Category Archives: Professionals

The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply

Normally there would be a budgetary report on the English Welsh and Scottish Trusts before the election. Home office staff are arguing that such data is so politically sensitive that it should be kept secret until after the election. What nonsense. Hiding the truth is not a good precedent for something which should be routine. Darlington Hospital is one of many who may not be able to pay their staff. The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply to something routine and pre-planned. BBC News reports 19th May: Reality Check: Why is NHS budget data delayed by purdah? and Will NHS stats spark polling day debate? 

Image result for nhs cartoon

All the Trusts are bust.

Ben Glaze in the Mirror reports 20th May 2017: Tories accused of ‘blocking damning figures on state of NHS finances’ – Key statistics were due to be released at the end of May but ministers are citing “purdah” rules to hold the information back until after the election

on 19th May in the Northern Echo, Graeme Hetherington reports: Darlington Memorial Hospital trust could run out of money to pay some wages unless plan to solve cash crisis is found

A HOSPITAL trust could run out of money to pay some staff wages unless it comes up with a plan to solve its dire financial predicament by next month.

Concerns over the future of Darlington Memorial Hospital have been raised after details of its financial situation were leaked to The Northern Echo.

Senior management and consultants are being told to tighten their belts as money-saving initiatives are missing their targets and an email sent to some staff has highlighted that the trust could run out of money if drastic action is not imposed.

The County Durham and Darlington NHS Foundation Trust ( CDDFT) introduced cost reduction targets (CRT) in an attempt to balance its books – but is missing its £6.9m savings target by about £1.7m.

The detailed email raises the prospect of the length of operation and appointment waiting times being extended beyond the Government target of 18 weeks, the Trust’s inability to cover staff wages and a reduction in nursing levels.

However, the CDDFT’s consultant surgeon and surgical care group director is reassuring people that patient safety is central to all discussions in the hospital and that there are no plans to reduce staffing levels.

The internal email was sent out to senior staff following a meeting of the Trust’s Financial Stability Programme, which was described as a “maul” after the stark warning was driven home by finance chiefs.

And the news comes just days after it was revealed that maternity services at the hospital could be lost as plans are being investigated to centralise care in Darlington, Durham and North Tees – albeit on a temporary basis.

Today, the full extent of the financial pressures on the hospital’s surgical departments can be revealed.

The email reads: “The three of us have to go back in four working days time with a full plan, costed and developed for a further £1.5m pounds of guaranteed CRT in addition to the already identified as an interim to meeting the full amount. So far in month one we are forecasting to be £350k (April) overspent due to not achieving CRT.

“I do not intend to just pass on this message in the same way. You all work hard and I know you are all very hard pushed for time. However, I need urgent and focused work form every one of you to help the senior triumvirate as yesterday’s is an experience I have not had before and never want to have again.

“I have been asked to ensure that all staff are fully briefed that if by June we do not have a full plan for CRT and are not completely in control of expenditure that we, CDDFT, will run out of cash to pay wages.

“Whist this has been briefed before I chose not to put it in these terms. I have been asked not to sanitise the message.”

But Mr Steve Scott, consultant surgeon and surgical care group director at County Durham & Darlington NHS Foundation Trust, has reassured people that patients’ health will not be put at risk, as the document is not a formal trust plan.

He said: “NHS organisations are working under financial pressure and we regularly review the best way to provide safe efficient patient care. It is worth noting that County Durham & Darlington NHS Foundation Trust ended 2016/17 with a surplus and ahead of our financial plan.

.

What and when is “purdah”?

Image result for nhs cartoon

 

Perverse outcomes abound in a Media Led society. The utilitarian imperative would be ignored by the press, and will be by shallow politicians.

The rationing of drugs by the four UK Health Services is logical. There may be post code differences but that does not mean it is wrong. It’s logical and ethical and pragmatic rationing. However, once a drug is of proven benefit and is very expensive there must be a level at which NICE disapproves. This is currently £30,000 per year. If we rationed low cost high volume medications (paracetamol etc) we could possibly afford to raise this threshold. If NHSreality was commissioning, it would spend the money on people… especially in Mental Health support care, and reduce the threshold!!

There is a large risk of another perverse outcome in a Media Led society. The utilitarian imperative would be ignored by the press, and will be by shallow politicians.

Image result for unreality cartoon

Laura Donelly reports in the Telegraph 15th May: Political parties urged to commit to reversing NHS drug rationing plans

More than 30 charities have written to the three party leaders urging them to commit to reversing NHS measures to increase rationing of medicines.

Health officials last month brought in new thresholds which mean access to one in five treatments could be delayed or restricted.

Under the rules, all drugs expected to cost the NHS a total more than £20 million a year will be checked against new “affordability criteria”.

The cost threshold set by NHS England could affect medicines costing as little eight pence a day, if used commonly enough, as well as high cost medicines used for rare diseases.

Rationing body the National Institute for Health and Care Excellence (Nice) has said it is likely to affect around 20 per cent of drugs it assesses, with the process including changes that the head of its rationing body has previously described as “unfair”.

In an open letter to Theresa May, Jeremy Corbyn and Tim Farron, the charities – which include Parkinson’s UK, the Children’s Heart Federation and the MS Society – ask all the parties to commit to reversing the changes.

The signatories – all members of the Specialised Healthcare Alliance – said that the measures “stand to restrict and ration treatments for people with rare and complex conditions, and were implemented without the agreement of Parliament.”

The letter comes as political parties prepare to publish their manifestos for the election.

Caroline Harding, chief executive of Genetic Disorders UK said: “Under these plans, some of the most critically ill patients are being denied access to potentially life-changing treatments.

“Any decision to ration access to medicines should be taken by ministers, not unelected officials.”

Kay Boycott, chief executive, Asthma UK, said: “There is a real risk that these plans will turn the clock back on access to life transforming treatment.”

Sarah Vibert, chief executive, Neurological Alliance, said: “Politicians from all sides should pledge to rethink these damaging proposals.

“It is completely unacceptable that patients with neurological conditions risk being denied access to treatment solely on the basis of cost.

None of the parties have formally published their manifestos. But the draft Labour manifesto, leaked last week, said: “Labour will tackle the growing problem of rationing of services and medicines across England, taking action to address postcode lotteries and making sure that the quality of care you receive does not depend on which part of the country you live in. We will ensure that NHS patients get fast access to the most effective new drugs and treatments.”

Jonathan Ashworth, shadow Health Secretary, said: “There is a real and growing worry that Theresa May’s ongoing underfunding of the NHS means patients just aren’t getting access to new medicines. Patients need fast access to medicines and treatments which are recommended by Nice as being clinically and cost effective. Labour is committed removing the barriers which are being put in place and to ensuring that NHS patients get fast access to the most effective new drugs and treatments.”

A Conservative spokesman said: “NHS spending on medicines and treatments is now second only to staffing costs – in fact, the NHS in England spent more than £15 billion on medicines last year, a rise of nearly 20 per cent since Labour left office. But we can only ensure more patients than ever get outstanding care if we continue to invest in the NHS on the back of a strong economy – something Jeremy Corbyn and the other parties who’d prop him up in Downing Street simply could not do.”

Liberal Democrat Health Spokesperson Norman Lamb said:  “This is a shameful retreat from the core principle of the NHS, that treatment should be available to patients regardless of their ability to pay.

“The rationing of treatments is an inevitable consequences of this government’s chronic underfunding of the NHS. NHS England is caught between a rock and a hard place because they simply don’t have enough resources.

China’s One child policy and pension

Why is the NHS under so much pressure?

An ageing population. There are one million more people over the age of 65 than five years ago

Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years

This has caused record levels of bedblocking, meaning elderly people with no medical need to be in hospital are stuck there. Latest quarterly show occupancy rates are the highest they have ever been at this stage of the year, while days lost to bedblocking are up by one third in a year

Meanwhile rising numbers of patients are turning up in A&E – around four million more in the last decade, partly fuelled by the ageing population

Shortages of GPs mean waiting times to see a doctor have got longer, and many argue that access to doctors since a 2004 contract removed responsibility for out of hours care

 

<img src=”/content/dam/money/2016/03/01/pills-small_trans_NvBQzQNjv4BqtGQB12KHxxQCrwnTZkX0nwgWqwm85JEWpGVhFb46TTg.jpg” alt=”Pills ” width=”320″ height=”200″ class=”responsive-image–fallback”/>

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

 

 

 

Hands up – who want’s to be a GP today? Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

We all know that the one on one confidential consultation is the bedrock of primary care. We have been taught that confidentiality is paramount, and as a profession we have honoured this. However, being a GP (or any type of Dr) means complaints and possibly litigation at some time in your career. These problems are much less if the Dr is a) female and b) British trained.

False claims against doctors are not yet commonplace, but to keep the confidentiality and the confessional nature of the GOP consultation will need audio-visual recordings in every room. The patient can undress behind a screen, but the acoustics should remain even when the video is missing.

An alternative, accepted in many hospitals and most dental practices, is to have a “chaperone” or another person (assistant) present at all times with patients. GPs could move in this direction, as could teachers. Male teachers in particular know about “false claims” against them. More and more teachers and doctors are female ….. the adverse selection processes, the timing of recruitment, and the behaviour of  students/patients/clients is excluding men.

The Yorkshire Post 11th May 2017 reported: Growing GP recruitment problem ‘staggering’ as vacancies hit new … ITV News reported 12th May 2017: ‘Staggering’ GP recruitment problem hits new high – ITV News – ITV.com and the Standard followed it up with a report by Eleanor Rose: GP recruitment problem “staggering” as vacancies hit new high, research shows.   for Pulse reports 12th May: One in five practices abandon recruitment due to ‘staggering’ shortage of GPs

Almost one in five practices has had to abandon searching for a new GP as vacancy rates have hit their highest ever, a shocking Pulse survey has revealed.

Pulse’s annual practice vacanies survey was answered by 860 GPs and reveals that 12.2% of all positions are currently vacant – an increase from the 11.7% reported at the same time last year.

More worryingly, 158 said they had to give up recruiting a GP in the past 12 months after unsuccessful attempts.

The survey – the only longitudinal data available on this subject – also reveals that the average time taken to recruit a GP partner has lengthened by almost a month over the past year….

Dr Richard Vautrey, deputy chair of the BMA’s GP Committee, said: ‘The high number of positions vacant and one in five practices abandoning their search) is another sign of the recruitment crisis with many practices struggling to find GPs.

‘This is adding to the pressure of the remaining staff. Some practices are looking to recruit therapists, pharmacists and other health professionals but of course they are not a replacement for a GP. There needs to be a real step-change in recruitment initiatives to ease the pressure on GPs.’

Professor Helen Stokes-Lampard, chair of the RCGP, said: ’We know that practices across the country are finding it really difficult to recruit GPs to fill vacant posts, and the degree to which this problem has increased over the last six years is staggering. In the most severe cases, not being able to recruit has forced practices to close, and this can be a devastating experience for the patients and staff affected, and the wider NHS.’

Abi Rimmer in GP careers warns: Workload pressure would not be a defence against clinical negligence, barrister warns

Rosemary Bennett The Times May 11th 2017: False claims ‘have made teaching a lottery for men’ and False claims ‘have made teaching a lottery for men’ : ukpolitics – Reddit

What kind of person makes false rape accusations?

 

 

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

All 4 Health Services let down the dying. International comparisons are not favourable..

The Economist has three articles in the current edition dated April 29th 2017. The theme is on how to ensure a better death, and that although death is inevitable, a bad death is not. A better death means a better life, right until the end. The irony of the UK system, whereby more care options are available in more affluent areas, is exposed. In a cradle to grave health service which is meant to be free and without reference to means this is patently unfair. In “Mending Mortality” the author says that “doctors are slowly realising that there is a better way to care for the dying”, and in “Death Wishes” a consumer survey shows that “living as long as possible is not people’s main concern”. If the service is as described by politicians, Palliative and Terminal Care should be fully funded throughout the country. 

Better Death

Mending Mortailty – Economist

Last wishes – What people most want in their final months

Image result for dying peacefully cartoon

NHSreality has posts on death and dying, and on Palliative and Terminal Care

A Dignified Death

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.

Right-to-die granny, 86, starves herself to death

Wales suffering: Surgeons wait for answers on deaths before heart surgery

GP workforce crisis set to undermine palliative care, BMA warns

GPs should be encouraged to take on palliative and terminal care out of hours..

Palliative and Terminal Care should be fully funded.

Image result for dying peacefully cartoon