Category Archives: Political Representatives and activists

With increased stress, litigation, complaints and expectations, all doctors know they are at risk of burnout or mental illness.

 

Don’t kid yourself. You could get mentally ill. This is why so many GPs and consultants are looking to go part time. The result is less continuity of care, and especially in GP land, lack of the doctor patient relationship which stopped complaints and led to understanding. I used to look after mild anorexics myself, and there is evidence that they do worse in the hands of the “experts”, but then of course only the worst get to the experts. Now a new NICE guideline means they will all go into the mental health system.. Without continuity of care perhaps this is just as well.

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With increased stress, litigation, complaints and expectations, all doctors know they are at risk of burnout or mental illness. It is so sad that with no votes in it, no large party is really interested in mental health.

40 % of primary care is mental health, and yet GPs do not all get mental health training.

In the Times 23rd May 2017 Kat Lay reports: Police investigate up to 20 deaths at mental health unit

Police are investigating the deaths of “up to 20 patients” at a mental health facility in Essex.

Last week an inquest ruled that the authorities had failed to protect Richard Wade, 30, who died in May 2015 after staff at the Linden Centre in Chelmsford failed to confiscate the item he used to hang himself when he was admitted.

Matthew Leahy, 20, died at the centre on November 15, 2012. The inquest into his death concluded there had been “multiple failures”.

The court heard that observation slots were missed, the ward was short staffed and no care plan was put in place for Mr Leahy after he was sectioned on November 7.

The two men were among seven inpatients known to have died at the centre since 2001, all of whom had attached a ligature to fixtures or furniture. Mr Leahy’s mother, Melanie, said that Essex police had told her they were “still investigating my son’s death but are also looking at . . . up to 20 patients, who all died by the same means”.

A Care Quality Commission report in 2016 on the Essex Partnership Trust, which runs the Linden Centre, found improvement was required at the trust and said that there were too many places where patients could hang themselves.

It warned: “Over the past five years, CQC inspectors, along with Mental Health Act reviewers, have inspected this trust several times. Each time we have identified problems that the trust needed to address; for example regarding safety at both the Linden Centre and the Lakes locations. Each time the trust had given assurances and then has not done so.”

Ms Leahy welcomed the fresh investigation and said: “I have worked tirelessly to collect evidence going back to 2001, which proves the trust knew about the ligature points on the ward.

“As proved by the Care Quality Commission inspection in 2015, the wards were not up to the standard required to ensure patient safety.

“The trust had been advised to change things after other patient deaths.”

One nurse, who left the trust in mid-2016 after a decade, speaking anonymously to the BBC, said that ligature points had been identified “many years before” Mr Leahy’s death but had not been resolved.

“If you asked too many questions you were deemed as a troublemaker and things made difficult for you,” he said.

A spokesman for Essex police said that the force was “conducting initial inquiries into a number of deaths which have occurred at the Linden Centre since 2000”.

He added: “This work follows further allegations surrounding the death of Matthew Leahy at the facility in Chelmsford on November 15, 2012.

“We would not put specific links to specific deaths, the research phase will look at the circumstances of a number and then identify those that may have a link due to the circumstances of how the individuals died.”

A spokesman for the Essex trust said the serious incidents were of “great concern” and the trust was “improving systems to ensure that investigations are carried out rigorously. The trust will co-operate with any police inquiries.”

Greg Hurst in The Times 24th May: Refer anorexia cases immediately, GPs told

Mental health now area of most public concern within NHS

No place but cells for those having mental breakdowns

The cost of poor mental health

The production line mentality of government. They are behaving like the worst employers..

Plan your hospital advocate…. NHSreality warned you that it was happening near you. The problems of Mid Staffs and Sussex Mental Health services are endemic, and Christmas is not a time to be ill..

1 in 5 mentally ill children turned away by the NHS. The “random walk” of health care decision making…

There is no money – and now there are no beds! Mental Health is a jungle…

Despite the crisis in child and adult mental health – The (depressing!) message that most politicians give us is that there are no votes in it.

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The Hacking reveals a collusion of anonymity for responsibility for rationing…

Update 13th May 2017: Mark Bridge May 13th in the Times: Outdated technology offers easy pickings

As readers know NHSreality says there is no NHS, but a regional system. The rationing of services, and this includes IT, is the responsibility of the Trust Boards, and commissioning groups in England. An inability to provide the requisite upgrades to computer systems is a decision made at a higher level. IT managers, paid much less than those in the private world, are rewarded by job security (never get sacked), but they have failed to use their leverage and knowledge to force the changes needed. The debate would have been puerile, if it ever happened at all. On December 8th NHSreality posted: Hackers get easy route to patient data – still on Windows XP but we have no sense of sangfroid, only sadness. The Hacking reveals a collusion of anonymity for responsibility for rationing…

“The first duty of government is to keep the nation safe”. (Amber Rudd on Radio 4 this am) The Health Services are part of this safety, but the net has been holed in so many places, and the responsibility for errors leading to potential disasters such as this is missing. NHSreality predicts that no heads will roll, and the media will fail to find a scapegoat.

The good that may arise is that computer systems may be updated. GPs in Wales were in charge of their own systems and backup until 5 years ago. The Welsh Government took over the computers, put all the data in one central server, and connected to the periphery by BT lines . ( Virtual Private Networks ) I recommended to my own practice that we had our own independent back up system which would ensure that, if the government server failed, or the lines were sabotaged, that we could perform our daily work. My recommendation was rejected but the idea needs re-visiting, even though Wales was unaffected on this occasion.

There is so much evidence for rationing, not prioritisation when it is “all or none” as in IT. Here are some articles/news from the last 24 hours:

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Laura Donelly in the Telegraph: Thousands of children and teenagers with anorexia forced to wait months for help

Chris Smyth in the Times: Hospital backlog is worst for decade – A&E units had their worst year since 2003, with one in ten patients not being seen within four hours and Patients wait longer as GP jobs lie vacant and, initially reported in the Shropshire Star: Nurses ‘forced to buy pillows for patients’

and because of the rising anger even a cancer sufferer is standing against the Minister for Health: The Deathbed Candidate. Getting nearer and nearer to “posthumous voting” isn’t it?

Paul Gallagher opines in the Independent: General election 2017: what role will the NHS play among voters? and implies Theresa May is more trusted than the others…. but this was written before the latest Hacking.

NHSreality trusts none of the parties. They are all lying. It is only going to get worse. Patients are going to wait longer. (Personnel Today) More and more, those who can afford it, will go privately.

Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”.

The debate is puerile. There is no addressing the real issues..

NHSreality on IT systems

Hackers get easy route to patient data – still on Windows XP December 8th 2016

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GP leaders to debate future of NHS, industrial action and ‘zombie GPs’. “GPs’ first priority must be their own health”..

The most important word any resilient GP needs to learn is how to say “No”. Our profession is well paid, and the argument is not about pay. The conditions of work, the restriction of choices, and the shape of the job have become so onerous that many feel like zombies. In a national incident such as a train crash the Drs need to ensure they are safe before treating the victims. They need to secure the site. They need to make decisions which perhaps amputate on site, or allow some victims pain killers only, whilst others are saved. The train crash which the UK health services are now having is similar. As Clare Gerada is correct; “we have to look after ourselves  first”.

Nick Bostock reports on GPonline 3rd May 2017: GP leaders to debate future of NHS, industrial action and ‘zombie GPs’

GP leaders at next month’s LMCs conference will discuss whether the NHS can survive chronic underfunding, whether GP contractor status has ‘reached the end of the road, and whether industrial action should be back on the table to defend the profession.

The conference in Edinburgh on 18-19 May could also discuss whether deceased GPs could be resurrected to ease the GP workforce crisis, and call for health secretary Jeremy Hunt to be sacked ‘for presiding over the worst time in the history of the NHS, missing targets, longer waiting lists and low morale’.

Pressure looks to be growing from the profession for a wide-ranging overhaul of GP funding, with LMCs set to warn that overall funding is too low, and that distribution through the Carr-Hill formula and other contract mechanisms is unfair.

Motions put forward by LMCs warn that no funding mechanism will deliver fair funding for GP practices until overall funding is increased. The GPC warned earlier this year that despite pledges to raise funding through NHS England’s GP Forward View, the profession remains underfunded by billions of pounds.

GP funding

But LMCs will question whether the existing funding formula gets the balance right between different priorities, with a motion put forward by Glasgow LMC warning that ‘careful consideration has to be given to the balance of the funding formula between deprived patients, remote and rural patients, elderly patients and those patients not in any of these groups who may face their funding being eroded’.

GP leaders will also call for a list of core GP services to be defined – a step the GPC has long opposed – in part to maintain services as new care models take shape across the NHS. The GPC has consistently argued that it is simpler to define non-core work, for example using its Urgent Prescription document to list services that practices should receive additional funding for.

The conference will also hit out at the rising cost of indemnity, warning that increased fees are driving GPs out of the profession. LMCs will argue for greater transparency from medico-legal organisations about risk criteria that can lead to sharp rises for individual GPs.

GPs will also warn that contract uplifts have not covered rising indemnity costs in full, and that direct reimbursement of costs would be a better option for practices than payments based on list size.

Locum GPs

Plans to improve communication with sessional GPs, with a proposal for a ‘national communications strategy to secure adequate communication of guidelines and patient safety communications to locums’ will also be discussed at the conference.

Broader ‘themed debates’ at the conference will discuss issues such as NHS rationing, independent contractor status, working at scale and workload.

One debate will look at whether the NHS can survive given overall underfunding, and whether co-payments for services should be considered. Another will consider whether independent contractor status has reached the end of the road and how it could be protected.

Further debates will look at whether GPs should remain within the NHS – in Northern Ireland GPs have suggested they will quit the NHS en masse if two thirds of practices hand in resignations – and whether there is ‘still a need to consider appropriate forms of action, and would this be effective or counter-productive’.

Another debate will encourage GPs to discuss whether the QOF has reached the end of its useful life – as NHS England chief executive Simon Stevens has suggested.

A motion put forward by Shropshire LMC, meanwhile, suggests ‘the urgent funding of a bioengineering program designed to immediately triple-clone all UK GPs, including the recently retired, in order to facilitate our prime minister’s glorious vision of a truly 24/7 health service’.

It adds: ‘The project should ideally extend to exploration of the resurrection of deceased general practitioners, though conference acknowledges that some health consumers might find zombie GPs unpalatable at first (assuming they even notice the difference.) However, we believe that public fears about human cloning and the walking dead could be swiftly allayed by the persuasive powers of the undisputedly veracious Mr Jeremy Hunt.’

Alex Matthews-King in Pulse 24th April reports: NHS England asks CCGs for rationing heads-up following media scrutiny

Isabella Laws on 2nd May reports Clare Gerada: GPs’ first priority must be their own health, warns former RCGP chair – GPs must put maintaining their own health above caring for patients and running their practices, former RCGP chair Dr Clare Gerada has warned.

It’s the shape of the GP’s job that needs to change. The pharmacist will see you now: overstretched GPs get help…The fundamental ideology of the Health Services’ provision. Funding of this type admits 30 years’ manpower planning failure

NHS ‘is like a train just before a crash’ (and it is now happennin g in slow motion)

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All 4 Health Services let down the dying. International comparisons are not favourable..

The Economist has three articles in the current edition dated April 29th 2017. The theme is on how to ensure a better death, and that although death is inevitable, a bad death is not. A better death means a better life, right until the end. The irony of the UK system, whereby more care options are available in more affluent areas, is exposed. In a cradle to grave health service which is meant to be free and without reference to means this is patently unfair. In “Mending Mortality” the author says that “doctors are slowly realising that there is a better way to care for the dying”, and in “Death Wishes” a consumer survey shows that “living as long as possible is not people’s main concern”. If the service is as described by politicians, Palliative and Terminal Care should be fully funded throughout the country. 

Better Death

Mending Mortailty – Economist

Last wishes – What people most want in their final months

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NHSreality has posts on death and dying, and on Palliative and Terminal Care

A Dignified Death

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Right-to-die granny, 86, starves herself to death

Wales suffering: Surgeons wait for answers on deaths before heart surgery

GP workforce crisis set to undermine palliative care, BMA warns

GPs should be encouraged to take on palliative and terminal care out of hours..

Palliative and Terminal Care should be fully funded.

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RCGP Chair’s address….

It takes 10 years to train a GP. There is no prospect of the 200 extra GP trainees needed per annum, when the total capacity is about 140 per annum now. There are schemes to attract doctors to Wales, such as £20,000 inducement for trainees, funding for moving and/or first exams taken, and other perks. However I am told that trainees will need to promise not to leave Wales for a year after completing training. (Contravening European Convention of Human Rights?) NHSreality takes issue with the college on only one issue: there is no longer an NHS. The evidence is all around the citizens of Wales, with limited access, much reduced choices, and covert post-code rationing. When the WHO reports on the 4 UK Health systems Wales will almost certainly have the worse figures for perinatal mortality, maternal mortality, life expectancy, obesity and smoking…

The solutions are all long term. They have been addressed many times, and ignored for 4 years on NHSreality. There is no reason to think this will change. Welcome to the reality of a two tier health service.

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In the latest Welsh newsletter, Rebecca Payne, the chair states:

This edition focuses on workforce, RCGP has been consistently calling for a rise in the workforce in Wales. Latest calculations show that 500 more full time equivalent GPs will be needed by the end of this assembly term in 2021 (5 years time)

Over 2000 more Full Time GPs would be needed to enter the workforce each year to make this a reality, and so we are acalling for more GP training places in Wales, as well as increases in the share of NHS funding going to General Practice, so that Wales becomes an attractive place to train and work. …..

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She has also welcomed increased funding…. but will it make any difference to you and me? Not for some years yet.

When will public anger over the NHS reach a political tipping point? More NHS mental health patients treated privately…

It seems we are a long way from the tipping point whilst “most” services are up and running for the articulate and coherent. NHSreality has opined that “civil unrest” is not far below the surface, but whilst the Regional Health services can hoodwink their populations, and whilst citizens (mainly healthy) can remain in denial as their elderly and mentally infirm get a “rough deal”, and whilst the media and press, including Toynbee, fail to grasp that “overt rationing” is a pragmatic necessity, post coded and covert rationing will drive more and more into private care, and result in a two tier service. Harry may have had “counselling” but I expect it was private, unlimited, and done by a fully trained psychology counsellor. In the Health service it would be limited to six sessions, provided by a Nurse Counsellor who has done an extra short course, and terminated when the allowed sessions expired.

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Polly Toynbee in the Guardian 13th April asks: When will public anger over the NHS reach a political tipping point?

here is an ebb and flow in reporting on the NHS as Trump, Syria and Brexit dominate front pages. But the pressure-cooker state of the entire service still worsens. This morning’s latest figures are just a snapshot of deterioration – but every target is missed: for A&E, ambulance response times, for treating psychosis within a week, for cancer waiting times, blocked beds and diagnostic tests.

“Demand” is rising, the government says, as if serious illness were a choice, though the pressure comes from well-predicted, rapidly increasing numbers of old, sick people: this February’s A&E figures are, as ever, better than deepest winter January, but worse than February last year, as this crisis ratchets up.

Major A&E centres are treating 81.2% of patients within four hours, against a target of 95%, which used to be hit before 2010. The government likes to blame frivolous users of A&E, but those are easily triaged to on-site GPs. Serious delays are because of very ill people needing to be admitted with no empty beds: bed occupancy is at dangerous levels, as Chris Hopson of NHS providers warns, where doctors often have to decide “one in, one out”, discharging those who still need more care too early.

Take the temperature in virtually every part of the NHS and the wonder is how the heroically overstretched staff keep the wheels on the trolley. Take this week alone: the Royal College of Physicians says 84% of doctors have to cope with staff shortages and gaps in rotas.

GPs? Two years after a government promise of 5,000 more GPs, numbers are still falling. They dropped by 400 just in the last three months of last year: as doctors find the workload unmanageable some escape abroad, take earlier retirement or become locums. Too few new doctors want the burden of running a GP partnership, so 92 practices closed last year, tipping hundreds of thousands more patients on to already overloaded neighbouring GP lists.

Today the Royal College of Nursing, traditionally most reluctant of unions to take action, starts consulting its members on whether to hold a strike ballot. But with public sector pay frozen yet again at 1%, when inflation will shortly hit 3%, nurses are departing – as are doctors – for less stressful, better-paid work. Recruitment from the EU is plummeting, as predicted…..

…This is the dismal background to the reorganisation that the head of NHS England, Simon Stevens, is attempting, almost undercover. His state-of-play review of his five-year forward plan passed hardly noticed, announcing a first tranche of England’s 44 STPs, (sustainability and transformation plans) to reconnect local services fragmented by the Lansley 2012 act.

Most observers think it the right way to go, putting the NHS and social care under a united structure with one finance hub, ending destructive and expensive competition and tendering of services. But hardly anyone thinks this can be done with no new money: every STP calls for capital for new beds and units. Virtually all involve closures and mergers stirring a local political outcry.

Jeremy Hunt, who always presented himself as the patient’s ally, rooting out poor quality, wallowing in the Labour disaster at Mid-Staffs, has fallen uncharacteristically quiet. He has nothing much to say about patient safety in A&Es or elderly patients turned out of beds too soon. Not even deaths on trolleys in A&E corridors in Worcester roused his usual righteous ire.

Concern about the NHS has risen high in recent polling: what no one knows is when public anger will reach a political tipping point. Theresa May and Philip Hammond stay iron-clad adamant: all this is NHS shroud-waving and there will be no more money. Lack of any opposition helps, but can they really tough it out where Margaret Thatcher, John Major and Tony Blair all bent in the face of NHS crises?

Chris Smyth in the Times 18th April reports: Sick children ‘denied drugs to save money’ and Spendthrift NHS regions face big cuts. This is the reality of todays health services, and which/what quality of service depends on which. post-code you live in. You cannot plan for the deficit, because the “priorities” change from year to year.

George Greenwood for BBC 18th April: More NHS mental health patients treated privately

 

NHS managers still growing as GP posts fall

The Observer reports 15th April 2017: Number of NHS managers still growing as GP posts fall again – Doctors say ministers’ ‘bureaucracy busting’ shakeup has failed to switch resources and manpower to the front line

The number of NHS managers has grown by almost 18% in the four years since the government introduced a “bureaucracy-busting” shakeup of the health service, according to the latest official data.

The rise of about 4,650 in total management posts since April 2013, when the controversial Health and Social Care Act came into force, contrasts with an alarming fall in the number of GPs over recent months at a time of unprecedented demand for health care. The figures have drawn criticism from the British Medical Association (BMA), who say ministers are failing in their central objective of shifting more resources and manpower from back-office posts to the front line….

Managers are at odds over rationing, and management recognises the case, but the “rules” don’t allow them to speak out.