Category Archives: Professionals

Will YOUR local trust be candid (honest and truthful) in a timely manner? No way….

In an epidemic of plague managers and bureaucrats have to draw a line between complete honesty, which might lead to anxiety and panic, and modified truths, which reassure and support the population through difficult times. But is this against HMG and GMC rules since 2013, which obligates a “duty of candour”.

It is unlikely that your local trust will be entirely honest and truthful, and this may be in your best interest. Unfortunately, the track record means that their honesty and decision making has been questioned so much in the past few years, especially in rural areas, threatening to close the local DGH, that the public will likely be dissatisfied whatever they are told. 

I was in favour of a new build hospital, but in Pembrokeshire. All hospitals are out of date almost as soon as they are built because of advances in science and technology. So we should only build hospitals with a short life expectancy, and there should be twice as much ground space as needed, so that the replacement can be built alongside, while the cardboard and plastic of the first one is demolished. But a new build out of the area will distance patients from loved ones, lose the community support, and because of poor infrastructure lead to loss of lives.

At present there is a problem if you have a coronary or a stroke, as increasing covid-19 admissions may mean home is safer, and yet the old fashioned thrombolytic, (treatment before stent) is not being encouraged. It could be given at home…. This would be appropriate rationing… And of course, we are being told rationing will have to take place – as if it never happened before!

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The BMJ leader, by Fiona Goodlee ( Covid-19: weathering the storm: BMJ 2020;368:m1199 ) gives a good indication of the way we are now, our focus oon immediacy and avoidance of blame until its all over… My post on Scapegoating was not meant to be political, as it showed all parties to be at fault. 

Fiona’s text is below:

The UK is at last in near lockdown. While further measures may be needed, the government’s announcement on Monday 23 March has brought the country nearly into step with its European neighbours. If we are indeed only two weeks behind Italy, the peak of the covid-19 pandemic is on its way. There is an eerie calm, as when the sea recedes before the tsunami. Few of us can imagine what lies ahead.

For some, especially in London, the wave has already hit. Intensive care units are full, and hard decisions are becoming harder. On BMJ Opinion Daniel Sokol hopes that hospitals will establish “ethical support units” to help clinicians choose which patients to prioritise (https://bit.ly/2WIlTsI). In our rapid responses David Barer makes a stark call for people aged over 60 to prepare for a lack of ventilatory support and to express their preferences for palliative care until WHO declares an end to the pandemic (bit.ly/3bqvubU).

Every aspect of the NHS is being reorganised to meet the increased demand, say John Willan and colleagues (doi:10.1136/bmj.m1117), but 20% of its workforce is either ill or in self isolation. Healthcare workers are at higher risk of infection, and personal protective equipment is still lacking, despite government assurances. The waiting and workload are worsened by fear and fatigue. Staff, already stretched, are now scared.

Could some of this have been avoided? Many think so. Over the years, opportunities to research influenza-like illness have been missed and money squandered on ineffective antiviral drugs (doi:10.1136/bmj.m626). The NHS has been stripped of resilience by years of attrition compounded by lack of investment in social care. Public health services have been systematically decimated and dismantled. The UK’s idiosyncratic response to the pandemic has been guided by questionable modelling rather than by long established fundamentals of communicable disease control (https://bit.ly/2UzRZnI).

David Oliver counsels against political point scoring: there will be time enough for that when this is over, he says (doi:10.1136/bmj.m1153). So we should for the moment focus on things that will help us weather the impending storm. An urgent return to community contact tracing, says Allyson Pollock (bit.ly/2ULmgAj). Testing of frontline healthcare workers, says Julian Peto (bit.ly/2QJLjCx). Lowering the baseline of underlying illness, say Robert Hughes and colleagues (bit.ly/33PhNRa). To these, like Mary Black (bit.ly/2JcjiiF), I would add three more necessary things: candour about the scientific and political uncertainties, kindness to ourselves and each other, and courage.

March 2020: Many governments and many ministers of health have made mistakes… They should be candid.

May 2019: Whistleblowing protection is important, but exit interviews that prevent the need for whistleblowing are more important.

Jan 2017: Candour and Transparency? – what a farce

April 2016: National NHS whistleblowing policy published. Doomed to fail. The duty of candour will be outgunned by fear of reprisal.

March 2016: Stephen Bolsin – Bristol Scandal Whilstleblower mock interview in BMJ confidential. The duty of candour shows no sign of overriding the culture of fear and bullying.

Dec 2015: The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

Nov 2015: Constructive deconstruction – of the ischaemic bowel in the UK Health Systems.. Politicians need a duty of candour like Mr Smallwoood

March 2013: No more covering up errors, NHS told. (A new “Duty of Candour”.)

March 2020: Doctors will ration health care if they have to. But the situation that led to the under capacity- shortage of staff, equipment, beds, plant and then morale, needs an independent enquiry

CV19. Lets see who we can scapegoat for our unpreparedness…? The magnificently ( unlucky ) 13

Image result for dishonest health cartoon

 

CV19. Lets see who we can scapegoat for our unpreparedness…? The magnificently ( unlucky ) 13

All breakdowns of the nature of the CV19 outbreak need a scapegoat. The trouble with this is that there are so many, from successive administrations. There are 13 over the last 30 years. It takes 10 years to train a doctor, so that is 3 generations of under-capacity in provision. The manpower planning has gone so wrong, even though the profession has been demanding more, that only these 13, and the 6 Prime Ministers can possibly take the blame. If you wish to download pictures for dart boards in the doctors mess, please feel free.

Bill gates gave his warning in 2015 regarding virus plagues.

NHSreality started as I retired 8 years ago and began NHSreality in 2013, warning of “killing the goose that laid the golden eggs”.

The secretaries of state for health and social care ( England) are listed here.

The department website ( DHSS ) is here.

Its evident that the person least responsible is the current incumbent. There is no need to go as far back as Lord Carlisle in 1848.  I have taken 30 years, and that covers the following administrations: John Major, Tony Blair, Gordon Brown, David Cameron, Theresa May and Boris Johnston.

William Waldegrave: 2 November 1990 – 10 April 1992 ConservativeWilliam Waldegrave visiting University of Salford 1981 cropped.jpg

Virginia Bottomley10 April 1992 – 5 July 1995 ConservativeOfficial portrait of Baroness Bottomley of Nettlestone crop 2.jpg

Stephen Dorrell 5 July 1995 – 2 May 1997 ConservativeStephen dorrell mp -nhs confederation annual conferencepercent2c manchester-11july2011 - crop.jpg

Frank Dobson 3 May 1997 – 11 October 1999 LabourFrank Dobson MP, crop.jpg

Alan Milburn 11 October 1999 – 13 June 2003 LabourAlan Milburn 2014.jpg

John Reid  13 June 2003 – 6 May 2005 LabourReidTaormina crop.jpg

Patricia Hewitt 6 May 2005 – 27 June 2007 LabourPatricia Hewitt.jpg

Alan Johnson 28 June 2007 – 5 June 2009 LabourAlan Johnson MP.jpg

Gordon BrownAndy BurnhamAndy Burnham2.jpg5 June 200911 May 2010Labour

Andrew Lansley11 May 2010 – 4 September 2012 ConservativeAndrew Lansley Official.jpg
(Coalition) Jeremy Hunt 4 September 2012 – 8 January 2018 ConservativeOfficial portrait of Mr Jeremy Hunt crop 2.jpg

Jeremy Hunt 8 January 2018 – 9 July 2018 ConservativeOfficial portrait of Mr Jeremy Hunt crop 2.jpg

Matt Hancock 9 July 2018 – Incumbent ConservativeOfficial portrait of Rt Hon Matt Hancock MP crop 2.jpg

Cartoon: Blair's War - The English Blog

 

The flock of geese that laid golden eggs has been culled. It takes years to rebuild, and the fox is at the door.

Burnout forces almost 10% of GPs to take time off work as pressure on occupational health services grows

The public will only miss what they had – when its gone. GP indemnity fees spiral out of control with 25% rise last year..

The desperate state of General Practice. Black swans will not be diagnosed as often, or as quickly.

Doctors to see groups of patients – is probably madness. The fox is waiting..

There are just not enough geese to lay enough golden eggs. The cupboard is bare. We cannot be cloned.

Pastor not prepared | Backpew | Cartoons | Entertainment

 

Reverse the devolution of health.. Now is the time to combine the 4 health services to give us efficiency, equality and unity.

The 3 smaller health services should be closed down, and decisions made by England should apply to all. Its clear to NHSreality that Now is the time to combine the 4 health services to give us equality and unity. Why have Public Health Wales when the English administration is fit for purpose? NHS Health Scotland is fine and dandy, and it sometimes comes out with advice earlier than England, but the duplication of expensive resources cannot be justified. How many more incubators, respirators, and hospital beds could we fund with this money? So not only equality and unity, but also efficiency would result from unification of health services.                                                                                                                  BBC Wales news emphasises the difference and independence of its health service 25th March 2020

The democratic and opportunity deficit in health will become apparent, especially in the retrospectoscope, after this pandemic. Watch for different death rates, infection rates, and survival rates. The fact is that devolution has failed greatest in N Ireland, whose parties and public remain in a repressed civil war, and secondly in Wales, where the population is only a little larger, and non violently, but multiply tribal, and more successfully in Scotland because they have a separate budget. Certainly reversing health devolution should be considered carefully.

Unfortunately politics and media conspire to forbid pragmatic and unemotional discussion of any change to devolution. Indeed, the mood amongst these two conspirators is for independent taxation and then what: fiscal independence as well?

The pandemic has shown us that unity helps. Big mutuals do better. In defence and armaments bigger stronger countries can defend themselves better, and weaker ones least. The same is true for a pandemic. Reverse the devolution of health. Thee shock of this virus will either bring us together more, or tear us apart. Europe is at risk of the latter.

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Poor state of Welsh health. The experiment with devolution has failed….

Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

Amazing how England has been able to kid themselves there is an NHS – until now. Manchester’s health devolution: taking the national out of the NHS?

The democratic deficit. Applies to health as well as devolution, and to leaving the EU. The first honest party should get public support.

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The shock of coronavirus could split Europe – unless nations share the burden

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Cannon fodder doctors after 30 yrs rationing…..

The staff have been decimated, undervalued and overworked. This for decades, and the trend would have continued without this epidemic. Whilst MPs always have access to the “best” in London, the shires have to put up  with second best. No way PPE will be made and distributed on time..

Germany with a similar population * 2 has 5000 ventilators, some 10 times the UKs. The number of scanners and imaging equipment is also much larger.

We have got into this situation by neglect. The people whio need to be in the dock are the successive ministers of health. I would suggest over 20 years.

Jane Haynes reports for Birmingham Live 22nd March 2020:

NHS frontline staff ‘lambs to the slaughter’ – Birmingham registrar slams lack of safety gear – Doctors’ Association chairman Dr Rinesh Parmar has hit out over desperate shortage of safety gear for staff

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A Birmingham registrar has launched an astonishing broadside at the Prime Minister, saying frontline NHS staff feel like “cannon fodder” and “lambs to the slaughter” as they fight the coronavirus pandemic.

Dr Rinesh Parmar, an anaesthetics specialist at a city hospital, claims nurses and doctors have been using out of date equipment, and new gear “does not all meet World Health Organisation guidelines.”

His shocking comments come after we revealed a 36 year old nurse from Walsall is fighting for her life a fter developing symptoms.

Areema Nasreen, a mum-of-three, tested positive for the virus after developing a soaring temperature, body aches and a cough.

The 36-year-old, who has no underlying health conditions, was taken to Walsall Manor Hospital after her condition worsened.

Her family say she is now on a ventilator in intensive care – being cared for by the medics she usually works alongside.

Dr Parmar chairs the Doctors’ Association UK, a group that advocates for frontine medics.

In an open letter to Boris Johnson, dispatched in his name and signed by thousands of fellow medics, the organisation paints a terrifying picture of desperate staff lacking the equipment they need to keep them safe.

Dr Parmar said this morning: “The Prime Minister needs to protect frontline staff. We urgently need appropriate PPE (personal protection equipment) quickly to safeguard ourselves and our patients and to ensure we do not take risks.”

Public Health England has announced that gear is arriving daily into hospitals and surgeries, with more on its way.

But Dr Parmar said that was not happening quickly enough.

“Some of the equipment is not adequate or does not meet WHO guidelines, or does not meet needs.” he said.

He also said doctors were reporting seeing younger patients in hospital with underlying health conditions as the pandemic heads towards a peak.

“This is not an illness that’s isolated to the elderly,” he warned.

Update 23rd March 2020: The Times – Letters to the Editor: Without protection, NHS staff are cannon fodder

We are 3,963 frontline NHS staff who are pleading with the prime minister to intervene to ensure we have adequate personal protective equipment (PPE) when facing the Covid-19 pandemic.

Frontline doctors have been telling us for weeks that they do not feel safe at work. Intensive care doctors and anaesthetists have told us they have been carrying out the highest-risk procedure, putting a patient on a ventilator, with masks that expired in 2015. Paediatricians have told us their stock of protective glasses and masks will run out in 48 hours, including in special-care baby units.

An acute medical doctor reported the stock of masks had already run out at one trust last weekend. GPs have told us they feel abandoned; many have been left without any protection for weeks and do not even have simple masks to protect them if a patient comes in with symptoms of Covid-19.

This is unacceptable. NHS staff are putting their lives on the line every day they turn up to work. The reality is that many of us will get sick. Doctors are all too aware of the possibility that they will lose colleagues, as has happened in outbreaks around the world. It is therefore deeply upsetting to hear dedicated healthcare professionals say they feel like “cannon fodder”.

NHS England has stated that the national supply of PPE has been “adequate” and any shortage is a local distribution issue. While this may be the case, it is not encouraging to see NHS England passing the buck.

We want to see action immediately. The supply of PPE in the coming weeks must be stepped up as we see a surge in cases. If it is not, the public will be endangered and dedicated NHS staff could lose their lives. It is time for the prime minister to demonstrate his commitment to the NHS and protect the lives of the life-savers.

Dr Rinesh Parmar and Dr Samantha Batt-Rawden, the Doctors’ Association UK; Dr Fiona Godlee, editor-in-chief, The BMJ; Dr Nicola Strickland, former president, Royal College of Radiologists; Dr Rosena Allin-Khan MP; Dr Rachel Clarke; and 3,957 others. For a full list, see thesundaytimes.co.uk/ppe

Coronavirus: NHS doctors feel like ‘lambs to slaughter’ without protective kit, warns senior medic

Personal Protective Equipment (PPE) – NHS Education 

Pulse: NHS England to distribute free coronavirus protective …

 

Assessment of differences of survival between countries. We have rationed anaesthetists, and ventilators, as well as hospital beds, for decades..

This is courtesy of a friend. His analysis betrays the British Politicians and Ministers of Health over decades. His Assessment of the differences of survival between countries may be superficial but its worth considering and reflecting.. We have rationed anaesthetists, and ventilators, as well as hospital beds, for decades.. Successive ministers of health should be in the dock giving evidence to the retrospective enquiry. (See below) Remember that in 2015: David Iacobucci reports on the opinion of David Nicholson. We have had at least 5 years warning, and done nothing.

All main political parties’ pledges for NHS will prove inadequate, says former chief executive: BMJ 2015;350:h2081

I’ve been asked why the death rate in Germany is relatively so much lower than the UK and Italy. I think that this might explain it to some extent.

Country Intensive Care beds Care beds with Ventilators Critical care beds per 100,000 population
Germany 28,000 25,000 30.0
France 12,429 5,065 12.0
Italy 7,560 15,000 12.5
UK 4,123 5,000 6.6
US 160,000 34.2

The 5,000 count of UK ventilators includes all of those use in the operating theatres which is why it exceeds the number of Intensive Care beds. Apparently the NHS has just requisitioned 1,200 more from the private sector.

The much lower death rate in Germany might be explained by their far higher availability of Intensive Care Beds and ventilators.

Age alone cannot explain the difference, as the median age of the population in Italy is 45.5 years compared with 47.1 years in Germany!

The other reason for Germany’s lower death rate (to date) seems to be “Test, test, test”.  They have been doing about 23,000 per day. That means that the people in the denominator include far more mildly affected people than in the UK (and I believe in Italy) where the only people being tested have turned up at hospitals with severe symptoms.

Let’s hope all of those companies which have been asked to help make ventilators are pulling out all of the stops.

We know that our scientists and medics are.

Many governments and many ministers of health have made mistakes… They should be candid.

Successive ministers of health are responsible for the nursing shortage. And they are not accountable!!

NHSreality wants scapegoats – and suggests the successive ministers of health (for England). Allyson Pollock might agree..

A 150% increase in patients going private is an indictment of the UK Health Services… Successive health ministers have ensured a thriving private system.

 

Dr Jack talks to Radio 2. Don’t touch. Stay isolated. The reality of the CV15 epidemic.

The reality of the corona virus CV 15 epidemic…

13 doctors have died so far…..

Swine flu is a ripple compared to this. It is catastrophic. I feel as if i’m in a different universe to what is going on outside the window. People have got to stop (unreasonable behaviour) and I’m going to be a different person after this. Going to the pub could kill people, or make them respiratory cripples for the rest of their lives. We will be overwhelmed, even now, if everyone behaves as they should from today.

Stay on your sofa. Use the internet and watch TV, listen to radio, records.

 

 

Many governments and many ministers of health have made mistakes… They should be candid.

If doctors have a duty of candour, then how about politicians? Many successive governments and many ministers of health have made mistakes… They should be candid about the reasons for poor manpower planning, fewer beds, fewer hospitals, fewer consultants, fewer nurses, fewer GPs, and fewer imaging diagnostic facilities than almost any other country in the G8.

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Rajaratnam Jeyarajah, consultant physician opines in a letter to the BMJ 14th Jan 2020: True candour about mistakes means full disclosure of system failures ( BMJ 2020;368:m104 )


BMJ 2020368 doi: https://doi.org/10.1136/bmj.m104 (Published 14 January 2020)Cite th

I agree with Maskell that we should be honest and volunteer all information to people harmed by provision of services.1 But why should we stop at doctors’ honesty about mishaps during patient care? Why shouldn’t we make the public aware of the shortages nearly all hospitals face and the stress and unrealistic demands this places on staff?

I suggest hospitals put a board outside the entrance, like those outside car parks, stating the number of staff shortages, vacant beds, and patients waiting on trolleys in the emergency department. As well as the number of scanners that aren’t working, and the delay in discharge because of the shortage of community care and nursing home beds. Also the number of staff who are absent because of stress or involved in appraisals and revalidation.

Then, some may decide that their hospital visit could wait another day or may even decide to have the investigation done elsewhere, and others may decide to take their loved one home and bridge the gap before care starts. This will make the public more appreciative of the care provided under difficult conditions in a constantly overstretched system. They will also be more understanding when unintentional errors are made. And less demanding.

I am in total agreement with the principles of the duty of candour. We need to be open and honest, not only about mistakes made but also about the contributory factors and the unreasonable demands imposed because of a shortage of resources.

Above all, staff should feel supported and their sacrifices appreciated. The public should realise that the NHS is the envy of the world but is giving way at its seams. If we don’t support NHS staff—the service’s greatest asset—we are in danger of losing our national treasure.

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