Category Archives: Political Representatives and activists

Private health care variations in price, access and quality… as the safety net fails

Anna Hodgekiss dramatizes for the Mail with the headline: Scandal of private health sharks overcharging their patients by up to £12,000 but it is evident that, as the safety net fails more frequently, that those who have the means will use them to get better treatment. Speed (avoiding waiting lists) and choice (consultant not junior) and fewer complications (less infections in private hospitals) mean we are morphing to a two tier system. Differences in outcomes between those with means and those without could well lead to civil unrest. Exactly what Aneurin wanted to avoid. Bringing back fear?

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Patients who pay for private surgery are falling victim to massive price variations of up to £12,000 for the same procedure.

A report by medical industry experts shows that depending on the provider and location, the quoted price of a total hip replacement ranges from £8,945 to £14,880, while a commonly performed varicose vein procedure can cost anything from £1,995 to £4,340.

However, a Mail on Sunday investigation has found that patients are often being charged several times this amount, with one woman quoted £15,000 for a vein operation.

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A Mail on Sunday investigation has found dramatic differences in the costs of private health treatment with a £1,500 difference in the bill for a simple back operation

There can even be a near £1,500 difference in the cost of simple back pain injections, and the bill for cataract surgery can almost double from one place to another.

The figures relate to the amounts that self-pay patients – rather than those having procedures covered by private insurance – are having to fork out for treatment

An increasing number of desperate Britons are being forced to self-pay as NHS rationing cuts deeper and waiting lists grow ever longer. More than four million people are currently waiting for NHS surgery – the highest figure since 2007 – according to NHS England.

And in October it was revealed that patients in Northern Ireland are waiting up to three years for an initial consultation about having surgery, following a GP referral.

The report, published by Private Healthcare UK, predicts that the self-pay market will surge over the next five years.

The Mail on Sunday also reported last month that record numbers of Britons are shelling out up to £15,000 for vital operations after being told they must wait for months by NHS hospitals.

In total, patients are forking out £623 million a year for self-pay treatment. They are cashing in ISAs or pensions, taking out loans and even ‘maxing out’ credit cards to fund treatment they should have had sooner on the NHS.

Experts are urging private patients to shop around after the report – which gathers data that providers are now obliged to publish – found alarming differences in prices. For example, the bill for an injection of local anaesthetic and steroids for back pain ranges from £950 to £2,370, while a knee replacement can cost anything from £8,750 to £15,410. Meanwhile, the quoted guide price of cataract surgery for one eye varies across the UK from £1,850 to £3,350.

The report highlights that the cheapest providers are specialist centres – day surgery centres for procedures such as steroid injections, veins and optical surgery – as opposed to private hospitals offering a range of services.

Some providers, including Spire and Nuffield Health, have prices that vary so much that they are often listed as both the cheapest and most expensive option, depending on the location of their centre.

For example, the highest bill for cataract surgery is found at Nuffield’s hospital in Exeter, where the procedure costs £3,350 for one eye. Yet the cheapest provider in the South East is the company’s Chichester hospital, where the same operation costs £2,090.

Keith Pollard, chief executive of Private Healthcare UK, said the figures emphasised the need for stringent research before committing to any hospital or clinic. ‘There has always been a wide variation in pricing,’ he explained. ‘But companies are now being ordered by the Government to publish their prices on their websites.’

When asked about the huge disparity in pricing, Nuffield Health said: ‘Our prices vary according to surgeon and anaesthetist fees and local market conditions.’ Spire Healthcare refused to comment.

Mr Ian Eardley, vice-president of the Royal College of Surgeons, said many desperate patients who did not fit the criteria for NHS treatment were now opting to go private if they could afford it. ‘There are some elective procedures, such as hip and knee replacements, where patients are being denied access due to local NHS policy. They may be told to go away and lose some weight before they are eligible,’ he said.

‘With procedures such as varicose veins, cosmetic appearance is no longer enough to get surgery. You must be at risk of developing other symptoms, such as painful ulcers, in order to be considered eligible on the NHS.’

Six things every self-payer needs to know

1 Mr Ian Eardley, vice-president of the Royal College of Surgeons, says: ‘Ask a potential surgeon how frequently they operate and what their results are.’ Details of how many procedures a surgeon has done and what their results are can be found on the NHS Choices website.

2 ‘If you are offered a new procedure, approach it with caution,’ urges Mr Eardley. ‘Don’t be afraid to get a second opinion or ask to speak to other patients who have had it.’

3 If you are going to be in hospital for a few days, stay in one with low infection rates. ‘Every hospital will have been assessed by the Care Quality Commission and you can read the report on the CQC website,’ says Mr Eardley.

Lower prices don’t always mean lower quality: clinics that specialise in a limited number of procedures can offer savings.

Check the Private Healthcare Information Network (phin.org.uk), which compiles information such as hospital performance, patient satisfaction and CQC rating.

Ask about hidden extras. What happens if something goes wrong? Is follow-up care covered? Make sure you and the surgeon are on the same page in terms of what you consider a successful outcome. For example, improvement in variables such as pain, movement and quality of life.

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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

 

Bullying is a sign of desperation. It is caused by circumstances.. These will get worse… Dead patients don’t vote…

The temperature is rising in some parts of the country. Services are failing as doctors leave, and now patients also are “leaving” to get better treatment abroad. Polly Toynbee is correct, but although the doctors are leaving, and commissioners and those that remain know what is happening, the politicians are protected by large incomes and private options. Surgeons and administrators don’t start off as bullies. It is circumstances that drive them to desperate measures. In North Wales the GPs are at desperation level: GP surgery blasts ‘bullying’ health board over claim it’s ‘at risk’  – Betsi chiefs deny claims they want to ‘destroy independent general practice’ across North Wales (Steve Bagnall reports) 

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In Northern Ireland BBC News reports: “NHS surgery waits run into years in Northern Ireland” and NI has never met key NHS cancer target

In Scotland the Telegraph: Bed blocking costs Scottish NHS more than £100 million a year and The Times Daniel Sanderson reports: ‘Brain drain’ as doctors abandon Scottish NHS in their thousands

And in the Telegraph more bullying, this time by Surgeons: Badly-behaved surgeons are ​putting patients’ lives in danger ​due to ‘culture of bullying’, report finds 

Tom Martin in the Express 23rd October reports: NHS crisis: SNP warned over doctor ‘brain drain’ which has seen THOUSANDS moving abroad – MINISTERS have been urged to tackle a medical “brain drain” amid warnings up to 3,000 doctors have quit Scotland’s NHS to work abroad over the past decade.

Laura Donnelly in the Telegraph reports 22nd October: Soaring numbers flying abroad for medical care as NHS lists lengthen 

The number of patients leaving Britain and flying overseas for medical treatment has trebled as NHS waiting times reach a record high, a Telegraph investigation has revealed.

Government data shows the number of people going abroad for healthcare has increased from 48,000 in 2014 to almost 144,000 last year as the health service struggles to cope with demand.

Polly Toynbee has it right when she writes in the Guardina 17th October: While all eyes look to Brexit, our NHS is about to collapse

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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.

GP numbers are falling (Trends in the NHS) , and over 700 practices have closed in the last 5 years. This means that list sizes are rising. This information dates to 2015, so is 2 years out of date. The rationing of places at Medical School, over 30 years and 8 administrations is to blame, along with poor selection age.

An example of a table of data is from Wales: 

In Wales there are 454 Practices, which consist of 1663 GPs, 334 other GPs (assistants), 3,187,000 patients, 7021 average patients per practice, and a residential population 3,099,000. This gives an average population per practice of 6826.

There are several issued hidden in these figures. There are more patients registered with Welsh GPs than there is population in Wales. This is because of the border issues, where patients in Wales get free prescriptions, but those eligible in England pay. There are many more part time GPs than there were 10 years ago. The figures, in rough terms, just have to be multiplied by 20 for England, and by 2+ for Scotland as the whole UK is under doctored.

The number of GPs up to 2011 is shown here (Nuffield Trust), but is of course 6 years out of date.. It is interesting that even professional reporters cannot find up to date comparison figures from the UK Regions to compare with England, and this emphasises that we have no “National” in our health services. There have however been consistently more GPs in Scotland

Another problem is the definition of a GP. WONCA had a go in 2005. Many different countries have many different interpretations. In the UK he has to be “Competent and Capable” (RCGP), able to work “Independently” and traditionally to provide continuity of care for families. This “cradle to grave” image is fast disappearing, and the reality of part time GPs who may not know their patients has to be faced. Is the GP going the way of the Dodo in the past, or the Salmon in the future?

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Laura Donelly and Patrick Scott reports in the Telegraph 16th October 2017: Rise of the ‘super-size’ GP surgery as quarter of practices now deal with more than 10,000 patients

New figures reveal the rise of the “supersize” GP surgery, amid the closure of almost 700 practices in five years.

Family doctors said they were being forced to handle far more cases than they could cope with, with one in four practices now seeing more than 10,000 patients.

The proportion of surgeries with such list sizes has risen by 27 per cent since 2013, the NHS data shows.

It follows admissions from the Health Secretary that the traditional family doctor role has been eroded by decades of underfunding.

Jeremy Hunt told a conference on Thursday that the “magic” of general practice was under threat, with GPs burned out and left feeling “stuck on a hamster wheel” with up to 40 patients to see daily.

The statistics from NHS Digital show that 28 per cent of GP practices in England have a list size of at least 10,000 patients – including some with more than 20,000 cases on their books.

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said family doctors were left overloaded, and too often unable to meet the needs of their patients.

It follows admissions from the Health Secretary that the traditional family doctor role has been eroded by decades of underfunding.

Jeremy Hunt told a conference on Thursday that the “magic” of general practice was under threat, with GPs burned out and left feeling “stuck on a hamster wheel” with up to 40 patients to see daily.

The statistics from NHS Digital show that 28 per cent of GP practices in England have a list size of at least 10,000 patients – including some withmore than 20,000 cases on their books.

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said family doctors were left overloaded, and too often unable to meet the needs of their patients.

She said: “The phenomenon of growing patient numbers, and a lack of GPs to deal with growing demand is a long-running trend, and something the College has been drawing attention to for many years.

“As a result, many GP practices are seeing escalating patient lists they they simply can’t deal with – although we must recognise that sometimes increasing list numbers are due to practices merging and pooling their resources,” she said.

Prof Stokes-Lampard said there was a desperate need for more GPs and practice staff.

Dr Richard Vautrey, GP committee chairman said doctors were struggling to cope with an extra 2.6 million patients registering in the last four years, while funding and staffing levels had not kept pace.

“GP services are struggling to cope with unsustainable workload and deliver the care their local communities need,” he said.

A recent BMA survey found that more than half of GP practices were considering closing their patient lists as they could no longer provide safe care to the public.

The figures show the total number of practices registered with a GP has risen from 56.2m to 58.7m in five years. Meanwhile the number of practices fell from 8,032 to 7,358.

Of those, 2,082 have more than 10,000 patients on their books – including 157 with more than 20,000 patients.

On Thursday Mr Hunt said many GPs were at the ‘end of their tether’ and dropping out of the profession. He said: “Too many of the GPs I meet are knackered, they are often feeling at the end of their tether.

“They feel that they’re on a hamster wheel of 10 minute appointments, 30 to 40 every day, seem never ending.

“They don’t feel able to give the care that they would like to to their patients and increasing numbers of them are choosing to work part-time and at worst to leave the profession.

“We have to think really hard about how to stop that happening if we’re going to use the magic of general practice to do what we need it to do for the NHS.”

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The decline of General Practice.. Bribes may be too late…

Update 24th October.

Tara Russell in the Daily Echo reports: GPs to be given £20,000 ‘golden hello’ for working at the coast or countryside.   

and the BMJ Zosia Kmietowicz reports: “Golden hello” of £20 000 to be offered to 200 GPs a year, says health secretary

There will be many post mortems once the old fashioned GP has disappeared, but it is not only about numbers, but also about experience and reduction of waste. A good GP reduces unnecessary referrals and investigations, lives with uncertainty and is trusted to use time as a diagnostic tool. 20 years ago most countries envied our primary care GP system of gatekeepers, but we have steadily destroyed it. In Folkestone, (and many other places) the population is in dire need. The goose that laid the golden egg for efficiency has gone… Perhaps readers should ask their MPs 1: “Why have 9 out of 11 applicants for Medicine been rejected for 30 years, when we continue to import so many doctors from overseas? 2: “Why are 80% of Medical students women, and should this be addressed by graduate entry, or adverse selection. The answers are short termism and rationing.

In the last week I have heard and witnessed two stories close to me. A citizen had renal colic and was getting  better when seen at home. After 8 hours in Casualty, an USS, a CAT scan and bloods as well as urine dip test (not available to the paramedic visiting) he was sent home. The other was a case of acute orchitis who had 3 courses of antibiotics, investigations ++ and 6 consultations in A&E and GP. An experienced GP would have dealt with both these cases much more efficiently.

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Shane Brennan interviews Dr for the Daily Post 19th September 2017: The North Wales doctors surgery … with no doctors

Reliance on locums since GPs retired means some days there are four available, but some days only nurses

Nurses are having to stand in for GPs at a surgery where on some days there are no doctors available to see patients.
The Pen y Maes medical centre in Wrexham is being run by Betsi Cadwaladr since its doctors retired last year.

The health board has had to draft locum GPs in to do the work, but according to local councillors and patients, on some days there are none available.
Fed up patients are now planning a protest to voice their frustrations with health board bosses, who say they are looking to recruit GPs to take over the practice.
Councillor Gwenfair Jones, who represents Gwersyllt West – one of the wards hit by the problems at the surgery – said: “Despite repeated requests we are not getting the service that we deserve, a total reliance on locums means that some days there are four GPs other days there are none.”

She added: “The Health Board is meeting this Thursday at 10am at the Catrin Finch Centre at Glyndwr and we will be there to give them a warm welcome and to make sure patient’s voices are heard”
Dr Sophie Quinney from campaign group GP Survival (Wales) welcomed the protest, she said: “Patients are absolutely right to be concerned by the direction of travel for primary care across North Wales. It is well accepted that surgeries run by family doctors are more cost effective and for the most part deliver a superior service to those run by administrators.
“Sadly, Welsh Government has offered too little too late by way of funding and resources to help ease the ever-increasing burden on these doctors, and they are voting with their feet.

“What is urgently needed is dialogue between GPs and their patients, so that the public can get behind this important cause and exert the type of pressure that is needed to turn this sorry situation around.”

A spokesman for Betsi Cadwaladr University Health Board said the board was trying to find a solution that would see full time doctors take over at the practice.

He said: “We remain committed to providing a high quality service at Pen y Maes, which includes working to fill vacant posts at the practice. We are actively looking to fill vacant salaried GP positions at the practice, and will be interviewing for Advanced Nurse Practitioner posts next week.

“We continue to work hard to develop a plan for the long-term future and success of the practice, and apologise for any difficulties patients have had in booking appointments.”
A Welsh Government spokesman said: “We expect all Health Boards to provide primary care services which meet the needs of their populations. Investment in general medical service has increased by approximately £27m as a result of the agreed changes to the GP contract for 2017/18. This provides a strong platform for GPs to continue to provide high quality, sustainable health care across Wales.”

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Reasons behind the decline (Letters in The Times 14th October 2017)

Sir, You report that Jeremy Hunt is proposing to pay golden hellos to a limited number of younger doctors (“GPs offered £20,000 bonus to stay in neglected areas”, Oct 12), and that GPs who know patients personally are at risk of dying out (Oct 13).

I retired from my general practice in 2015 at 57 but carried on working as a locum until October last year because I did not feel ready to stop doing the job that I had previously enjoyed for most of my career.

Before my eventual retirement I had worked as a “family doctor” for 30 years in the same practice. I have never been afraid of hard work and many of my patients will remember the days when doctors were called out from home or would visit out of hours. But towards the end the pressure of the “day job” was starting to affect my health and was putting me at risk of “burn out”. I was also spending not much more than 50 per cent of my time in “real” patient contact.

To the many patients who would ask why I was retiring early, I would reply that the problems of general practice go back at least ten years, with governments of all political persuasions failing to listen to GPs. I would often say that the failure to listen to GPs went back as far as Tony Blair’s government, if not before that.

Although the government is beginning to make some belated proposals to improve GP recruitment I can also only guess how many GPs of my age and experience have been lost to the profession because of the inaction of successive governments.
Dr A G Bennett

Leek, Staffs

Sir, For a brief moment after the GP contract of 2004 was implemented GPs felt valued, but then the attacks began: an onslaught of criticism, started by Labour and continued by the Conservatives. It felt like a strategy: an intention to demoralise GPs. If so it worked, as general practice is now in crisis, with problems with recruitment and retention. And yet the health secretary states that GPs are the heart and soul of the NHS — if general practice fails, the NHS fails. What on earth was the GP bashing of the past 13 years all about?
Dr Bruce Halliday

Dumfries

GP practices close in record numbers – Wrexham patients protest about GP staffing levels. This is only the beginning….

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

How to kill the goose and create a shortage of 10,000 GPs – Patients kept waiting as new doctors shun GP jobs

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Hands up – who want’s to be a GP today? Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

 

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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NHS is not fit for the 21st century, hospital chief inspector warns

The professionals all know that we have 4 unsustainable health services. The comments by Prof Baker refer to failure of the previous Labour government but actually it has been successive administrations who have deferred the problem to their successors. The perverse incentives in our first past the post 5 yearly elections, appears to mean that we will never address this problem until there is a system failure… Is any political party brave enough to tell the truth, ration overtly, and create a sustainable health care system? Its not just doctors who need to be honest about their mistakes, and to face reality.

In The Telegraph 30th September 2017 Laura Donelly reports : NHS is not fit for the 21st century, hospital chief inspector warns

The NHS is not fit for the 21st century, the new chief inspector of hospitals has said – warning all trusts to take urgent steps to make Accident & Emergency departments safe.

Prof Ted Baker said it was “not acceptable” to keep “piling patients into corridors” as he urged hospital leaders to act swiftly to guard the safety of those in their care.

In his first interview as chief inspector, he said too many hospitals had normalised “wholly unsatisfactory” arrangements which endangered patients, as well as denying basic privacy and dignity.

Prof Baker has written to all hospital chief executives, calling for immediate action to improve safety in A&E, amid fears the NHS will struggle to cope with overcrowding this winter.
Trusts are instructed not to force patients to queue in ambulances, and warned of the dangers of leaving patients in corridors, where staff cannot even see them.
He told The Telegraph that he was concerned that a culture of “learned helplessness” had sprung up in some A&Es, where staff “just pile the corridor full of patients” leaving them exposed, unmonitored and even without access to vital supplies, such as oxygen.

But the Care Quality Commission (CQC) inspector said far more radical action was needed to stop hospitals becoming entirely overwhelmed.
“The model of care we have got is still the model we had in the 1960s and 70s,” he said.
“That is the fundamental thing that needs to change; we need a model of care that is fit for the 21st century and the population as it is now.”
Around half of hospital beds are now taken up by people who should not be there, he said – either because their health would not have deteriorated with the right care, or because they could have been discharged if help was at hand.
Prof Baker, a former hospital medical director, said the NHS had made a critical error, in failing to take decisive action under the last Labour government, when it became clear that reforms to build community services were required.

“I think the one thing I regret is that 15 or 20 years ago when we could see the change in the population the NHS did not change it’s model of care,” he said.

“It should have done it then – there was a lot more money coming in – but we didn’t spend it all on the right things – we didn’t spend it on transformation of the model of care,” he said.

In the last three decades, the population has risen by 16 per cent, but the number of pensioners has risen by more than one third, with increasing numbers of living longer, but often in frailty and illness.

Next month the CQC will issue a report on the state of the country’s health and care services, which is expected to highlight mounting pressures on hospitals, a year since the watchdog warned that social care was approaching a “tipping point”.

Dr Baker suggests that hospitals – increasingly running at occupancy rates exceeding 95 per cent in winter months – are in danger of running out of beds and staff, without radical reform

“Capacity is being squeezed all the time,” he said. “That is a real concern going forward – because there comes a point at which the capacity isn’t there” .

Why is the NHS under so much pressure?

An ageing population. There are one million more people over the age of 65 than five years ago

Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years

This has caused record levels of bedblocking, meaning elderly people with no medical need to be in hospital are stuck there. Latest quarterly show occupancy rates are the highest they have ever been at this stage of the year, while days lost to bedblocking are up by one third in a year

Meanwhile rising numbers of patients are turning up in A&E – around four million more in the last decade, partly fuelled by the ageing population

Shortages of GPs mean waiting times to see a doctor have got longer, and many argue that access to doctors since a 2004 contract removed responsibility for out of hours care.