Ed Daly makes a mess of his oppportunity to sell “honesty” on Radio 4. Theres nothing in the Liberal shop to sell except sympathy right now.

Being a Liberal is frustrating. Its like opening a shop without anything in the window to sell that matters to the voting citizen. Young people dont listen so that any politician speaking on this channel is aiming at the votes of people over 50. Ed Daly on Radio 4 Today 20th March 2024 was aked about health and social care, and about Liberal approach to the local elections, and what party plans and policy were. Apart from spending more money, taxing more companies and banks, and “smooching” his language he said very little. The program director and the presenter must have been frustrated because Ed Daly was “first on” for a series of interviews of all the parties. The Interview starts at 07.52 and ends 07.57. The team rightly ask “Where are your bold headlines?”, and “something like stopping falls at home is just too small”, and “wheres the money coming from? – local councils are desperate”…. When asked about EU |Ed again had no bold headline, focussed on negative effects of the EU, but would not commit to Liberal desires to be either in the EU or in the Single Market. He rightly pointed out the lack of trust in UK plc by the EU, which reflects the lack of trust in all politics and politicians by the electorate. Certainly South Devon and SOmerset are setting the pace with citizens juries and meetings, and may be threatening the necessary revolution. If unsuccessful NHSreality feels civil unrest in less affluent and left behind shires is possible.
The other day I was told that cross referencing debt to the voting register is a fear which stops people voting. Is this cross referencing a fact/reality? Can it be supervised in a way that prevents abouse and fear of big brother? It does not help that a royal’s medical records are fair game. It does not help that “childcare is not meeting expectations”, or that inflation seems to be falling. The interviewers omitted “defence spending” and the “guns or butter choices” that await the next government. They did not mention the environment, and greenhouse gas reduction, or agriculture and fishing, probably because these are areas of “void” for the Liberals. Bold policies are needed telling hard truths that differentiate us from our competitors. The party has been taken over by Single Interest Pressure Groups, and is unwilling to re-brand or to have a cooperative sharing of seats with (say) Greens. The Liberal deserve better, but our system commits them to fighting for “wasted votes” until any form of proportional representation is introduced. If we have been led by the nose in a media led society, up til now, the media is now being revolutionalised so that even I at 74 years old prefer podcasts to the BBC when it comes to in depth reporting. When Politicians speak on the health service I am reminded of Billy Joel and his song Honesty...(Lyrics) Musical link is below.

Guns or Butter: Its becoming a clear choice. Defence or health…

Open Britain calls for Proportional Representation

The Liberal Party message today is:
Rishi Sunak could call a General Election in the next couple of days.
With just a few weeks until 2nd May, we’ve just heard Conservative HQ has dramatically increased their online ad spending by over 1,200%.
They are getting ready for an election.

But in the Guardian yesterday 19th March: Hunt hints at October election – UK politics live – Chancellor says date would allow a spending review to be carried out in time for next April

George Monbiot in the The Guardian opinion today 20th March 2024: A revolution in the way Britain does politics has begun in Devon. Tory MPs should be afraid
This is what democracy looks like: hundreds of people queueing in the rain, seeking to take back control of a political system that treats voters like an afterthought. Last weekend, a remarkable democratic experiment reached its first conclusion. A process that began here in South Devon and is now spreading to other constituencies has allowed voters to reclaim the initiative from centralised and self-interested political parties. It directly confronts our unfair electoral system.
Ours is one of many constituencies in the UK known as “progressive tragedies”: places in which most people vote for parties to the left of the Tories but which, thanks to our iniquitous first-past-the-post system, end up with Tory representatives. The Conservatives have ruled here since 1924, often without majority support….

NHSreality posts on the possibility of civil unrest

2023: BBC iPlayer – Disclosure – Is the NHS There for Me?

Trying to level up by doing the opposite! NHSreality

NHS at 75 live. Fit for the future? BBC Iplayer

Billy Joel Honesty sung by BillY Joel.

Cynical culture of short termism defines the Health Services. Ombudsman chief speaks out giving his own retirement exit interview.

Dennis Campbell in the Guardian 18th March 2024 reports: NHS ombudsman warns hospitals are cynically burying evidence of poor care – Exclusive: Rob Behrens says ministers and health leaders are doing too little to end ‘cover-up culture’ in England
NHS ombudsman warns hospitals are cynically burying evidence of poor care. Litigation costs were rising well before covid and standards really started to fall.

NHS ombudsman Rob Behrens: ‘There are serious issues of concern’

Hospitals are cynically burying evidence about poor care in a “cover-up culture” that leads to avoidable deaths, and families being denied the truth about their loved ones, the NHS ombudsman has warned. Ministers, NHS leaders and hospital boards are doing too little to end the health service’s deeply ingrained “cover-up culture” and victimisation of staff who turn whistleblower, he added.
In an interview with the Guardian as he prepares to step down after seven years in the post, Rob Behrens claimed many parts of the NHS still put “reputation management” ahead of being open with relatives who have lost a loved one due to medical negligence. The ombudsman for England said that although the NHS was staffed by “brilliant people” working under intense pressures, too often his investigations into patients’ complaints had revealed cover-ups, “including the altering of care plans and the disappearance of crucial documents after patients have died and robust denial in the face of documentary evidence”.
Behrens urged ministers to overhaul the way the NHS deals with complaints and how the array of regulatory bodies scrutinise it.
His concerns included that:
Avoidable deaths were too common, especially in maternity care, mental health and cases of sepsis (blood poisoning).
The NHS sometimes did “dreadful” and “cynical” things in obstructing families’ pursuit of the full facts about a death, including lying and concealing evidence.
The service’s legal “duty of candour” was not forcing hospitals to be open when things went wrong.
Although Martha’s rule, which enables families to seek an urgent second opinion if a patient’s condition deteriorates, was a major step forward, bereaved families still struggled to overcome trusts’ reluctance to admit mistakes, he added.
In a plea to the health secretary, Victoria Atkins, and the NHS England boss, Amanda Pritchard, Behrens said: “NHS leaders, including ministers, set the tone for the whole organisation. Time and again we hear that patient safety is a priority, but actions too often suggest otherwise. “We need to see urgent significant, joined-up intervention to accelerate improvements in culture and leadership, not just in trusts or primary care, but also in NHS England and government.
“Culture is determined not only from the core of an organisation but also from its top leadership.” The ombudsman voiced alarm at the recurring pattern of hospitals intimidating whistleblowers rather than taking their concerns seriously. He cited University Hospitals Birmingham trust for referring 26 of its medics over 10 years for alleged misconduct to the General Medical Council, which regulates doctors, in an apparent attempt to punish them for raising concerns. None were found to have committed any wrongdoing.
The trust’s board and regulators should have acted earlier to tackle the trust management’s “disgraceful” behaviour, which was well known in the NHS, Behrens said.
The Health Service Journal reported last week how North Tees and Hartlepool NHS trust had been told to pay the surgeon Manuf Kassem £431,768 in damages for racial discrimination and harassment he encountered after he told bosses of his fears that patients had “suffered complications, negligence, delayed treatment and avoidable deaths”. Last year the same trust had to pay £472,600 in compensation for unfair dismissal to another whistleblower – a nurse – who warned that a patient had died as a result of heavy workloads. James Titcombe, the chief executive of Patient Safety Watch, who did not get a full explanation for 17 months after his son Joshua died in 2008 of sepsis at nine days old, said he endorsed Behrens’s concerns. He said research had found that tens of thousands of avoidable deaths occur in the UK every year because safety standards are lower than in other countries.
Paul Whiteing, the chief executive of the patient safety charity Action Against Medical Accidents, said the Countess of Chester NHS trust’s failure to act on doctors’ concerns about the serial baby killer nurse Lucy Letby – including forcing them to apologise to her for doubting her integrity – was an example of Behrens’s charge of “reputation management”.
Last year, a third of NHS personnel during their work saw errors, near misses or incidents that could have hurt staff or patients, according to the latest annual NHS staff survey, he added.
Responding to Behrens, an NHS spokesperson said it was “absolutely vital that everyone working in the NHS feels they can speak up and that their concerns are acted on. “The NHS has updated its freedom to speak up guidance [and] brought in extra background checks for board members to prevent directors involved in serious mismanagement from joining another NHS organisation. “As the ombudsman is aware, there have been major efforts to prioritise patient safety in England and progress in creating a more positive safety culture amongst the workforce, which has led to higher levels of patient safety incident reporting than ever before and a widespread focus on improvement, including through the new patient safety incident response framework.

A Department of Health and Social Care spokesperson said: “The safety of all patients is of vital importance, and we have made significant improvements to strengthen protections for patients including publishing the first NHS patient safety strategy.
“We are determined to make the health service faster, simpler and fairer. We are putting record levels of investment into the NHS, and training and retaining staff through the long-term workforce plan to properly resource our NHS for decades to come.”

This is Personal: I was let down by the health service, and the Health Ombudsman in West Wales – and there’s nothing I can do other than litigate..

Mark Britnell asks for a “tech revolution”. The culture has to change at the same time, and litigation fear has to diminish.

“Deaths arising from long waiting lists no longer make the news today, alas.” (Neither do many accidents, critical incidents, litigations etc.) |We need real time information to make an informed choice when its our turn.

2018: Curb rising NHS negligence payouts, health leaders urge

The 4 dispensations of the former NHS now each spend twice as much compensating mothers as it does caring for them. A systemic cultural and managerial failure (as in Surgery). No-one should be surprised. there are no exit interviews.

Open Britain calls for Proportional Representation

In my own part of the UK the estimate is that 85% of those under 34 dont vote. \why do they feel that their votes, the right to which many died for. dont matter? Open Britain has the support of NHSreality and most of the medical profession. The only proviso is that we do not yet have a referendum rules book, which is badly needed, along with a consitution. Our elected MPs tend to come from the “elites” and populism decries this. Populism needs constraints and rules of the game which are clear and considered over time. NHSreality fears that Open Britain might not address the underlying issues, but then again, thank goodness we have an upper house which still scrutinises, suggests, and rejects or amends legislation. The perverse incentives for both parties to reject PR are too great without the atruism of believing it to be necessary. But Open Britain needs to say if it wants “guns or butter”: defence or health, and whether they will want populist referenda when the tax bills start to mount.

Open Britain “Our democracy is broken. We know it. You know it. Everyone knows it.
Saving our planet from climate catastrophe. Ending the cost of living crisis. Getting the NHS off its knees. Rejoining the European Union. Public support for all these issues is overwhelming, but the government isn’t listening. And it never will, unless we make big structural changes.
First Past the Post (FPTP) will never deliver the action we need to get our country back on its feet. Our system only works for those in power and their wealthy backers.
Since you signed up to our list we’ve been busy holding those in power to account.
We were the heart of those calling for a People’s Vote.
We were first to campaign to have Boris Johnson removed from office when it was clear he had repeatedly lied while Prime Minister.
We defied the government’s attempts to silence protest by holding our noisy Stop The Rot rally right outside Downing Street…just days after the new law came into effect.
We played a central role in highlighting Suella Braveran’s unsuitability for high office and led calls to have her removed from power.
We have worked with partners across the sector like Fair Vote UK, European Movement, and Amnesty International to protect and enhance our democratic rights.
We’re now getting in touch ahead of the next General Election because we want to know if you’re on board to help protect our democracy.
Will you join over 30,000 others and sign our latest petition calling on Keir Starmer to use his first 100 days in power to commit Labour to implementing Proportional Representation?

SIGN THE PETITION
Fixing our democracy doesn’t end with a change in our voting system, but it will be a huge leap forward. It will force parties to work together. To listen to the people. To tackle the country’s big issues, not use them to divide us.
Here’s the deal though – we hope you’ll add your name to our petition and choose to stay on our mailing list. Let us send a few more emails and if we’re not your cup of tea, we understand and you can easily unsubscribe.
That being said, if you already know that protecting democratic rights and holding those in power to account is not for you, we want to give you this opportunity to leave our list now:
Here is a link to fill in the petition for the Labour party to initiate the necessary change in their first session in government.

Guns or Butter: Its becoming a clear choice. Defence or health…

Its going to get worse… “Even without Nye, the cult of the NHS is verging on pathological”

Robert Colville in the Sunday Times 17th March 2024 brilliantly dissects and exposes the illogical thinking and denial that prevents the 4 UK Health Dispensations from getting any better. NHSreality makes no apology for printing in full exactly what most of the profession wish to say, but cant. Other countries do better. People need to realise they cannot live off charity, and that not all mental illness is a reason not to work. Education is key, and in my own town “feral friday” is the afternoon when gangs of kids without parents at home, or activities to amuse them, or self directed learning, roam the streets. They will ensure that “their mentalhealth” is a problem for decades to come. Their care will be rationed of necessity, and the use of psychotropic drugs has to be limited to those with serious illness or psychosis.. “Even without Nye, the cult of the NHS is verging on pathological”
Imagine trying to come up with the ultimate piece of right-on left-wing theatre. After considering and rejecting Che! The Musical and Johnson’s Inferno, you might hit on the idea of a three-hour play about how Nye Bevan single-handedly won the war, invented the NHS and brought civilisation to Britain. Starring Michael Sheen. And then you’d probably scrap the idea for being past the point of parody.
But no. The National Theatre’s big spring production is indeed Nye, featuring that man Sheen. And, if possible, it’s even less subtle than his recent BBC drama The Way, in which Wales turned into a nightmarish ethnofascist state because, um, the Tories.
The central thesis of Nye, to quote Sheen’s peroration, is that founding the NHS was “the most civilised step any country has ever taken” — despite the best efforts of Winston Churchill and the British Medical Association. No wonder Sir Keir Starmer was so keen to go for a backstage tour. Or that the government responded to this naked electoral propaganda — complete with stalls flogging hysterical anti-Tory tracts about NHS privatisation — by, er, bunging the theatre another £26 million.
I appreciate that mine will be a minority view. For all the crushing obviousness of his politics, Sheen is a damn fine actor. And Bevan’s story certainly is an inspiring one (even if the framing device of “man on his deathbed relives his past” is about as clichéd as it gets). For every audience member like me who gets a little vomit in their mouth, many more will leave with tears in their eyes. But I still have reservations — and not just because I’m an evil Tory.
First, theatre people always talk about how they want to challenge and provoke. “Gosh, the NHS really is amazing” hardly does that. Not in a country where a Tory chancellor of the exchequer can claim that the health service is “the biggest reason most of us are proud to be British”, and apparently actually mean it.
Second, the play is not just partisan but in places deceitful. Neville Chamberlain, real-life creator of the Unemployed Assistance Board, is depicted as happy to see the poor starve. Bevan’s role in persuading America to enter the war is grossly overblown; his enthusiasm for Soviet Russia completely unmentioned. As for his parliamentary record, I consulted John Bew’s wonderful biography of Attlee, Citizen Clem. Bevan’s index entry starts with “continually tries to undermine Attlee and his supporters”, and goes on from there.
But the biggest lie is about the NHS. The health service, in Nye, springs almost entirely from Bevan’s personal compassion. The Beveridge report does not get a mention. Nor does the cross-party support for its conclusions. Labour went into the 1945 election promising a National Health Service — a commitment made long before Attlee asked Bevan to deliver it. But the Tories too pledged that “the health services of the country will be made available to all citizens. Everyone will contribute to the cost, and no one will be denied the attention, the treatment or the appliances he requires because he cannot afford them.” Sound familiar?

In other words, we owe to Bevan not the National Health Service but this National Health Service — the one that turned the existing profusion of provision into something regimented, standardised, centralised and nationalised.
In the play, this is presented as the greatest and most compassionate moment in our history. As the cast leave, statistics are projected on to the stage: “Within ten years of the creation of the NHS, infant mortality decreased by 50 per cent. Since its founding, life expectancy has increased by 12 years. Every day 1.3 million people are treated, based on clinical need, not the ability to pay.”
Well, yes. Infant mortality did fall in the 1950s. But it was already six times lower than at the start of the century, when a horrifying 23 per cent of children died before the age of five. Likewise, life expectancy here has increased by 12 years since the war. But it has risen by 14 in Germany, 16 in France, 17 in Italy and a staggering 21 in Spain. How can that be, without the blessed NHS?
And this is what I really find depressing about the fetishisation of the NHS. It cuts off any debate about how we can actually do things better. For example, people endlessly cite a 2017 report that pronounced the NHS the best of ten western healthcare systems across a broad range of measures including administrative efficiency and access to treatment — while ignoring the fact that it came dead last for actually treating patients.
As I’ve pointed out before, Tony Blair and his team came to believe, and argue, that Bevan steered Britain down the wrong path, and that the model adopted in much of Europe, under which the state funded healthcare, but relied on communities, charities and (yes) private companies to deliver it, had worked better.
This argument, that local people should be trusted to run local health services, is briefly made in Nye. But it is made by the sinister, snivelling figure of Herbert Morrison, Attlee’s deputy, and so is instantly discredited. Indeed, the producers seem to hate the Labour right even more than they do the Tories.
Today, it seems almost heretical to argue that the NHS exists to serve the country, rather than the country existing to serve the NHS. But the more we romanticise and mythologise the thing, the less clearly we are able to see it. And we really do need to see it clearly. In 2022-23, the NHS budget in England was £182 billion. Between 2013 and 2023, the number of staff went up from 973,261 to 1,308,825. There are record numbers of doctors, of nurses, of midwives. The Tories have spent the £350 million a week promised on that famous bus, and far, far more.
But with an ageing population, it can never be enough. Over the next five decades, we will need to find a further £285 billion a year to cover the costs of pensions, care and healthcare. That’s the equivalent of doubling income tax, capital gains tax and stamp duty. The NHS’s long-term workforce plan envisages the service employing 1 in every 11 workers by 2036-37, up from 1 in 17 today.
In other words, the question of whether the NHS is actually set up to deliver the best possible healthcare, at the lowest possible price, is the most important in public policy.
But instead of having a debate, we have a religion — one that treats the idea that other countries also have healthcare systems that are free at the point of use, and that they might actually work better than ours, as outright heresy.
If you clapped for carers during the pandemic, and wept when N-H-S flashed up at the 2012 Olympics, then Nye will be the best three hours of your life. But, ultimately, treating our largest public service as an object of cultish adoration is the very opposite of healthy.

Its me mental – the problem affects younger doctors too. Sink or swim in the “National Suffering Service”

How Enoch Powell helped make the NHS

Sensible rationing of dementia drugs – a lead from France

Intermittent medical generic strikes seem set until change of power

Wales, offering a lesser payment to its staff, is in an evern worse position as there is a speedy exit offer for its doctors to better pay in England. Add to this the diagnostic and legal problems associated with being a Physician Assistant (Georgia Lambert – BMA redefines role of ‘physician associates’ after actress’s death – Doctors’ body issues guidelines amid mounting concern that support staff are handling situations beyond their qualifications) and Wales could be bancrupt through medical litigation when its staff start to move to pastures new. (England, Canada, Auatralasia) Wales has to import from Kerula, and the UK 4 health services get a taste of the pain of paying for training, and their trainees subsequently leaving. ( it can replace them – from Kerula this time. ) Medicine is politics. It is often considered rude to discuss politicas in many people’s company but we really do need to discuss the depoliticisation of health care and our system.

Kamran Abbasi opines in the BMJ: Doctors’ industrial action: in search of an endgame 2024-03-14 , DOI:10.1136/bmj.q633 A year into the UK doctors’ strikes the conclusion is the same (doi:10.1136/bmj.q591).1 ………..No endgame is in sight, because however much the government might have agreed or disagreed with the demands for pay restoration it had no intention to settle (doi:10.1136/bmj.q600).2 A government shedding support of voters has regressed into austerity economics and ideological straitjackets. How else should we interpret a succession of health ministers refusing to negotiate meaningfully with “junior” doctors (a term that undoubtedly needs its own endgame). Whether any future government, exposed to the realpolitik of ruling, will be more receptive is yet to be seen…….
…..The endgame cannot be about pay only. Huge personal debt, limited training opportunities, uncertain career progression, erosion of team working, and a loss of a sense of belonging (doi:10.1136/bmj.q392) are all major contributors to discontent.15 They must be resolved. Looking wider still, it is the professional status of doctors—taking in the science, ethics, and conduct of good medical practice—that has always made it hard for politicians to negotiate with medical professionals (doi:10.1136/bmj.h502).16 Governments can ignore the working conditions and demands of doctors as readily as they once ignored the working conditions and demands of miners, but doctors cannot be done away with so conveniently. The endgame for industrial action, when it comes, must consider all these elements. Perhaps this is why the endgame, one year on, seems no nearer.

What could be more important than “Life expectancy inequality”

Wales can  replace them – from Kerula this time. 

September 2023: Its about culture and feeling undervalued and disrespected. The strikes are about more than pay, and thats why so many medical students are planning to leave after qualifying. and The last thing GPs want is to strike. ..

We who are about to die salute you – the former NHS

The author and producer continue to use the term “NHS” and although they expose the truth for those of us in our last decade of life, they have no short ot long term solutions, and they fail to name those responsible for the short term thinking that has led to this impasse. “We who are about to die salute you: a universal health dream that has died, but of whom we took full advantage while it lasted”. The prior episodes on justice and education are similaerly full of anecdotes and examples of system failures. The excessive death rates mean a lot of patients have died earlier than they might have. The facetious suggestion of posthumous voting deserves a thought. Any other system would be better than what we face in the next few years – if we try to pretend that our system is working.
Darren McGarvey: The State We’re In – Justice, Education and Health in Scotland
With privileged access to hospitals, schools and prisons, writer and rapper Darren McGarvey takes an unflinching look at the UK’s public services.
Health Scotland: The news is dominated by stories about the NHS as waiting times, doctors’ strikes and funding make it seem like it lurches from one crisis to another. To find out how the beloved NHS got into this state, and to see how it might pull itself out, writer and rapper Darren McGarvey travels across the UK to meet the staff on the front lines of the battle for Britain’s health. 
Beginning his journey in a Belfast A&E, Darren meets patients waiting days to be seen and spends time with the nurses struggling to find beds as the patients continue to flow in. 
Faced with a chronic shortage of social care workers, the hospital struggles to discharge patients. Darren spends a day in Dunoon with two social care workers to find out what the job is really like, and chats with the patients reliant on their care and attention. But where does the problem start? 
Heading to Nairn, Darren sits in as GP Dr Baker tackles what seems like a never-ending queue of patients. With lots of people turning to private healthcare, what exactly do you get for your money? Darren gets a full private health MOT in Liverpool and finds out from the doctor what it’s like to turn to ‘the dark side’. 
As the UK’s population becomes older, the country must work out how to deal with the resulting problems. Darren travels to Denmark to visit a unique multigenerational accommodation space where the elderly live among families and young people. And back in the UK, Darren’s final stop takes him to a pharmacy in Glenrothes to get a glimpse of what healthcare could be like in the future.

Posthumous voting: NHSreality opines

Excessive death rates – NHSreality opines

Depoliticise health please – Any of the EU country models would be better!

What could be more important than “Life expectancy inequality”

The BMJ may advocate the “founding principles” are still appropriate, but the professions of medical allignment do not. The cause of health inequalities is mainly issues outside of the 4 uk health services (BMJ 2024;384:q505): housing exercise education diet and smoking to start with. We now know that “Waiting lists unlikely to return to pre-pandemic levels until at least 2029, warns think tank (BMJ 2024;384:q535)
Thats 45 years time, and its a minimum. Add to this that self employed GPs and Dentists are having contracts forced on them and that this means access is going to get worse still, ( ‘Industrial action is the only option’: GPs urge BMA to move fast – GP leaders are urging the BMA to start preparing immediately for industrial action in general practice, warning that the contract imposed on practices this month has left the profession with no alternative.) Nick Bostock reporting in GP on line. We know that they were willing ike to strike months ago.… This has been building for 3 years “GPs move towards industrial action after rejecting “rescue plan” for general practice” so there has been plenty of warning. “Fewer doctors now want to develop their careers in Wales, with some health boards reporting vacancy rates of over a third for senior doctor posts. Colleagues are now choosing to retire early, reduce their hours, or move out of Wales to where pay is competitive and wards better staffed,” BMJ Feb 2024 Consultants and SAS doctors in Wales vote to strike and its in Wales where “thousands are witing hours and days” and dying early. (Channel 4 news). Wales is losing its own trained doctors and nurses as fast as it can replace them – from Kerula this time. NHSreality does not espouse conservatism, but Andrew RT Davies is correct in the title of the article he wrote in the Express 7th March. He is incorrect in much of the content however, and has no real solutions for Wales. Wales rations choice, as well as medical care more effectively than any oy=ther part of the UK. Liberals belive in choice and deride the covert rationing. We also believe in honesty, but unfortunately this appears only at individual level and is absent from the Liberal party – on health issues particularly.

The Times letters 12th March 2024: Life expectancy inequality Sir, Our organisations work to create the building blocks for good health, from affordable homes to stable jobs, clean air, neighbourhoods with green space and social connections. We have come together in the coalition Health Equals to campaign for a new health bill. We welcome The Times Health Commission’s focus on the growing challenge facing Britain concerning life expectancy, and support your call for all political parties to commit themselves to reducing health inequalities as a legally binding target in their manifestos.
Average life expectancy in Britain increased from the age of 46 in the early 1900s to about 80 by 2011. These improvements stalled in the 2010s and went backwards in the pandemic. Inequalities in health have been entrenched and exacerbated. The gap between places with the highest and lowest life expectancy was 7.4 years in 2017-19 and it grew to 8.7 years in 2020-22 (analysis by the Health Foundation of ONS data). More deprived areas, and those in the north, tend to have the shortest life expectancy. The same places also suffer higher rates of long-term sickness. Such wide geographic inequalities in health hold back prosperity and cut lives short.
Paul McDonald, Chief Campaigns Officer, Health Equals; Jo Bibby, Director of Health, Health Foundation; Will Snell, Chief Executive, Fairness Foundation; Andy Bell, Chief Executive, Centre for Mental Health; Jabeer Butt, Chief Executive, Race Equality Foundation; Joan Edwards, Director Policy and Public Affairs, Wildlife Trusts; William Roberts, Chief Executive, Royal Society for Public Health; Larissa Lockwood, Director of Clean Air, Global Action Plan; Tony Wilson, Director, Institute for Employment Studies; Anna Taylor, Executive Director, Food Foundation; Naomi Phillips, Deputy Chief Executive, Learning and Work Institute; Frank Soodeen, Director of Communications and Public Engagement, Joseph Rowntree Foundation; Osama Bhutta, Director of Communications, Policy & Campaigns, Shelter; Jennifer Walters, Executive Director of Social Change, Mind; Sal Copley, Executive Director of Communications and External Affairs, British Red Cross; John Hume, Chief Executive, People’s Health Trust; Chris Thomas, Head of the Commission on Health and Prosperity, IPPR; Duncan Shrubsole, Director of Policy, Communications and Research, Lloyds Bank Foundation for England and Wales; Dan Corry, Chief Executive, New Philanthropy Capital; Thomas Abrams, Co-Head of Health, ShareAction

Eric Tyler on 11th March in the Guardian gibes his personal accoiunt of the “rationing” experience. An agonising wait for surgery – and NHS rationing – forced me to go private

2023: GPs to consider industrial action after NHS England imposes contract

NHS Wales performance activity April and May 2023 – its got a lot worse since

Theo Davis-Lewis asks in the Times “Have the Tories abandoned Wales?” 11th Feb 2024

Thursday March 7th in the Express and subsequently in the Times: Mark Drakeford’s extremist policies are destroying Wales, warns Andrew RT Davies

NHSreality posts on Wales and variations in UK life expectancy

Sensible junior doctors call for “cultural change”. No solution in sight until we have Proportional Representation.

The poaching of our own expensively trained docs by Canada and Ireland is in the medical news. NHSreality would not blame any doctor or nurse in todays bullying and gagging and uncaring dispensation within the 4 UK systems, for leaving the UK. We poached from all over the world for decades, and now the boot is on the other foot. West Wales BMA passed resolution in debate to “ration overtly” and to “have an honest debate” on the options in health – and that was over 10 years ago. The sustainability of the current politisised system is impossible when the pace of technological advance is faster than any government can fund. NHSreality has pointed out that few GPs do post registration jobs in Psychiaty or Paediatrics, and that many male doctors are unable to examine women internally.. No solution is in sight for all these problems until we have Proportional Representation (PR). Once we have PR we can change the system, ration overtly, and charge in some way that encourages self care for all.
BMJ Letters: We’ve failed our Generation Next of doctors – Listen to the voices of the next generation of doctors BMJ 2024;384:q347 Harshit Kondapally, foundation year 3 doctor,  Ellie Jackson, foundation year 2 doctor
As members of “generation next,” we know that there are several reasons contributing to a sense of being failed.1 Throughout history, a career in medicine was thought to have great job security. Doctors today, however, find themselves in an increasingly competitive job market with tightening bottlenecks at every stage of training. There has been an admirable, but perhaps shortsighted, drive towards increasing medical school places in recent years with less thought given to increasing specialty training positions. Internal medical training, for example, has increased its vacancies from 1550 to 1633 over the past eight years, but the number of applications in the same timeframe rose from 2631 to 4406, with this year’s number of applications at 6174, an increase of 43% compared with last year.2 It seems an increasingly bleak prospect for current medical students.
We agree with Kar that the rise in anonymous accounts on social media is a symptom of the current system of raising workplace concerns. But if doctors felt that raising concerns through the traditional chain of command led to tangible improvements, we wouldn’t see social media being used as a substitute. This problem is compounded by the rotational training model, which is receiving renewed scrutiny by BMA members.3 Is a four to six month rotation long enough to make meaningful improvements in departmental systems? Are rotations too short to foster a culture of teamworking where concerns can be raised openly?
Given the range of causes for increasing dissatisfaction and rates of burnout,4 it is no surprise the current generation of doctors seems more vocal than ever. We hope the near future brings about a change in our culture so we can have more open conversations about these matters, whether it is with our trusts, royal colleges, or our regulator. Until then, we must listen to the voices of our next generation of doctors, even if they come from behind a keyboard.

Cancer survival: we may be rationing sensibly, but not overtly and often without informed consent.

We seem to give plenty of money to research, cancer, but not enough to treat all our citizens, and the elderly in particular. The fact is that all lives are not equally valuable (vertical equity) and if care is rationed then it is appropriate to put a 24 year old before a 74 year old. It might be acceptable that those in work are operated on before those who are retired. After all it is workers taxes that are funding the system. Lack of foresight, planning and political denial have conspired together to create the anarchic, unfair, post coded, covert maelstrom of medical care that is the UK. Civil unreast is a risk, and it is essential to balance up life’s chances across the nation if we are to avoid it. If its going to get worse, at least make it fair!
I suspect many elderly people have a better death by not having the most aggressive therapies, but this should be their choice rather than that of their consultant. Perhaps this explains the differences in survival and we have sensible rationing of oncological treatments.
Informed consent only comes when there are alternatives, and oncologists are not consulting patients along with with GPs &/or Palliative Care consultants yet. We just don’t have the staff!
Laura Donelly in the Telegraph reports 27th Feb: UK cancer survival rates lag 15 years behind other major countries – Patients in Britain more likely to be denied chemotherapy or radiotherapy than those in Australia, Canada or Norway
UK cancer survival rates are lagging 15 years behind other major countries because of a lack of chemotherapy and radiotherapy, research shows. For the first time, experts at University College London examined the differences in treatment for eight cancer types across three continents. They found cancer patients in the UK were much less likely than people in other countries to receive chemotherapy or radiotherapy.
Those who did receive it were forced to endure longer waits, while the disease was spreading. The differences were most stark among older patients, with those in Canada seven times as likely to receive chemotherapy, compared with those in Britain.
Researchers said the lower rates of treatment in the UK helped explain why Britain’s cancer survival rates were 15 years behind those of comparable nations. Across the countries examined, the UK was worst for cancer of the stomach, lung, colon and ovaries. The UK five-year-survival rate for stomach cancer was just 20.8 per cent in 2010-14. This is lower than figures other countries achieved 15 years earlier. In 1995 to 1999, Australia had survival rates of 25.7 per cent, while Canada had 21.5 per cent, with 21.3 per cent in Norway.
Experts said NHS shortages of both staff and equipment meant patients were too often being denied treatment or waiting so long that it could no longer benefit them. The studies, funded by Cancer Research UK and the International Cancer Benchmarking Partnership, published in the Lancet Oncology examined data from more than 780,000 patients in Australia, Canada, Norway and the UK diagnosed between 2012 and 2017. In total, just 31.5 per cent of cancer patients in the UK received chemotherapy, compared with 42.1 per cent in Australia, 38.5 per cent in Canada, and 39.1 per cent in Norway. For radiotherapy, the UK figure was just 19.8 per cent, compared with 25.7 per cent in Canada, 23.9 per cent in Australia and 22.5 per cent in Norway.

Older patients fared particularly badly in the UK. Just 2.4 per cent of UK patients aged 85 and over received chemotherapy, compared with 8.1 per cent in Australia and 14 per cent in parts of Canada. Experts have also warned of “fatalistic” attitudes – especially towards older patients, and those with other health problems – with rushed consultations meaning that there was not enough time to explore treatment options.
Dr John Butler, clinical lead for the International Cancer Benchmarking Partnership and an ovarian cancer surgeon, said: “For many aggressive cancers – such as ovarian, lung and pancreatic cancer, it’s vital that people are diagnosed and start treatment as soon as possible. “Lower use of chemotherapy and radiotherapy in the UK could impact people’s chances of survival, especially for older patients. “Although we have made progress, the last benchmark showed that cancer survival in the UK is still around 10 to 15 years behind leading countries. “This study captures missed opportunities for patients in the UK to receive life-prolonging treatment.” Dr Butler said there were a number of likely factors behind the trend. “In some cases, it’s about patients being so unwell by the time they are diagnosed that they are not well enough to receive chemotherapy. And furthermore, if there are long delays in the diagnostic pathway then that is more likely.”
He said the low rates could also reflect “nihilism” from some doctors, in assuming that the side effects of treatment were not worth the potential benefits, particularly in elderly patients. The figures, which used international benchmarking data, tracking survival between 1995 and 2014, found that the UK figures were often on a par with other countries 15 years earlier. For colon cancer, the UK’s rate of 58.9 per cent in 2010-14 was similar to those in Australia and Canada 15 years earlier. Australia now achieves survival rates of 70.8 per cent for colon cancer, while Canada is at 66.8 per cent. UK lung cancer survival, at 14.7 per cent, is similar to the rates in Australia and Canada 15 years ago. Latest benchmarking data has Australia at 21.4 per cent and Canada at 21.7 per cent.

Michelle Mitchell, chief executive of Cancer Research UK,  said: “All cancer patients, no matter where they live, deserve to receive the highest quality care. “But this research shows that UK patients are treated with chemotherapy and radiotherapy less often than comparable countries. “When it comes to treating cancer, timing really matters. Behind these statistics are people waiting anxiously to begin treatment that is key to boosting their chances of survival.” Prof Pat Price, a leading oncologist and chairman of the charity Radiotherapy UK, said the study showed “devastatingly” poor levels of access to treatment.
The co-founder of the Catch Up With Cancer campaign said: “A shortage of oncologists and front-line staff to deliver treatment, insufficient equipment, lengthy travel times, a negative approach to cancer care, particularly in the elderly, and an acceptance of variable and poor care in some parts of the country have all resulted in patients not receiving the treatment they need. This is simply not good enough for cancer patients and is costing lives.”
The study also compared trends within the UK. Take up of chemotherapy and radiotherapy was lowest in Northern Ireland and Scotland. The studies also found the average time to start chemotherapy was 48 days in England, 65 in Scotland, 57 in Northern Ireland and 58 in Wales. In New South Wales, Australia, the wait was lower at 43 days and 39 in Norway.
For radiotherapy, the UK fared even worse, with it taking 63 days to start treatment in England, 53 in Northern Ireland, 79 in Scotland and 81 in Wales. In Alberta, Canada, the figure was 48 days and 53 days in British Columbia, while in New South Wales, Australia, it was 43 days.
An NHS spokesman said: “More people than ever are being diagnosed at an early stage of cancer and more treatment options are available – and over the last 12 months, nearly three million people received potentially life-saving cancer checks compared to 1.6 million in 2013. “Whilst cancer survival is at an all-time high, it remains crucial for people to come forward and get checked if they have unusual symptoms – finding cancer earlier saves lives.” A Department of Health and Social Care spokesman said: “These figures cover only the period from 2012-2017. 
“Since then, we have made significant investment in cancer diagnosis and treatment, including £162 million towards radiotherapy equipment and £2.3 billion to launch 160 Community Diagnostic Centres across England, which will help us achieve our aim of catching 75% of all cancers at stage one or two by 2028. “Cutting waiting lists is one of the Government’s top five priorities, and we have treated record numbers of patients over the last year.
“Survival rates are also improving across almost all types of cancer, and we will shortly legislate to create the first smoke-free generation – the biggest single public health intervention in decades.”

2012: The BMA rather than the RCGP represents my views and those of most GPs… The enormity of the crisis has not yet dawned on politicians. Civil unrest is no longer just possible; it is likely.

BBC Radio 4 highlights cancer outcome differences.

It’s m’e mental doc”. Why is the epidemic of mental poor health Britain’s biggest problem? It is unique to our country.

We have a large proportion of the younger generation feeling disenfranchised in the FPTP (First Past the Post) system we have now, and so being unwilling to waste their time voting. The drivers towards this are lack of housing, lack of reliable altruistic long term politics, fast media distribution of often false news, (Girls Mental Health especiallyis threatened) and a threat that they might be conned by the media… And of course the betting industry will complain! There is the added risk of “spiked drinks” which has happened to Kate McCann (Times Radio) and other celebrities and a brigade of people. The mental health of dying patients is better with continuity of care, but we all know thats a dream now. Choosing how we die is important…
The Fench are removing state provision of drugs for new cases of non psychotic depression.and anxiety. The bill for “Big Pharma” should reduce, and the savings made fund the alternative treatments for depression: exercise, gardening, singing, art, hobbies etc. We in the profession know how hard it is to stop these drugs, but also how many side effects and unintended consequences there are. Overuse of Benzodiazepines, intensively marketed over decades, has led to a dependency culture. We fell into the same trap with Opiates and in the USA particularly, fentanyl is the coming plague which is possibly coming here. Gambleing, encouraged by on-line living, is an oncoming tsunami as well.. We need to treat and care for those with psychosis, and with the oncoming drugs epidemic there will be many more of them.
The NHS has one of the worst sickness and absentee rates in the world. This is partly because it acts as a working safety net for many low paid workers. It also employs many part timers, and it needs to provide creche and schooling facilities for these workers if they are to work maximally and efficiently with less time away. The “friday afternoon” culture means that hospitals, and recently, schools are now much less efficient than they used to be. In my neglected town centre children appear at friday lunchtimes with noone at home. They are free to do as they wish, and often the health and social care services are at low staff levels concurrently. Junior doctors in GP training should all do a session in Psychiatry as this may become the bulk of their work… As a doctor said to me the other day, many patients each day come to see them and say “Its m’e mental Dr”….

in the Spectator 22nd Feb 2024: Why Britain stopped working – there is a 50 minute podcast to explain the differences both before and aftter covid between the UK and the rest of the world.
“According to The Spectator’s calculations, had workforce participation stayed at the same rate as in 2019, the economy would be 1.7 per cent larger now and an end-of-year recession could have been avoided. As things stand, joblessness is coexisting with job vacancies in a way that should be economically impossible, writes Kate Andrews in the cover story. She joins the podcast alongside Paul Nowak, general secretary of the Trades Union Congress (TUC), to debate the problems plaguing Britain’s workforce. (03:11)” ….. “One factor seems to be the inability of medical and welfare services to help with mental health problems” “Over 22% of the working age population in Middlesborough is unemployed. In Hartlepool its 24%; in Blackpool 25%. Were watching these people waste away..”…. “Britain is one of only a handful of countries …whose workforce has not bounced back”. “Even in 2019, a year before lockdowns, the number of working age people who were off with long term sickness had already risen to 2 million. Now its almost 3 million”. “The department of work and pensions predicts it to increase by another 1 million in the next 3 years. According to the ONS 53% of those off work with depression.. ” “Workers are disincentivised from increasing theit hours, as their efforts yield diminishing rewards,” “working age disability benefits are expected to rise from £19bn to £29bn in the next partliament, while the bill for working age incpacity will jump from £26bn to £34bn. ” “In april the income tax to be paid by a cleaner working 35 hrs on minimum wage will be almost 50% higher (than in march) due to “fiscal drag”, the stealth tax whereby thresholds are frozen rather than raised in line with inflation. Some of the lowest paid workers will be hit hardest in proportion to their pay, with those on £16000 losing £780 – equivalent to about 5% of their earnings” Meanwhile council tax will also rise… A single parent working 30 hours a week could stand to lose 76p of every £1 they earned in extra work, due to the withdrawal of universal credit and the loss of other benefits.”

Tom Witherow reports in the Times 23rd Feb 2024: How can a nurse gamble away £200,000, minister asks as he vows new curbs – New stake limits announced for addictive online slot machines, but bereaved families fear they do not go far enough to stop suicides

A UK Governement in itiative is WorkWell to try and help

Will cultural change be possible? Will free speech, exit interviews, and open debate about the future of the 4 UK health services be possible? Sickness and absenteeism levels suggest not.

2015: Is there a Monday to Friday (morning only) culture in the NHS?

Sensible rationing of dementia drugs – a lead from France

Ketamine and Fortral – the big self harms facing the EU and UK over the next decades..

Gambling: there is no strategy, no oversight, no evaluation and no unified front. Alexander Kallman

Homelessness is not a personal choice or inevitable – BMJ Rapid response – Urgent Need for Integrative Approaches to Address Homelessness and Mental Health in India: A Call for Global Solidarity and asks for a Global Strategy on Homelessness

19th March 2019 Gambling-Related Harm – read and listen to between the lines as to why the conservatives with an enormous majority did not act then!

The Resolution Foundation reports on 1/3 of young adults willing to sign themselves off sick more easily than those who are older. The Times follows this up with James Beal reporting 26th Feb 2024: Young more likely to be out of work than fortysomethings in ‘mental health crisis’ – People in their early twenties are more likely to experience a disorder than any other age group, according to research by a think tank. The BBC reports: More people in early 20s out of work from ill health than early 40s and the BMA team opines: New BMA report highlights ‘broken’ mental health system

The Spectator: How to choose a better death Feb 2024

Safety review of anti-psychotic drug – Times letter 23rd Feb 2024

Sir, Regarding your report “Anti-psychotic drug reviewed after 400 deaths” (Feb 19), I have met Kate Northcott Spall and it is clear she has an important story to tell. We identified areas where the standard of care for people with schizophrenia and other forms of psychosis could be improved and I am confident that her brother’s experiences will help to drive change. Clozapine is the most effective treatment for schizophrenia and other psychoses. However, it is also associated with side effects that can be life-threatening when not monitored effectively, and there have been cases where it has contributed to deaths that could have been prevented. There also exists longstanding discrimination against people with severe mental illness. Services for them are under-resourced; there is little research around their needs; and they are made to feel ashamed about their condition, so hide it or do not engage in treatment. This can no longer continue. We must create an environment where everyone can thrive and participate in society.
Dr Lade Smith
President, Royal College of Psychiatrists

27th Feb – What’s going on with girls’ mental health? BBC Claudia Hammond and guests consider the worrying statistics around mental health issues in children and young people – in particular, the long-term trends among teenage girls.