Category Archives: Political Representatives and activists

Tayside bullying

Concerns raised with Tayside NHS over systematic bullying, MSPs are told. The Courier 20th September 2018. .

Allegations of “systematic bullying” at NHS Tayside and the stress-related suicide of a trainee doctor there prompted the resignation of the health board’s whistleblowing champion, MSPs were told.

Munwar Hussain was one of three non-executive directors of the troubled health board who quit in the wake of what was branded a “crisis of public confidence” there.

Labour health spokesman Anas Sarwar said Mr Hussain had been frustrated that concerns raised were “not being acted upon by managers”.

Mr Hussain was contacted by a former trainee doctor who said they “left the NHS due to issues of systematic bullying and negative cliques”, Mr Sarwar said.

There is a crisis of public confidence with NHS Tayside following a series of issues

Labour health spokesman Anas Sarwar

The Labour MSP continued: “There were claims that people were raising issues but these were not being acted upon by managers, including allegations in the email that a previous trainee took their own life and the stress was unbearable for some.

“A serious set of allegations including that a trainee took their own life due to stress.

“He (Mr Hussasin) goes on to say that he asked for this to be raised at a board meeting but was told that he could not.”

Mr Sarwar said Mr Hussain “eventually” raised concerns at a staff governance committee meeting but said he felt “this is viewed as an ongoing issue which is tolerated”.

It emerged at the weekend that Mr Hussain had decided to resign from NHS Tayside – along with colleagues Stephen Hay and Doug Cross – but he did not make public the reason for his decision.

Health Secretary Jeane Freeman told MSPs she was aware “other board members are considering their future plans”.

But she stressed she had “immediately followed up” the issues Mr Hussain raised with her.

These included concerns about “doctors in training” as well as senior management pay, the use of public funds, and CAMHS (Child and Adolescent Mental Health Services) issues, she said.

Mr Sarwar said he had seen the letter Mr Hussain sent to the Health Secretary, as he claimed: “There is a crisis of public confidence with NHS Tayside following a series of issues, including financial mismanagement leading to brokerage loans, raiding of the charity endowment fund, a chief executive and chair forced to resign.”

Ms Freeman conceded there were “undoubtedly challenges for NHS Tayside”, adding she “would not underestimate those in any respect”.

She insisted the “appropriate place” for Mr Hussain to have raised his concerns was at the staff governance committee meeting “and not in the wider public board meeting”.

And the Health Secretary said the board at NHS Tayside – which had a new chief executive and chairman appointed in April – were “responding appropriately in my opinion to the whistleblowing issues that have been raised with them”.

Ms Freeman pledged: “I will continue to monitor how the board deals with those and what the end result will be.”

Liberal Democrat health spokesman Alex Cole-Hamilton later pressed the Health Secretary on the “revelations” from Mr Sarwar.

The Lib Dem MSP asked: “On something this serious, on a failure of whistle-blowing systems this serious, can we really expect the board to mark it’s own homework on this?”

He argued it was “in our national interest” for the Health Secretary to “instruct a full, independent public inquiry” into whistle-blowing in NHS Tayside.

But Ms Freeman told him: “I do not believe that is necessary.”

She added: “We have a set of very serious claims by a member of NHS Tayside’s board which was communicated to me via email on September 3. That member then indicated his intention to resign following his period of ill health absence on September 11.

“The board has acted on these concerns. I have seen the actions they have taken prior to Mr Hussain being in touch with me and I have made a commitment I will keep a very close eye on how the matters progress.”

Advertisements

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

Societal debate on CRISPR should occur: but it won’t…… Of course there is a cost too, but that’s another matter. Lets just see if we can agree that CRISPR is desirable.

Just as politicians and administrators are unable to focus on a meaningful debate about the UKs four health services, they will be unable to debate the ethical challenges, and great opportunities afforded by gene editing. The CRISPR technique holds the potential to reduce greatly many diseases, such as cystic fibrosis and Huntington’s disease. Naturally occurring new mutations will not be preventable, but there is great hope, especially for single gene disorders..

Along with the aforementioned, those who preach about the different faiths will disagree about the best way we can use, control, and benefit from this new technology. Their disagreements, and especially the resistance to change from the right wing fundamentalists, will not advance us. The debate we need on CRISPR will be denied, just as we are denied one on health.

What about the media? Why are they not addressing these issues? It is because they are both complex, and need long words and sentences to describe. They will not sell newsprint or media. The broadsheets may have a go, (it would need to be sustained!) but the Sun and the Mail, main formers of opinion, will duck it. 

In a representative democracy, I have a right to expect my elected MP to be informed and have a view on these matters, but he will not differ from the traditional resistance to change, because he thinks there are more votes to be lost by being in the vanguard of political thinking. One way is for patients with these diseases in their family to demand action from their representatives.

See the source imageOf course there is a cost too, but that’s another matter. Lets just see if we can agree that CRISPR is desirable. Once 95% of the population accept it is more good than bad, what will be our attitude to those who reject it, and incur large expense for the state?

Shaun Griffin in the BMJ July 2th opines: Broad societal debate should inform the use of genome editing in reproduction

Over the last year, I’ve seen many global media stories documenting the incredible technical progress made by researchers using a method of genome editing called CRISPR-Cas9. The purpose is to change the function of a gene—usually from a variant that may cause disease to one that doesn’t. The CRISPR technique, more precise than conventional gene therapy techniques, is already starting to be used therapeutically, and under licence in research using leftover IVF embryos. It also has the potential to be used to alter the DNA of embryos before transfer to the womb, allowing parents to exclude an inherited disease in their future children. Although such “heritable genome editing” is currently illegal in many countries, were that to change, the most likely early application would be for a very few serious inherited genetic conditions, such as cystic fibrosis and Huntington’s disease.

Of course, parents are already making reproductive decisions in the context of expanded opportunities for genetic testing, including preimplantation genetic diagnosis. But, according to a major new report by the Nuffield Council on Bioethics, the ethical considerations of heritable genome editing don’t just impact on parents, but extend far more widely, relating to the interests of their children, wider society, and future generations.

One of the report’s main conclusions is that vastly improved public engagement is essential before any change in policy is made, but also as a condition through which society can express what’s in the public interest. For example, those affected by conditions most tractable to genome editing may have a differing view on its use than the general public; as might those with disabilities, with significant differences of view within these groups.

Given the uncertainly of how safe CRISPR genome editing actually is, with studies, including one this week from the Wellcome Sanger Institute, coming to wildly variable conclusions, the Council report calls for more clinical research on safety before it could be allowed. The Council argues that there is great uncertainty about what heritable editing can actually achieve. For example, we know too little about how genes interact with each other and the environment to have a clue how it could be used in multifactorial disease.

Even if heritable editing using CRISPR were safe for a few conditions with a clear genetic cause, the ethical complexity will increase when its use is considered in human enhancement. That may seem fanciful now, but would enhancements be viewed by society as legitimate if they were for personal gain (e.g. sporting or academic ability in one’s child), or broader social gain (e.g. resistance to epidemics or climate change)? And what impact could this have on groups whose conditions might be edited out? We need to ask such questions of society.

But the importance of proper public engagement extends beyond these wide and complex societal concerns. We know from past experience that well informed public debate, or the lack of it, can make or break the application of a technology. For genetically modified crops, the absence of appropriate engagement, as well as the involvement of big commercial companies, damaged public trust and resulted in a backlash. The progression of GM technology in the UK was effectively stopped in its tracks. Effective debate, on the other hand, can pave the way for progress, as it did for mitochondrial donation, the subject of another Council report. It is now is lawful in the UK. The danger for any new technology is that if perspectives are not shared and misconceptions not addressed, it risks being rejected out of hand.

So far there have been some efforts to engage the public on genome editing, with some useful insights, but it’s fair to say that in the main the “usual suspects” have responded, the engagement has been small scale or not in-depth, and the respondents have not been followed up. This is not a criticism of those who have done so, who include the Council itself, they just haven’t got that role, the resources, or in some cases the neutrality.

The report calls for a new advisory body to be established to lead public debate on genome editing and related areas of scientific and technological development, and to inform Government on policy and governance arrangements. There is a model for public engagement that has positively informed, stimulated and monitored public opinion already. Had it not been edited out of existence in a government cull of quangos in 2012, the Human Genetics Commission would have been an ideal body to do this job. As well preconception genetic testing, the HGC produced reports on genetic profiling of newborns, direct to consumer genetic tests. It also had a panel of people personally affected by genetic conditions to inform its work, as well as working groups on genetic discrimination. It’s time to bring it back.

Shaun Griffin has a PhD in DNA repair from UCL. He has worked in communications and public affairs roles for 20 years at Wellcome, UK Biobank, Human Tissue Authority and the Nuffield Council on Bioethics. He is currently at the Association of Medical Research Charities and is vice chair of a research ethics committee. The article is written in a personal capacity.

Twitter: @drshaungriffin

Declaration of interests: I am a former employee of the Nuffield Council on Bioethics and supported the genome editing project until I left in Jan 2018.

See the source image

 

No need to comment on the “Culture of fear”

What a pity that the editor chose not to make this letter the first. Instead letters on the Koran, veils and letterboxes were felt more important.

In the Times letters August 19th 2018: 

NHS ‘CULTURE OF FEAR’
Sir, The highly critical report of an independent inquiry into the self-immolation of an award-winning nurse, Amin Abdullah, who burnt himself to death outside Kensington Palace in February 2016 after going through a “kangaroo court” dismissal process, raises serious questions about management behaviour in the NHS (“Nurse who burnt himself to death at palace should not have lost job”, Aug 9). The report vindicates concerns that have been raised since at least 2010 about NHS management procedures, with at least 17 other similar cases where senior judges or coroners were highly critical of NHS managers or clinicians in management roles.

Protests over the years to the Department of Health, NHS England, the Care Quality Commission, NHS Employers and NHS Improvement have fallen on deaf ears. If they had been heeded, Mr Abdullah could still be alive today. In a letter to The Times on April 30, 2015, 50 leading doctors and clinicians asked for an overhaul of NHS disciplinary procedures, which are often used to bully and deter whistleblowers. We were ignored. This culture remains in the NHS, and contributes to low morale in the NHS workforce.

We hope that effective action will now be taken to learn lessons from the inquiry. This could include chief executives of health trusts being required to sanction every case of dismissal of an NHS employee.

Dr Narinder Kapur, Past-President, British Neuropsychological Society; Dr Stephen Bolsin, consultant anaesthetist and senior research fellow, University of Melbourne; Dr Clare Gerada, Past Council Chair, Royal College of General Practitioners; Dr Kim Holt, Founder Patients First; Dr Ramesh Mehta, President British Association of Physicians of Indian Origin; Dr Chandra Kanneganti, National Chair, British International Doctors Association; Professor Barbara Wilson, Past-President, International Neuropsychological Society; Dr Steven Kemp, Lead Consultant Neuropsychologist, St James’ University Hospital; Dr David Drew, retired consultant paediatrician

“Serious risk of collapse”. The BMA represents the majority of consultants and GPs thoughts, and not the Royal College of GPs (RCGP). We ALL need to worry. Its going to get worse, until we face up to reality.

The journal of the RCGP has a laudable edition with the 1948 Parliamentary White Paper and legislation on the front page. The leading article by a former chairperson, speaks of the sudden change in tone and funding with appreciation. But it is not enough….  the members are more in sympathy wit the BMA tan their academic college. We ALL need to worry. Its going to get worse, until we face up to reality. GPs are well paid, but it is not money that is the issue. It is the shape of the job…

The report in GPonline 29th June 2018 highlights the parlous state of General Practice, but fails to ask for rationing. The full text of Dr Richard Vautrey’s (GPC chair) speech is here.

For 70 years, general practice has been the foundation on which the NHS has been built. For 70 years general practice is where the vast majority of patient contacts have occurred, where generation after generation have been looked after by GPs and their teams, embedded within their community, providing care even before the cradle and often after the grave to those left behind grieving the loss of loved ones.

It’s been on this foundation of general practice, and the primary care we provide, that other NHS services have depended. We’ve managed demand, enabled efficient working elsewhere in the system, directed patients to the right specialist service, been innovative in care pathway design, and above all managed clinical risk on behalf of the NHS as a whole.

But when nearly 40% of GPs intend to quit direct patient care in the next five years, and over 90% of GPs are reporting considerable or high workload pressures, we know that the foundation of general practice has serious structural faults.

When instead of gaining an additional 5,000 GPs, we’ve lost over a 1,000, we know that the foundation of general practice is cracking.

When over a 1,000 GPs have referred themselves to the new GP Health Service in England because of stress and mental health problems, or when hundreds of practices have closed and over 1m patients have been forced to look for a new GP service, we know that the foundation of general practice is breaking down.

For far too long our service has been undervalued and taken for granted. GPs’ work ethic and dedication to their patients has been exploited through a decade of underfunding and soaring workload pressure, with the assumption that the GP practice will always be there to pick up the workload that others say they cannot or will not do.

GP workload

The NHS fails to commission a specialist service, well don’t worry, the GP can do it; local authorities cut smoking cessation or weight management services, but don’t worry, just make an appointment with your GP and they’ll prescribe what you need; a new specialist care home or private hospital opens up in an area without any warning or planning, but don’t worry, the GP will pop around regularly to visit everyone; and then some bright spark comes up with a well-meaning idea that just requires the patient to get a letter from their doctor, but don’t worry because that’s what GPs are there to do, isn’t it?

Well let me make it clear, it is now time to worry. The foundation of general practice on which the NHS is built is seriously at risk of collapsing and if the NHS wants to survive in to old age we need urgent action now. If we cherish our NHS it’s time to save general practice.

In Scotland this has meant over two years of work that has led to the introduction of major new contract changes this year, aiming to reduce risk and workload for practices. In Wales a second QOF suspension helped practices struggling with workload pressures over the winter. In Northern Ireland, even without politicians being prepared to get back to their responsibilities in national government, NIGPC has secured agreement for additional funding for practices and pharmacists.

GP funding

In England we have outlined what must be done, and made clear how any additional funding promised by the government as part of a long-term plan for the NHS must be spent. In our report Saving General Practice we highlighted the need for real investment that provides an additional £3.4bn recurrently each year.

We need to seriously step up our workforce plans to ensure every practice can recruit a GP when they need to and that existing GPs are properly supported to encourage them to stay in the service. We need to ensure every practice has the support of a pharmacist working in their team, to not only reduce GP workload, but to improve the safety of patient care and reduce medicine related adverse incidents.

We need to invest properly in premises, to reduce the risks for those potentially left last-person-standing and prevent bodies like NHS Property Services from pushing practices to the point of closure by their unacceptable and unjustified cost hikes. The deal in Scotland shows that something can be done about this and it is possible for the NHS to share some of the risk.

We need a step change in IT support, enabling every practice to have reliable demand-management systems and the technology to offer smartphone consultations when appropriate, without the need to exploit the out of area registration arrangements by cherry-picking young healthy patients as a provider in London is doing.

Primary care support

We need primary care support services that actually support practices and GPs, and don’t make our work harder and more difficult to deliver. The National Audit Office has forensically exposed the national scandal of NHS England’s abject failure over more than two years to sort out the shambles that they created when they privatised our back office service and left us with Capita’s Primary Care lack-of-service England. NHS England may have made over £60m savings on the deal but its practices, GPs and above all patients that have paid the price.

We need to protect, enhance and reinvigorate our independent contractor model of working and the partnership model that gives all GPs involved a voice in decision-making, which has delivered continuity of care for generations of patients and enables GPs to be positive advocates for their patients. It’s good therefore that the Jeremy Hunt has listened to us and set up a partnership review led by Nigel Watson.

And we also need to deal with the problem of indemnity. GPs effectively pay an indemnity tax of thousands of pounds just for the privilege of working. Securing commitments in England and now also in Wales to introduce a state-backed indemnity scheme by next April are important steps forward. All we ask is for equality with our colleagues in hospital. It cannot be acceptable for a GP to be working alongside a consultant colleague in the same community service, and for one to pay indemnity tax of thousands of pounds whilst the other has their indemnity covered by the NHS.

A comprehensive system, that covers all GPs – locums, salaried and partners – as well as the staff who work in our practices, has to be put in place, and we will work with government to make sure this happens.

I want to conclude by thanking the skilled BMA secretariat who support our work across the UK, the executive team and negotiating team members in the four GPCs who give up so much time to work on your behalf, and particularly to thank my colleague chairs, of GPC NI, Scotland and Wales.
However, this will be the last ARM at which Alan McDevitt and Tom Black chair their respective GPCs, and we owe a huge debt of gratitude to both of these giants of general practice, not only for the work they’ve done in Northern Ireland and Scotland but also for the huge impact they’ve had for GPs across the UK. Thank you to both of them.

Despite the challenges and the pressures, the government’s recent announcements show that we are winning the argument but there is much that still needs to be done. We will not give up on our vital task to save general practice, to rebuild the solid foundation on which the NHS has been built for 70 years and work with the whole BMA to ensure our patients get the best possible healthcare for generations to come.

 

 

Why are we so pround of our 4 health services pretending to be one? “NHS is way down international league for healthcare”

With the Nuffield Trust and The British Medical Journal commenting on “70 years of NHS spending” and how much is enough, we are all bound to consider our service in comparison with other rich countries, and we do not compare well in outcomes. In access, equity and cost we are good enough, but not in that most important indicator: OUTCOMES. 

There are several truths, amongst which is the fact that we have a 10 year shortage of diagnosticians, and technological advance faster than any state’s ability to pay.

At a local meeting those present were assuming that being honest about “rationing” would lose votes. I am increasingly worried by the assumption that the R word is unacceptable to the voters, and particularly the professions. It is honest. By obfuscation with other words managers and politicians, leaders, will be asked “is this not rationing” and the answer will lose all credibility, unless it’s yes.

Image result for rationing honestly cartoon

Kat Lay reports in the Times 26th June 2018: NHS is way down international league for healthcare

The NHS performs worse than comparable international health systems in preventing deaths from eight common causes, including heart attacks and cancers.

New research found that the UK was the third poorest performer out of 19 developed countries at preventing people dying when good medical care could have saved them.

The analysis, published by the research groups and think tanks the Nuffield Trust, the Health Foundation, the Institute for Fiscal Studies and The King’s Fund, compared 19 countries including France, Germany, Japan, Australia, Italy and the USA.

While the NHS was world-leading at treating people regardless of their finances, it had less resources than other countries and spent a slightly lower proportion of national income on healthcare.

Babies were more likely to die at birth or in the week after in the UK than other countries, the research found, with 7 in 1,000 dying within a week of birth in 2016, compared with an average of 5.5 across the other countries.

Lung, bowel, breast and pancreatic cancer patients receiving NHS treatment were less likely than the international average to still be alive after five years.

Performance on preventing deaths from heart attacks, strokes and chronic obstructive pulmonary disease was described as “poor”.

On the upside, only 2.3 per cent of Britons skipped medicine due to cost, compared to an average of 7.2 per cent and on the treatment of some conditions, such as diabetes and kidney disease, the NHS was a good performer.

Chris Ham, chief executive of The King’s Fund, said: “The evidence that the NHS lags behind other countries in reducing premature deaths from diseases like cancer and heart attacks is a timely reality check.

“The UK stands out in removing financial barriers to people accessing care but needs to do better in improving health outcomes.”

Image result for rationing honestly cartoon