Category Archives: Consultants

Consultants are at the highest point of their profession – or are they? What ambitions do they have and are they able to do research easily?
How does sub-specialisation fit in with keeping ones skills as a generic doctor? If those generic skills are lost, does it matter?
Should all consultants be in teams run by tertiary centres and with opportunities to go to the centre for updating?
Are the consultants in your local hospital happy they are there? Would they have preferred to be elsewhere? And how do they see management and professional standards changing?

After promising to clone GPs, and failing, Mr Hunt promises to “make” more radiologists… Importing them will block our own for years. Exporting films abroad is an option…

The strict and high standard training of radiologists has been threatened by cutbacks, just like GPs. Numbers have been insufficient for years, and although “Intelligent computerised reading” may reduce the numbers needed in the longer term, but short term there is a terrible risk. Will patients be asking for their X rays to be read by a consultant, and if this is not possible in their DGH then they should ask for the films to be read privately… The result of long term under capacity rationing is here and now: a two tier health service. Trusts who insist patients who go privately are put at the bottom of NHS waiting lists might have a problem with patients already admitted to hospital. Will they send them home again? Instead of recruiting from abroad, and blocking our own youngsters from Radiology careers, the films should be sent abroad pro tem. (Commissioning export?)

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The Times December 5th reports: Hunt promises 300 more radiologists for NHS England

The NHS will take on 300 more radiologists in England, Jeremy Hunt, the health secretary, has said. The pledge is part of the Cancer Workforce Plan, intended to tackle what one charity called a “crisis in the diagnostic workforce”. Another 200 clinical endoscopists, who use tiny cameras on flexible tubes to investigate suspected cancers inside the body, will also be appointed. It is hoped that the new staff will be trained by 2020, according to Health Education England.

Mr Hunt said: “We want to save more lives and to do that we need more specialists who can investigate and diagnose cancer quickly. These extra specialists will go a long way to help the NHS save an extra 30,000 lives by 2020.” However, the all-party parliamentary group on Cancer said that NHS England would “struggle” to achieve ambitious plans to improve cancer care. John Baron, the chairman, said that the cancer strategy was in danger of being derailed and added: “Corrective action now needs to be taken.”

They dont really care – they have known about the shortage of Radiologists coming for decades..

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

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A sinister development in the role of the GMC the position of a trainee, and the risk of a worsening, defensive culture of fear

Honesty and Candour are at risk. In a post truth world we need to control the damage being done to the medical profession. Without a no-fault compensation scheme this situation will get worse. Already precedent has been set by demanding access to Trainee doctors “educational portfolio”, and these two cases together are worrying. A sinister development in the role of the GMC the position of a trainee, and the risk of a worsening, defensive culture of fear. Gagging with such behaviour is really another form of bullying.

In Letters in the Times 5th December a team of 760 professionals at the top of their game question the GMC and it’s approach to candour. Medicine on trial:

MEDICINE ON TRIAL
Sir, We are concerned that the General Medical Council (GMC) is putting the culture of candour in medicine at risk and perpetuating an injustice by seeking the permanent erasure from the medical register of Dr Hadiza Bawa-Garba. Dr Bawa-Garba, a trainee paediatrician, was convicted in 2015 of negligent manslaughter after the tragic death of Jack Adcock in 2011.

The Medical Practitioners Tribunal Service (MPTS) then had to decide if she was fit to continue to practise. It heard that her clinical practice was generally regarded as excellent, with no other concerns flagged against her. It recommended she could apply to return to service as a doctor after 12 months’ suspension. The MPTS identified “multiple systemic failures” within the service. The evidence for these failures was not fully examined at the criminal trial; had they been, this would almost certainly have reduced her purported culpability.

The GMC is now appealing, via the High Court, seeking to have her struck off. We know of no evidence that terminating Dr Bawa-Garba’s medical career will make any patient safer. On the contrary it promotes a climate of defensiveness. In 2001, the joint declaration by the government and the GMC recognised that “honest failure should not be responded to primarily by blame and retribution, but by learning and by a drive to reduce risk”.

We urge the GMC to recognise that many within and outside medicine are already losing confidence in it and that this case could define its future.

Dr David Nicholl, consultant neurologist, Birmingham; Sir Peter Bottomley, MP; Nick Ross, journalist; Captain Niall Downey, doctor, pilot & patient safety trainer; David Field, professor of neonatal medicine, University of Leicester; Professor Sir Iain Chalmers, James Lind Initiative, Oxford. Plus a further 769 names at manslaughterandhealthcare.org.uk/letter

Trainee’s portfolio ‘used as evidence against them’ in legal case

The real man smiles in trouble, gathers strength from distress, and grows brave by reflection. Thomas Paine Article from Pulse magazine once again the opportunity to learn from mistakes will be lost in order to satisfy the thirst for cash for claims bonanza that is going on in the UK. Good luck retaining doctors with […]

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

The breaking up of the old “National” health service into the 5/6 different health services (If we include London) is a form of self harm in many ways. The benefits of a large mutual in health, where we cannot predict our future diseases, or our own “lottery of life” ticket, were fully understood by Aneurin Bevan.

The NHS Executive (England) announced 26th October: NHS ahead of schedule for procurement savings but this is still small savings in relation to the potential. The Logistics Manager, Supply Chain reports 30th October: NHS Supply Chain delivers £250mn of savings, nearing £300mn …But the “Public Finance” site 9th November reveals the truth in its concern to compare: DoH to rank NHS hospitals in ‘procurement league tables’. You have to believe in the power of the mutual to understand the reduction in risk, as well as the potential savings. Devolving powers is all very well, and “liberal”, but if it reduces life expectancy by increasing risk, reducing choice and purchasing power, and makes a Regions (such as Wales) bust then it is not a public good.  Imagine if we were so “liberal” as to give each citizen a health budget of their own? The benefits of mutuality are lost as those lucky enough to avoid disease choose to lead hedonistic lifestyles at the expense of the unlucky. The post-code lottery is reality, but nobody knows it until they are a victim. Dead patients don’t vote.

With the inefficiencies in mind, one wonders why London has been approved as the 6th health system in the UK? The only explanation I can believe is that it muddies the water even further: it allows more comparisons, and less choice. Politicians of course, with access to London will always have access to the best! For the rest of us it will be second rate care or a private plan/ purchase option.Image result for the mutual health cartoonI wonder if the youngsters understand the principles behind a mutual organisation? It is not hard to find examples which we revere such as the John Lewis partnership. The question of “what is the John Lewis Model” was addressed in the Guardian. If you want to read and then answer questions on a “business case study” the opportunity is here.  In Insurance, such as the old NHS, the advantages are clearer still…

Oliver Wright reports in the Times 20th November 2017: No cash bailout until you make savings, Hammond tells NHS ( a reality warning before the budget ).

Health service leaders have failed to keep their promise to save billions of pounds to spend on frontline services, Philip Hammond claimed yesterday, as he ruled out a budget bailout for the NHS.

The chancellor rejected calls by Simon Stevens, the chief executive of NHS England, for a £4 billion funding boost, saying that people running public services often claimed “Armageddon” if they did not get the money they wanted from a budget.

He warned that although the government might find some money for “particular pressure points” in the NHS it would not be at the scale demanded by Mr Stevens. The chancellor is understood to be prepared to find the money to fund limited pay rises for nurses and some capital investment programmes but there will be no significant increase in total NHS revenues.

Mr Hammond’s comments came after Mr Stevens said that the government should honour the pledge of the Vote Leave campaign and hand some of the money “saved” by Brexit to the NHS…….

Drawing on analysis by the Health Foundation, King’s Fund and Nuffield Trust charities, Mr Stevens suggested that the NHS needed about £4 billion more next year to prevent patient care from deteriorating.

Mr Hammond said that the government had already agreed to provide the NHS with an extra £10 billion by 2020 — a figure requested by Mr Stevens in his five-year plan.

“That plan is not being delivered,” Mr Hammond said. “We need to get it back on track.” He added: “In the run-up to budget, people running all kinds of services come to see us and they always have very large numbers that are absolutely essential, otherwise Armageddon will arrive.

“I don’t contest for one moment that the NHS is under pressure. We have been doing some very careful work with the Department of Health, with the NHS, to look at where those pressures are, to look at the capital needs of the NHS, to look at where the particular pressure points around targets are. And we will seek to address those in a sensible and measured and balanced way.”

His remarks about the five-year plan irritated NHS England, which sent out a series of tweets shortly after Mr Hammond was interviewed on The Andrew Marr Show on BBC One, citing “evidence” that Mr Stevens’s reforms were working. The shadow health secretary, Jonathan Ashworth, described Mr Hammond as out of touch. Mr Ashworth said that an extra £6 billion was needed to avert “Armageddon”.

He told Sunday With Niall Paterson on Sky: “It’s incredibly serious and if I may say so I’ve seen Philip Hammond doing interviews today, being dismissive of the calls for more money for the NHS, saying well you know it’s not going to be Armageddon.

“This is happening now, today, in the NHS, and if he doesn’t realise that, he’s completely out of touch. We are calling on the chancellor to put aside an extra £6 billion in this budget.”

NHS England declined to comment but is understood to reject suggestions that the plan it set out for NHS efficiency savings is not working.

 

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The Health Services Procurement – inefficient and risky… Centralisation and management control is needed

Devolution of health to Wales was a mistake?

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.

Health postcode lottery: The Mirror’s online tool shows how many years of illness you can expect – but only for those living in England….

Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

Stroke patients in Wales ‘could die’ because thrombectomy not available Acute shortage in NHS of specialist doctors who undertake life-saving treatment means hospitals cannot provide it

It’s about to blow up. There is no Mr Fawkes to arrest, blame and punish (hang draw and quarter) for the coming NHS failures

If you are planning a holiday rather than saving that heard earned cash, you might want to consider the true cost of health care, what will not be available to you in your particular Post Code, and what you could afford to buy straight, or insure for. Being off work for long periods, especially for mental health problems is soul destroying, and reduces standards of living. Houses have to be re-possessed, and re-employment is difficult. Only the large state employers seem to ignore the mental health record. Small organisations are unlikely to keep those who keep needing time off unpredictably. If you do go on holiday, especially to Greece, take cash! The bomb under the health service is about to go up, and there is no Mr Fawkes to arrest, blame and punish (hang draw and quarter) for it’s failures. If, like most people you cannot contemplate a life without mutual health cover, find out what your premium would be and take it off your income… scary. “The sums involved are colossal” – see below, and tinkering with fraud and overseas patients are distractions.

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Tony Stubbington reports in The Sunday Times 6th November : NHS cash crisis reveals the fractures in our finances. The chancellor has little room to prop up the health service in his budget

At Birmingham Children’s Hospital, staff who go the extra mile get the chance to be named “Star of the Month”. Looking through the recent nominations for the award, Sarah-Jane Marsh noticed a worrying trend. The number of people who were nominated for working through weekends or holidays without extra pay was “unbelievable”, said the chief executive of Birmingham Women’s and Children’s NHS Foundation Trust.

“We are running on goodwill,” she said. “People don’t take breaks. They work through annual leave. Over the past two years we’ve been cut to the bone.”

The trust’s funding has not kept pace with steadily rising patient numbers and the soaring cost of ever-more sophisticated treatments, according to Marsh. Staff have stretched themselves, but the cracks are starting to show. In the three months to September, the trust missed its target for A&E waiting times for the first time since 2003, she said.

Her complaints cut to the heart of the dilemma facing Philip Hammond as he prepares for an extremely politically charged budget on November 22. Most government departments claim they are at breaking point and have started leaking stories about the strains on policing, social care, prisons and creaking infrastructure.

Yet there is simply not enough money to throw more than a bit of cash at some minor problems and hope for the best. The chancellor already faces a productivity slowdown expected to blow a hole in plans to balance the budget by the middle of the next decade. A cash injection for the NHS could sink these plans.

 

Image result for cash crisis cartoonThe Sunday Times 5th November reports on child and adolescent mental health with:

Parents beg universities for help after rash of suicides.

Crisis in child psychiatry as vacancies soar.

Coroner attacks failures of care for anorexic teacher.

But these are the thin edge of a very large wedge. No commissioning group fails to accept that child psychiatry is core health service provision, but in a cradle to grave and un-rationed NHS, why is dementia excluded? Why is palliative and terminal care funded by charities? Why is psychiatry (40% of GP work, and rising) not part of the training for all GPs? We know it is unpopular, but it becomes much less o once doctors are exposed to it as a speciality. I wonder how many of our UK psychiatrists trained in a UK medical school? This is a speciality that needs good communication and cultural awareness…. Even in Germany they have trouble with “fakes” which makes me wonder about quality control…

Shortage Occupation List – Royal College of Psychiatrists

1,000 more psychiatrists needed to tackle ‘unacceptable failings’ in care

Shrinking: The Recruitment Crisis in Psychiatry | The Psychiatry SHO*

Why Don’t Medical Students Choose Psychiatry? | The Strangest Loop

Psychiatric nursing: an unpopular choice. – NCBI

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Counting the cost: NHS cuts to cataract surgery can be fatal

We were made with two eyes, and two ears for a purpose. Reducing vision to one eye means there is less visual stimulation, and the same is true for only one ear or hearing aid. Besides the falls and accidents, there is a possible dementia potential…

In the kingdom of the blind, the one-eyed man is king. - Desiderius Erasmus

Chris Smyth reporting in the Times October 26th 2017: Counting the cost: NHS cuts to cataract surgery can be fatal

If analysis of cost effectiveness is a little technical for most patients, then it does not get any starker than this: cutting back on cataract surgery could cost lives.

The latest research from the US does not prove that fixing cataracts directly cuts the risk of early death by 60 per cent — but patients whose cataracts are not treated are known to injure themselves more and generally disengage from the world. It is powerfully plausible that for some this proves fatal.

The study appears just as the National Institute for Health and Care Excellence publishes guidelines that tell the NHS that rationing is unjustified. Its calculations are unequivocal: fixing cataracts is almost always a good use of NHS money.

The problem is that the NHS’s resources are being spread ever thinner. It is striking that health officials no longer bother to dispute the evidence nor claim that their policies are not really about cost cutting. With admirable honesty, they now simply say they cannot afford to treat everyone who needs it, even for something as basic as 20-minute cataract surgery. Even if it means those patients are more likely to die early.

So far voters have tacitly accepted this. The big political question is: for how much longer?

The Telegraph: Stop rationing cataracts until patients are nearly blind, NHS warned

The Mail: End of the cataract postcode lottery: NHS are told to halt rationing

Doctors forced to plead with NHS for treatments for patients, BMJ finds …Growing healthcare rationing means GPs are having to submit exceptional requests for treatments including cataract removals and new hips and knees

Many NHS trusts ‘rationing cataract surgery’ – BBC News

Hearing loss and dementia: more research is needed. Patients with hearing aids in hospital need special consideration, and for over 70s, that’s over 60% of us …

 

Why won’t anyone in power talk about rationing? “We need to talk about NHS rationing”…

The downside of honesty must be greater than the upside – what an indictment of our media led society. Why are our leaders and administrators, trust chairmen and CEOs so afraid to speak out?

In Pulse 10th October 2017 David Turner opines: We need to talk about NHS rationing

A woman requesting breast reduction.

A child with severe behavioural problems in need of psychological assessment

A seventy year old brought to tears daily with knee pain, waiting for physiotherapy.

A new cancer drug costing thousands per month that has just received NICE approval.

What have these patients got in common? They all have a legitimate claim on the NHS pot of money for funding.

The recent announcement that NICE has approved nivolumab for treating patients with certain types of advanced lung cancer is fantastic news for those patients and will add valuable months to their lives.

There is, though, a rather large pachyderm in the room, which sooner or later needs to be faced. I’m afraid all of us – doctors, patients, managers and politicians – seem reluctant to address the rather obvious reality that NHS coffers are not infinite. Funds for healthcare are always going to be finite and even with the best political will in the world (and we certainly don’t have that at the moment) we cannot pay for everything.

Funding an expensive cancer treatment to give someone extra time on earth will impact on other aspects of healthcare. Increase funding to one area and others will suffer with reduced services and longer waiting lists.

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Do we say only disorders that can be fatal go to the front of the queue?

Many will say we should prioritise the most serious illnesses which can kill quickly such as heart disease or cancer. Nobody dies from osteoarthritis, but thousands suffers tremendous pain every day while waiting joint replacement surgery. It’s also not unheard of for people with mental illness to kill themselves while waiting to see a psychiatrist.

Name virtually any condition or disease and there will be individual sufferers and support groups making their case as to why more taxpayers’ money should be spent researching into or treating their disorder.

The reality is everyone’s health matters to them more than anything else and few people will be altruistic enough to say public money should be spent treating others before themselves and their loved ones.

I don’t claim to have the answers, but unless we start to talk more openly about the very real issue of rationing in the NHS we are just postponing some very serious questions for the future and they are not going to get any easier to answer.

Dr David Turner is a GP in west London

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Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

If commissioning groups insisted that oncology clinics had a GP present, and that he was involved in decision making with the patient, and especially the decision to move from oncology cancer care to palliative  or terminal care, there would be far less wastage. There is an issue: there are not enough GPs. Undercapacaity means the most pragmatic way would be a phone call to the GP BEFORE any decision on treatment is taken. The savings involved, the quality of life gained, and the honesty of such teamwork seems to be unimportant… 

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Chris Smyth in the Times reports 5th October 2017: Cancer patients given new drugs that won’t help them

Most new cancer drugs are given to patients without any evidence that they extend or improve lives, an overview of data has concluded.
Only half show they have any real benefit, according to researchers who say regulators must make it harder for medicines to be approved. Other care for patients is being rationed to pay for drugs that are often useless, they add.
Regulatory approval, however, does not mean the NHS will pay for the drugs. Health chiefs will see the study as vindication of a tougher line which has seen them rejecting many new medicines as poor value for money.
NHS England yesterday defeated a legal challenge to its decision to add an extra layer of rationing to new medicines. Even cost-effective treatments can now be delayed or restricted if the total cost to the NHS exceeds £20 million a year, after a High Court judge refused the Association of the British Pharmaceutical Industry (ABPI) permission to take the plans to judicial review.
In an effort to assess the effectiveness of new medicines, scientists looked at data on all 68 cancer treatments approved for routine use by the European Medicines Agency between 2009 and 2013. They found that only 35 per cent had been shown at the time to lengthen patients’ lives.

A further 7 per cent could show they improved patients’ quality of life, according to data published in The BMJ. Instead, drugs were approved on the basis of studies that looked only at interim measures, such as how many patients responded, or how long the disease went without worsening. However, these turned out to be poor markers that patients would live longer, with just 7 per cent of drugs without a survival advantage when they were approved going on to demonstrate one over the next five years.

Overall, no more than 51 per cent of the treatments approved have shown any benefit in terms of life expectancy or quality, they say.

Courtney Davis, of King’s College London, who led the study, said patients often did not realise that the drugs they were offered had not been shown to extend life. “What people often don’t realise is that it’s not just resources taken away from other disease areas, they are also being taken from other cancer treatments that are actually more effective than drugs.”

Many of the best-known treatments approved during the study have been shown to extend life, including abiraterone and enzalutamide for prostate cancer, and Herceptin and Kadcyla for breast cancer.

Paul Catchpole, of the ABPI, said: “It can take many years to gather overall survival data on new medicines, which is why meaningful surrogate outcomes are used by regulators so that promising new medicines can be provided to patients whilst further evidence is collected. These cancer patients often have no other remaining options.”