Category Archives: Guest

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 …

More research is needed into the relationship between hearing loss and dementia. Patients with hearing aids in hospital need special consideration, and for over 70s, that’s over 60% of us … The rationing of hearing aids is patently perverse, and the outcome could be more long term dementia care demand on the state. And of course the politicians making the decisions today will not be those addressing the future problem.

Image result for hearing loss and dementia cartoon

A letter from Dr Ted Leverton in the JRCGP October 2017 reads: 

Iliffe and Manthorpe’s editorial in the August issue1 is apposite in view of the publication in July of the Lancet Commissions’ report Dementia prevention, intervention, and care, which expands on several of the themes raised.2 In particular, the editorial’s focus on the role of general practice in prevention and research is to be welcomed. However they do not mention hearing loss, to which the Lancet report devotes considerable space and ascribes a significant potential preventive role. Hearing loss is independently associated with developing dementia in about one-third of cases.

Recent research has suggested that use of hearing aids may reduce or prevent the increased prevalence of dementia seen in adults with hearing loss.3,4 This needs confirmation, as current evidence is weak due to the large number of confounding factors. General practice is ideally suited to carry out this research thanks to our large-scale and long-duration databases. In the meanwhile, GPs are likely to see increasing numbers of patients asking for referral for hearing aids, as some in the commercial sector are stating this benefit of hearing aids as fact. Such referral should be expedited; GPs are sometimes accused of minimising hearing loss and delaying referral, but early users of hearing aids are more likely to use aids successfully over a longer timescale as they can be difficult to use. Hearing loss is associated with depression and social isolation;5 denial of the disability is common, as is irritability and interference with relationships. By the age of 70 years, 70% of GP patients have hearing loss. If in doubt, or if the patient is reluctant, a simple validated screening test is available over the phone or online.6


  1. (2013) Hearing loss and cognitive decline in older adults. JAMA Intern Med 173(4):293299. Lin FR, Yaffe K, Xia J,et al.
  2. (2015) Hearing loss and cognition: the role of hearing aids, social isolation and depression. PLoS One 10(3):e0119616, (accessed 5 Sep 2017). Dawes P, Emsley R, Cruickshanks KJ, et al.
  3. Action on Hearing Loss. Check your hearing. (accessed 5 Sep 2017).

Whistleblowing and gagging update

If Scotland accept the proposals there will be another area of Post Code differential. Peter Gregson in Scotland posts as a guest, and NHSreality hopes that other Regional Health Services will follow (but it will take more than this to change the culture):


I wanted to let you know that the Scottish Parliamentary Petitions Committee will be discussing petition PE1605 this Thursday the 9th February at 9.15am. It will  take evidence from:

·         Laura Callender, Governance and Compliance Manager and Kirsty-Louise Campbell, Head of Strategy (interim), City of Edinburgh Council;

·         Cathy James, Chief Executive and Andrew Pepper-Parsons, Head of Policy, Public Concern at Work;

·         Tam Hiddleston, Secretary, Scottish Healthcare Branch, UNISON Scotland

 The agenda can be downloaded at

I’ll be there, but I won’t get to speak. If you want to attend, book your ticket at

You will also be able to watch it live on Parliament TV here

I’ll circulate the official report and link to the video in about 10 days’ time. (NHSreality will give a link in an update to this page)

 Here’s hoping for a revealing discussion. I think the Petition will be continued after Thursday – the clerk tells me that the Chief Exec of NHS Scotland is due to attend to discuss this but was not free on Thursday – he thinks Paul Gray will likely attend on the 2nd March.


File on 4: Speaking Up – Whistleblowing in the NHS (BBC iPlayer 7th Feb 2017)

…Two years ago the first independent report into the treatment of whistle…

…Two years ago the first independent report into the treatment of whistle-blowers in the NHS was published. The Freedom to Speak Up report was commissioned by…

…Two years ago the first independent report into the treatment of whistle-blowers in the NHS was published. The Freedom to Speak Up report was commissioned by the government amid concerns not enough progress had been made to create a more…

Whistleblower Bullying hotline – proposed by petition for Scotland – could be rolled out across the UK

Peter Gregson, who works for the Scottish Health Service (NHS Scotland) has proposed that the Scottish Parliament cover the costs of a Whistleblower Bullying hotline in his i-petition. If accepted then this should be rolled out across the UK. But barriers to acceptance include the trade unions. Peter was asked to leave a meeting in which he was handing out leaflets (see below) recently. ( Peter Gregsons press release. )

whistleblower cartoon

So if we do stay together this could be one area where we improve the culture together. The current system of relying on line managers to back you up, is not good enough.

Whistleblower HotlineHealth workers in Scotland are being blocked from debating whether to support a Parliamentary Petition calling for a whistleblower hotline. It would allow NHS staff to report mismanagement, bullying, perceived negligence, malpractice or ill treatment of a patient by a member of staff.

The Petition PE1605 is shortly to go before MSPs and union support is crucial to seeing it implemented. But all four big health sector unions either won’t support (or won’t allow their members to discuss) the Petition, which calls upon the Scottish Government to establish an independent national whistleblower hotline for NHS staff to replace the current helpline. It would differ in that it would investigate reports about mismanagement and malpractice, often without recourse to NHS managers.

The reason why the unions oppose the measure is because they say they are tied into partnership arrangements with NHS Boards and will do nothing that might undermine that. But it is clear that they have not even discussed the scheme with NHS Management; they have rather instinctively chosen to side with what they think managers will say.

It is unreasonable of them to assume that NHS bosses will oppose a hotline. When a similar approach was made by the same petitioner to Edinburgh Council in 2013 the Corporate Management Team initially opposed it, but now pay tribute to its success. The hotline has been in place since May 2014 and was recently lauded by the Council in its Whistleblowing Annual Report : “Many of the recommendations that have resulted from investigations have led to amendments to policy, improvements to procedures and processes, the development and sharing of best practice and improved service delivery.”


Whistleblower reports are taken by the Council’s Governance Risk And Best Value (GRBV) Committee and have led to numerous improvements at the Council.

The Petition to the Scottish Parliament has been signed by politicians from right across the spectrum. Supporters include MSPs Kezia Dugdale (Scottish Labour Leader); Jeremy Balfour (Conservative Shadow Minister for Childcare & Early Years- who also helms Edinburgh’s GRBV Committee) and Green MSPs Alison Johnstone and Andy Wightman.

It is supported by The UK Patients Association, by Action for a Safe and Accountable People’s NHS (ASAPNHS), the Scotland Patients Association, the NHS Lothian Branch of Unite and Accountability Scotland.

The only agencies refusing to support the scheme are the unions and staff associations…..

Whistleblowing cartoons, Whistleblowing cartoon, funny, Whistleblowing picture, Whistleblowing pictures, Whistleblowing image, Whistleblowing images, Whistleblowing illustration, Whistleblowing illustrations

'And this is Mr Proctor, he manages the hospitals whistleblowing support team.'..


1 in 20 Welsh voters wants to abolish Welsh Assembly Government – and the “One party state”

Wales is funded and founded differently to Scotland. The monies available for Health and Education in particular are less, and this is because of the structure. The Nuffield Trust commented earlier this year. In effect more money would be available for Health and Education under the former regime with a Welsh office. If 1 in 20 want abolition without publicity and media coverage, how many more will vote next time? Turnout was just over 50%.. When will the dying “one party state” of Wales change?

How will abolishing the welsh Assembly benefit the people of Wales ? If readers consider that £350 m is equivalent to one fully staffed new hospital per annum. From waiting times, mortality and morbidity, life expectancy and general standards overall it looks to the professions as if Devolution of Health in Wales was a mistake. How much worse must it get before the voters realise this?


James Cole writes in Walesonline Letters Tuesday 10th May 2016: ‘Abolish’ Party is proving worthy

Thank you one and all who voted for the Abolish the Assembly Party.More than 44,286 votes! Abolish is now the largest party in Wales (in terms of votes) that doesn’t have a seat in the Senedd.

Making a huge gain first time out was clearly beyond reality. However, we got 44,286 votes despite the fact that perhaps most voters were either still unaware of our existence or were, at least, taken by surprise at the last moment. It seemed at times that, apart from the BBC, the Welsh media boycotted our campaign. This, despite the fact that the “No, to a Welsh Assembly” vote in the 1997 referendum received 552,698 votes.

That was 49.7% of the votes cast when only half the Welsh electorate actually voted. So, only a quarter of us actually voted Yes to the Assembly. Hardly a mandate for fundamental change.

I urge everyone to consider the possibility that the Welsh Assembly was not designed for the benefit of the Welsh people, but for the benefit of the career politicians.

They get big salaries, expenses and pensions. What do we get? The bill.

Issues that are perhaps best devolved can be made the responsibility of our local authorities and their 1,265 councillors. That really would be power closer to the people.

We think the Assembly just gets in the way while costing far more than it would take to keep Port Talbot steelworks operating.

We consider our result in this election to be a foundation stone for the fightback. We have drawn a line in the sand.

We will keep this movement going.

James Cole, St Thomas, Swansea


A campaign to abolish the Welsh Assembly will continue

Spokesman David Bevan claimed the assembly benefitted “career politicians”, not the Welsh people.

He said the election result was “a foundation stone for the fight-back”.

The Abolish the Welsh Assembly Party put up candidates on the regional lists, claiming abolition would save the taxpayer £500m a year.

Further info below from the party website

“The cost of running The Assembly is very difficult to estimate. We are tempted to think this is deliberate as the figure would, no doubt, be truly shocking. Now we find that Welsh Assembly members are going to see their salaries increased to £64,000 in 2016. Assembly Cabinet ministers will get £100,000 p.a. The First Minister’s salary is due to increase to near the level of Prime Minister David Cameron, £140,000 pa. The First Minister is only in charge of devolved issues covering Wales.” from the abolishthewelshassembly website

Welsh Assembly Final Budget 2016-17


Components of the Welsh Budget £000s
Departmental Expenditure Limits Resource Capital Total
Health and Social Services      £7,004,269
Local Government  £3,370,622
Communities and Tackling Poverty  £ 707,323
Economy, Science and Transport  £988,747
Education and Skills £ 1,756,578
Natural Resources £ 376,575
Central Services and Administration  £311,897
Total Welsh Government MEG Allocations

Resource 13,159,112 Capital 1,356,899  TOTAL £14,516,011

The amount of funding allocated to Welsh Government Main Expenditure Groups (MEGs) for 2016-17 is £15bn.

Abolish the Welsh Assembly Party

Seats0 Net change in seats Votes 44,286 Vote Share4.4%  




On a turnout of 45.3% Letters Walesonline May 10th  , but no candidates fielded in the constituencies.

The Abolish the Welsh Assembly Party put up candidates on the regional lists, claiming abolition would save the taxpayer £500m a year.

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?

Patients and the professions are ready to ration health care strategically, without devolution. It’s the politicians and the managers who won’t hear of it because the strategy might mention rationing.

The State of Wales: we should all rage against it dying

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 this  sort of thing  going on …. We will become the dumping ground for the worlds worst practitioners , man can only learn through experience. LINK TO FULL ARTICLE BELOW

“If you want a vision of the future, imagine a boot stamping on a human face – forever.”  Could be a quote from any tory politician …. but alas not their actions speak far louder than words …


Trainee’s portfolio ‘used as evidence against them’ in legal case
|15 April 2016 |By Alex Matthews-King

GPs must provide ‘honest explanation’ to patients if something goes wrong, says GMC
03 Nov 2014
A trainee’s ‘written reflections’ on an incident in their training development portfolio was used against them in a legal case, which GP leaders have said illustrates the medico-legal ‘minefield’ that GPs are having to operate in.

Health Education England bosses in London and the South East have warned that a recent legal challenge saw a trainee release their reflections – a vital part of a trainee’s portfolio – which ‘was subsequently used against the trainee in court’.

But in a letter to postgraduate deans and training supervisors, HEE said trainees should continue to make particular note of cases where ‘things do not go well’.

It highlights that for trainees the reflection process is exactly the same as for GP appraisal, and that these should avoid patient-identifiable information and focus on the positive lessons learned.

RCGP’s guide to revalidationGP leaders warned that GPs need to take all precautions to not incriminate themselves

The letter from HEE, which was shared by doctor and medical educator Dan Furmedge on Twitter, said: ‘Recently, a trainee released a written reflection to a legal agency, when requested, which was subsequently used as evidence against the trainee in court. This has resulted in questions about whether trainees should still provide reflection about incidents in their portfolios.

Some words from the USA that strike a chord with Doctors in the UK

Link to original full article below

“The doctor’s autonomy is now nonexistent,” one doctor lamented. “We are being dictated to by insurance companies, hospital administrators, national medical boards, and state medical boards. We are being recurrently credentialed by the same entities. All of this constrains our ability to perform as physicians. We are cogs in a system designed for the maximum profitability. There is no continuity of care, and younger doctors are perfectly happy to work from 9 to 5. Mindfulness training and yoga can’t cure those problems. There has to be mass action to get insurance companies, politicians, and government out of the practice of medicine, and physicians need to take back their responsibilities.”

……… a physician wrote. “The problem is a crisis of professional identity, work overload, powerlessness, and job insecurity. We are responsible for the operational capacity of the system [and] are held accountable for all the outcomes, but have little say in how decisions are made and the direction in which things are going. The only effective treatment is physician independence! The employment model is bad for patients and bad for healthcare costs. Worst of all, it is destroying physicians. Burnout is a symptom, not the problem. We are not suffering burnout. We are suffering because of feelings of helplessness and deep dissatisfaction.”

This applies in  the NHS but with different titles to each of the factors implicated above substitute NICE / NHSE / Jeremy hunt and the DOH / LHB/GMC /    etc etc





Samir Dawlatly: The countdown to the 2020 GP conundrum

31 Dec, 15 | by BMJ

There can be no doubt that the problems facing general practice are complex and interconnected, and that the answers have proved elusive for many. GPs and the organisations that represent them have been very vocal about the obstacles hampering the ability of grassroots GPs to do their jobs safely and effectively: from increasing workload from hospitals (due to increasing patient expectations and demands) to the strain of excessive regulation. These problems and, some would argue, the way that they are discussed openly are probably contributing to the decreased recruitment and retention of GPs…………………

Link above to full article