funding arrangements, which at present may be top-sliced obligatorily, and causing resentment. In Wales we even cerebrate a reduction in the degree of bankruptcy…   and the poorest standards in Bowel Cancer screening, results, and Waiting times.

The Scottish Government contract and website is different again

NHS England contract 2019 which all the headlines are about. They ignore the other 3 dispensations. The Medical Indemnity scheme is funded separately in England, and will not be top-sliced as threatened in Wales.

“A new state backed indemnity scheme will start from April 2019 for all general practice staff including out-of-hours.” (NHS England)

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