Category Archives: Professionals

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

Poor state of Welsh health Letter in the Sunday Times 17th December 2019
Labour has announced it will outspend the Tories on the NHS and reduce waiting times. Here in Wales the NHS has been devolved to the Labour–led Welsh assembly since 1999. Waiting-time targets for most elective surgery are twice those in England (36 weeks as opposed to 18) and even then are often exceeded.

The Welsh NHS also performs considerably worse in A&E waiting times, with some health boards even allowing 12-hour waits.
Eleanor London, Penarth, Vale of Glamorgan

Devolution of health to Wales was a mistake?

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

The advantages of mutuality are being shunned. Purchasing power in small regions is little. Choices are disappearing.. Hammond is unlikely to help ..

Less talk more action on General Practitioners

LESS TALK, MORE ACTION ON GPs – The Sunday Times 17th November 2019
You report that “Tories make more ‘empty promises’ on extra GPs” (News, last week). These will do nothing for the millions of patients who are unable to see their GP because of the recruitment and retention crisis. This is a government that has proven its inability to deliver on its 2015 commitment of recruiting an extra 5,000 GPs.

As GP numbers are falling, we need more than just election soundbites — we need investment in the working conditions and retention of our existing GPs, who have been neglected for the past decade.
Dr Rinesh Parmar, chairman, The Doctors’ Association UK

Reality check-up
While election pledges to deliver more family doctors are encouraging, we must not forget that previous promises have fallen far short and GP numbers have continued to decline. We need meaningful action to keep experienced GPs in the NHS, not least the scrapping of absurd pension regulations that punish doctors for staying in work.

Both main parties say extra GPs will provide millions more appointments, but thousands more doctors are needed just to meet present demands. Politicians owe it to patients to be realistic about what can be delivered.
Dr Richard Vautrey, chairman, BMA GP committee

A night (or two) on a hospital trolley is better than living on the street. Asda type performance will not help…

Aneurin Bevan would not have accepted a night on a trolley as a compromise when he set up the former NHS. The cost of looking after overseas visitors is minimal, and not an important financial loss, but it does signify how we expect nobody to pay anything at all! Politicians have big salaries, good holidays, secure pensions, and access to London hospitals. If they want to they can avoid the A&E waits and mistakes and go privately. They usually do…. It will all get worse unless our managers and Trust Board Directors speak out honestly. Co-payments are not as bad as a failing service..

Cartoon 11.02.2017

Michael Sainato in the Guardian 14th November 2019 reminds us of why we live in one of four “Mutualised health services”. ‘I live on the street now’: how the insured fall into medical bankruptcy – Having health insurance is often not enough to save Americans from massive debts when serious illness strikes

Iain Williams on 14th Feb 2015 opined: £1 coin for your hospital trolley? The NHS’s supermarket-style makeover – cartoon

A government minister has said the NHS should be more like Asda. Should we expect bogof deals on hip replacements?

New Registrations: More non-UK graduates than home grown clinicians…. in 2018

After failing to provide the 5000 extra GPs promised 4 years ago, the numbers have actually fallen by 1600, and of those remaining a far larger proportion are part time. The complete failure of forward planning is due to rationing of med school places, and the First Past the Post electoral system. It will happen again, and repeatedly. If the conservatives win an outright victory the money will dry up quickly. If Labour wins they wont be able to borrow, and they will have to print more money. Both outcomes are likely to lead to a fall in the value of the pound. We still have 11 applicants for every place. Increasing the numbers by a small % is not enough…. We now need locality based virtual training for medicine. It can be run by the local medical scghool, and exams and assessments can be centralised, but the training should be local, and graduate based. Traditional medical schools just dont have the capacity. …

Doctors‘ early retirement triples in a decade BMJ 21st June 2019

Rowena Mason reports in the Guardian 8th November 2019: Boris Johnson promises preferential immigration for NHS staff

The GP recruitment farce – Mr Hunt never said the 5000 would come from the UK!

PM proposes half-price visas and quick decisions for doctors and nurses as part of points-based system

Jonathan Paige reports in the Times 8th November 2019: Hospitals told to pay doctors cash over fears of winter crisis

Andrew Gregory in the Times 9th November 2019 reports: Will Tory promises help to clear your GP’s waiting room? 500 more GPs in training per annum promised……

The Conservatives today promised to create an extra 50m more GP appointments a year if they win the election.

In this early stage of the campaign, the NHS has dominated the agenda….

Adrian O’Dowd reports in the BMJ: More non-UK graduates than home grown clinicians joined medical register in past year (BMJ 2019;367:l6203 )

Where are the UK’s doctors from?

new registrations as an image

Of the 251 319 doctors on the UK medical register in 2019:

  • 164 525 trained in the UK (65.5% of the total, and a 2.2% rise from the number in 2018)

  • 22 280 trained in European Economic Area countries (8.8%, and a 2.2% rise from 2018)

  • 64 514 trained outside the EEA (25.6%, and an 8.3% rise from 2018)

There was an especially large increase in the number of medical graduates from Africa and the Middle East, but most non-EEA joiners still come from South Asia.

The trend of increasing numbers of doctors joining from Central and Eastern Europe and the Baltic countries continued in 2019. The number joining from northwest Europe remained the same in 2019, after a prolonged period of steady decline. Southern European doctors have joined in slightly greater numbers in 2019, a contrast to decreases since 2014.

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..

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Some good news on new medical schools. Lets hope the politicians sieze the real opportunity for virtual medical schools living in local communities


Those “halcyon” days…


Sir, Dr Andrew Bamji (letter, Nov 2) asserts that the Blair and Brown Labour governments were truly awful in their handling of the NHS. I wholly concur with his withering assessment but the past nine years of Conservative government have not been the answer. From catastrophic cuts in funding (as a percentage of GDP) to top-down reorganisations of the NHS that we were promised would not happen by David Cameron, we have witnessed a systematic destruction of the NHS by the Conservative Party. The disdain with which Labour treated junior doctors during the modernising medical careers (MMC) fiasco of 2007 was dwarfed by the contempt shown by Jeremy Hunt during 2015-16 and which prompted the first junior doctors’ strike in a generation. Consultants and GPs have not fared better, with brutal taxation policies from 2016 onwards that have prompted mass retirement, decimation of overtime and the worst waiting lists since John Major’s premiership. Many patients are now waiting in more than a year for planned surgery, suffering pain and disability as a direct consequence of this government’s mismanagement. When this is coupled to the abolition of nursing bursaries, perilously low staffing on wards, mental health crisis, and the effects of Brexit on a multicultural and multinational NHS workforce, one can see that this is the worst of times. Dr Bamji should be grateful that he is retired as many of us of left working in the NHS now look back at the Blair-Brown years as halcyon days.
Professor Neil Smart

Consultant colorectal surgeon, Royal Devon & Exeter Hospital

Image result for playing politics cartoon

Health Services might be designed wrongly: In praise of dissenters.. Currently there is little ability to speak out, “without fear of sanction”.

The Different health services in the UK are not open to the suggestion that they might be designed wrongly. They are failing more quickly than anyone imagined (other than those in the profession, and NHSreality). An interview with Helen Stokes-Lampard (RCGP chair) In “You and Yours” on Radio 4 17th October 2019 tells it straight: its going to take at least 12 years to remedy the failure in forward and manpower planning. (The interview is at the end of the recording) The culture of fear means that opportunities to learn constructively are being lost, educational standard are falling, and engagement with the politics of health is minimal. One route to honesty is the exit interview, and these collated together could give messages that lead to the changes needed. Meanwhile……  “Winter is coming”. We will all be hearing how they will listen (See Jill Patterson in Walesonline below), but NHSreality can tell you that even if they hear, they don’t have the human resources to act. 

In Bartleby in The Economist 12th October 2019 “In praise of dissenters – It pays companies to encourage a variety of opinions “

The ability to speak up within an organisation, without fear of sanction, is known as “psychological safety” and was described by Amy Edmondson of the Harvard Business School in a book on the issue. Mr Syed cites a study of teams at Google, which found that self-reported psychological safety was by far the most important factor behind successful teamwork at the technology giant. ….“In praise of dissenters

As many practices disintegrate, I give a link to a local practice in the news.

Eleanor Philpotts in Pulse 12th October 2019 reports on Ferryside practice.: Practice set to close after 3 years without a GP

In Walesonline Sandra Hembury on 14th October reports: The GP surgery that hasn’t had a GP for over 3 years..

A doctors’ surgery hasn’t had a GP working there for three years and is now being threatened with closure.

The Mariners Surgery in Ferryside has only had nurse sessions since 2016, because there were no GPs available to operate from it.

Now plans have been unveiled to close the surgery and relocate services to other practices, forcing patients to have to travel for miles to receive treatment.

A public drop-in session is being held to consult with patients at the Three Rivers Hotel in Ferryside between 2pm and 7pm tomorrow (Tuesday, October 15).

But there are fears those less mobile patients will struggle to get to the next nearest surgeries in the Meddygfa Minafon practice – in Kidwelly or Trimsaran.

Cllr Mair Stephens is ward councillor for St Ishmael and deputy leader of Carmarthenshire County Council.

She said the Carmarthen Road practice had been there for a number of years.

“There’s traditionally been a dispensing surgery, which is exactly what we do need,” she said.

“The majority of people who live in the area are older, and the surgery has been on the decline in recent years, but it still has such things as foot clinics and heart clinics.

“They are now going to close it, which is out of all proportion.”

She said the nearest surgery in the group was Minafon in Kidwelly, which was about four miles away. But it was difficult to get to if patients needed public transport. The nearest bus route to the Kidwelly surgery dropped passengers off at least 10 minutes away from the practice, which wasn’t suitable for the less mobile, she added.

She suggested the practice could set up a bus route taking passengers without suitable transport from the Ferryside surgery to Kidwelly.

Cllr Stephens added: “This is about moving services from their locality.

“What older people want to do is to see a GP. They don’t necessarily want to see a nurse.

“Once they have seen the doctor they are quite happy to meet a nurse or practitioner. That’s where the whole system seems to be falling down.”

She felt the consultation was not being spread out enough to the wider community, including nearby Llandyfaelog.

A petition has been set up to maintain the surgery in Ferryside.

Started by Ute Eden, it says: “We feel very strongly that it is essential to maintain a surgery in Ferryside.

“We need a doctor, a nurse and a dispensary to provide the vital services required by a village where most residents are over the age of 50.

“It is an integral part of Calon y Fferi Community Centre, which is very accessible.”

The petition, which has been signed by 44 people, said it would be a backward step to oblige all residents to leave the village for treatment.

Jill Paterson, director of primary care at Hywel Dda University Health Board, said: “As a health board we are committed to listening to and engaging with local populations around our proposals to relocate our primary care services from Mariners Surgery to neighbouring surgeries.

“We would therefore like to invite residents to come along and get involved in the conversation.

“Following a review of how services are used by patients at the surgery, it is becoming clear that these services are limited and not fully utilised and could be relocated to Minafon and Trimsaran Surgeries.”

A&E standards fall – the end game means an opportunity for private A&E and Ambulance services in richer areas

Don’t wait until you are ill, or your next of kin needs emergency care. Try and think ahead to what options you have in your post code. In reality most of us will have no choice, but there may be a choice in the bigger cities. Certainly NHSreality expects market forces to mean private services expand. As A&E standards fall – the end game means an opportunity for private A&E and Ambulance services in richer areas. And its going to get worse…

It is all very well having long waits for access to GP and cold hospital care, but it is quite another when one of the holes in the safety net gets so large that the net has been removed. I can attest to the fall in standards from personal experience with a recent Right hand compartment syndrome that was ignored at first, and then operation was delayed, for a total of 18 hours. The recovery will be longer, and more painful than it might have been, but thank goodness I have kept my hand.

The failure in manpower and forward planning in general, the over supply of doctors who wish to work part time, and under supply of those who wish to work full time, rationing of medical school places, and lack of increased reward for working a shift pattern career are all part of the problem. There is no valuing of what are seen as temporary staff, and it has to get worse…

The Care Quality Commission

Henry Bodkin in the Telegraph 15th October: More than half A&E services failing

More than half of A&Es are now failing because patients who should be treated at home or in clinics are flooding through emergency departments’ “ever-open doors”, inspectors have warned.

The Care Quality Commission said breakdowns in provision for dementia and mental health patients are fueling the deterioration of standards….

ITV News: A&E under tremendous pressure as more departments need improvement (Standards fall)

Shaun Lintern in Health Service Journal: Regulator warns of ‘extraordinary’ winter for A&Es

  • Chief inspector warns of “extraordinary circumstances” for emergency departments this winter
  • Care model failure leaves hospitals overloaded
  • Watchdog warns of deterioration on mental health, learning disability and autism wards

A failure to provide the right models of care is forcing thousands more people to attend emergency departments each day, the Care Quality Commission has said, while warning of a “perfect storm” for the health service this winter……

Dennis Campbell in the Guardian: More than half of A&Es provide substandard care, says watchdog – Hospitals struggling to cope with rising numbers of patients who cannot get help elsewhere

Kaya Burgess in the Times: More than half of A&Es not up to job, says care watchdog

The health watchdog has warned that A&E departments are under “tremendous pressure”, with more than half now deemed inadequate or in need of improvement.

The Care Quality Commission’s annual State of Care ( England only) report also warned of a “perfect storm” across health and social care where people cannot access the services they need or where care is provided too late.

The regulator found that A&E standards had slipped over the past year and that emergency departments were the most likely part of a hospital to be ranked as inadequate.

In 2018-19, 44 per cent of urgent and emergency services were rated as requiring improvement — up from 41 per cent the year before — with a further 8 per cent deemed inadequate, up from 7 per cent the year before.

Inspectors said that A&E departments had not had their usual “breathing space” over the summer months to prepare for the perennial winter pressures.

He said: “We know that it’s a combination of increased demand and challenges around workforce [that] are creating something of a perfect storm and if that perfect storm is allowed to continue we will have a number of problems.”

He said that the 18-week waiting list for planned hospital treatment had grown from about 3 million people to 4.4 million over the past five years.

The CQC also warned of a “serious deterioration” in the quality of inpatient services for people with mental health problems, autism or learning disabilities. About 7 per cent of child and adolescent mental health services were rated inadequate last year, up from 3 per cent the year before.

Mr Trenholm said: “We also know that adult social care remains fragile. We know that the failure to agree a long-term funding solution is driving instability in the sector.”

Sally Warren, director of policy at the King’s Fund health charity, said: “The CQC’s report provides further evidence that staffing is the make-or-break issue across the NHS and social care. Staff are working under enormous strain as services struggle to recruit, train and retain enough staff with the necessary skills.”

Nick Scriven from the Society for Acute Medicine said: “At some point in the near future all these sustained and repeated problems with increasing demand, inadequate workforce that is haemorrhaging senior cover, the pension tax crisis, crumbling estates, insufficient community medical care and community social care in general totally under-provisioned, we will reach a vital tipping point and care will be compromised despite all the heroic efforts by the human side of this, the staff in post.”

An NHS spokesman welcomed the watchdog’s finding that quality standards had remained stable when taken as a whole and said: “While the NHS Long Term Plan set out an extra £4.5 billion to ramp up GP and community care, the CQC rightly highlights the need for a long-term solution to adult social care so that older and vulnerable people get the right care when they need it.”

March 2015 NHSreality: From bad to worse: “NHS medical accidents investigation unit ‘needed’”

Jan 2016 NHSreality: Accident and Emergency – departments understaffed – report suppressed

Doctors let dying patients waste their last days in Accident and Emergency

The Care Quality commission has different standards and reports in different jurisdictions