Category Archives: NHS managers

NHS managers still growing as GP posts fall

The Observer reports 15th April 2017: Number of NHS managers still growing as GP posts fall again – Doctors say ministers’ ‘bureaucracy busting’ shakeup has failed to switch resources and manpower to the front line

The number of NHS managers has grown by almost 18% in the four years since the government introduced a “bureaucracy-busting” shakeup of the health service, according to the latest official data.

The rise of about 4,650 in total management posts since April 2013, when the controversial Health and Social Care Act came into force, contrasts with an alarming fall in the number of GPs over recent months at a time of unprecedented demand for health care. The figures have drawn criticism from the British Medical Association (BMA), who say ministers are failing in their central objective of shifting more resources and manpower from back-office posts to the front line….

Managers are at odds over rationing, and management recognises the case, but the “rules” don’t allow them to speak out.

 

Scotland and Whistleblowing

NHSreality takes the view that since morale is so low, no internal assessment of a whistleblower is possible. Cultural change needs to come quickly, and the start of this is meaningful “exit interviews” by an independent HR company. This company should report in general publically, for a Region, but specifically, in private to Health Boards. Copies of reports should go to the Minister concerned, and should be released once they are not embarrassing to individuals concerned. Incognito exit interviews could then be possible, and done for all staff moving or leaving posts; in particular juniors. I have delayed this post for 3 months hoping there would be some good news follow up… Post will be updated if there is. Some “good news” – Hywel Dda Trust in West Wales have told the consultants that they will initiate exit interviews. At least they are recognising their importance – now they need to recognise the barriers to speaking honestly to their own HR, especially for those moving post within the Trust, but even for those at retirement. The Health Services are on fire… Interesting that the problem has been deferred to the Health and Sports committee… reminds me of “turfing”, or passing the buck in the House of God. (Sam Shemm 1978)

Update 15th March 2017 from 17th Feb 2017:

Hello, If you want to read the transcript of the Petitions Committee meeting where MSP’s quiz Edinburgh Council, Public Concern at Work (PCAW) and Unison on whistleblowing read it here and you can see the video here which last 45 minutes. The Council scheme comes over as having overcome the culture of fear around when I worked there and contrasts hugely with NHS arrangements. The Council reps pointed out that they’d had 53 reports in the 3 years since it was introduced compared to only 3 disclosures over 8 years prior. PCAW said NHS Scotland needed better arrangements but disappointingly said nothing  about the shortcomings of Scotland’s Board Champions, who can’t take or deal with reports (even though I’ve heard they think this is a problem). Unison didn’t really say anything. The next landmark will be on 2nd March when the NHS Scotland Chief Executive, Paul Gray, is called to account.

Important news – the Scotsman reported that “the Parliamentary Health Committee has commenced an enquiry to investigate how the NHS deals with whistleblowers amid concerns there is a culture of fear which discourages staff from raising patient safety issues. NHS staff are to be asked for their views as part of the inquiry launched by MSPs on Holyrood’s health and sport committee.”
More details can be found on the Parliament website “Call for written views on Inquiry into NHS Governance – Creating a culture of improvement” at http://www.parliament.scot/parliamentarybusiness/CurrentCommittees/103512.aspx The Committee is considering whether staff are managed in a fair and effective way.

 And on 5th March 2017:

Hello, The evidence submitted by the NHS Chief Executive, Paul Gray, to Petitions Committee on the 2nd March was underwhelming. The MSPs gave him an easy ride. You can view the 45 minute video here: http://www.scottishparliament.tv/20170302_public_pets?in=00:00:17&out=00:45:04 The transcription is here: http://www.parliament.scot/parliamentarybusiness/report.aspx?r=10824

I was surprised that the Chair brought up grievances at the beginning, ignoring the fact that staff only bring grievances after they feel they have been unfairly treated. Why did she not ask not ask directly for views on the petition? Indeed, it felt as if they’d rehearsed the whole discussion beforehand. There were no questions as to the efficacy of the whistleblowing champions – in having no staff-facing role, with no means to knowing how many (and when) concerns were raised.  At no point did the well-known victimised whistleblowers at Aberdeen, Forth Valley, Ayrshire & Arran and Lothian get a mention, and how they could have been better protected- and no mention of Robert Francis’s recommendations. The only point at which any MSP acknowledged they’d read any of the submissions was when Paul Gray was quizzed about the falling number of helpline calls – to which the Chief Exec answered that the “bottled-up” frustrations in 2013 had created a “spike” – and also, due to ongoing improvements, staff had less need – so there was little, on an ongoing basis, to worry about. There were no references by the MSPs to the staff survey showing fear at speaking up and no calls for it to be run again. Whilst it was acknowledged that an independent whistleblowing officer would be good, it sounded like another consultation was  likely in August – (although they already consulted on this a couple of years ago, so maybe this would be the precursor to a Parliamentary Bill).

Interestingly, the Scotsman managed to make the evidence look newsworthy- see “Health staff fear consequences of whistle-blowing, NHS Scotland chief tells MSPs” here.

Anyway, the Petitions Committee concluded that they would now refer the petition onto the Health & Sports Committee for consideration. We can only hope that they seriously consider what the petition proposes. At no stage did the Petitions Committee express a view on the petition. Sigh.

Thus my petition has followed its course. If it is to go anywhere now, that will depend if the Health Committee. Let’s hope they’ll really discuss the subject properly.

They are currently conducting an inquiry into NHS Governance – Creating a culture of improvement. Whistleblowing fits well. The call for evidence has another 9 days to go – please send something in if you can; I know a few of you have– you can do it confidentially, if you wish.

So I won’t be sending you any more “Update” emails, unless you want updates on the Health Committee’s conclusions. If you would like that, please let me know.

You can submit your evidence openly, anonymously or confidentially. But you only have until the 15th March, just four weeks, to do so. I’ll be writing in – hope any of you at the NHS (either past or present) with views will do too. This represents a real opportunity to call for change.

 

Peter Gregson wrote 4th December 2016:

The Petitions Committee considered the petition again on 24th Nov. The official (verbatim) report is here: https://shar.es/18jO8j

You can view their 6-minute deliberation on the webcast at http://www.scottishparliament.tv/Search/Index/1548bdac-8fee-42b8-8e00-d890656e9e1a – it starts 52mins 34 seconds in and runs onto 58.05. In a nutshell, the Committee now wants to hear from the Chief Exec of NHS Scotland and “representatives of whistleblower organisations”. They suggested the unions, especially Unison. The minute  of the meeting states “The Committee agreed to invite the Chief Executive of NHS Scotland and other relevant stakeholders including the City of Edinburgh Council, Public Concern at Work and trade unions, to provide oral evidence at a future meeting.”

I immediately wrote to the Chair of the Committee and the other four MSPs, suggesting that I could assist with whistleblowing organisations, individual whistleblowers (Rab Wilson, ex-nurse, of Ayrshire & Arran has offered) and asking they try again to contact the English Health trusts (there are 3 in all). No response yet.

I subsequently did some searching and found Whistleblowers UK who assist whistleblowers and give support at tribunals. They have been around a bit more than a year and their website is at http://www.wbuk.org/. They have a helpline for whistleblowers (and no – it isn’t like PCAW at all!). I spoke with their chief exec and she may be able to come up from London to the Scottish Parliament, or send in a submission.

A Scottish whistleblower has been in touch with me saying that if evidence could be taken with the webcam switched off, then they would like to attend to speak to Committee. If any of you feel the same way, please let me know and I will relay this to Johann Lamont.

If you have time, you might like to read the 10 submissions that have come in from Scottish NHS chief execs on the Parliament website here. Only one institution has been positive- the City of Edinburgh Council – and there is a negative one from Unison. A reversal of fortunes from three years ago, when each of these body’s positions were the opposite of what they are now, when I last petitioned for a hotline for local authority staff.

I urge you to read the Edinburgh Council submission that shows how their hotline actually works and the difference it makes- the link is here (I had also petitioned them too, back in 2013). I was also pleased Dr Peter Gordon wrote in – the support of clinicians is key to securing change. Finally, my comment on all the submissions was published as well (Petitioner letter of 9th Nov).

I think the Petitions Committee will revisit the petition with the NHS Chief Exec, probably in late January. I think that will be a very telling meeting – I’ll keep you posted.

 Other news- my FOI to Grampian Health Board on the costs of Professor Krukowski’s treatment has been refused again (see their response here ) so I have now submitted an appeal to the Information Commissioner.

Other news is that on 22nd Oct at their conference, the Scottish Green party adopted this motion, thanks to one of our campaigners:

The Trade Union Group conference identified that existing policy is not clear about the role of trade union representatives on boards. Experience has shown that partnership working between trade unions and management, for example on Health Boards, can be used to incorporate unions into the agenda of management. This motion is supported by SGP TUG.

 …For publicly funded bodies (such as the NHS, local authorities, education institutions, etc.), which have a distinct and particular responsibility to protect employees and those using the services they provide, such measures should include the establishment of a whistleblowing hotline, independently managed by an organisation invested with powers of investigation and disciplinary powers will provide an additional mechanism to ensure good practice is adhered to and wrongdoing is addressed.” 

Best wishes

Pete Gregson

www.kidsnotsuits.com/nhs-staff-whistleblower-hotline-parliamentary-petition/

HSJ implies Managers and Directors are now at odds with Politicians over rationing..

t seems that systematic rationing might become acceptable to managers (who run the HSJ). The Health Service Journal headline 10th March: “Exclusive: NHS England warns CCGs over ‘arbitrary rationing’” implies that whilst it is random rationing is not acceptable. What about systematic rationing? Are NHS England open to overt rationing yet? More importantly, are our politicians willing to say what will not be covered systematically (Nationally), and what would be acceptable locality rationing. This article is of interest to us all, but is only available if you subscribe… It implies that Managers and Directors are now at odds with Politicians over rationing..

NHS England has issued a warning to commissioning groups accusing some of “rationing” surgery using “arbitrary cut offs”, amid growing concern about the issue, HSJ can reveal.

 

 

 

Evidence basis is needed for all treatments – and confirmation by independent third party. Hospitals and pysicians collude to waste money.

The Crick Institute, with buildings at Mill Hill and in Central London, could be a useful tool in health rationing once rationing is overt. It’s evidence could be an additional source for NICE. However, the incentive for government keen to reduce costs is on questioning too much, and delaying, and the incentive for big Pharma is to sell more. The evidence for many drugs in common use should have been questioned more, and the alternative use of funds which might have been used on Pharma products needs more consideration. Only overt rationing can do this. Bisphosphonates such as Alendronate cost money, and it might be better spent elsewhere. The advertising and the sale pitch is on fear of fractures, and the misconception that X ray improvement of bone density correlates with less risk. Hospitals think they will reduce costs, and physicians want to do good, so they conspire/collude to waste money. Knowing this, Big Pharma is willing to pay us when it’s arm is twisted.. (Drug companies propped up NHS with £250m after cabinet’s threat)

Tom Feliden reports in the Times 1st March 2017: Osteoporosis drugs may make bones weaker

Drugs used to treat weak bones in elderly patients suffering from osteoporosis may actually make them weaker, research suggests.

Scientists at Imperial College London examined the bone structure of hip-fracture patients who had been treated with bisphosphonates.

They found evidence the drugs were linked to microscopic cracks, making bones more fragile and prone to break.

Osteoporosis affects three million people in the UK.

What is osteoporosis?

Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.

Bisphosphonates – the main treatment for osteoporosis – are an extremely successful and commonly prescribed class of drugs that slow down the natural processes by which the body removes ageing or damaged bone.

But doctors have raised concerns about the number of fractures occurring among elderly patients who have been taking the drugs for a long time.

To find out why, the team led by Dr Richie Abel took samples of bone from 16 hip-fracture patients and studied them at the Diamond Light Source – the massive doughnut-shaped Syncatron or particle accelerator at the Harwell campus in south Oxfordshire.

“What we wanted to see was whether the bone from bisphosphonate patients was weaker or stronger than bone from untreated controls,” Dr Abel explained.

“Rather startlingly, we found the bone from the bisphosphonate patients was weaker. That’s a conundrum because the bone should be stronger.”

By bombarding the samples with X-rays 10 billion times brighter than the Sun, the team were able to generate images of the internal structure of the bones in unprecedented detail.

These showed microscopic cracks building up in the bones of patients treated with bisphosphonates.

Dr Abel said: “The drug is clearly working, but it also leads to the build-up of micro-cracks in the bone and that could increase the likelihood of a fracture.”

It’s a surprising result, but the study was small and the work is at an early stage.

Even so, Prof Justin Cobb, a co-author on the paper, says the discovery raises important questions about how we prescribe bisphosphonates for long-term conditions such as osteoporosis.

“There’s no hurry, but we should think about how long people are taking them for, and how we might monitor the development of these micro-cracks,” he said.

In the meantime the researchers say people should continue to take medications prescribed by their doctor.


Osteoporosis: Are you at risk?

If you answered: “Yes,” to more than one of these questions, then you may be more at risk of developing osteoporosis:

•Has anyone in your family ever been diagnosed with osteoporosis?

•Have you ever broken a bone after a minor bump or fall?

•Are you female and aged over 50?

•Do you drink more than three units of alcohol a day?

•Do you miss out on summer sunlight (through being housebound, avoiding the sun, always covering your skin or wearing sunscreen)?

•Do you miss out on doing at least 30 minutes of activity five times a week?

Source: National Osteoporosis Society

Medline Evidence on Osteoporosis

NICE pathways to Osteoporosis treatments

(Drug companies propped up NHS with £250m after cabinet’s threat)

No party is offering a credible alternative….. the future of the 4 UK Health Services may lie in social media

 

No party is offering a credible alternative….. the future of the 4 UK Health Services may lie in social media

Richard Vize in The Guardian 25th Feb 2017 offers: “The NHS is struggling. Labour must offer a credible health policy” , but as we know from NHSreality’s 4 years, none of the political parties is prepared to talk and answer questions honestly. There are occasional managed releases of “good news”, ( Portsmouth News 19th Feb 2017: Cancer charity welcomes NHS pledge on stem cell treatment ) whenever possible, but these are mere distractions. Management at the top recognises this, and hence is demoralised and allows errors such as letter, note, and data loss. It appears this was manual records, and IT systems could be much safer, as long as such were not managed and designed internally..Breach of security in national diagnostic indexes may follow…  No politician or party is offering a credible alternative to the current rules of the game: Everything for everyone for ever…..Therefore the future of the 4 UK Health Services may lie in the pressure built up by social media.

Image result for dishonest politics cartoon…and the perverse incentives may make patients lie as well. The post-truth medical world is really here in the UK today.

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….The manner of Labour’s defeat in Copeland is instructive. It took the most emotionally charged line possible, on an issue of great local sensitivity, on its signature issue of the National Health Service, and lost to the government.

Yet the defeat came as evidence mounts that all three of the drivers of current NHS policy – quality and efficiency improvements under the Five Year Forward View, reconfiguration of local health systems under the Sustainability and Transformation Plan (STP) process, and devolution, are in difficulty.

NHS accused of covering up huge data loss that put thousands at risk – Exclusive: More than 500,000 pieces of patient data between GPs and hospitals went undelivered between 2011 and 2016

Pithed politicians collude in unsafe care, ministers told

NHS data-sharing project scrapped – another opportunity missed..

Health service ‘at risk of sudden collapse’ – and the honest debate has yet to occur

Happy 2017: …politicians’ ‘persistent, blinkered denial’ – Say no to a post-truth health service

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Inside Health – What (Who) has to give?

As part of an attempt to start a conversation about unpleasant and pragmatic issues around the failing health service, the BBC’s “Inside Health” on Valentine’s day 14th Feb 2017 was honourable. However, there were many issues ducked: the most obvious being that the WHO does not accept that the UK has one system any longer.  Members of the medical professions will welcome the transparency and honesty of the participants, and their questioning of the “market”. The first question was on co-payments, and the last on depoliticising  health, and in the middle rationing service(s) was up for debate. However, in view of the morale and gagging issues in the organisation, it was a pity that the power of exit interviews was never mentioned. On co-payments no one challenged Nick Black: “…is it to raise money or is it to deter demand”. The other good reason is to encourage self sufficiency. On Money and co-payments nobody challenged the 90% exemptions.. perhaps we could pragmatically agree that everyone pays something, whatever their means.
In the middle we heard criticism of spending on prevention without evidence, and a call for decommissioning of non evidence based prevention and screening. Post code differences, particularly in fertility treatments, were decried. When the panel called for a discussion of what was worth retaining they did not address need to be honest about what would not be available, so the issue of “overt” as opposed to “covert” rationing did not arise. Mark Britnell’s book was mentioned, but not to say how helpful it could be: Mark would take something good out of many systems, but does not hold up one as the best. Comparisons with other countries, particularly those who changed from a UK style (Everything for everyone for ever) to a rationing by co-payments and other methods was not mentioned (N.Z.) The idea that the health service is funded by those in work, and that when waiting lists are long the workers need to be treated first was not aired. The poor manpower planning and restriction of places at medical school, and the immoral enticement of doctors from poorer countries never arose. However, the panel did acknowledge the short termism of health ministers and politician’s posturing in general. They admitted psychiatry got a bad deal, but did not have time to split off the dementia component.

Image result for hippo and cub pic cartoonGPs listening might feel the panel is “out of touch” with grass roots feelings, and NHSreality would agree.

The panel was:

Clare Marx, President of the Royal College of Surgeons

Chris Hopson, Chief Executive of NHS Providers

David Haslam, Chair of NICE

Professor Sir Nick Black, London School of Hygiene and Tropical Medicine

Margaret McCartney, Glasgow GP

Programme Transcript – Inside Health from the BBC

Listen to the original conversation.

What would the world’s best health system look like?

Books on the NHS, and others pertinent …..

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Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

What would the world’s best health system look like? Mark Britnell

Inside Health changed from 7th to 14th Feb BBC Radio 4 21.00 – listen to questions and answers in a public debate

 

Speaking up – Whistleblowing in the NHS – file on four. The profession needs a scapegoat – Mr Hunt.

Nothing has substantially changed since the Francis report – indeed the leadership of politicians was not referred to in the debate, making out that the lack of a proper lead in cultural change was needed from Management, when actually it is needed from Politicians. The only way to find out if Jamie Grierson is correct is to do exit interviews on all staff (like those in file on four), and have these done by an independent Human Recourses body. SOSR means “some other serious reason” and all whistle-blowers need to consider whether this might be attached to their file after spilling the beans. The admirable ideology of whistle-blowers contrasts strongly with the ideology of HR departments described in File on Four today. If 66% of doctors are under “serious stress” then the profession, and the public, need a scapegoat….. Mr Hunt will do as a sub for all the successive ministers of health. Civil unrest is likely without honesty. The current winter “murmurings” of starlings will become a riot of protest and discontent. One of the major reasons for a state to exist ;”keeping it’s citizens safe”, is failing…

Speaking up – Whistleblowing in th NHS – file on four and part of the report is from BBC Liverpool (Staffing ‘inadequate’ at Chester baby death hospital)

Dave Simonds 12/02/2017

This is reinforced by Jamie Grierson in the Guardian: NHS hasn’t improved enough since Mid Staffs, says inquiry lawyer

Robert Francis, whose report uncovered poor care in hospital trust, says pressures on health service generally are ‘pretty bad’

Current conditions in the NHS ”sound familiar” to those that existed during the Mid Staffordshire scandal, according to the lawyer who chaired the inquiry into the hospital trust.

Sir Robert Francis QC said the health service was being hit by a combination of financial pressures and high demand.

The barrister whose 2013 report uncovered poor care in Mid Staffordshire said the pressures the health service was under were “pretty bad”.

His remarks came after a week of scrutiny of the NHS, with performance figures showing a raft of missed targets and record waiting times, leading health secretary Jeremy Hunt to say conditions were “completely unacceptable”.

Francis told the BBC’s The Andrew Marr Show on Sunday: “I think they are pretty bad. We’ve got a virtual storm of financial pressures, increased demand, difficulties finding staffing, and pressure on the service to continue delivering. And some of that sounds quite familiar, as it was those were the conditions pertaining at the time of Mid Staffordshire.

“Things have changed since then, so the very fact that we’re talking about this today the way that we are, the very fact that the secretary of state says things are unacceptable, shows that there’s a greater level of transparency.

“So people are talking about the problems in a way that they weren’t before. But the system is running extremely hot at the moment and it’s only working at all because of the almost superhuman efforts of the staff of the NHS, and it can’t carry on like that indefinitely without something badly going, or risking going badly wrong.”….

NHS Surgeons kicking their heels as thousands of operations delayed.

Michele Hanson opines: We are a rich country that can afford to pay for proper care – so why don’t we?  and Why are GPs having to beg for appointments to get their patients treated in hospitals?

Matthew Weaver reports: A&E in England had worst delays ever in January, leak suggests – Provisional data shows an unprecedented number of patients spending longer than four hours waiting to be seen

Dennis Cambell reports: Two-thirds of young hospital doctors (Anaesthetists) under serious stress, survey reveals -Trainee anaesthetists complain of fatigue, disillusionment, ‘burnout’ and fears for patients’ safety as pressure mounts on NHS

Undercapacity leads to undersupply. When skills are valuable and in short supply they demand high payment, especially if working “overtime”. Which party believes in market forces? All parties have failed to control the supply in a market it commands completely?

NHS ‘pays £7.5m a year for 20 most expensive agency doctors’ – Watchdog says health service could save £300m a year if locums charged within set price cap, after data found some are paid £375,000 a year

Jeremy Hunt: NHS problems completely unacceptable – Health secretary says there is no excuse for some of health service’s shortcomings after figures show record delays for patients

One in six A&E departments at risk of closure or downgrade- As many as 33 casualty departments across the UK could be lost by 2021 in an attempt to save £22bn from the NHS’s budget

Alexandra Topping reports: Woman, 89, trapped in hospital for six months despite being fit to leave – University Hospitals Bristol NHS trust launches inquiry after lack of social care led to stay that cost health service £80,000

BBC News: 2000 NHS doctors call on prime minister to increase spending

Robert Pigott for BBC news reports: NHS Health Check: ‘Most staff have been attacked’, doctor says

Nick Triggle reports for BBC News: 10 charts that show why the NHS is in trouble

An “existential crisis”? – as civil unrest gets closer… 

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