Category Archives: Post Code Lottery

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…

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What happens when targets (and standards) change (decline)?

The Nuffield Trust has published a paper after John Appleby did so in the BMJ. If targets decline so do standards, and inequality increases as more citizens are tempted to pay privately. Did NHSreality ever say that we would eventually get a two tier (overall) service?

What happens when targets for waiting times change?

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2584 (Published 01 June 2017) Cite this as: BMJ 2017;357:j2584

In Soviet era Russia Pyotr Petrov, manager of the state run ball bearing factory on the outskirts of Magnitogorsk studied the new production target. The target came from the chief department for ball bearing production, part of the Ministry of Automobile and Tractor Industries. From now on the Magnitogorsk factory was to produce 200 tons of ball bearings a month. “200 tons! That’s a huge increase in the number of ball bearings,” Petrov thought, “… or is it?” At the end of the month the factory had managed to meet its target: one, 3.7 m diameter, 200 ton, ball bearing.

Poorly designed or badly policed targets can create perverse incentives (a giant ball bearing), but they can also provide the right motivation to improve performance. So what has been the real life experience of the NHS and its use of targets, particularly to improve waiting times?

Two targets become somewhat iconic: one arising from the Labour Party’s 2007 manifesto pledge that “by the end of 2008, no NHS patient will have to wait longer than a maximum of 18 weeks from the time they are referred for a hospital operation by their GP until the time they have that operation” and the other, a maximum wait in accident and emergency departments for patients of four hours (before being admitted, discharged, or treated).

The referral to treatment target covered two separate standards—that a minimum of 90% of patients admitted to hospital should wait less than 18 weeks from referral by their GP, and that 95% of those seen in outpatients (“non-admitted”) should have waited no longer than 18 weeks. In April 2012, a third overarching target was added covering patients still waiting for treatment—that 92% of what were called “incomplete pathway” patients should not wait longer than 18 weeks.

But in October 2015 a review of what had now become quite a complicated set of targets recommended dropping the two earlier standards1 as the new target essentially did the job—covering patients’ total waiting experience from referral to treatment and included all patients waiting, not just those seen in outpatients or admitted as inpatients. It also avoided the perverse incentive that once a patient still waiting had tripped over the 18 week limit, as soon as they were seen in outpatients or admitted into hospital, a trust would then automatically fail on the old targets as well.

As figures 1 and 2 show, by the time these targets were dropped, the percentage of patients who waited more than 18 weeks before being admitted or seen in outpatients had been on a rising trend since 2012, leading to breaches of the targets in 2014 and 2015. Since then, perhaps unsurprisingly as the targets have been dropped, the percentages of patients who waited more than 18 weeks for admission or being seen in outpatients have continued to rise—and now stand at 22.6% and 9.7% and respectively.

Fig 1 Percentage of admitted patients who waited more than 18 weeks from referral by their GP (English NHS).5 Estimated performance from October 2015 is author’s calculation based on historical relation between adjusted (not published since October 2015) and unadjusted statistics (which continue to be published). Adjusted figures allow for various waiting time clock stops and starts due, for example, to patients refusing offered admission dates

“>Figure1

Fig 1 Percentage of admitted patients who waited more than 18 weeks from referral by their GP (English NHS).5 Estimated performance from October 2015 is author’s calculation based on historical relation between adjusted (not published since October 2015) and unadjusted statistics (which continue to be published). Adjusted figures allow for various waiting time clock stops and starts due, for example, to patients refusing offered admission dates

Fig 2 Percentage of patients seen in outpatients who waited more than 18 weeks from referral by their GP (English NHS)