Category Archives: Professionals

Another form of rationing: restriction of GP access should be blamed on politicians

Chris Smyth reports on March 7th 2018 in the Times: GP leaders draw up plan to turn away excess patients

This is merely another form of rationing: restriction of GP access should be blamed on politicians. They have inadequately planned for the increasing demands of an ageing population. They have mismanaged the manpower planning – for 10 successive administrations. They have ignored the work-life-years lost by the gender imbalance, and they remain in denial. The unreality of 5000 new GPs…. and killing the geese that laid the golden eggs of efficiency. (GPs)

Family doctors will be able to turn away patients once they have done 35 appointments in a day under plans drawn up by GP leaders to deal with overwhelmed surgeries.

Once doctors have exceeded a safe daily number of consultations, extra patients would be sent to an overspill centre further away in a system modelled on the “black alerts” that allow overstretched hospitals to divert ambulances elsewhere.

The British Medical Association (BMA) insists that the plan will make patients safer because they will no longer be treated by exhausted doctors who are more likely to make mistakes. It also argues that capping workloads will prevent the GP system from collapsing as doctors fed up with rising patient numbers increasingly desert the NHS.

However, patient leaders attacked the “dangerously crude” plans and NHS chiefs insisted they must not go ahead.

Ministers have accepted that GPs can no longer cope with a “hamster wheel” of rising numbers of older, sicker patients and have promised an extra 5,000 doctors by 2020. However, GP numbers fell by more than 1,000 last year, fuelled by rising numbers of early retirements. Patient satisfaction with the GP service dropped 7 percentage points last year to a 35-year low of 65 per cent.

The BMA acknowledges that there is “surprisingly little” evidence defining when a GP’s workload becomes unsafe, but suggests that anything below 25 routine appointments a day is fine, with danger levels reached at 35, or 15 more complex consultations. It says that local areas should be able to set their own limits.

A poll by the health magazine Pulse this year suggested that GPs did an average of 41 appointments or phone calls a day, with 1 per cent dealing with more than 100 patients daily.

Richard Vautrey, chairman of the BMA GP committee, said: “GP workloads have become increasingly unmanageable owing to the demands of more complex patient needs, widespread recruitment issues and years of underinvestment, all of which takes a toll on GPs’ physical, mental and social health.

“There is an urgent need for cultural shift. Having a system of overworked and undervalued GPs is unsustainable, and a change to safe working practices is vital to ensure the survival of general practice.”

In a report, the BMA acknowledges the practical difficulty of finding somewhere else to send patients, proposing a system of local “overflow hubs”. It also concedes that many doctors will be reluctant to turn patients away, saying that the black alert system “will require a cultural change to remove the current noble but potentially self-destructive urge within general practice to simply work harder and longer to meet patients’ needs.”

The Royal College of General Practitioners is supportive, with its chairwoman, Helen Stokes-Lampard, saying: “Hospitals have ‘black alerts’. They don’t use them when they don’t need to — they only use them when they can’t cope, to protect patient safety. We don’t have an equivalent in general practice, but we need one, as it is not safe for patients to be seen by fatigued doctors and their teams.”

However, a spokesman for The Patients Association said: “Blanket decisions not to see patients above a fixed number would seem dangerously crude, and guarantees cases of people not getting treatment and care at critical times, with serious consequences for their health.”

NHS England said: “While arbitrary caps on patient appointments would breach GPs’ contracts, we understand the pressures general practice is facing. That’s why the NHS is investing £2.4 billion extra in GP services, growing the number of new doctors entering general practice and rolling out evening and weekend appointments to patients across England over this coming year.”


Should there be lighter regulation in order to reduce inequalities? How high earning professions lock their competitors out of the market. Old style GPs are becoming extinct.

Doctors in full time work are high earners. More and more doctors are part time, which brings earnings to average. The pressures and drivers to this part time medical profession are well documented on NHSreality but it is the patient who suffers. The lack of continuity of care, of palliative and terminal care from your family doctor, and subsequent distrust and disillusion with General Practice are evident. The goose that laid the golden eggs is becoming extinct.  This article is food for thought. Should there be lighter regulation in order to reduce inequalities?

In the Economist Feb 17th 2018: ” How high earning professions lock their competitors out of the market ” derives how to rig the market!

EVERY month Debbie Varnam of Shallotte, North Carolina, must pay a doctor’s bill. It is not for treatment. Ms Varnam is a “nurse practitioner”, a nurse with an additional postgraduate degree who is trained to deliver primary care. North Carolina, like many states, does not allow nurse practitioners to offer all the services they are trained to provide. Ms Varnam cannot, for example, prescribe the shoes diabetics often need to prevent the skin on their feet from breaking down. To do so, she needs the approval of a doctor. So Ms Varnam employs one. For about $1,000 a month, the doctor reviews and signs forms that Ms Varnam sends him. The doctor, she says, has a similar arrangement with five other offices.

Occupational licensing—the practice of regulating who can do what jobs—has been on the rise for decades. In 1950 one in 20 employed Americans required a licence to work. By 2017 that had risen to more than one in five. The trend partly reflects an economic shift towards service industries, in which licences are more common. But it has also been driven by a growing number of professions successfully lobbying state governments to make it harder to enter their industries. Most studies find that licensing requirements raise wages in a profession by around 10%, probably by making it harder for competitors to set up shop.

Lobbyists justify licences by claiming consumers need protection from unqualified providers. In many cases this is obviously a charade. Forty-one states license makeup artists, as if wielding concealer requires government oversight. Thirteen license bartending; in nine, those who wish to pull pints must first pass an exam. Such examples are popular among critics of licensing, because the threat from unlicensed staff in low-skilled jobs seems paltry. Yet they are not representative of the broader harm done by licensing, which affects crowds of more highly educated workers like Ms Varnam. Among those with only a high-school education, 13% are licensed. The figure for those with postgraduate degrees is 45%.

More educated workers reap bigger wage gains from licensing. Writing in the Journal of Regulatory Economics in 2017, Morris Kleiner of the University of Minnesota and Evgeny Vorotnikov of Fannie Mae, a government housing agency, found that licensing was associated with wages only 4-5% higher among the lowest earning 30% of workers. Among the highest 30% of earners, the licensing wage boost was 10-24% (see chart 1). Forthcoming research by Mr Kleiner and Evan Soltas, a graduate student at Oxford University, uses different methods and finds no wage boost at the bottom end of the income spectrum, but a substantial boost for higher earners.

One way of telling that many licences are superfluous is the sheer variance in the law across states. About 1,100 occupations are regulated in at least one state, but fewer than 60 are regulated in all 50, according to a report from 2015 by Barack Obama’s White House. Yet a handful of high-earning professions are regulated everywhere. In particular, licences are more common in legal and health-care occupations than in any other (see chart 2).

These professions share two characteristics. First, it takes years of study—and often lots of student debt—to join them. Becoming a doctor takes a four-year undergraduate degree, a four-year postgraduate degree, and then a multi-year medical residency. Those barriers to entry mean that once the law requires the involvement of a doctor, costs soar. Yet it surely does not take all that training, argue nurse practitioners, to know when to prescribe diabetic shoes. The evidence is on their side. A review of the literature in 2012, paid for by the federal government, found that no study raised concerns about the quality of care offered by nurse practitioners. There are plenty of comparison points, because 22 states have overcome doctors’ objections and given nurse practitioners so-called “full practice authority”.

Second, it is often practitioners themselves who define—and expand—the boundaries of the regulated profession. For example, in North Carolina a board of dentistry, mainly elected by dentists themselves, regulates the profession. In 2006 it tried to stop hygienists and beauticians from whitening customers’ teeth, after dentists complained that they were being undercut on price. (The Federal Trade Commission (FTC) objected, and in 2015 the Supreme Court put a stop to the practice by ruling that the board was not exempt from competition law.)

Occupy K Street

Both problems are acute in the legal industry. Almost every American state forbids those who do not have a three-year law degree from providing most legal services. Bar associations—composed of lawyers themselves—often define what counts as legal practice. In 2000 the American Bar Association, after rejecting a proposal to allow lawyers to split fees with non-lawyers, asserted that “the maintenance of a single profession of law” was a core priority. “In no other country does the legal profession exert so much influence over its own regulatory process,” writes Deborah Rhode of Stanford University in her book “The Trouble with Lawyers”. Outsiders typically cannot even invest in law firms, limiting funding for innovative new business models, such as providing fixed-fee legal advice over the internet, or through retailers. Even those who are qualified can struggle to compete across state boundaries, because of the need to pass a separate bar exam.

Advocates for reform compare America’s model unfavourably with that of Britain. There, non-lawyers have a built in majority on legal regulatory bodies, which are tasked with promoting competition as well as protecting consumers. Outside court, anyone can offer legal advice, or provide basic legal services like drafting documents. The result seems to be cheaper access to justice, and more innovation. The World Justice Project ranks America 96th of 113 countries for access to and affordability of justice, sandwiched between Uganda and Cameroon. (It does not help that there is hardly any legal aid.)

American policymakers are increasingly aware of licensing’s potential to chill competition. In 2017 the FTC launched a task force on “economic liberty” to campaign against unnecessary licensing. Some states have implemented reforms in recent years. Arizona rolled back some licensing requirements in 2016 and has since made it easier to challenge regulations in court. Last year Mississippi brought its licensing boards under closer supervision. Delaware, Nebraska and Wisconsin are considering proposals for reform.

State courts can also intervene. In 2015 the Texas Supreme Court struck down a law requiring eyebrow-threaders to obtain expensive and unnecessary training in cosmetology. The judges found that the Texas constitution guarantees a minimum level of economic freedom from regulation. Some scholars think such a right can be found in the federal constitution, implicit in the right to “due process”. The federal courts have mostly resisted this idea since a Supreme Court ruling in 1955 gave states plenty of room to regulate their economies as they themselves saw fit. But President Donald Trump’s appointments to the federal courts might help “shift the centre of gravity” on the issue, says Dick Carpenter of the Institute of Justice, a libertarian legal charity, optimistically.

When it comes to medicine and law, however, it can be hard to convince the public that some licensing requirements are frivolous. California not only requires that nurse practitioners are supervised by doctors, but also bans doctors from overseeing more than four. Three liberalising bills, which would have given nurse practitioners full-practice authority, have failed since 2007. The California Medical Association, a trade group for doctors, has campaigned hard against reform.

The medical and legal professions account for around a quarter of the top 1% of earners, whose incomes have grown faster in America than in other rich countries in recent decades. A study published in Health Affairs, a journal, in June 2015 found that the average doctor earns about 50% more than comparably educated and experienced people in other fields. Another study, from 2012, put the wage premium from working in law at 23%.

Doctors are also unusually well-paid compared with those in other countries. The average general practitioner earns $252,000 and the average specialist $426,000, according to the Bureau of Labour Statistics. According to OECD data on a handful of other rich countries, the averages there were $130,000 for generalists and $273,000 for specialists in 2014. (These figures adjust for differences in living costs, and include only self-employed doctors, who tend to earn more.)

More competition would surely bring both wages and prices down. And less licensing across the board would make entrepreneurship easier. It might even palliate populism, which is partly driven by voters’ sense that the economy is rigged to benefit the rich and powerful—a hypothesis which the evidence on licensing plainly supports. Politicians in distant Washington are usually the target of populist anger. But most licensing laws are local. Those looking to level the economic playing field could start closer to home.

GPs less popular: You cannot expect an under manned and underfunded service to maintain it’s all star rating, especially in our media led society.

Ian Westbrook reported 28th Feb 1018 for BBC news: Satisfaction with GP services at record low.. Correspondence in the Times 1st and 3rd March follows. You cannot expect an under manned and underfunded service to maintain it’s all star rating, especially in our Media led society. But since there is less continuity, less involvement in terminal care, and no emergencies, the shops of the job has changed, and distilling has been exchanged for quality of life.


…Only 57% of people were happy with the service – the lowest level since 2011 – while dissatisfaction has risen to 29% – the highest level in a decade.

Bar chart showing reasons for dissatisfaction with the NHS

The survey was conducted by the National Centre for Social Research (NatCen) and analysed by the Nuffield Trust and the King’s Fund think tanks.

A nationally representative sample of 3,004 people in England, Scotland and Wales were asked about their overall satisfaction with the NHS and 1,002 of them were also quizzed about their satisfaction with individual NHS services.

Sir, Further to your report “Patients give GPs lowest satisfaction rating for 35 years” (Feb 28), public perception of GPs changed irreversibly in 2003 when Tony Blair’s government allowed them to opt out of responsibility for 24-hour care. The tragic case of Ellie-May Clark (report, Feb 27) highlights (among other failings) how the GPs caring for her did not “know” her. That this five-year-old girl had a history of severe asthma should have been indelibly imprinted on her own GP’s memory rather than in a hospital letter in the depths of the computer record.

Attending one’s own patients in the middle of the night or at the weekend added an inestimable level of respect in the relationship between GP and patient. This has been further eroded with the trend towards part-time working and portfolio careers, and will sadly never be regained.
Dr Andrew Cairns

Retired GP, Liss, Hants


Sir, Dr Andrew Cairns (letter, Mar 1) falls into the (rose-tinted) common trap of a retired GP. Over the past 20 years GP workload has increased considerably. When I started as a GP in 1991, our practice did all the “on call” for our patients. There was time to rest between morning and afternoon surgery to gather strength for an evening and night on call. Now there is no spare time in the day, and in my view it would be very difficult to find a GP who thought that doing an evening and night on call after a non-stop 11-hour day would be a safe option, even if there were benefits to the doctor-patient relationship.
Dr Steve Brown

Beaconsfield, Bucks


Are there any administrators in the declining UK health services? We need more professionals, and we get managers.

The recent headlines on health service management numbers reveals the impotence of the politicians. The fact is that these are administrators who sore paid as managers. They need contraception and/or sterilization, rather than reproduction. Perhaps they are “cloning” in preparation for the thousands of new doctors they are recruiting from thin air…… are there any administrators? The emperors (politicians) have no clothes.

Chris Smyth reported in the Times 1st march 2018: NHS manager numbers up, but GP and nurses down. And he had warned us before, on 17th February with Hiring of NHS managers soars by over a quarter In  only 5 years.

NHS manager numbers have risen by a quarter in five years and are higher than before the implementation of reforms designed to cut bureaucracy.

The increase in administrative staff far outstrips that for doctors and nurses over the same period, provoking anger from health unions.

More than 6,000 managers have been hired since April 2013 when controversial reforms by Andrew Lansley, then health secretary, came into effect, abolishing more than 150 NHS organisations and making thousands redundant.

The Times has previously revealed that pay-offs for managers have cost £2 billion, with at least £92 million given to staff who were quickly rehired. They included a married pair of NHS managers who were given new jobs at the same hospital months after a redundancy settlement of £1 million between them.

Jeremy Hunt, the health secretary, has defended the reforms on the ground that they had saved money by cutting bureaucracy. Yet analysis of NHS Digital figures by the Health Service Journal finds that manager numbers have grown almost without interruption since the reforms took effect.

The 26,051 full-time equivalent managers and senior managers in April 2013 grew to 32,133 in October last year. This exceeds the 31,041 recorded on the eve of the reforms in March 2013.

The latest figures include a 26 per cent increase in senior managers, who earn £77,653 on average, to 10,279. Ordinary managers earn an average of £47,459.

Nursing numbers have increased by 4.6 per cent since April 2013, to 287,147, but there is concern about the rising numbers of nurses that left the NHS last year. Doctors are up 11 per cent to 109,679.

Janet Davies, chief executive of the Royal College of Nurses, said: “The public don’t want to see the NHS haemorrhaging nurses but hiring more managers. The health service must be well run but the majority of patient care is given by nursing staff. Standards are being hit as their number dwindles.”

Yesterday it emerged that managers in a hospital in Grimsby were drafted on to wards to help to deal with a shortage of clinical staff. They wore scrubs and gloves to help with making beds, collecting medicine and serving meals after nurses called in sick. The Diana, Princess of Wales Hospital insisted that they were not involved in direct patient care.

Nigel Edwards, chief executive of the Nuffield Trust think tank, said that the Lansley reforms, and subsequent attempts to unpick the least popular elements, had left the NHS with an “alphabet soup of new structures”.

“It’s not surprising manager numbers have gone back up again but the question we want to ask is not are there more or less managers, but is what they are doing adding more value?”, he added.

John O’Connell, chief executive of the Taxpayers’ Alliance, said: “Not only are the NHS recruiting more senior managers, but they’ve also increased salaries at a faster rate than that of nurses. Taxpayers expect their money to be spent fairly.”

A Department of Health and Social Care spokeswoman said: “We have record numbers of dedicated frontline staff working on our wards while there are actually 3,600 fewer managers compared to 2010. We will continue to work with NHS Trusts to cut bureaucracy and red tape even further.”

And the recent article:

The NHS is losing nurses and GPs while senior managers are the fastest-growing group of staff, official figures show.

Demoralised frontline workers are quitting and there are not enough trained doctors and nurses to replace them, unions have warned.

Data from NHS Digital shows the equivalent of 283,853 full-time nurses in hospitals at the end of September last year, down 435 from 12 months earlier. There is mounting concern about higher numbers of nurses quitting the NHS because of rising workloads and stagnant pay.

GP numbers were down 742 to 33,062 despite a government pledge of a 5,000 boost to the workforce by 2020. Figures showed that public satisfaction with GP services hit a record low last year.

Managers were up 3 per cent to 21,673 while senior managers, paid an average of £77,653, were up 7 per cent to 10,282.

Janet Davies, head of the Royal College of Nursing, said: “It feels to front-line nursing staff that, in a cash-strapped NHS, they have become an easy target for cuts. It will be galling when they see senior management burgeoning too — now officially the fastest growing part of the NHS.”

Candace Imison, of the Nuffield Trust think tank, said: “The NHS actually spends relatively little on management compared to other countries, so I’m not too worried by the relatively small increase in the number of managers. What does worry me is the GP and nursing numbers. This isn’t a question of the NHS intentionally reducing numbers. We haven’t trained enough in recent years and there is no strategy in place which will guarantee that changes.”

Many NHS bosses are more concerned about the difficulty of recruiting trained staff than about money. Official estimates say the NHS could need another 190,000 frontline staff over the next decade.

A Department of Health spokeswoman said: “NHS staff are our greatest asset and whilst there are now record numbers working in the NHS, investing in our workforce will continue to be a top priority. That’s why we recently announced the biggest ever increase in training places for both doctors and nurses, as well as helping existing staff to improve work/life balance and work more flexibly.”


Compassion needs to be tempered with honesty.

We need more compassionate care of the dying and elderly for whom there is no curative treatment.  If we are to improve patients’ experience and quality of life in the last few months, as well as saving money, we will need more trained primary care people explaining what is going to happen when the time arrives. Compassion needs to be tempered with honesty, and this needs to come from a doctor you know. Unfortunately there are fewer rather than more, of these individuals, and less and less time to discuss choices with patients. A good professional handover to adequate numbers of staff with good language and cultural awareness would negate this “need”, but whilst standards fall it is for the greater good. More patients die in Hospital than at home, and their desire is the other way round. This good news initiative needs integration into Primary Care…

Kent and Canterbury begins “compassion” symbol.

The Pilgrims Hospice logo which is being used for compassion signs on hospital wards

Chris Smyth reports 19th Feb 2018: “compassion” symbols alert hospital staff to dying patients.

Dying hospital patients will be marked with “compassion” symbols to encourage staff and visitors to be more respectful.

Hospitals in Kent have begun placing the symbol on bedside curtains or on doors next to people expected to die within days.

The project, thought to be a first in the NHS, is in use in 50 wards after managers found that it went down well with grieving families by encouraging a more dignified atmosphere on wards.

Annie Hogben of Pilgrims Hospices, which runs the project with East Kent Hospitals University NHS Foundation Trust, said: “How a loved one dies can have a profound and long-lasting impact on those who are left behind. Therefore it’s essential that staff and visitors are sensitive to the needs of the person who is dying, and their loved ones at all times.”

The hospital insists that symbols are only displayed with the consent of patients and relatives, and are not designed to single them out or chastise rowdy visitor.

Dying hospital patients will be marked with “compassion” symbols to encourage staff and visitors to be more respectful.

Hospitals in Kent have begun placing the symbol on bedside curtains or on doors next to people expected to die within days.

The project, thought to be a first in the NHS, is in use in 50 wards after managers found that it went down well with grieving families by encouraging a more dignified atmosphere on wards.

Annie Hogben of Pilgrims Hospices, which runs the project with East Kent Hospitals University NHS Foundation Trust, said: “How a loved one dies can have a profound and long-lasting impact on those who are left behind. Therefore it’s essential that staff and visitors are sensitive to the needs of the person who is dying, and their loved ones at all times.”

The hospital insists that symbols are only displayed with the consent of patients and relatives, and are not designed to single them out or chastise rowdy visitors.

“It would never be done without consultation and is really about raising awareness among other visitors to the ward that someone is receiving end-of-life care and to encourage an atmosphere of quiet dignity and respect in that area,” Steve James, a spokesman, said.

Almost 300,000 people die in hospital every year and the NHS has been criticised for not taking end-of-life care seriously enough. A review by the Royal College of Physicians two years ago found that thousands were dying thirsty and in pain because doctors and nurses were terrified of talking about death.

Bill Noble, medical director of the charity Marie Curie, said that compassion was an “essential part of palliative care”, but urged the hospitals to learn the lessons of the well-intentioned Liverpool Care Pathway, which was scrapped after patients were left thirsty and suffering because of misuse of the end-of-life protocol.

“This [compassion symbols] appears to be excellent idea but like all interventions of this nature it requires evaluation. We have learned there are unintended consequences of labelling people as requiring end-of-life care,” Dr Noble said.

The logo, featuring a stylised pair of hands cupping a person’s face, is also used on bags containing property of patients who have died that is awaiting collection by relatives.

Andrea Reid, from Folkestone, said that the sign made a big difference to her aunt’s final days. “The nursing staff all hesitated at the door, explained why they needed to come in and gave us time to either leave the room or move out of the way with a calm, unhurried air,” she said.

“Our hospital staff are often working in a pressured and high-speed environment but the small and unassuming compassion symbol is just enough to trigger a pause and a moment’s consideration for those dealing with the worst news possible.”

Sue Cook, a palliative care nurse and the trust’s end-of-life clinical lead, said: “Those of us who work in the NHS have a duty to ensure that our patients are cared for with dignity, respect and compassion until they die. That’s why the Compassion Project and its symbol is so important to us and all who help those approaching the end of their lives.”



Standards “Going into reverse”….There is no button to push… we need tens of thousands of staff

Chris Smyth reports in the Times on the reality of the staff shortages, which are worsening as those who failed to move on to pastures new fail to manage the brutal workload. “100,000 job vacancies as  NHS pushed to limit” in the Times 22nd of Feb 2018. Stories of leaderless dysfunctional consultant teams spread over wide regions, of GPs who take sabbaticals being shocked that even after a break they cannot cope, and resulting early retirements are legion. There are only politicians to blame, as the administrators are only doing their behest. There is a risk of anger, walkouts, burnouts, and serious mistakes through a collusion of denial and disengagement. Exit interviews conducted by an outside and independent HR department are now an essential and emergency need.

Image result for work walkout cartoon


About 100,000 NHS posts are vacant and hospital deficits are twice as high as planned even after a winter bailout, according to official figures.

A rapid financial deterioration means that hospitals have overspent by £1.3 billion so far this financial year while waiting times have not improved.

Patient numbers continue to rise, with 5.6 million A&E visits in the three months to December, a quarter of a million more than in the same period the previous year.

Despite efforts to improve links with social care, patients spent almost half a million nights stuck in hospital over the quarter.

One in 11 NHS posts cannot be filled amid a shortage of doctors and nurses. In London, one in seven nursing posts is empty, rising to almost a quarter in the ambulance service. Overall 35,000 posts for nurses are vacant and 9,500 for doctors.

Janet Davies, chief executive of the Royal College of Nursing, said: “All the evidence shows that standards of patient care rise and fall as nurse numbers do. That was the lesson from Mid Staffordshire and we cannot afford to forget it.”

Nigel Edwards, chief executive of the Nuffield Trust think tank, said that the “dangerous” shortage of nurses was more worrying than worsening NHS finances.

“Shortages of nurses damage patient care and make working life harder for those who remain, potentially driving them away too,” he said. “We can bring back more money onstream if the will is there, but there is no button to push which will suddenly bring us tens of thousands of qualified extra staff.”

Hospitals warned that they were being “pushed to the limit” by rising patient numbers. “Having one in eleven posts vacant makes it much more difficult to provide high-quality care,” Saffron Cordery, of the lobby group NHS Providers, said. “There is an increasing feeling among frontline trust leaders of ‘We cannot carry on like this’.

carry on like this’.“The NHS has shown extraordinary resilience in sustaining performance in the midst of an unprecedented financial squeeze. We have managed to keep the show on the road. But the warning signs are now clear and in plain sight. The time to act is now.”

Officials pinned the blame for worsening finances on a minority of hospitals that were overspending by far more than planned. However, Richard Murray, director of policy for the King’s Fund, the independent health charity, said this “raises serious questions about how reasonable the financial targets were in the first place . . . these are not pressures that have sprung up in the last few months and [they] show no sign of abating.”

Ian Dalton, chief executive of NHS Improvement, the financial regulator that published the figures, said: “More people than ever before are going to emergency departments up and down the country at a time when providers are already having to tighten their belts. It would be unrealistic to assume the demand, which has been building for a number of years, is going to reverse.”





A bigger and bigger deficit in West Wales…… Now at £600 per head……

Pembrokeshire, Carmarthenshire and Cardiganshire are broke. According to the latest published overspend for Hywel Dda we have used £400 per head, extra, over the last three audited years. We are nearly at the end of another unaudited year, and can expect the overspend to top £70m this year alone. If we total the last 3 years it comes to £150m, and divide by 372,320 population of Hywel Dda we get to a figure of £402 each. If we add this year, another £200 is minimum… In 3 years time £1000 per head is predictable. We should stop making comparisons with the USA, but make comparisons with Canada, Germany, France or Holland. Even Ireland has a system which spends little to give very reasonable results… and is financially sensible. There is no perfect system, but there are examples of excellence in many. Spending less (with consent) as a % of the total in our last year of life is also important. The decisions taken in Scotland will be a sign of whether “reality” has sunk in to their politicians. Sustainable solutions are beyond our current leaderless houses..

Image result for leaderless team

BBC News reports 8th Feb 2018: Hywel Dda health board facing bigger deficit

The health board in Wales with the highest level of overspending has seen its financial situation worsen.

The projected deficit this financial year at Hywel Dda, which covers west Wales, has increased to nearly £70m.

The health board blamed increased pressure on services in the autumn for the overspend, which follows deficits of £49m in 2016-17 and £31m in 2015-16……

on 6th February the BBCs “Reality Check Team” (Nick Triggle – did he pinch reality from NHSrealaity?) published: Reality Check: Does UK spend half as much on health as US?

If you look at all healthcare spending, including treatment funded privately by individuals, the US spent 17.2% of its GDP on healthcare in 2016, compared with 9.7% in the UK.

Chart showing health spending as proportion of GDP shows US spends more than UK

In pounds per head, that’s £2,892 on healthcare for every person in the UK and £7,617 per person in the US.

So as a proportion of the value of the goods and services produced by all sectors of the economy the UK spends a bit more than half what the US spends, and in spending per head it’s a bit less than half.

Bar chart showing spending per capita is higher in US than UK

The difficulty is, when it comes to comparing healthcare in different countries, you’re never exactly comparing like for like.

Almost all health systems are a mixture of public and private – it’s the ratio that varies.

In the UK, the public health system can be accessed by all permanent residents, is mostly free at the point of use and is almost entirely paid for through taxation.

Americans are far more likely to rely on private insurance to fund their healthcare since accessing public healthcare is dependent on your income.

Many European countries, meanwhile, have a social insurance system where insurance contributions are mandatory. This doesn’t fall under general taxation but is not dissimilar from paying National Insurance in the UK and means everyone can access healthcare….

Safety, affordability and efficiency

In the summer, US think tank the Commonwealth Fund ranked the NHS the number one health system in a comparison of 11 countries for safety, affordability and efficiency. It did less well when it came to cancer survival

The US was ranked last out of the 11 countries.

The American health system came off badly in comparison when it came to infant mortality, life expectancy, and preventable deaths, but did relatively better on cancer, heart attack and stroke survival.

Meanwhile, the UK’s cancer survival rates have historically been below the European average, although they are improving for certain cancers.

The UK has fewer doctors, nurses and hospital beds than the OECD average.

Image result for hospital closures cartoon

Other countries have sensibly funded healthcare. (Scandinavia and NZ), & “the schemes used by most countries on the Continent are preferable to the NHS model.

If the NHS really is the envy of the world, why don’t countries copy it?

Performance relative to other countries. Commonwealth fund “mirror”.

Self Sufficiency is a dream Mr Hunt. Rationing of Med Students means it will take over 15 years – starting now  – April 2017

Oh dear. More money from Taxation will make no difference.. Digging the hole deeper?

Why NHS money matters

In Search of the Perfect Health System – a new book reviewed

Not many first world countries have gone backwards in health provision, population health and life expectancy. The UK may be the first…

Life would be better if we faced up to death…. important conversations are put off until too late

NHS in Scotland must face up to “difficult decisions” to remain sustainable BMJ 2018;360:k567

Time is rapidly running out for Scotland to develop and implement solutions that will create a sustainable health service, a high level report warns.

The report,1 from the Royal College of Physicians of Edinburgh and the Good Governance Institute, makes key recommendations for securing the NHS’s future in Scotland, including difficult decisions about what the NHS can afford in the future….

Image result for hospital closures cartoon

Image result for hospital closures cartoon