Category Archives: Post Code Lottery

Tax and control: of course drugs should be legalised. We would have more for cancer treatments…

Legalising the production, purity, distribution, and sale of drugs makes sense. By controlling the processes above the criminals will need to  stop or change into a different field. We as citizens stop spending on prevention and punishment in a system that produces more criminals in training schools (prisons). The savings from both prison and police can be spent on providing a better health service. Wales might even find the money for Cancer Cervix victims..

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Louis Emmanuel in the Times: Uruguay becomes first country to legalise cannabis sales over the counter

Valentine low in the Times reports the royal prince: Should drugs be legalised, asks Prince William

It is a debate that has divided society for decades, with libertarians, hippies and the state of Colorado on one side, and conservatives and anxious parents on the other. Now the Duke of Cambridge has raised the question: is it time for drugs to be legalised?
He spoke out as he visited a charity in east London that helps people with addictions.
Prince William, 35, told a group at the Spitalfields Crypt Trust in Shoreditch who had all been helped by the charity: “Can I ask you a very massive question — it’s a big one. There’s obviously a lot of pressure growing on areas about legalising drugs. What are your individual opinions on that?
“You seem like the key people to actually get a very good idea as to what the big dangers here are.”
Heather Blackburn, 49, from Hackney, said: “I think that it would be a good idea but the money is kind of wasted on drug laws that put people in prison . . . of the people I’ve known in recovery, 95 per cent have massive trauma and terrible stuff happen to them and using drugs to cope and then you get put in prison, you don’t get the facilities and actual help you need.

“ You get punished — which is not going to stop anyone taking drugs.”
William asked: “So there needs to be more of a social element to it?. . . So prison doesn’t tackle the root cause of why someone is taking drugs?” Ms Blackburn replied: “No, it just punishes.”
A royal aide said that while William had been careful not to proffer an opinion, “he has long taken a keen interest in the issue of homelessness and is not immune to the fact that addiction can play a big part in this”.
The aide added: “If there is a social issue then he believes it is important not to talk about it in the abstract but ask questions of and listen to those who are affected.”
A spokesman for Transform, the think tank pressing for a change in drug laws, said: “Transform is delighted that Prince William has the courage to ask one of the most crucial questions of our time . . . legalisation would better protect the most vulnerable people by putting government, not gangsters in control of the drug trade.”

The National Drugs problem: Stop Prohibition – even Mr Clegg might be getting there..

BBC Wales: Welsh women denied cervical cancer drug on NHS


90% of GP care is good quality. Are you lucky enough to be in a post code with good GP care and good choice?

I am still asked “how should I choose my GP practice”, and I usually give a guarded reply which amounts to “It depends what functions/services you value most”. Continuity of care is a rarity these days, and with more and more part time GPs the problem will get worse. Patients are not “ill” on days that suit a Dr working 2-3 days a week. Children are ill suddenly, and so practices where partners offer a daily surgery, albeit with a different doctor, are valued. One thing to consider is whether there is an “individual list” system, or a “shared list” system. In the former it can be harder to see your doctor, but it may be worth waiting especially for older patients with chronic conditions. In the latter system patients are often fitted in quickly but usually see a different Dr each time if it is an emergency (as defined by the patient)! Mothers of young children usually prefer this type of system, but not always. Does the practice have an active Patient Participation Group?Other things to consider are whether the practice is a teaching practice, what the turnover of staff is, and whether they have a QPA (Quality Practice Award) which is in date. If you know a family who have had a death recently, the quality of any palliative or terminal care is pertinent, but remember “dead patients don’t vote“. Despite all this, and the Care Quality Commission report, most patients will still ask their neighbours…

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It’s a pity that we don’t know the quality of care for comparison in the other 3 UK health regions, thus emphasising that there is no NHS. Rather than reporting the bad news, the Times could report that 90% of GP care is good quality, and ask “Are you lucky enough to be in a post code with good GP care and good choice?” as many areas have reduced choices, even in cancer care.

Chris Smyth in The Times reports 21st September 2017: 7m patients are urged to leave unsafe GP surgeries

Seven million patients are treated at GP surgeries with serious safety problems, according to the first comprehensive review.
Inspectors urged patients to switch to better performing surgeries after finding that one in seven had issues with safety and one in ten was not good enough overall.
They uncovered “pockets of persistent poor care” including out-of-date medicines, a failure to follow up on test results, delayed cancer diagnoses and a lack of checks on the medical qualifications of staff.
Smaller surgeries were more likely to do badly, the review showed, with the worst half the size of the best. They have been ordered to end “professional isolation” by linking with neighbouring surgeries to share resources and expertise.
The Care Quality Commission (CQC) has finished inspecting all 7,365 GP practices that existed when it started its revamped regime three years ago. Nine in ten were good or outstanding, significantly better than hospitals or care homes. It initially found that one in three was not safe enough, forcing inspectors to take action including shutting dozens of surgeries. One in seven still had safety problems, however, covering seven million patients, with 13 per cent “requiring improvement” and 2 per cent, with almost a million patients, “inadequate” for safe care.

“Safety is the one clinical area that we worry about,” Steve Field, chief inspector of GPs, said. “You find surgeries where they have lots of [test] results that haven’t been acted on, they might have out-of-date medication, their fridges might be at the wrong temperature so the vaccines might not work. It’s really poor leadership.”

Professor Field recently had to intervene to replace out-of-date emergency adrenalin that could have led to the death of a patient, he revealed. He urged patients to use ratings on the CQC website to switch to a better surgery. “I was in a surgery two weeks ago where they said they’d had 300 patients move to them because they were rated outstanding,” he said.

The average “inadequate” practice has 5,770 patients compared with 10,126 for the average “outstanding” one. Professor Field said that smaller places often found it harder to stay up to date, manage services well and employ nurses to help patients with long-term conditions. He said that most should be linked to other family doctors and social services. “I suspect that if you’re a weak leader but a good clinician and you’re part of a larger group, the quality of care will be better,” he said.

Ministers have promised GPs £2.4 billion as they struggle with rising patient numbers and Professor Field said that this had to get through before a “winter crisis”. Richard Vautrey, chairman of the British Medical Association GP committee, said: “These positive results are undoubtedly down to the hard work of GPs and practice staff, but many are in an environment where they are increasingly struggling to deliver effective care.”

The union has clashed with Professor Field, insisting that his inspections were not fit for purpose. Dr Vautrey insisted that the process “remains overly bureaucratic and continues to result in GPs spending time filling in paperwork when they should be treating patients”.

Jeremy Hunt, the health secretary, said: “Nearly 90 per cent of GP surgeries in England have been rated as ‘good’ or ‘outstanding’ — and that is a huge achievement for GPs given the pressures on the front line.”

What do we know?

  • Every GP practice has an overall rating shown on the CQC website
  • Each practice is also given sub-ratings assessing whether it is safe, clinically effective, caring, responsive and well-led
  • The NHS GP patient survey assesses whether people would recommend their surgery, whether GPs give them enough time and whether they see the same doctor
  • There is little other official data on GPs
  • Patients can post ratings on websites such NHS Choices

Dead people don’t vote… End-of-life care ‘deeply concerning’

The NHS and reckless election promises. How about posthumous voting?

NHSreality postings related to choosing a practice

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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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A summary of health rationing in the news this last week. Weak (cowardly) politicians have led the NHS to ruin

Just this last week we can see evidence of removal, restriction, limitation or prioritisation decisions made by CCGs or Trusts. In addition the administration are unable to keep up with the complaints and requests for information. I myself have a request on perinatal and maternal mortality pending which is over the 8 weeks at Hywel Dda Trust. There are so many fingers in the dam that there are no hands to repair ur security and health systems.. As for the elderly demented, they don’t vote and don’t seem to matter… An IPR report on Death Dying and Devolution explains clearly the post code and unfair rationing of resources. Weak (cowardly) politicians have led the NHS to ruin 

Mark Smith for Walesonline 6th September: Thousands of complaints against the Welsh NHS are not being handled quickly enough

Health boards claim it is sometimes impossible to respond within the 30-day timescale

Forty percent of Welsh NHS complaints miss target

Tom Knowles exposes the temporary nature of the employment currently offered. In the Times on 12th Septtember: Summer hiring spree for builders and NHS

Adele Couchman in Kentlive on 12th September reports:

The number of nurses specialising in dementia and other mental health problems in the elderly has been cut by a fifth since 2010, according to “incredibly concerning” figures.

Psychiatric nurses treating older people have been among the hardest hit by a reduction in mental health staffing despite government pledges to prioritise the rise in dementia, analysis of NHS data for The Times shows.

While the overall number of NHS nurses has risen slightly over the past seven years, this has been due to increases in acute hospital and maternity services, helped by a recruitment drive after the Mid Staffordshire scandal. Figures from NHS England show that the number of mental health nurses working for the health service fell by the equivalent of almost 5,000 full-time posts between May 2010 and May this year, a drop of more than 12 per cent.

Old age psychiatric nursing is among the worst hit specialisms, with 1,000 full-time posts gone since 2010, a fall of 22 per cent, to 3,541 posts.

Older patients often need more intense monitoring and are susceptible to problems with medication and side-effects. A nurse’s role also involves emotionally supporting patients’ families and helping patients stay independent for as long as possible.

Caroline Abrahams, charity director of Age UK, said: “An ageing population inevitably means we need more psychiatric nurses specialising in work with older people, so the fact their numbers have shrunk by a fifth over the last seven years is incredibly concerning.
“Historically, older people’s mental health needs have often gone undiagnosed and been overlooked and these depressing figures provide no cause for optimism that the situation will improve any time soon.” She called for urgent government action. With psychiatrists for the elderly also overstretched, doctors say they are increasingly reliant on specialist nurses to help manage the rising need for treatment.
More than 850,000 people in Britain have dementia, a figure which is expected to pass a million within seven years.
Hilda Hayo, head of Dementia UK, said that the charity’s specialist dementia nurses and helpline were picking up cases of families under increasing pressure as a result of the loss of nurses.
“These reductions are coming at a time when people live for longer but are not necessarily healthier — and dispersed families are unable to provide the support needed,” she said. “More families are going into crisis and having to make decisions which may result in earlier admission to hospital or a care facility due to the lack of community support.”
A Department of Health spokesman said: “This government is committed to improving care for those with mental health conditions, which is why we have started one of the biggest expansions of services in Europe.
“Our ambition is to create 21,000 new posts by 2021 by supporting those already in the profession to stay and giving incentives to those considering a career in mental health.”

Death Dying and Devolution

Weak (cowardly) politicians have led the NHS to ruin

West Wales Health has to have a future – somewhere in the “middle” ground… Back to 2006 and reversing the wrong decision taken then not to build a new Hospital.

Pembrokeshire and the Welsh health services are degenerating rapidly. In the Pembrokeshire Herald on September 1st 2017 Jon Coles writes  “Minister’s answer raises more Withybush questions. But it is the staffing crisis across the nation (see Times letters; page down) which is the issue, due to political denial and short termism. This is a template for the debates going on all around the country.

The article rightly points out the problems of recruitment and retention, but gives the impression that this problem could be solved locally. It is of course a National problem, of rationing of medical student capacity over decades, and of a gender bias towards female doctors, who work fewer life hours.  The gender bias is a result of undergraduate recruitment, and could be addresses by graduate recruitment. The problem of few applicants from rural schools and deprived areas needs to be addressed by adverse selection. State supported places at Medical School are a majority in the UK, but this is not the case abroad. So more and more determined applicants who are rejected may choose to train in Prague or in Malta. This is a National Problem and the “rules of the game” mean Hywel Dda is going to fail. To attract medical staff for the next decade areas such as Pembrokeshire need to combine resources with surrounding areas, and have high tech cold surgical units in their centre. 

The “middle” ground is around Whitland or St Clears. Funny than was mentioned some time ago…

Katy Woodhouse in the Western Telegraph writes: Last chance to have a say on health services changes 

As if the Trust are going to take any notice. Utilitarian decisions taken for the people of West Wales mean that each District General Hospital will lose a little, but the overall result could be better eventually, provided there is adequate funding and the longer term rationing of medical student and nursing places is corrected. Do attend the last meeting in Pembroke Dock on Friday 15th September, and then reflect in a decades’ time… Kate implies that the Trust are reconsidering the plans of 10 years ago!

IT may feel like deja vu but the idea of a new hospital between Haverfordwest and Carmarthen has been raised again, over ten years since it was suggested by the then health board.

As Hywel Dda Health Board prepares to make more changes to services in the area – stating that changes need to be made – residents are being urged to have their say.

The current consultation on ‘transforming services’ and mental health provision are drawing to a close and Hywel Dda state there have been a number of surprising suggestions made by those who have already taken part.

“I’d like to thank everyone so far who has taken the time to attend an event, write us a letter or fill in our survey. We understand that this may not be a new message to most, that you may have heard us say many times in the past that the NHS needs to change. But what is different this time is that we have our doctors and services telling us that if things don’t change, our money and the time and expertise of our staff will be spent on simply maintaining the same services and plugging gaps.
“In the field of medicine we should be investing in new ways of working, modern buildings and giving our staff the time to change the way they work for the benefit of their patients. It is time to move forward and no longer stand still.
“So I’d like to formally invite any Pembrokeshire residents who haven’t yet shared their thoughts to come to Pater Hall and make their voices heard. Now is the time for people to speak up and share their ideas and experiences to help make the NHS in mid and west Wales the best it can be.”


Sir, Most people realise that there is a looming crisis in the NHS because of the growing shortage of capable and qualified people available to work in it at all levels. It is perhaps less well understood that this manpower shortage will be greatly exacerbated by the impact of Brexit. If solid reassurances are not forthcoming in the near future, there is a real risk that the quality of the service people expect from the NHS will deteriorate. We are already seeing staff who are EU citizens leaving the NHS or seriously considering their options for the future. This should concern us all.

While I acknowledge the complexities of negotiating with EU officials representing the interests of 27 other member states, and the need to seek guarantees for UK citizens in living and working in Europe, surely the prime minister and her ministerial team could do more now to assuage the fears of our EU colleagues.

If nothing is done now, then we face the very real threat of highly qualified and valued members of staff leaving in ever greater numbers in a relatively short period of time. Nobody should underestimate the dire consequences if and when this scenario becomes a reality over the coming months.
Tim Melville-Ross

Chairman, Homerton University Hospital NHS Trust, and former director-general, Institute of Directors

Breaks Ranks 24052006

Patients in same street get different NHS care. Neighbouring surgeries provide sick with different levels of care.

 We need to go back to Aneurin Bevan and re-examine the fundamental reasons for the UK health services. We all pay under the same tax regime and should have universal fair and equal access, but this does not mean rationing out some services is impossible.
Rationing by post-code exclusion, covertly, and in a way that means patients are unaware of the lack of cover until they need it is morally wrong.
The only fair way is overt rationing. Since technology will continue to outstrip the states ability to pay there will also be some low volume high cost treatments we have to ration or exclude. Our system needs to be good enough, and with short waiting lists, so that these conditions are as few as possible.
Identity cards giving access to health care, and at the same time tax codes, could be used to create differential co-payments. These might be accepted if the standards were high, there was meaningful choice, and if waiting times were low. The opposite is true at present, and the under capacity looks to be getting worse.
The result of training too few of our own, and importing form abroad is disillusion. Short termism in political thinking has led to a crisis which will get worse and result in two tiers of health: state and private and the dishonesty has disengaged the professions. This is exactly what Aneurin Bevan wished to avoid.

Kat Lay and Tom Wills, Times Data Team report in the Times 3rd July 2017: Patients in same

street get different NHS care

Patients are facing a lottery of services from GP surgeries even within the same postcode, a Times investigation has found.

People attending different GP practices in the same building face huge variations in waiting times for the same procedures, the analysis shows.

Choosing one practice over another could influence whether it is possible to have a baby after fertility treatment, or mean waiting five weeks longer for knee surgery, according to the study.

The Times data team analysed the addresses of all English GP surgeries and found 120 pairs within 500 metres of each other that were governed by separate clinical commissioning groups (CCGs), the GP-led bodies that decide what the NHS will pay for locally.

Many had identical postcodes and all are thought to accept patients from the same or overlapping areas, but provision varied wildly within the pairs.

Some of the starkest variations occurred in fertility treatment. At the Museum Practice in Camden, north London, patients can have three cycles of IVF. However, 327 metres away, patients at Covent Garden Medical Centre would be offered only one. The discrepancy occurs because of different policies followed by Camden and Central London CCGs.

Infertile patients at Bawtry Health Centre, near Doncaster, will be offered three cycles of IVF, but patients at Mayflower Medical Practice in the same building will be offered two.

Waiting times for treatment can also vary, in some cases by months. In Birmingham, Modality Attwood Green is on the second floor of the same building as Bath Row Medical Practice, which is one floor down.

Bath Row comes under Birmingham South and Central CCG, where patients requiring general surgery face an average wait of 12.4 weeks. Modality Attwood Green is governed by Sandwell and West Birmingham CCG, where the waiting time for general surgery is 7.4 weeks.

On Stroud Green Road, in Finsbury Park, north London, the Stroud Green Medical Centre and the 157 Medical Practice are a few doors apart. The former comes under Islington CCG, with an average 11.8-week wait for general surgery, the latter under Harringey CCG, where the general surgery wait is 7.4 weeks.

A spokesman for the Royal College of Surgeons said: “It will no doubt surprise and anger people to discover that patients visiting GP practices in the same building, or indeed very near by, could have different access for surgery . . . Commissioning groups must investigate why their waiting times are so much longer than their neighbours.

John Kell, head of policy at the Patients Association, said: “Expecting patients to have the understanding of the system needed to navigate these complexities, for instance by choosing a GP practice based on the CCG it sits under, is obviously ridiculous.”

Chaand Nagpaul, chairman of the BMA’s GP committee, said that the “arbitrary drawing of lines on a map” to create CCGs had led to “a serious and unfair postcode lottery”.

Under the Health and Social Care Act 2012, CCGs are responsible for paying for the NHS care of any patient registered at any of their member GP surgeries, but can set their own policies on what they will fund.

Susan Seenan, chief executive of the Fertility Network UK charity, said: “This highlights how utterly unfair access to NHS fertility treatment is in England. An individual’s choice of GP practice should not determine the medical help they will receive and yet, this is what is happening: if you register with one GP you will have a chance to have a baby with IVF, but if you’re unlucky enough to choose another practice you will not.

“Sadly, not all patients realise that their choice of GP practice can determine whether they receive fertility treatment or not, or how much clinical care they receive.”

Under a “capped expenditure process”, local NHS leaders have been told to consider further cuts. Measures could include extending IVF limits or increasing waiting times for elective surgery.

Julie Wood, chief executive of NHS Clinical Commissioners, said that commissioners had to take into account the needs of the local population and their finite funding so it was “right and inevitable” that there would be variation in provision. She added: “We appreciate this can be difficult for some patients, and particularly sharply felt when relating to neighbouring areas.”

Behind the story
Most patients choose their nearest GP but few realise that this can influence which treatments the NHS might offer (Chris Smyth writes).

When people use an NHS hospital, the bill is sent to their GP’s clinical commissioning group. The groups control £77 billion of NHS cash, deciding what care they will pay for.

Created by Andrew Lansley’s reforms in 2012, GP-led commissioning groups were meant to allow doctors to use this clout to tailor services to their patients’ needs. Yet an NHS squeeze has meant that cost control has become an ever-bigger part of decisions. Stories abound of CCGs cutting back on fertility treatment, curbing surgery or restricting care for the obese and smokers.

Few patients shop around for a group with a favourable approach to fertility treatment, for example, but they have that right. They are entitled to register with any GP, providing the surgery is willing to accept them. Treatment decisions would then be taken by that practice’s CCG. The right to choose a GP for reasons other than proximity is not widely exercised, but some may soon feel it is worth their while.

Everything for everyone for ever for free?

Families asked to feed dementia patients…. How do we design a system that is fair to both the well spread, and the very locally based families?

The quality of care that demented and dementing patients are receiving is inadequate. There is not enough funding, in any system, and especially one without rationing, to provide the quality of care needed. ( National Dementia Audit: Important improvements in dementia care, but more support needed report finds) If you have a stroke, or have cancer, the treatment deficit is similar. These people won’t have votes for much longer, but they have paid into the safety net. So what is to be done: an open and frank discussion about the need to ration, and then an informed discussion of the options and the implications of those options…. It may be reasonable that, where possible, families should feed their relatives in todays financially constrained world. But this is rarely possible in our mobile society. Many UK children think internationally rather than nationally ( hence the Brexit differences between generations), and are working intensive days. Should the next generation be contributing financially if they cannot contribute with care/feeding? How do we design a system that is fair to both the well spread, and the very locally based families? And do this before we are completely swamped?

An educational imperative on Advanced directives might help reduce the numbers….

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Chris Smyth reports 22nd July in the Times: Families asked to feed dementia patients

Families must be drafted on to wards to feed relatives with dementia who are routinely going hungry in hospital, a comprehensive audit of NHS care concludes. One in four staff caring for dementia patients says they cannot feed them properly, with some resorting to sharing their own food, the study by leading doctors found.
Overstretched hospitals can struggle to provide meals when people need them and do not have the staff to ensure vulnerable patients actually eat what is put in front them, the figures suggest.
Oliver Corrado, consultant geriatrician and author of the report, argued that if families helped out more, it would also be good for those without relatives…….

….“we can’t subcontract out feeding people”, saying it would be “awful” if families felt they had no choice but to come in at mealtimes.
Ms Carter said the system worked well in hospitals where staff discussed with relatives what role they wanted to play and both showed flexibility.
Eileen Burns, of the British Geriatrics Society, said: “On the surface it might be perceived as simply a cost-saving exercise but in reality it is often highly beneficial for older patients with dementia. Relatives and carers can help create a supportive, familiar environment.”

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Understanding NHS financial pressures and how they are affecting patient care (The Kings Fund report) by Ruth Robertson, Lillie Wenzel, James Thompson, Anna Charles 14th March 2017

Harvard Medical School and Medical Publications: Practical advice for helping people with dementia with their daily routines – 7 ways to make life easier and more rewarding for demented people

( National Dementia Audit: Important improvements in dementia care, but more support needed

report finds) Simple Measures: National Dementia Audit: Important improvements in dementia

care, but more support needed report finds 

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Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

An advanced directive or living will – It’s important to specify, especially lying flat. Good news if you take action.