Category Archives: Post Code Lottery

Proton beam therapy arrives in the UK.

BBC News rightly reports some good news. The shaming of the health services by the case of Ashya King is recorded in the posts below. Ironic that Wales has the first UK Proton Beam therapy, but I suspect a lot of political machinations were done to get an edge over England… It has taken 27 years since the first Proton Beam therapy in 1990…

UK’s first proton beam machine arrives at Newport clinic

UK to get first proton therapy centre after Ashya King’s plight raised awareness of vital cancer treatment – The Telegraph 20th May 2017

Patrick Hill in the Mirror today: You’re still failing him: Parents say brain cancer survivor Ashya King is being refused vital treatment by the NHS – Plight of boy, 8, hit the headlines when his mum Naghmeh and dad Brett took him from a hospital without consent to get pioneering treatment abroad

In 2014 Joan Smith gave a balanced account of the case for the Independent: Ashya King: This story isn’t quite what it seems – The five-year-old isn’t dying – but nor is he getting the urgent treatment he needs, despite Jeremy Hunt’s extraordinary offer

Image result for proton therapy cartoon

Crisis – what crisis?

Proton Beam Therapy – it’s covert rationing in all UK regional health services since 1990!

It was rational rationing: but it revealed the lack of Proton Beam therapy in the UK: a shame on the Health Services

D.C. approves proton beam cancer centers

The English Health Services have finally been shamed into action by Ashya Prague’s parents. Proton beam centres ‘to treat 1,500 patients a year’….

I told you I was ill. Playing a short and irresponsible game: Ignoring the long term, and best advice, comes naturally to Politicians on both Health and the Environment….

Genetic engineering jpg 359x400 Gene linkage cartoon

Will the state expand whoever wins? Why is dementia excluded from state care, but all other conditions are not? A mutual fund for elderly care can only work if it is universal….

It feels from the party manifestos that there is an agreement that the state needs to do more, especially to reduce inequalities. The conservatives wish to use capital assets for domestic/home based care in the same way as assets are used for Nursing Homes now. ( Down to £23,000 ) NHSreality sees nothing wrong with this approach – it has the virtue of being honest and open rationing. Methods of saving for a demented old age do not appeal – after all most of us pretend we are going to live for ever, and if we go, hope we die suddenly. A mutual fund for elderly care can only work if it is universal….

The Times leader 20th May 2017: the Art of the State

All parties in this election share a belief in big government. If that becomes blind faith, it will be bad news for the economy and public finances

Modern British history is often carved into periods of consensus. The postwar consensus venerated the state. For 30 years no party seriously challenged Clement Attlee’s nationalisations, universal welfare or the heavy regulation and union power established by a war economy. Then came the Thatcherite consensus, and it venerated the market. Privatisation, low tax and deregulation were, in time, accepted even by Labour. The manifestos released this week were in some ways as different as any set in decades. Yet there were whispers of a new consensus, too. All parties emphasise the role of the state. They should be careful not to forget what is good in Mrs Thatcher’s legacy.

Nobody expected a swashbuckling treatise on the virtues of economic liberalism from Jeremy Corbyn. His manifesto was true to form. Proposals for new taxes on income, profit and financial transactions were accompanied by promises of public ownership for Royal Mail, the railways and water, along with the higher spending on public services. The Liberal Democrat manifesto was less economically radical, but not much more economically liberal, its hefty spending promises financed by a mixture of tax rises and borrowing.

If the parties are converging on a new consensus, however, it also warrants scrutiny. The Times supported Mr Cameron’s programme of austerity not only because it was needed to sustain market confidence, but also because too unwieldy a state apparatus chokes the private sector and wastes money. Public spending as a proportion of GDP has fallen in the past seven years, and Britain is now at near full employment. That should be celebrated.

Yet public debt is still high and rising. Cost pressures in the NHS and welfare budgets will put more pressure on the exchequer in the coming years. Despite this no major manifesto has dared question the principle of an NHS free at the point of use. The main parties in this election have defined fiscal prudence as the ability to finance a big state. Any bigger than the present one is too big.

leading article – The art of the state -Times

Postcode lottery in elderly care | News | The Times & The Sunday Times

Elderly homeowners may be forced to pay 56% of their property in …

 

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

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

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

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

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

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

Image result for peril doctor

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

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

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

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

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

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

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

NHSreality on IT systems

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

Image result for peril doctor

 

 

 

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

In the Times this letter from many oranisations on 10th May 2017, under the title “HEALTH REFORMS PLEA” got little publicity because of the Media focus on Brexit. Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”. Is the great thing about a democracy is that the citizens get what they deserve…..  or is it that the uninformed can be led by a right wing press? Governments ration covertly, and it is much more sensible to ration those whose votes count least. Its going to get worse I’m afraid… A Health Tax is a non starter, but so are Sticky Toffee Puddings.
Image result for health tax cartoon
Sir, We want to see an NHS that provides high-quality care, support and treatment to everyone who needs it — and to ensure that our voice is heard during the general election campaign. In particular, we want all politicians standing for election to know of our deep concern with the reforms to the National Institute for Health and Care Excellence (Nice) that the government and NHS England implemented from April 1. These reforms stand to restrict and ration treatments for people with rare and complex conditions, and were implemented without the agreement of parliament.

With that in mind, we urge political parties to commit in their manifestos to reverse these recent reforms, and to guarantee that any future reforms will be considered by parliament before being implemented. We also ask that any decisions to restrict the availability of Nice-approved treatments are taken by democratically-elected politicians.
Deborah Bent, Charity Manager, Limbless Association; David Bickers, CEO, Douglas Bader Foundation; Kay Boycott, CEO, Asthma UK; Roger Brown, Chair, Waldenstrom’s Macroglobulinemia UK; Nic Bungay, Director of Campaigns, Care and Information, Muscular Dystrophy UK; Liz Carroll, CEO, The Haemophilia Society; Tanya Collin-Histed, CEO, Gauchers Association; Ann Chivers, CEO, Alström Syndrome UK; Genevieve Edwards, Director of External Affairs, MS Society; Sue Farrington, CEO, Scleroderma & Raynaud’s UK; Steve Ford, CEO, Parkinson’s UK; Kye Gbangbola, Chair, Sickle Cell Society; Deborah Gold, CEO, National AIDS Trust; Caroline Harding, CEO, Genetic Disorders UK; Tess Harris, CEO, The Polycystic Kidney Disease Charity; Dr Lesley Kavi, Postural Tachycardia Syndrome UK (PoTS UK); Anne Keatley-Clarke, CEO, Children’s Heart Federation; Caroline Morrice, CEO, GAIN; Allan Muir, Development Director and Type II Co-ordinator, Association for Glycogen Storage Disease (UK); Patricia Osborne, CEO, Brittle Bone Society; Jill Prawer, Founder and Chair, LPLD Alliance; Lynne Regent, CEO, Anaphylaxis Campaign; Richard Rogerson, Niemann-Pick UK; David Ryner, The CML Support Group; Timothy Statham OBE, CEO, National Kidney Federation; Laura Szutowicz, CEO, HAE UK; Paddy Tabor, CEO, British Kidney Patient Association; Jeremy Taylor, CEO, National Voices; Oliver Timmis, CEO, Alkaptonuria (AKU) Society; Gabriel Theophanous, President, UK Thalassaemia Society; Sarah Vibert, CEO, The Neurological Alliance; Dr Susan Walsh, Director, Primary Immunodeficiency UK

Chris Smyth reports a day later, May 11th: Hospital bosses demand another overhaul to sort minister’s mess

….new laws to overhaul the health service are likely to be needed by the end of the next parliament even though they are still struggling to implement the most recent changes…..One STP head said: “It’s a huge problem. Everything takes ages, but the difficulty with legislation is that it’s an implicit recognition that Andrew Lansley f***ed everything up.”…..Niall Dickson, chief executive of the NHS Confederation of senior managers, said: “It’s a no-brainer that you will need at some point a legislative underpinning for the structures….Senior Conservatives regretted the changes almost immediately, with one cabinet minister saying it was the coalition’s biggest mistake. The disruption distracted from the central task of making big financial savings and when Mr Lansley was demoted in 2012, his vision failed to take. Simon Stevens began reversing key elements of the reforms barely two years after they were completed.

Read the full article below..

Hospital bosses demand another overhaul to sort minister’s mess

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

Chris Smyth: Ageing population brings risk of stroke epidemic

Chris Smyth: Saving for dementia bill would take century

Andrew Harrap: This could be the health tax election

Sustainability and transformation (rationing) plans – surely STPs deserve a better acronym…

The Inefficient English Health Service is compared with the German one. Hypothecated Taxation with choice of provider?

Image result for health tax cartoon

 

 

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

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

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

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

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

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

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

GP funding

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

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

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

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

Locum GPs

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

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

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

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

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

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

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

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

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

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

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

Image result for each for himself cartoon

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

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

Image result for health tipping point

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Doctors warn NHS is rationing best drugs to cut costs

Far better to have fairness in rationing so that all of us know what is excluded, wherever we live. Devolution and GP Commissioning have ensured inequality, and covert rationing of fearful conditions. Remember, drugs do not improve the health of populations… This is an issue for public health consultants, but are there any left?

Image result for public health cartoon

Jon Ungoed-Thomas in the Sunday Times 16th April reports: Doctors warn NHS is rationing best drugs to cut costs

Hospital doctors have revealed how some of the best available medicines are being rationed by the NHS in a cost-cutting drive.

Doctors including gastroenterologists, rheumatologists and dermatologists say they are being prevented from prescribing the most appropriate drugs by their local clinical commissioning groups (CCGs).

CCGs are already reducing the number of hip and knee operations by using pain thresholds to ration procedures.

Now a survey of 200 clinicians, commissioned by the drugs company UCB and conducted by ComRes, has found that seven out of 10 clinicians claim NHS funding pressures have restricted their ability to prescribe approved medications.

The Breast Cancer Now charity revealed last year that some women were missing out on a potentially life-saving drug that costs 43p a day. Bisphosphonates cut the risk of cancer spreading to the bone, but many CCGs have blocked their use.

Dr Thomas Sheeran, a consultant rheumatologist at the Royal Wolverhampton NHS Trust, said bureaucratic hurdles and financial restrictions were hampering clinicians. “It’s frustrating that the people we have to try to persuade are accountants and the CCGs,” he said.

In one case last year he said a woman at risk of going blind was turned down by her local CCG for £2,000 of drugs to save her sight. The woman was admitted as an emergency patient so the trust could pay for treatment.

The drug in question, infliximab, is approved for use by the National Institute for Health and Care Excellence (Nice) for some conditions, but the treatment for this patient was considered experimental.

Sheeran said another drug used to treat arthritis and approved by Nice, abatacept, was not being permitted by Wolverhampton CCG for some patients.

He said there were concerns that patients who were not given the most suitable drug were more likely to be readmitted to hospital, so the drive to cut the drugs budget was in fact not cost effective.

Patients are entitled to drugs approved by Nice for specific conditions, but there is often no national guidance and CCGs make their own funding decisions.

A spokesman for NHS England said: “As the NHS goes into the most financially challenging few years in its history, it is right that we strive to ensure maximum value for patients from every penny available, but ultimately these are legally decisions for clinical commissioning groups, informed by best evidence and national guidance where appropriate.”

A spokesman for Wolverhampton CCG said that although it could not comment on individual cases, “a number of individual funding requests have been approved for the prescribing of abatacept”.