Category Archives: Perverse Incentives

Unfairness in infertility is symptomatic of a far more important unfairness – in survival and life expectancy.

£68m out of £122bn is significant when all other demands are considered. Ask the commissioners. Why should fertility be treated differently to stent insertions or stroke or cancer treatments? At least these are life saving. Every health system rations care. The debate should be about whether this rationing should be overt or covert, and whether different for different post codes/regions. Rationing by insurance differentials as in many EU countries is giving better overall outcomes and is less unfair than what we face now. Nobody knows in advance what will be rationed for them. Their future health demand results from the lottery of life, but the unfairness results from the lottery of where we live, and the dishonesty inherent in a lack of national debate. . The WHO will not in future report on an NHS: rather on 4 systems of covert rationing. A pragmatic and honest debate is needed on what the health services are for, and whether the founding principles outlined by Aneurin Bevan (in place of fear, chapter 5) need to be reassessed and rewritten. Meanwhile our denial is bringing back fear, especially to those without the means to make a private choice.( Politicians often go privately….) 

 The hearts and minds of the coalface workers are disengaged from the politics because of this denial. They are also concerned that the media may be colluding in the denial, so that things get worse. 

 Three MPs write a letter to the Times revealing their state of denial and poor understanding of the rationing decisions commissioners are having to take to keep within budget.. The Times then follows up with a leader which is equally banal. “Unfairness in Infertility”. There will be fewer staff now that we are leaving Europe, and Katie Gibbons reports 30th October that “Staffing crisis will put NHS care at risk, says charity”. The Kings fund report is more circumspect but they really agree. Rationing by not having enough people with sufficient skills is a disgrace, and reflects more on our politician and political system than anything. Unfairness in infertility is symptomatic of a far more important unfairness – in survival and life expectancy. Of course genetic selection IVF should be a choice for those with inherited diseases, but in other cases we need to question priorities. (See Letter from Richard Childs in the Times 2nd November 201& – posted at the end, followed by another letter on cost and perverse incentives from Prof Nargund)

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NHSreality ‘ response to the Times is:

“£68m out of £122bn is significant when all other demands are considered. Ask the commissioners. Why should fertility be treated differently to stent insertions or stroke or cancer treatments? At least these are life saving.

Every health system rations care. The debate should be about whether this  rationing should be overt or covert, and whether different for different post codes/regions. Rationing by insurance differentials as in many EU countries is giving better overall outcomes and is less unfair than what we face now.

Nobody knows in advance what will be rationed for them. Their future health demand results from the lottery of life, but the unfairness results from the lottery of where we live, and the dishonesty inherent in a lack of national debate. .

The WHO will not in future report on an NHS: rather on 4 systems of covert rationing.

A pragmatic and honest debate is needed on what the health services are for, and whether the founding principles outlined by Aneurin Bevan (in place of fear, chapter 5) need to be reassessed and rewritten.

Meanwhile our denial is bringing back fear, especially to those without the means to make a private choice.( Politicians often go privately….)

The hearts and minds of the coalface workers are disengaged from the politics because of this denial. They are also concerned that the media may be colluding in the denial, so that things get worse.

CUTS TO IVF CYCLES – The Times letters 31st October 2017
Sir, This month marks the 40th anniversary of the creation of the embryo that went on to become Louise Brown, the world’s first IVF baby. This medical breakthrough has brought joy to countless people.

In England, the provision of IVF treatment on the NHS is now reaching crisis point, with clinical commissioning groups (CCGs) decommissioning services, and several areas in the southeast offering no service at all. Research carried out by Fertility Fairness shows that the number of CCGs offering the Nice-recommended three IVF cycles to eligible women under 40 has halved in the past five years so that only 12 per cent now follow national clinical guidance. CCGs need to be held accountable for these cuts but neither the government nor NHS England seem to have the powers or the appetite to do this. Even when CCGs consult their local population, and the latter support retaining fertility services, the CCGs cut them anyway. Surely the time has come to consider commissioning this service centrally in England, as they do in the devolved nations, so that the provision of fertility treatment is equitable.
Steve McCabe, MP (Lab); Tom Brake, MP (Lib Dem); Ed Vaizey, MP (Con)

Unfairness in FertilityAfter 40 years, IVF treatment on the NHS is unacceptably patchy

Whether couples have children should not depend on where they live. Forty years into the age of in-vitro fertilisation, those who could benefit should have access to it on a roughly equitable basis. Unfortunately, they do not. Huge variations in the availability of IVF on the National Health Service have emerged since local doctors’ groups were given new control over how NHS money was spent in the Lansley reforms five years ago. This is an injustice that the government has helped to create and that the government can help to end. It should do so without delay.

National guidelines on how many cycles of IVF should be available on the NHS are being ignored at the local level, and especially in the southeast. As of this year, couples having trouble conceiving in Cambridgeshire and Croydon have no chance of IVF except by paying for it themselves, while those in most of Greater Manchester are still assured of three cycles on the NHS as long as the would-be mother is under 40.

This is unfair. It is especially galling for couples trying unsuccessfully to have children for want of enough IVF treatments, who through their taxes are subsidising effective treatments for others for no better reason than their postcode.

Such a lottery is avoidable. Since April this year, commissioning of IVF in Scotland has been centralised so that all couples who could benefit are guaranteed three cycles. Commissioning has also been centralised in Wales and Northern Ireland, although the provision there is less generous. MPs are demanding a similar centralisation of IVF provision in England.

Four decades ago, Patrick Steptoe and Robert Edwards pioneered the laboratory fertilisation of a human embryo and its successful re- implantation into the womb of the egg’s donor, Lesley Brown. Later knighted, Sir Robert was also awarded a Nobel prize for his work in reproductive medicine. Mrs Brown’s daughter, Louise, the world’s first IVF baby, is this week attending a fertility conference in Texas at which she has said the heartache of couples denied access to the treatment that gave her life can be devastating.

More and more people hoping to conceive in this way are being affected. National guidelines recommend up to three IVF cycles for women under 40, but these are not binding. Replies to Freedom of Information requests sent to clinical commissioning groups (CCGs) by a fertility pressure group reveal that the number following the guidelines has halved in the past five years to one in eight. Thirteen CCGs have stopped offering IVF in the past year. Nationally, one in 30 offers none at all.
For a given locality, the arguments against generous provision can seem compelling. IVF is not strictly a health treatment. Its effectiveness falls steeply as women approach 40. It is expensive, and resources are finite. At the national level, however, these arguments carry less weight. The NHS funds IVF for roughly 20,000 couples a year at a cost of about £68 million — a small fraction of the service’s overall budget of £122 billion. Guaranteeing three IVF cycles for all women who might benefit from it would carry an extra cost, but so would withholding the treatment. This cost might be measured in sadness and loneliness in later life, but would be no less real for that.
The lottery of fertility is harsh enough. There is no reason for government to make it harsher still.

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Letter from Richard Childs in The Times:

Sir, Susan Seenan, of Fertility Fairness, suggests that IVF is a “medical need”. Cancer treatment and tumour surgery are medical needs, IVF is not. It is a personal or social “want” — a very different thing. Financially the NHS is only able to provide funding for genuine medical needs. I do agree with her, though, that whether someone receives treatment of any sort should not be dependent on a postcode. A fair solution for IVF is, therefore, that irrespective of postcode no one should receive it on the NHS. Ever more scarce resources could then be diverted to addressing real medical needs.
Richard Childs

Collingham, Notts

Letter from Prof Nargund:

Sir, Your report “First test tube baby Louise Brown warns over ‘devastating’ impact of IVF cuts”, Oct 31) covers increasingly familiar and depressing ground. However, the continued reporting of IVF funding cuts misses the crux of the issue. The scale of the NHS budget is not the problem; the existing budget could easily fund the required IVF treatments in accordance with National Institute for Health and Care Excellence guidelines. The real problem is twofold: first, there is a fundamental deficit of IVF pricing knowledge within the NHS and among NHS commissioners. Simply put, a lack of awareness as to the various methods of IVF delivery, treatment and drug doses is resulting in a flawed (and highly expensive) procurement process.

Second, and more worryingly, the problem is compounded by the vested interests of the drug companies and IVF providers, where both enjoy a lack of transparency on IVF costs and profit at the expense of NHS patients.

If these challenges were to be sufficiently addressed we could halt the NHS rationing of treatment and help those denied treatment by virtue of their postcode.
Praful Nargun
d
CEO, ABC IVF, Harley Street

 

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Jeremy Hunt to unveil state-backed GP indemnity deal. Bribery is an admission of perverse recruitment and education processes..

GPonline reports 12th October (Jeremy Bostock): Jeremy Hunt to unveil state-backed GP indemnity deal

Health secretary Jeremy Hunt will reveal plans for a ‘state-backed scheme for clinical negligence indemnity for general practice’ at the RCGP annual conference in Liverpool on Thursday.

This “Bribery” is an admission of perverse recruitment and education processes over many administrations. Rationing of training places and recruiting from overseas 6 years later….

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The anxiety about indemnity is evident in GP Frontline – Raging against the rising costs of medical indemnity (Author unknown) ,and in numerous recent publications.

Anu Patel on 23rd March: Indemnity: Rising indemnity costs are a threat to general practice

David Millett on 9th October: Thousands of GPs urged to write to MPs about indemnity

It is no wonder that bribes have been offered, and in Wlaes this has helped fill some GP Training posts, but as predicted, England has, in a competitive market, offered to march the inducement fees of £20K.

Alex Matthews-King in March Pulse: £20,000 GP ‘golden handshake’ scheme to be expanded this year

BBC News today 12th October: Jeremy Hunt to pledge £20,000 ‘golden hello’ for rural GPs

Newly-qualified GPs are to be offered a one-off payment of £20,000 if they start their careers in areas that struggle to attract family doctors.

The £4m scheme, to be announced by Health Secretary Jeremy Hunt, aims to boost the numbers of doctors in rural and coastal areas of England.

Mr Hunt will also pledge to “secure general practice for the future”.

The Royal College of GPs backed the plan saying there is a “serious shortage” of family doctors.

The one-off payment will be offered to 200 GPs from 2018.

As of September 2016, there were 41,985 GPs in England.

Mr Hunt is due to speak at the Royal College of GPs’ annual conference in Liverpool, where he will offer something for those already in the profession too, by announcing plans for flexible working for older doctors – to encourage them to put off retirement.

He will also confirm plans for an overseas recruitment office which will aim to attract GPs from countries outside Europe to work in England.

“By introducing targeted support for vulnerable areas and tackling head-on critical issues such as higher indemnity fees and the recruitment and retention of more doctors, we can strengthen and secure general practice for the future,” the health secretary will say.

The Royal College of GPs said the package must be delivered in full and welcomed the commitment to incentivise working in remote and rural areas.

NHS England has already pledged an extra £2.4bn a year for general practice in England – part of which will fund plans for 5,000 extra GPs by 2020.

But Dr Richard Vautrey, chairman of the British Medical Association’s GP committee, said the government was not on course to reach that target.

“General practice is facing unprecedented pressure from rising workload, stagnating budgets and a workforce crisis,” he said.

“‘Golden hellos’ are not a new idea and unlikely to solve the overall workforce crisis given we are failing badly to train enough GPs to meet current demands.”

In 2016, the BBC learned that there were some practices in England offering a bonus of up to £10,000 to attract new doctors.

But The Nuffield Trust think tank said recruitment was “only half the battle”.

“The NHS is struggling to hang on to qualified GPs, with surveys showing 56% plan to retire or leave practice early. Many trainees also drop out when they finish,” said senior policy fellow Rebecca Rosen.

Performance related pay schemes, such as QOF, are not suitable for professionals.

Management courses have taught for a long time now that Performance Related Pay (PRP) has a short half life. The box ticking production line style of management is not for professionals. The QOF (Quality Outcomes Framework) is another form of PRP and has been in existence for far too long. Elderly multi-pathology and terminal care patients are the future of primary care, and their care will mostly have to be at home. Hospital at home projects are the future, and they will need staffing…… Lets hope we can train them up from our own population, because we have alienated the immigrant labour force. NHSreality agrees that there may be a sudden surge in deaths from epidemics such as flu, and most of these will have to be at home. Commissioning groups need to abolish QOF, remove the perverse incentive to ration those services that pay less, and trust the overstretched GPs to ration their care appropriately.

Kat Lay reports 10th October in The Times: Cash incentives for GPs do not make care better

A financial incentive programme for GPs may not improve the quality of care, according to researchers.
The quality and outcomes framework, introduced as part of the 2004 GP contract, means that up to a quarter of a surgery’s income is linked to targets on areas such as heart disease, diabetes and smoking.
Researchers from University College London and Imperial College London reviewed a series of studies evaluating the worth of such financial incentives.
They found that although a number reported initial improvements in the treatment of a range of chronic diseases such as hypertension, diabetes and asthma, these were often not sustained. Any positive effects were not consistent across ethnic, gender and age groups.
There was also a suggestion that patients whose conditions were outside the framework “experienced higher mortality and poorer quality of care”.

The study, published in the British Journal of General Practice (BJGP) will add weight to calls to scrap the scheme. NHS England has said it supports such a move in principle but failed to make any changes in the latest round of GP contract negotiations. A year ago, Simon Stevens, the chief executive of NHS England, said: “For the most part it has descended into too much of a box-ticking exercise.”

Last month a review commissioned by NHS England concluded that the framework did not improve care and should be replaced, but cautioned that removing it could have a severe impact on GP practice incomes and patient care. The study’s authors warned that any new incentives should be looked at carefully. “Despite uncertainly about their effectiveness, financial incentives receive widespread political attention and are increasingly being implemented,” they said.

A spokesman for the British Medical Association said that the framework had “helped deliver substantial improvements to patients across the UK” and had raised detection rates.

•A survey in the BJGP found GPs were concerned about the introduction to the NHS of physician associates, graduates without traditional medical training. Patients, however, had fewer fears.

 

Tears, tantrums and no pay – my life on a zero-hours contract in the NHS

You get what you pay for — which, for most NHS users, is nothing

NHSreality response to the RCGP Questionnaire into the future of Welsh health and social care

A fearful anonymous consultant tells it as it is… “the NHS is in crisis”.

Fighting for the NHS’s moral life: There are 4 Chernobyl’s waiting for meltdown..

Getting to see a Health Service physio – like getting to see a health service dentist

 

More votes could be lost if the politicians are honest? Ministers must admit that the health service can’t cope

The perverse incentives to deny the truth about the four UK Health Services is greater than the desire to be honest, have a long term view, and engage in the debate which Mr Stevens has asked for. But the pressures are getting bigger, and as more and more unnecessary deaths occur, and waiting lists become longer, and staff remain disengaged from the politics, but more and more angry, the penny may drop. We have to ration health care overtly. Only once this decision has been taken can we debate exactly how..

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Dennis Campbell reports 12th September 2017: Ministers must admit that the health service can’t cope

Is the NHS constitution still worth the paper it’s written on? It’s the nearest thing the health service has to tablets of stone. Its 15 pages enshrine the principles and values that should guide the conduct of the NHS in England. They say “the patient will be at the heart of everything the NHS does” and that, as a tax-funded service, decision-making should be transparent.

Sadly, on both counts, the deeds of a cash-strapped and understaffed service operating in a strange and volatile political environment are increasingly failing to match either the spirit or letter of those fine words.

That is closely linked to the document’s detailed description of key patients’ rights, including the NHS’s duty to treat those who need A&E care, an ambulance, non-urgent hospital treatment or cancer care within specified waiting times.

But the truth is that almost no part of the NHS can now cope with the demands on it. The decision to in effect shelve the referral to treatment (RTT) target – that 92% of patients should be treated in hospital within 18 weeks of referral, usually by their GP – tells us something profoundly worrying. The health service’s leaders such as NHS England boss Simon Stevens, ministers and the health secretary, Jeremy Hunt, know it can’t treat the required volume of patients within the agreed timeframes, but dare not say so in case their honesty triggers a media backlash or Theresa May’s displeasure.

Since the decision to relax the 18-week target in March, the total number of patients on the RTT waiting list has crept to more than 4 million people for the first time in a decade. But what really matters is the lack of honesty here. Neither NHS England nor the Department of Health has yet publicly acknowledged that a key target – unmet for 16 months – has now been downgraded or that patients are suffering pain, anxiety and distress as a result.

The same attempt to deny reality applies to the NHS budget. As NHS Providers, an organisation representing NHS trusts, says, hospitals face “mission impossible” trying to deliver the waiting time targets this year, the seventh of austerity funding. In a briefing last week on RTT, it said: “We should not maintain a fiction around what the NHS can deliver, given current demand increases, workforce shortages and sustained levels of funding increase that are well below historic averages. To do so carries several risks, including misleading the public.”

Faced with a government in denial on health and social care funding, the NHS is increasingly doing less for patients, despite rising demand – but again dare not admit that’s what’s happening. Jeremy Taylor, the chief executive of National Voices, a coalition of more than 100 health and care charities, is worried NHS England is increasingly making decisions that are bad for patients in a desperate attempt to make its sums add up. “We’ve seen a relaxation of the RTT target, a ‘budget impact test’ that could delay new drugs being available [for up to three years] if they cost more than a £20m threshold, an attempt to push the cost of pre-exposure prophylaxid drugs to local authorities, and a number of court cases where the NHS is seeking not to pay for certain treatments.” Taylor is also struck by the NHS’s “lack of meaningful engagement with the people who stand to gain or lose” from these decisions.

The NHS’s refusal to acknowledge that proposals to centralise many types of hospital care would inevitably generate controversy was judged a mistake by the King’s Fund, the British Medical Association and the Local Government Association – which is quite a feat. And NHS England has surrounded its bid to get 13 already cash-strapped areas to make £500m of extra savings this year, through the “capped expenditure process”, with almost total secrecy.

Such concealments, on all these difficult, politically charged issues, betray the service’s duty of transparency. But they also raise again a key question about Simon Stevens that won’t go away: is he the NHS’s voice in government or Whitehall’s man in the NHS?

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It is essential to look into health staff claims and be aware of fraud and exaggeration. It’s our money being spent…

Insurance companies are right to be “doubtful” about many claims in todays world. Since the Health Services insure themselves (doctors are covered by Medical Liability), there is an interest in justifying and confirming claims. It is essential that a jaundiced manager does acquire evidence by video and surveillance. He is protecting our money. It is not outrageous, and it would still be necessary if we had “no fault compensation”. Its just that in the latter instance settlements would be lower and calculated on a formulaic basis. There are perverse incentives to exaggerate especially if there is no due diligence.

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Jon Ungoed-Thoms in the Sunday Times 3rs September reports: NHS spying on negligence ‘victims’ hits record level

The NHS is mounting more than 50 surveillance operations a year on alleged victims of medical negligence or accidents in its hospitals.
NHS Resolution, which deals with clinical negligence claims in hospitals, says it is launching an offensive against exaggerated claims and fraud. The operations include the use of private detectives to follow patients who sue for compensation.
A record high of 55 surveillance operations were authorised in 2016-17, up from 24 in 2013-14.
In one case a 42-year-old patient claimed more than £2.5m in damages after alleged negligent surgery. The woman was put under surveillance and it was noted she could undertake most daily activities. She was awarded £115,000 and the judge found her case had been “in part dishonest and in part grossly exaggerated”.

In about half of the cases — 23 in 2016-17 — evidence of exaggeration was detected. It means in some cases victims of NHS blunders who are not exaggerating their claims are being put under surveillance.

Peter Walsh, chief executive of Action Against Medical Accidents, said: “This is outrageous. This is an invasion of the privacy of patients who have already suffered untold misery through negligent treatment.”
The surveillance is described as “non-obtrusive” — which can include private investigators filming patients or researching social media.
The investigations extend to NHS staff who sue. Lorna Hayden, a former cardiac physiologist at Kent and Sussex Hospital in Tunbridge Wells, was awarded £425,000 in a High Court judgment in December over an injury she sustained moving a 16-stone patient in March 2007.
It emerged during the case that she had been filmed by investigators.
Jacqueline Hardaway, a lawyer at Dawson Hart, said: “The NHS trust seriously injured one of their hard-working employees, through negligence, then subjected her to years of heartache, filming her and calling her a fraud, until, after a nine-year battle, a High Court judge awarded her substantial compensation . . . clearing her of any dishonesty.”
NHS Resolution said it always considered privacy before proceeding. “While it is very rarely used, surveillance helps to protect the public purse from paying unreasonable or unjustified levels of compensation.”

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Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

If you have a stroke on your way to the hereafter, your life expectancy is short, demand for services is high, and nobody listens to you, even if you can be understood.  Dumped is the right political word. Congratulations to the reporter on his understatement however, The real word, especially with regard to intensive physiotherapy, is abandoned. Dead patients don’t vote, and those near death don’t appear to count. Commissioners have a perverse incentive to save money, richer areas can have more physio as more patients go privately, and the post-coded, covert rationing lottery continues..

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Jon Ungoed-Thomas in the Sunday Times reports: Stroke survivors ‘are dumped by the NHS’

Sufferers feel abandoned after leaving hospital and face waiting up to a year for the right treatment — or paying for it themselves

Stroke survivors are being left to languish at home with a “shocking” lack of support. Many say they feel abandoned by the NHS.
Juliet Bouverie, chief executive of the Stroke Association, said a new national plan was required to help the 1.2m stroke survivors in the UK. Some have to wait up to 12 months for psychological help.
“As a stroke survivor, your life and the life of your family is turned upside down,” she said. “Many stroke survivors say they feel abandoned, as if they have dropped off a cliff. The provision in some areas is shocking.”
About 100,000 people suffer a stroke every year in the UK; it is one of the country’s leading causes of death.
Andrew Marr, the broadcaster and journalist, who suffered a stroke in January 2013, said better support for stroke survivors — many of whom are of working age — could help them return more quickly to employment. He was back at work within six months, but largely because he paid for additional physiotherapy.

Stroke survivors can wait up to four months for speech therapy and up to a year for psychological support, according to data from the Royal College of Physicians. Stroke survivors say there is insufficient physiotherapy, a treatment which would ensure the best recovery.

Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner<img class=”Media-img” src=”//www.thetimes.co.uk/imageserver/image/methode%2Fsundaytimes%2Fprod%2Fweb%2Fbin%2Ffa4fb670-698c-11e7-8ef4-9d945f972597.jpg?crop=2250%2C1500%2C-0%2C-0″ alt=”Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner”>
Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work soonerDavid Cheskin/PA

A stroke strategy, launched in 2007, outlined a 10-year plan to overhaul stroke services and has seen significant improvement in acute treatment. The Stroke Association is calling for a new action plan to build on improvements and outline a new strategy for the rehabilitation of stroke victims.

Nathan Ridgard, 40, a self-employed businessman and a father-of-two from Harrogate, North Yorkshire, suffered a stroke on New Year’s Eve 2012. After being discharged from hospital, he said he was given some leaflets by the NHS on coping with a stroke, but struggled to read them because of his poor vision.

“I just felt I had been dumped out in the world,” he said. He received some NHS physiotherapy, but also paid for private sessions to supplement them. He has since made a good recovery.

Professor Tony Rudd, National Clinical Director for stroke at NHS England, said: “The quality of care and survival rates for stroke are now at record highs. We are working with the Royal College of Physicians and others local health service leaders to improve rehabilitation care for everyone who suffers a stroke.”

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A fundamental dishonesty is behind almost all the Health Services System news… and our failure to respond appropriately and improve.

There are many signs that the rivets have popped (The NHS: have the rivets popped? ) and those of us in the professions know this. The reasons include poverty, perverse incentives for commissioners and trusts, covert rationing, and lack of choice. These can all be covered by “dishonesty” in the language of health and the way information is given to the public. We all need to know what is not available in our particular health care cohort. A lack of honesty is behind almost all the Health Services System news… It is similar to the lack of open honesty in London after the Grenfell Tower. The Independent 29th June 2017: Grenfell fire: Kensington council cancels meeting after High Court lets journalists attend. It is the same with Trust and Commissioner Boards: all the important decisions are taken in private. Even the National Health Executive is at odds over integration of Health and Social Care… (NHS and council bosses at odds over divisive Better Care Fund targets

If silence is dishonesty, then dishonest politicians and administrators have resulted in dishonest doctors and nurses.

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The small amount of “good news” is in “Learning from Scotland’s NHS” – from the Nuffield Trust (particularly mental health) but does not comment on the financial state of their health service, or choice limitation. May needs to put young people’s mental health at the centre of policy.

This report looks at Scotland’s unique health care system, and explores how other parts of the UK might be able to learn from it. But remember what is lost in Scotland: Analysis: Why is Scotland not doing more to offer stem cell treatment … Herald Scotland30 Jun 2017

and on 6th July: BMJ investigation: NHS ‘postcode rationing’ on the rise

Clinical Commissioning Groups (CCGs) in England are increasingly rationing treatments amid growing financial pressure, an investigation by the BMJ reveals.

Freedom of Information data from 169 CCGs shows a 47% rise in the overall number of individual funding requests (IFRs) submitted to CCGs by doctors over the past 4 years, with substantial variation across the country.

Cataract removal, hip and knee replacements, and mental health care are among the top 10 most commonly requested treatment areas….

and

Chris Smyth in the Times 5th July 2017:  Patients forced to beg for routine operations

( and Council revolt over NHS chief Simon Stevens’s ‘secretive’ social care reforms – see below)

Patients are having to beg for treatment that was once routine as the NHS rations procedures ranging from hip replacements to cataract removal.

Requests by doctors for exceptional funding have surged by almost 50 per cent in four years as health trusts restrict what they will automatically pay for, an investigation has found.

Patients are left in pain because of long delays even when permission is granted, in the latest sign of the impact of cost-cutting. In Buckinghamshire, every patient referred for hip and knee surgery must have their request scrutinised by a panel. The local health trusts that pay for care have been ordered to make savings in order to help the NHS balance the books after years of hospitals running deficits. An investigation by the BMJ has found that doctors seeking common treatments for their patients are increasingly forced into individual funding requests — pleas for discretionary approval for procedures.

In 2016-17, doctors made 73,900 such requests, up 20 per cent from the year before and 47 per cent from 2013-14, when 50,200 were made, according to data gathered under Freedom of Information laws. About half the requests are granted, often after months of delay.

The requests are most commonly used for fertility treatment or cosmetic procedures but an increasing proportion are now for treatment that was once routine. Three years ago just 49 such requests were for hip and knee surgery. This rose to 899 in 2016-17.

The Times also reported July 5th: Doctors send scans by social media to bypass ‘backward’ NHS systems

Georgie Keate, Fariha Karim report6th May 2017: Bosses knew about groping surgeon for years

and Chris Smyth: Antibiotic factory waste water was as toxic as drugs

Council revolt over NHS chief Simon Stevens’s ‘secretive’ social care reforms

Councils have turned on the NHS over “secretive, opaque and top-down” reforms that they say will fail patients.
Simon Stevens, chief executive of NHS England, has staked his tenure on co-ordinating care more effectively and has said that local authorities are crucial to the process because they oversee public health and social care for the elderly.
However, only a fifth of councils think the plans will succeed amid widespread complaints that they have been shut out of the process by the NHS, according to a survey by the Local Government Association.
Not one councillor who responded said they had been very involved in drawing up plans and nine out of ten said the process had been driven from Whitehall rather than locally. Cultural clashes with a “command and control” NHS that did not trust elected councillors meant that more local authorities believed the process was harming social care than helping it.
Mr Stevens has created 44 “sustainability and transformation partnerships” (STPs) where hospitals and GPs are meant to plan with councils on how to improve care and help close a £22 billion black hole in the NHS budget. However, four out of five councillors said the system was not fit for purpose and criticised the NHS for prioritising cost-cutting and closing hospital units over preventing illness.

Izzi Seccombe of the Local Government Association said: “Many councillors have been disappointed by the unilateral top-down approach of the NHS in some of the STP areas. As our survey results show, the majority of local politicians who responded feel excluded from the planning process. If local politicians and communities are not engaged then we have serious doubt over whether STPs will deliver.”
Half the 152 councils with social care responsibilities responded to the survey and 81 councillors with responsibility for health contributed. “The way in which the STP has been handled (top down, secretive, lack of engagement) has harmed relationships between the council and some NHS colleagues,” one said.

Another said: “It is entirely driven from the top, via budget pressures. The process has been overly secretive and opaque. It has got in the way of closer working between councils and health.”
Councillors criticised STPs as “complex and full of jargon”, saying “the NHS simply does not understand the decision-making of local government”.
Ms Seccombe said that in a centralised NHS, managers often did not want to share information with party political councils accountable to local voters, saying that the process was “trying to mix oil and water”.
Chris Ham, chief executive of the King’s Fund think tank, said: “This survey suggests worrying numbers of council leaders are still frustrated by the process and lacking in confidence in their local plan. A huge effort is now needed to make up lost ground.”
A spokesman for NHS England said: “By creating STPs we have issued a massive open invitation to those parts of local government willing to join forces, while recognising that local politics can sometimes make this harder. The fact that public satisfaction is more than twice as high for the NHS as it is for social care underlines the real pressure on councils. It should serve as a wake-up call to every part of the country about the importance of joint working.”

(NHS and council bosses at odds over divisive Better Care Fund targets)

St Albans Advertiser 7th July: St Albans patients could have to pay for hearing aids and IVF under new NHS cost-cutting proposals

Walesonline 14th May 2017: Shortage of GPs causing waiting times ‘crisis’ for patients in Wales …      

Sarah Marsh in the Guardian 6th July 2017 reports: More patients waiting longer than a week for GP appointments – Annual survey shows that in England 20% must wait at least seven days and many are unable to get an appointment at all

In Chester the Jez Hemming for Daily Post 4th July 2017 reports Health council slams system delaying new GPs coming to work in Wales – Geoff Ryall-Harvey, chief officer of North Wales Community Health Council, says GPs wait up to 12 weeks to get on Welsh NHS Performance List

Dishonesty about open government is not restricted to London:  Labour revolt spreads as councillors barred (The Times May 19th 2017)

Governments can do a great deal of harm in health… Aneurin Bevan’s dream is being replaced by a greater fear…

Image result for dishonest doctor cartoon