Category Archives: Political Representatives and activists

Doctors are being asked to play God…….. The FT thinks it has the solution…

Philip Stevens in the FT reports: Doctors are being asked to play God – The coronavirus pandemic is presenting hospitals with a terrible choice about whose life to save

web_Nursing coronavirus balance
So who decides between life and death? As the Covid-19 outbreak threatens to overwhelm healthcare systems, it also presents a harrowing human dilemma. We have caught a glimpse of this in Italy. Distilled to its essentials, it can be expressed more or less as follows. Doctor A has one ventilator and two patients in the grip of the coronavirus. Arriving first at the hospital, patient B, a 65-year-old retiree thought to have only a slim, albeit still measurable, chance of survival, is being kept alive on the ventilator. Patient C, a 35-year old teacher who arrived later, is deteriorating fast, but is judged to have a high chance of recovery if transferred to the ventilator. ….

And the FT then opines that it has the solution: How to avoid rationing urgent healthcare during the Covid-19 outbreak

But I’m afraid you will have to buy or register to get the answer.

A changing opportunity for the four UK health services.. Solution: avoiding paternalism, for rationing, and for financial probity.

This type of social revolution brings some good thoughts from our media correspondents. Whether their thoughts are translated into action is another matter. Populism, embraced by leadership in the UK, is aware that by changing the services so that they are founded on a rock will be traumatic, controversial, and lose them votes because the opposition will pounce on them. Co-payments – no way. Rationing – never happens, Standards – always rise! These are lies that need to be exposed and debated in an open society.

Lets start with standards. In a short article hidden in a small side column on the Times 4th April, and not on line, :

Medics’ Extra Insurance: Doctors have been given extra government assurance for lower care standards and a commitment that regulators will be lenient on failures at the height of the pandemic. In a letter to medics, seen by The Times, health authorities acknowledged that satff may “need to work in different ways”, adding “We do not want indemnity to be a barrier to delay to such changes”.

Well let me tell you that not only hospital doctors, but also GPs are taking extra risks. For a start not examining the patient and relying on phone and video calls raises the risk. I wonder if GPs, already in meltdown before the crisis, are going to be absolved if they make the inevitable error. We should go the whole way and have no fault compensation.

Co payments. Well Janice Turner  on 4th April in the Times in This fad for fitness could last a lifetime – All the generations are coping with their fears by trying to improve their health, which will be good news for the NHS

….The one notable downside of the NHS is it leads to physical complacency. If we get obese, diabetic, develop joint problems or high blood pressure we just see a GP and are treated “for free”. No need to change your lifestyle: pop a statin. An NHS physio told me patients expect to be fixed in a single appointment, rarely doing the therapeutic exercises at home. Writing about diabetic amputations, I met nurses begging high-risk patients not to live on chocolate bars, and a surgeon who eventually cut the limbs off patients who’d carried on smoking even after losing several toes.

Ms Turner exposes the achilles heel of the paternal society that is the 4 UK health systems. One that even Anneurin Bevan recognised, but felt he had to put up with to get his bill through. We do not encourage people by stick, as well as carrot, to look after themselves.

And rationing: In Paul Nurse opinion in the Times 4th April: ‘Boris knows he’s out of his depth. Suddenly experts are useful again’

…The country is, he warns, paying the price for ten years of austerity. “If you’re always strapped for cash, you will invest in what’s going to be needed next week, and not what might be needed in ten years.” Too often, the political debate about the NHS “focused too much on short-termism — what money can be saved here — and you do have to have a longer-term perspective,” he says. The calculation that “we’re tying up money in something that is unlikely to be used . . . is OK if you’re running a business, but it isn’t so OK if you’re running a healthcare system”.

The pandemic also, he argues, proves the importance of “left-field” scientific research that may not be immediately useful. “I work with yeast, and people think that’s utterly useless. But what we discovered some years ago is what controls how a yeast cell divides . . . and then we showed that’s the same in humans. That is absolutely critical for cancer.”

The next big challenge is to create a coronavirus vaccine.

It needs more money, resources, people and plant. But we cannot afford it if “Everything is free for everyone for ever”.

Kat Lay in the same paper thinks that the Pandemic is set to future-proof the NHS

but NHSreality would contend that is only if we face the issues above honestly.

…New ways of working, including centralised hubs co-ordinating cancer care, are likely to persist even after the pandemic has passed, experts say…..

…He estimated that even after the pandemic, up to half of GP appointments would be online or by telephone.

Efforts are focused on how GPs can access patient records securely from home, with many having to travel to surgeries to conduct remote appointments…

Hospitals, too, have moved outpatient appointments online. The move ties in with a pre-pandemic ambition to reduce travel and thus air pollution.

Pando, a communications app for healthcare workers, is being downloaded by more than 1,000 doctors daily.

Last week, Matt Hancock, the health secretary, wrote to all NHS organisations giving them legal backing to set aside the normal confidentiality for patients until at least September if sharing patient data was deemed relevant in helping the fight against Covid-19.

 

 

Reverse the devolution of health.. Now is the time to combine the 4 health services to give us efficiency, equality and unity.

The 3 smaller health services should be closed down, and decisions made by England should apply to all. Its clear to NHSreality that Now is the time to combine the 4 health services to give us equality and unity. Why have Public Health Wales when the English administration is fit for purpose? NHS Health Scotland is fine and dandy, and it sometimes comes out with advice earlier than England, but the duplication of expensive resources cannot be justified. How many more incubators, respirators, and hospital beds could we fund with this money? So not only equality and unity, but also efficiency would result from unification of health services.                                                                                                                  BBC Wales news emphasises the difference and independence of its health service 25th March 2020

The democratic and opportunity deficit in health will become apparent, especially in the retrospectoscope, after this pandemic. Watch for different death rates, infection rates, and survival rates. The fact is that devolution has failed greatest in N Ireland, whose parties and public remain in a repressed civil war, and secondly in Wales, where the population is only a little larger, and non violently, but multiply tribal, and more successfully in Scotland because they have a separate budget. Certainly reversing health devolution should be considered carefully.

Unfortunately politics and media conspire to forbid pragmatic and unemotional discussion of any change to devolution. Indeed, the mood amongst these two conspirators is for independent taxation and then what: fiscal independence as well?

The pandemic has shown us that unity helps. Big mutuals do better. In defence and armaments bigger stronger countries can defend themselves better, and weaker ones least. The same is true for a pandemic. Reverse the devolution of health. Thee shock of this virus will either bring us together more, or tear us apart. Europe is at risk of the latter.

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Poor state of Welsh health. The experiment with devolution has failed….

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

Amazing how England has been able to kid themselves there is an NHS – until now. Manchester’s health devolution: taking the national out of the NHS?

The democratic deficit. Applies to health as well as devolution, and to leaving the EU. The first honest party should get public support.

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The shock of coronavirus could split Europe – unless nations share the burden

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Dr Jack talks to Radio 2. Don’t touch. Stay isolated. The reality of the CV15 epidemic.

The reality of the corona virus CV 15 epidemic…

13 doctors have died so far…..

Swine flu is a ripple compared to this. It is catastrophic. I feel as if i’m in a different universe to what is going on outside the window. People have got to stop (unreasonable behaviour) and I’m going to be a different person after this. Going to the pub could kill people, or make them respiratory cripples for the rest of their lives. We will be overwhelmed, even now, if everyone behaves as they should from today.

Stay on your sofa. Use the internet and watch TV, listen to radio, records.

 

 

Many governments and many ministers of health have made mistakes… They should be candid.

If doctors have a duty of candour, then how about politicians? Many successive governments and many ministers of health have made mistakes… They should be candid about the reasons for poor manpower planning, fewer beds, fewer hospitals, fewer consultants, fewer nurses, fewer GPs, and fewer imaging diagnostic facilities than almost any other country in the G8.

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Rajaratnam Jeyarajah, consultant physician opines in a letter to the BMJ 14th Jan 2020: True candour about mistakes means full disclosure of system failures ( BMJ 2020;368:m104 )


BMJ 2020368 doi: https://doi.org/10.1136/bmj.m104 (Published 14 January 2020)Cite th

I agree with Maskell that we should be honest and volunteer all information to people harmed by provision of services.1 But why should we stop at doctors’ honesty about mishaps during patient care? Why shouldn’t we make the public aware of the shortages nearly all hospitals face and the stress and unrealistic demands this places on staff?

I suggest hospitals put a board outside the entrance, like those outside car parks, stating the number of staff shortages, vacant beds, and patients waiting on trolleys in the emergency department. As well as the number of scanners that aren’t working, and the delay in discharge because of the shortage of community care and nursing home beds. Also the number of staff who are absent because of stress or involved in appraisals and revalidation.

Then, some may decide that their hospital visit could wait another day or may even decide to have the investigation done elsewhere, and others may decide to take their loved one home and bridge the gap before care starts. This will make the public more appreciative of the care provided under difficult conditions in a constantly overstretched system. They will also be more understanding when unintentional errors are made. And less demanding.

I am in total agreement with the principles of the duty of candour. We need to be open and honest, not only about mistakes made but also about the contributory factors and the unreasonable demands imposed because of a shortage of resources.

Above all, staff should feel supported and their sacrifices appreciated. The public should realise that the NHS is the envy of the world but is giving way at its seams. If we don’t support NHS staff—the service’s greatest asset—we are in danger of losing our national treasure.

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See the source image

 

 

Doctors will ration health care if they have to. But the situation that led to the under capacity- shortage of staff, equipment, beds, plant and then morale, needs an independent enquiry.

Health has become the political issue of the day. We have to ration health care and it has to be seen to be rationed fairly…. Doctors will ration health care if they have to. But the situation that led to the under capacity- shortage of staff, equipment, beds, plant and then morale, needs an independent enquiry. It is our short term horizons, and first past the post electoral system that stinks… and ensures that the under capacity will continue after the crisis is over.

The Times’ Daniel Finkelstein opines 17th March 2020: Doctors need help deciding who lives and dies – Parliament must take the lead in weighing up the economic and medical trade-offs that will be required in this crisis

In the summer of 1944 a new and terrible weapon was unleashed on Britain. The first V1 bombs began to land shortly after D-Day. The Germans had developed a way of killing that didn’t require a pilot and could destroy the centre of London and cripple its government.

Only it didn’t. The bombs landed, and kept landing, primarily to the southeast of the capital. Thousands did die and many buildings were destroyed, but the consensus of historians is that if the centre had been hit many more would have died and much more would have been destroyed.

And this judgment is important, because the diversion of the bombs to the south was a deliberate act. Winston Churchill sanctioned a programme, using double agents, that deceived the Nazis about where their bombs were landing and made them carry on missing the administrative centre of London.

Was this “playing God”, as one cabinet minister argued at the time? Was this sacrificing the less powerful so that the seat of government could escape? Or was it a difficult but acceptable choice in the circumstances?

The moral dilemma that faced Churchill is one that we grapple with all the time, as we make decisions on rail safety, to give one example. If you stop all the trains you can ensure 100 per cent safety on the railways, but people may travel by road and that can be more dangerous. Yet most of the time we don’t discuss the trade-offs we make. It’s too uncomfortable.

The present crisis means this silence is unsustainable. The government, scientists, economists and health workers are all facing agonisingly hard decisions, and they shouldn’t make them by themselves. Apart from anything else it isn’t fair on them.

In his splendid short book Would You Kill the Fat Man? the philosophy writer David Edmonds recognises in Churchill’s dilemma an example of what is known as the trolley problem. Over time this thought experiment has become fearsomely complicated. But at its core is something simple.

A tram (or as Americans call it, trolley car) is heading for a group of five people tied to the tracks and will kill them. You have the chance to divert the trolley by pulling a switch, but if you do it will go down a spur and kill one person. What should you do?

But here is another version. It isn’t a spur, it’s a loop. If the trolley was left unimpeded after you switched the signal, it would eventually loop around and kill the five people after all. It only doesn’t do that because it is stopped by the body of the one person. In the spur version you would be delighted if the one person leapt up and escaped. No one would die. In the loop version you need the one person to die because their body will stop the trolley. Should you pull the switch?

Or yet another version. A trolley car is hurtling towards five people who are tied to the track. You are standing on a bridge above it all. There is a fat man next to you and you realise that his bulk is just large enough that he will stop the train if you push him off. He will die but five will be saved. Should you kill the fat man?

Spur seems pretty straightforward, at least at first. You can save a net four lives. Pull the lever! But loop and especially fat man are much harder. They save the same number of people but they involve intent to kill, and the more intent they involve the more our intuition rebels against it.

There was something of this in the debate over the weekend about herd immunity. Part of the debate was about how many lives could be saved by immediate action. But part was about intention. It may be (and this depends on vaccines and other medication) that in the end we have to rely on herd immunity to bring an end to this crisis. But it is one thing arguing that herd immunity might happen in the end, and quite another arguing that herd immunity, which can only happen as a result of many people dying, should be an intentional aim.

I said that the spur option seemed straightforward but even with this there are complications. It’s all easy when the six different people tied to the track are anonymous and undifferentiated strangers. But what if the one is a child, and the five are old? Or the five are very sick and the one is full of vigour? Or the one is your relative and the others are people you don’t know?

Gordon Brown, when he was prime minister, once had a trolley-type question put to him after a speech on globalisation. If there were a tsunami and he was on the beach and could warn only one British person or five Nigerians, what would he do? Rather cleverly he instantly replied, while acknowledging his responsibility as British PM, that modern communications would allow him to warn both and he then spoke about the need for early warning systems.

He was quite right, of course. The first response must be to try to save as many lives as possible and to reduce the dilemmas. But it’s obvious it won’t dissolve the problems entirely. Hospital staff are going to have to choose between patients — young and old, sick and less sick, acute and less acute. They are already doing it, actually, as they put off operations to keep intensive care beds free.

Parliament and government need a proper debate and must provide guidance, and if necessary law, to assist medical staff in this unenviable task. If, for instance, young are to be preferred to old we had better discuss that preference in all its complexity.

But it isn’t only medical staff who face a dilemma. Our entire strategy involves a trade-off. We are choosing to suppress the disease in a way that will do great harm to the economy. And that seems the right choice, to me at least. But we should recognise, at least, the cost. There will be a cost to pay in terms of human life in an economy that, however much is done to pump it up, will be smaller than it once was — not just in less life quality, but in the amount of lives.

If we are poorer, we will have less that we can spend on healthcare and on fighting disease and people will die. I would like to see the government modelling on this, too, as we consider when and if to take breaks from suppression over the coming year.

And not only modelling on the impact now. The economic impact will be felt for years to come. It’s another spur complication. If one person would be saved but five people yet unborn might die young, would you pull the lever?

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The 4 health services and the demands of gambleing addiction…. We need more legislation and not more money.

Gambling usually attracts those least able to afford it. Thus it is a regressive form of indirect taxation. Politicians should look at this from a social and holistic national view. The small loss of liberty implied by strict regulations is justified. This is an area where Liberals should speak out. We need more legislation and control: not more money.

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Eleanor Howard in the Mail 16th January reports that Claire Murdoch demands an end to “shameful” bribes offered by betting firms to customers to get them to carry on gambling.

Even worse is the sponsorship of sports teams, the adverts at half time, and between activities and even between overs at cricket. Many of these are watched by children and the ironic “responsible gambling” adverts are irrelevant.

BBC News reports: NHS tells betting firms to stop ‘vicious gambling cycle’ but this needs political will and legislation: not agreements. Letters to the companies will not help.

The head of mental health services in England has written to five major gambling companies, demanding urgent action on tackling gambling addiction and its impact on people’s health.

Claire Murdoch said incentives such as free bets and tickets should be banned to stop the “vicious gambling cycle”.

The industry said it was determined to make gambling safer.

Bets using credit cards are to be banned from 14 April, and the regulator is investigating “bet to view” schemes.

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‘Dangerous habit’

In her letter to the chief executives of William Hill, BetFred, bet365, GVC and Flutter, Ms Murdoch said she was worried that problem gamblers were being targeted….

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BBC News 8th Jan: Sunderland gambling clinic opens doors to North East addicts

Sarah Marsh in the Guardian: NHS should not have to pick up pieces from bookies’ tactics, says health chief