Category Archives: Political Representatives and activists

Poverty and Wealth, and pregnancy rates. Will the slave society mean that Middlesborough et al supply the future low paid workforce?

The Economist in an article on 20th April reports on the state of childbirth demographics, and the differences between rich and poor areas.  Surprisingly, Wales is improving compared to the North East and even in Breast Feeding, although the length of time this applies to is not recorded in the Guardian figures…. How many of the IVF conceptions (3% of all) are private and how many public? The health divide ….. The Economist says it explains: Why the middle-aged are replacing teenagers in maternity wards – The conception rate is rising for women over 40, even as it crashes among under-18s.

There are many interesting graphics below, and the Teenage Pregnancy Rates in England and Wales) are most interesting. They do not include Scotland and N Ireland. Presumably Scotland similar to Wales, and N Ireland will have many, and fewer terminations because of their archaic laws.

Since most pregnancies are “high risk” in older first timers, will this mean that midwifery led units disappear? They should. (The risks in having babies in rural areas – midwifery-led units questioned by consultant.)

Will the slave society mean that Middlesbrough et al supply the future low paid workforce?

Maybe Later baby – The Economist 20th April

…. The conception rates of the youngest and oldest mothers are now close to converging (see chart). Middle-aged maternity may soon be more common than teenage pregnancy.

Advances in health care help to explain the convergence. Although assisted conception accounts for only a small proportion of pregnancies, it is growing more popular and more successful. Between 1991 and 2016, birth rates from in vitro fertilisation treatment increased by more than 85%. In 2016 more than 20,000 babies were born following IVF (out of a total of 696,000 births that year). About three-fifths of women who use it are 35 or over. Demand is likely to increase as women learn of others whose treatment has been successful. Ms Fenelon was inspired by a magazine article about egg-freezing……
Patrick Butler in the Guardian 2018: New study finds 4.5 million UK children living in poverty

New measure by Social Metrics Commission aims to focus political attention on the issue

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The four GP dispensations / jurisdictions. Nothing “national” about GP contracts.

There is nothing “national” about the GP contracts around the UK. The only way to ensure adequate supply is to train enough. NHSreality believes we should aim at overcapacity to ensure both supply and financial control. The contracts seem to endorse “private practice” but at the same time stop GP premises being used at all for private activity. Will this include Insurance and DVLA medicals? We are all in the UK (just) and pay the same taxes, and yet we have dofferential, hidden, randomised post code rationing.

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The BMA in England has produced “A five-year framework for GP contract reform to implement The NHS Long Term Plan” but this does not apply to Scotland N Ireland and Wales, and indeed, it has not been agreed by NHS England in it’s entirety. Despite the lack of recruitment, loss and early retirement of GPs, the whole edifice is falling like a pack of cards.

Pulse commented on the headlines in January observing that this was the most significant reform since 2004. The comments on line are “looks like the exodus will continue” and “150K lloks like a lot but after tax and pension it’s a much more modest sum.” Another is “Well if you are close to the !%)K limit …. what will happen is GPs will simply stop doing NHS work”.

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In Northern Ireland the HSC (Health and Social Care) Board rules.

In Wales the GPone website from the Welsh Government supplies their details. In Wales agreement has not been reached on the litigation funding arrangements, which at present may be top-sliced obligatorily, and causing resentment. In Wales we even cerebrate a reduction in the degree of bankruptcy…   and the poorest standards in Bowel Cancer screening, results, and Waiting times.

The Scottish Government contract and website is different again

NHS England contract 2019 which all the headlines are about. They ignore the other 3 dispensations. The Medical Indemnity scheme is funded separately in England, and will not be top-sliced as threatened in Wales.

“A new state backed indemnity scheme will start from April 2019 for all general practice staff including out-of-hours.” (NHS England)

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No Out of Hours service for taxpayers in Pembrokeshire. Be prepared to camp wherever you are sent…

As readers know there is no NHS, and in Pembrokeshire citizens who pay their taxes have no  GP Out of Hours Service/ Doctors on Call – in Pembrokeshire County …  

If you are elderly, or have young children, it looks as if you will have to camp in Casualty, and even that is poorly staffed, incompletely covered, and failing. NHS 111 is an appalling service. Confidence is failing, and private care will have to step in when the demand for it occurs. If there are deaths this might be sooner rather than later.

ITV news reports that for the second week running “GP shortages mean Out of Hours closures. 5th April 2019.

and prior to this, on 29th March: Out of Hours GP service closed again at Withybush Hospital this weekend.

For those who don’t know the area, the nearest (and also failing) DGH is 35 miles and many agricultural vehicle obstructions away, in Carmarthen. The situation is akin to the loss of services in Chester, except this is worse: it is access to emergency care rather than cold planned care that has been rationed out by successive administrations (of all colour).

The service in West Wales is now an official failure… but nobody is admitting their complicity in this disaster. The Post Code lottery is worse for distant and remote places. We are expecting a decision on a new hospital… 

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GP shortages this weekend mean that out of hours services in Carmarthenshire and Pembrokeshire will be closed intermittently. 5th April ITV News 

Hywel Dda University Health Board says they are continuing efforts to fill the shifts but expect the following disruptions:

  • Withybush General Hospital – closed 12am to 8am on Sunday.
  • Prince Philip Hospital – closed 2pm on Saturday until 8am on Sunday.
  • Glangwili General Hospital – closed from 10:30pm on Saturday to 8am on Sunday.

Analysis by Health Reporter James Crichton-Smith:

The fact that Hywel Dda is struggling to fill its GP out of hours rota is not a new one.

Health boards across Wales regularly have gaps in GP out of hours cover and Hywel Dda has previously warned of a shortfall at weekends, like it has this afternoon.

Read more:

Staffing problems and poor morale affecting GP out of hours

Health Board has had no doctor available overnight

The cause is a simple, and familiar, one. There simply aren’t enough GPs in Wales.

Efforts are ongoing to try and change this. The Welsh Government has its Train. Work. Live. campaign – and it has been getting results.

But training new GPs and attracting them to Wales takes time. The challenges are in the here and now.

August 2013:A series of intellectually and ideologically bancrupt administrations has led us to a GP recruitment crisis.

April 2019: GP suicides: LMCs call for action to reduce “appalling” numbers

March 2016: Top GP warns of threat to NHS as BMA calls emergency conference

August 2014: Recruitment rationing: GP magazine calls on political parties to support general practice

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Halfhearted support from Scotland. English Whistleblowers: “promises of protection are repeatedly broken”, meeting hears.

In Scotland the “whistleblower blast” is on 19th June, but there is no funding for the room Peter Gregson needs. For fundraising go here

He ends his message: “Please chuck in a few £. Then I’ll be able to afford to feed my children this month”. The petition is here

and the Scots are also looking at the Independent Contractor Model (GPs) after it has been cleaned out by understaffing and underfunding.

The health services are too proud and mean to contract out their human resources, but this is what is needed, along with a whole dose of repeated honesty, exit interviews, removal of targets, and giving the profession more powers over their own destiny..

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The BMJ opines: Whistleblowers: promises of protection are repeatedly broken, meeting hears BMJ 2019;364:l1482

There has never been a more dangerous time for frontline NHS staff to consider speaking up in defence of patients, a consultant surgeon who lost his job after reporting concerns about an avoidable death has told a meeting on whistleblowing at the Royal Society of Medicine.

All three levels of supposed protection—the NHS itself, regulators, and the law—are failing whistleblowers, Peter Duffy said.

Duffy, who reported his worries to the Care Quality Commission in 2015, won his case for unfair constructive dismissal at an employment tribunal last July. He was awarded £102 000 (€120 000; $135 000), which related to a dispute over pay, not his disclosures.

He told the meeting, opened by the RSM’s president, Simon Wessely, that he had been forced to resign from University Hospitals of Morecambe Bay NHS Foundation Trust in 2016 “for my own protection” and was “unemployed and, it seemed, unemployable.”

Since 2017 he has worked outside the NHS as a consultant surgeon at a hospital on the Isle of Man, living alone, while his wife, family, and friends still live in the Morecambe Bay area. “It really does feel like being two years into a 10 year prison sentence,” he said.

His case showed, he added, that “we have NHS promises of whistleblower protection repeatedly broken, leaders who don’t show leadership, regulators who don’t regulate, guardians who don’t hold organisations to account, and a law which simply exposes whistleblowers to more hate, threats, intimidation, and allegations.”

He said that the law failed whistleblowers in at least three critical areas. First, the whistleblower was the one on trial, not the NHS trust and managers. Second, whistleblowers were “threatened with costs if they don’t drop the case.” Finally, for success in a claim of sacking on the ground of whistleblowing the law demanded an evidential link or “smoking gun” to link the whistleblowing and the sacking. “This evidential link is an almost impossible task, particularly with the NHS conducting a scorched earth policy to evidence right from the start,” said Duffy.

He advised potential whistleblowers, “If you speak up as a group, you are infinitely more powerful. My mistake was to go it alone.”

David Nicholl, consultant neurologist with Sandwell and West Birmingham Hospitals NHS Trust, asked how far the NHS had come since the report of Robert Francis’s Freedom to Speak Up review in 2015.1 “Not very far,” he answered.

Nicholl said that one hopeful sign was that the CQC had fined Bradford Teaching Hospitals NHS Foundation Trust in January for breach of the duty of candour because it had failed to tell a family within a reasonable time that there had been delays and missed opportunities in treating their baby, who had died.2

Peter Wilmshurst, consultant cardiologist at Royal Stoke University Hospital and a whistleblower who has reported several research misconduct cases to the General Medical Council, said that there was an inequality of arms because “the individual can never match the resources of the trust.” He added, “There are no effective sanctions for those who treat whistleblowers badly.”

Several speakers and delegates called for reform of the whistleblowing legislation the Public Interest Disclosure Act, which Duffy described as “full of loopholes.”

Nicholl said, “There are fundamental problems with the legislation. If there’s anything we can do to press on that, it’s absolutely vital.”

David Walker, medical director of the Morecambe Bay trust, said in a statement, “We strongly encourage staff to come forward if they think patients may be in any way at risk, so we can investigate and learn from any mistakes. He added that the concerns raised by Duffy had been thoroughly investigated at the time and that “the employment tribunal found there was no evidence that he was ill treated or suffered a detriment for raising those concerns.”

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The Health Service is no longer National, and there is blatant finacial rationing because Wales has not paid up!

Any illusions that there is still a “National” health service have been destroyed today. The news that Welsh patients will not be welcome at their normal English (Over the border) hospital has been coming for some time. See the entries from NHSreality below those for the news from various sources in Wales and Chester as well as the BBC. It is interesting how our politicians and our media collude in the fantasy that there is a “National” health service.. There is a national shortage of diagnostic skills, worse in Wales, and if the money moves with the patient, and Wales has no money….  The politicians and the media need to break their collusion of denial.. The admin cannot sanitise this..

BBC News today 5th April 2019: Countess of Chester Hospital: Funding threat in patient row

and the day before Countess of Chester Hospital says no to Wales’ patients

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June 28th 2013: Border Issues – When we will need border controls? Bevan’s “frontier” issues..

Devolution of health to Wales was a mistake? NHSreality 15th August 2015

An increase in prescription charges encourages autonomy, but only in England. It also encourages movement between different systems… In Wales we already know we are second class citizens. NHSreality 28th Feb 2019

Wales is an unsustainable state: another good reason not to leave the EU. Graphics in support… NHSreality 16th April 2016

April 1st 2016: 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?

NHS ‘postcode lottery’ denies Welsh nurse £70,000 treatment for rare stomach cancer because the hospital is across the border in England NHSreality 14th September 2014

The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change.. Dec 3rd 2015 NHSreality

Election 2015: Bevan would be ‘turning in grave’ over NHS. Welsh Health Service derided.24th April 2015 NHSreality

Disintegration? Plaid Cymru publishes proposals to recruit an extra 1,000 doctors to Welsh NHS. Meanwhile a “managed service”..

Where did Labour’s prescription for treating the Welsh go wrong?

Don’t go West – go East!. An example for us all: Welsh patients in the dark about EU treatment options

Welsh NHS ‘is a scandal’, says David Cameron. The philosophy of not aspiring to excellence, but rather to reducing inequalities

Mr madam’s approach to a national shortage of diagnostic skills is understandable, but only partly truthful.

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

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In the Chester Daily Post 4th April 2019:Chester hospital refusing to accept Welsh patients – despite being just miles from border – The Countess said it had taken the decision over ‘unresolved funding issues’ but Welsh Government says move is ‘unacceptable’

Walesonline: Countess of Chester Hospital says it will no longer accept patients living in Wales.

The Wrexham.com: Countess of Chester says unresolved funding issues to blame for no longer accepting some patients in Wales

The Independent: NHS patients in England refusing to accept patients from Wales.

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£1m a year!! Sex offence payouts cost NHS £4.6m in five years…

And its all about money…. and sex it seems. We all know we cannot afford this …

Andrew Gregory and Leila Haddou report “Sex offence payouts cost NHS £4.6m in five years” in the Times 31st March 2019.

The NHS has spent almost £5m compensating patients, staff and members of the public who had been sexually harassed, abused or assaulted, The Sunday Times can reveal today.

A freedom of information request by this newspaper reveals for the first time the damages paid to 94 victims during the past five years. Some 75 were patients.

The precise nature of the cases, including when and where in the health service they took place and details of the perpetrators behind the offences, were not disclosed. NHS Resolution, which handles negligence claims against the NHS, declined to provide even brief details of any of the incidents.

In total, £2.2m was paid out in damages, £2m was spent on claimants’ legal costs and another £400,00 went on defence costs.

John Kell, head of policy at the Patients Association, said: “Sexual harassment of a patient by anyone working in the NHS is a dreadful betrayal of the trust that patients place in clinicians and healthcare professionals and will inevitably shake the confidence of victims in the integrity of the NHS.”

In January this newspaper revealed that the NHS had been left with a £1m bill for compensating victims of Jimmy Savile after the estate of the late sexual predator contributed only £53,000. The DJ and television presenter raped and assaulted scores of patients, staff and visitors in 41 hospitals, children’s homes and a hospice over nearly 50 years.

NHS Resolution declined to identify NHS hospital trusts where fewer than five people had been awarded damages, insisting there was a risk that individuals “may be identified either from this information alone, or in combination with other available information”.

The only trust identified by NHS Resolution was Cambridge University Hospitals NHS Foundation Trust. It paid £249,000 in damages to five patients. The trust said all the cases were linked to Dr Myles Bradbury. He was jailed for 22 years — later reduced to 16 — in 2014 for abusing 18 boys in his care at Addenbrooke’s Hospital.

 

How can the NHS offer fulfilling, lifelong careers? The managers have no idea why doctors quitting in droves…. Exit interviews?

The exit interview is a rare event in the 4 health services. The BMJ opinion from Wilson and Simpkin is honest and powerful, but their drawing attention to the absent “exit interviews” now needs attention, and from a completely independent HR company. None of the staff will trust the “in house” services. Yes, its got that bad, and its going to get worse. Life expectancy has peaked already and went down this last year….

The BMJ offers some advice on workforce retention: How can the NHS offer fulfilling, lifelong careers? BMJ 2019;364:l1100

With morale and retention among UK doctors declining, The BMJ hosted a discussion at last week’s Nuffield Trust health policy summit, asking what the NHS can do to support clinicians throughout their careers. Abi Rimmer reports

“Enabling people to pursue their other interests is one key thing,” said Rakhee Shah, paediatric registrar and research associate at the Association for Young People’s Health, kicking off discussions. She highlighted the importance of giving clinicians more control over their working lives.

Ronny Cheung, consultant paediatrician at Evelina London Children’s Hospital, took this further, saying that it was also important to give clinicians control over their everyday workload. He said that his trust, Guy’s and St Thomas’ NHS Foundation Trust, had been “trying to make time and space for teams to come together.”

“It’s about regaining control,” he said, “and investing in people to allow them to do that.” This not only made staff feel more valued but also helped to remind them what they enjoyed about their work. “It has a multiplying effect,” he said.

Claire Lemer, consultant at Evelina London Children’s Hospital, highlighted the importance of food for staff. She described a successful initiative at her hospital that encouraged the executive team to provide food for clinical and administrative staff……

……The demise of the firm structure of working in hospitals had reduced support for clinicians, said Morrow….

…The panel also discussed how the intensity of clinical work affects clinicians’ ability to maintain a long term career in the NHS. Lemer said that, in some specialties, “the pressure and intensity of work is so extreme that it’s not sustainable for a whole career.”…

…Cheung also warned that the rigidity of medical training pathways was denying doctors the flexibility they needed, as they were forced to choose a specialty so early in their career.

“If we squeeze people into these pathways we shouldn’t be surprised if people break free, and we shouldn’t be surprised that we’re developing a workforce that isn’t particularly happy,” he said.

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The NHS is failing to look after its staff and patients, expert warns

Abi Rimmer, The BMJ

Anne Gulland, The BMJ

Opinion from Hannah Wilson and Arabella Simpkin is honest and ends with the paragraph: (This was not available in the on-line edition)

Quitting in DrovesHannah Wilson and Arabella Simpkin P 473 of the BMJ

Surprisingly, while there is little literature that discusses both the quantity of doctors that leave the NHS and the factors that may drive them, there is no literature discussing the attributes and characteristics of doctors that leave. To understand what is driving the flight, we must first ask who are the doctors that quit? Surprisingly exit interviews are rarely held. Yet this is critical information to develop interventions and strategies to stem the leak.

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