Category Archives: NHS managers

Standards were falling anyway, so what better opportunity than to stop rankings.. The Minister’s denial will cost us all.

NHSreality has explained how standards are falling several times. The Corona virus outbreak gives politicians and administrators a chance: Standards were falling anyway, so what better opportunity than to stop rankings.. The opportunity is there to ration overtly, but the minister of health (England) lost the opportunity when he only half grasped the nettle recently.. He actually denied the need to ration for certain high cost and emotional areas – like IVF. His denial will cost us all. 

Image result for nhs efficiency cartoon

Katherine Hignett reports in the HSJ 17th March 2020 (Health Services Journal) that:  Trust rankings put on hold over ‘unprecedented’ covid-19

Acute trusts have been told not to submit efficiency data to NHS England/Improvement until at least May amid increasing supply pressures.

Preeya Bailie, director of commercial and procurement at NHSE/I, told trusts not to share certain procurement metrics in an email sent late Friday afternoon.

She wrote: “Due to the complex, challenging and unprecedented situation we are facing as a result of the covid-19 virus, the NHS is having to make some tough decisions on where it prioritises its resources at the moment.

“I am conscious of the additional pressure on you and your teams, and as a result have decided to ask you not to submit your procurement metrics for the next couple of months. I will review the situation in May 2020 and communicate the process for submission, once the impact on operational activity is understood more fully.”

The next two procurement league tables, which rank trusts quarterly on several efficiency metrics, will be delayed until further notice. The latest table, which used data from the second quarter of the current financial year, was released earlier this month.

Mrs Bailie wrote: “We will ensure you have a revised timetable for retrospective data submission and league table publication, once the landscape we are currently working in becomes clearer.”

A Health Care Supply Association spokesman told HSJ the trade body “strongly supported this sensible decision” which would allow procurement teams to focus on the current challenges.

HSJ has approached NHSE/I for comment.

The global demand of supplies like face masks and hand sanitiser have soared in recent weeks because of the spread of covid-19. Factories in China — the original epicentre of the disease — have focused on supplying protective equipment domestically, putting a strain on the global supply.

HSJ understands some Chinese manufacturers are now exporting face masks, but countries including the UK still face significant supply pressures.

NHS Supply Chain, which procures common consumables and medical devices for NHS trusts, has been “managing demand” for increasing lines of personal protective equipment and infection control products since the end of February.

The body recently told customers it was implementing “controls on excessive order quantities” of a range of personal protective equipment to make sure stock was managed “fairly”. A spokeswoman from the Department of Health and Social Care denied this amounted to rationing…….

NHS Supply Chain announced last week it would begin distributing FFP3 respirators from national stockpiles to NHS customers. It has begun hosting daily webinars for its customers.

“We have stock on order from the UK and European countries in addition to suppliers based in the Far East to continue to secure a pipeline and replenish the stockpiles to help ensure the uninterrupted supply to the NHS”.

Grasping part of the nettle, but not the whole rationing genus.. So what are the criteria for the services that will not be rationed, and for those that can be. How will we do it?

The title assumes that there will be rationing: always denied until now. So exactly how will Mr Hancock choose those services not to ration? Just because he appreciates the post code imbalance of the different commissioners to IVF, does not mean he has grasped the whole nettle. Grasping part of the nettle, but not the whole rationing genus.. So what are the criteria for the services that will not be rationed, and for those that can be. How will we do it? One thing is certain. It is not up to doctors. These are political decisions.

Gareth Iacobucci in The BMJ reports that: Hancock vows to stamp out “absurd” rationing of some NHS services (BMJ 2020;368:m804)

The health secretary Matt Hancock has vowed to stamp out what he described as the “absurd” and “unwarranted” postcode variations in access to certain clinical services on the NHS.

In a keynote speech at the Nuffield Summit 2020 setting out his future priorities for the system, Hancock said that one of two key goals for the NHS—alongside increasing healthy life expectancy—was to increase public confidence in the service.

As part of this, he called for an end to rogue rationing decisions that deviate from national guidance and deny some patients access to treatments that people in other parts of the country can receive.

He cited the example of IVF, where access varies depending on the policies of local clinical commissioning groups (CCGs), leaving patients in parts of the country unable to access it or only being permitted one cycle.

Hancock said, “In the 2020s we must make it our mission to put the ‘national’ back into the national health service.

“At the patient facing end of the service that means levelling up across healthcare and ending some of the postcode inequalities so, for instance, your chance of seeing a GP doesn’t depend on where you live.”

Turning his attention specifically to inappropriate rationing of care, Hancock said, “Being a national service means having consistent standards that patients can expect. We want less unwarranted variation in both commissioning and delivery of services.

“Why should three cycles of IVF be allowed in some parts of the country while some other parts offer none? A local part of the NHS deciding it’s okay not to offer IVF with no accountability is absurd. It’s unacceptable in a national system.”

He added, “It’s not for a CCG to decide whether you should have one, two, or three rounds of IVF available. They are a local body that does not have democratic legitimacy.”

Our local debate: Debate Rationing final

NHS rationing – by Julia Manning


An extra tax of £66.66 per head. The cost of “English” health litigation, and its rising…

Litigations: There is a choice, but the “short term” attitude of every administration has ducked the right option. No fault legislation …. Those of us in the know, and those working at the coal face can only laugh cynically at the DHSS statement:

‘Our ambition is for the NHS to be the safest healthcare system in the world and it has been recognised that the rise in costs of claims is not due to a decline in patient safety.’ ( !!! Ed )

The finances of Wales, Scotland and Ireland are no different, and probably worse. Poorer people have less means and ability to litigate, but on the other hand the services in Wales are worse. So much too for a “National” health service.

( No Fault Compensation claims are handled by Government run schemes that each have their own set of rules and regulations. The amount that is paid out, if the claim is successful, is usually less than you would normally get in a standard personal injury claim.7 Apr 2016 )

How about some trial areas, a report on comparisons with other countries, and a costing. Surely it has to be cheaper than £4.3 bn, which works out at £66.66 each assuming 60m people in England. Best to be either very poor or very rich to make a claim.

Image result for health legal aid cartoon

BBC News today: NHS faces huge clinical negligence legal fees bill

The NHS in England faces paying out £4.3bn in legal fees to settle outstanding claims of clinical negligence, the BBC has learned through a Freedom of Information request.

Each year the NHS receives more than 10,000 new claims for compensation……

The Mail: NHS England faces £4.3BILLION legal bill to settle negligence

…The Department of Health has said it has no option but to tackle ‘the unsustainable rise in the cost of clinical negligence’.

According to a Freedom of Information request by the BBC, the figure includes existing unsettled claims and projected estimates of future claims…..

Patient complaints hit a ‘wall of silence’ from NHS – No fault compensation would help change the culture…

Another argument for no fault compensation. Longer waits will mean we are poorer…

The blame game. The proliferation of compensation claims – needs a “no fault compensation” cure, possibly through a social insurance fund.

£500 each citizen, man, woman and child, paid for “negligence” annually by 2010. Why no “no fault” compensation?

Cancer sufferer urges patients to stop suing NHS – No fault compensation is the answer.

No fault compensation systems BMJ 2003;326:997

William Gaine opines in the BMJ: Experience elsewhere suggests it is time for the UK to introduce a pilot scheme BMJ 2003;326:997

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So why did Mr Stevens get an honour? He failed…

In the New Year’s Honour’s list: HSJ reports that “NHS England chief executive Simon Stevens has been knighted in the 2020 new year’s honours list.”

Why did he get an honour when he has FAILED to deliver an honest debate that he asked for in 2014. Health service provision is like death. We wont face it honestly. Rather similar to the environment..

2019: Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

 2018: Public must pay for better NHS, says Stevens to spineless politicians at King’s Fund

2014: A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this. (U tube 4th June 2014)



March 2019: Melting down….We are all getting what we deserve. Without honesty to ration overtly the system will only get worse.

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?

Even London and the Home Counties are feeling the squeeze… as standards and staff numbers fall re revert to the pre-NHS divide.

Just some of the pain felt in the rural shires is now feeding into London and suburbia. Standards of staffing and clinical diagnosis and speed are all falling. The blame is long term political neglect and denial from an elected elite who always felt they had access to the best – in London. No longer… it is impossible to report on all GP surgery closures as there are so many. The reality is that private services for ambulance, GP, A&E etc will follow… Bevan wanted the same high standards for the miners as the bankers – instead the standards are falling, but as before we had a health service, the bankers can afford the private option.

Owen Sheppard for MyLondon reports 7th September 2019: West London overspends by £112m!!

GP surgeries across Surrey are facing an uncertain future, with two confirmed closures and a third possibly following suit, which are set to put pressure on those nearby.

Patients say they are worried about the pressures on neighbouring services following the announcement of closures of surgeries in Staines and Guildford.

In Burpham, a petition has been launched to save the Burpham New Inn surgery which is also facing closure.

So why are surgeries closing?

The Guildford and Waverley Clinical Commissioning Group (CCG) has cited problems with leases and premises, which have led to the closures of two practices in the area.

In Staines, the Staines Thameside Medical Practice shut on Saturday (August 31) following a decision by the doctors to end their contract with the NHS to provide GP services. This was reportedly due to personal reasons.

Patients will lose the St Nicolas branch surgery in Bury Fields, Guildford, which will close at the end of October following issues with the premises and its lease.

Guildford and Waverley CCG has confirmed the surgery will close on October 24. All services will instead be provided by the main surgery at Guildford Rivers Practice in Hurst Farm, Milford.

One St Nicolas patient, who did not wish to be named, said: “I am very upset about the closure of St Nicolas Surgery, it came as a shock.

“[I believe] this was pre-planned since last year but without telling patients previously. I have not received a letter as yet about the closure.

“I think it’s been about a year that all the telephone calls to St Nicolas Surgery have been re-directed to the general practice in Milford.

“The closure of St Nicolas Surgery will put extra pressure on other GP surgeries in Guildford as patients who are ill, disabled, elderly or who don’t drive won’t be able to get to Milford.”

The CCG has said it will work with the practice to ensure that despite the changes, patients will continue to receive high quality care.

A spokesman said: “The CCG received an application from Guildford Rivers Practice that proposed the closure of its branch surgery, St Nicolas Surgery, due to issues with the premises and the lease which was proposed to have had a negative impact on the service offered to patients.

“Following a period of engagement with patients and neighbouring GP practices, the application to close the branch has now been approved by Guildford and Waverley’s Primary Care Commissioning Committee (PCCC).”

The spokesman added: “Registered patients of Guildford Rivers Practice will remain so, following the branch closure, with GPs from St Nicholas Surgery transferring to the main site and continuing to offer appointments to patients.

“Any patients who require home visits will continue to receive these in the usual way.

“The practice is committed to providing the best service for patients by operating solely from the Guildford Rivers Practice main site and the CCG will work with the practice to ensure patients continue to receive safe and high quality care moving forward.”

The news comes as patients await the decision on the future of Burpham’s New Inn surgery. A decision was set to be made on August 28 but this has been delayed.

A spokesman for Guildford and Waverley CCG said: “The PCCC has been re-arranged to ensure every option put to the CCG is fully explored, before a final decision is made.

“The committee has been rescheduled for September 13.”

In a letter to patients sent on July 31, the CCG said it was likely the New Inn Surgery in London Road would have to close later in 2019 due to problems securing a long-term home.

The letter said the surgery’s lease was expiring and no other suitable alternative sites have been found.

Patients launched a petition to save the surgery, which has been signed by 282 people to date.


Around 4,500 patients have had to re-register with another GP surgery after Staines Thameside Medical Practice closed its doors on Saturday (August 31).

Other GP surgeries in the area are accepting new patients despite some having recently had their lists capped.

Two Staines councillors are concerned about the additional pressure on those surgeries.

Councillor Jan Doerfel, Green Party member for Staines, said: “Expecting other GP practices to absorb the additional 4,500 patients is likely to result in longer waiting times for all those affected and additional travel for those that had to enrol with those practices. This is not acceptable.”

Councillor Veena Siva, Labour member for the ward, said: “Yet another GP surgery closes. Smaller practices are closing due to underfunding and insufficient GPs which means they can no longer be run safely and sustainably.”

She added: “As it stands, it is unfortunately no surprise that there was no interest from GPs to take over the surgery when in doing so all they would face is under-resourcing, enormous pressure and stress.”

NHS North West Surrey Clinical Commissioning Group (CCG) was responsible for supporting patients as they switched to a different GP service.

St David’s Family Practice Doctor Jagit Rai works at one of the surgeries receiving patients from Staines Thameside and is a governing body member at NHS North West CCG.

Doctor Rai said: “The closure of this practice does not relate to funding or staff shortages. The CCG was disappointed to receive notification from GPs at Staines Thameside of their decision to end their contract with the NHS to run the surgery.

“They made this decision due to a change in personal circumstances that could not have been predicted or planned for. The CCG asked neighbouring practices about the option to take over the running of Staines Thameside and reviewed their capacity to take on new patients.

“The surgeries decided the best way to care for Staines Thameside patients is at their practices where they can benefit from an established team and range of services.”

It’s slightly brighter news for the residents in Chiddingfold, where a new surgery is being built after the former building was destroyed by a fire.

Chiddingfold Surgery in Ridgley Road was gutted on January 7, 2019.

Plans were submitted in March to Waverley Borough Council for the complete rebuild.

The surgery has relocated to Cedar ward at Milford Hospital, where full doctor and nurse surgeries are in place. Expanded opening hours are available for patients at Dunsfold surgery.

Update : Diane Taylor in the Guardian 8th September 2019: London GPs told to restrict specialist referrals under new NHSThe New “Rationing Plan”. Plans for new cuts sent same day Boris Johnson reinforced NHS spending commitments..

NHS s compared to 10 days for public sectors workers generally (10 days) and private sector (5 days) NHS staff take average of 14 sick days a year

You are twice as likely to take sick leave as a public sector than the private sector worker. Those who take least sickness are the self employed. If you are self employed you cannot get Statutory Sick Pay as you are working for yourself and therefore do not have an employer. GPs are self employed, but more and are becoming “salaried”, and of the new entrants a large majority are women. If GPs do become self employed, rest assured their sickness rates will go up. I suspect rates for hospital doctors are rising right now..  without their hearts and minds believing it is sensibly founded this will continue and worsen..

In the public sector, 9.8 days were lost to sickness per employee last year (compared to 5.0 days in the private sector), while employees at businesses with 1,000 or more staff took 7.6 days off sick. Mean is the sum, or average, of a group of numbers in a set. Median is the middle value of a list of numbers.4 Jul 2018.

In 2017, women had, on average, 72% higher physician-certified sickness absence than men, compared with 33% higher self-certified sickness absence than men [42,43]. The present study therefore concentrates on the evaluation of longer sickness absences that may qualify for physician-certification.

Doctors in training had an average annual sickness rate of 1.1%, and the average rate among consultants was 1.2%. This compares with an average annual sickness absence rate of 4.2% for all NHS hospital staff, 4.5% for nurses, and 5.5% for ambulance workers.

Andrew Gregory in the Times 25th August reports: NHS staff take average of 14 sick days a year

Ashleigh Webber in “Personnel” on 4th July 2018 reports: Employees taking less time off sick, yet costing employers more.

NCBI resources Aug 1st 2018: Gender equality in sickness absence tolerance: Attitudes and norms of sickness absence are not different for men and women

Andrew Goddard 26th May 2018 in the BMJ: Doctors sickness rate is a third of other NHS staff. (And its even less in self employed GPs)

Physiotherapy and counselling for NHS staff in drive to cut sickness rates

Hospital job vacancies top 100,000 due to bad planning. NHSreality adds political short termism, & high sickness and absenteeism..

The NHS culture is sick – and so are its staff – But is there any “quick fix”?

Waste in the Health Services. It;s mainly due to staff absenses…

Cleaning up the UK Health Services, changing the culture and importing honesty..

A recent article in the BMJ pondered “Why Doctors Don’t take Sick leave”

Independant GPs: RCGP chair Clare Gerada calls for all GPs to become salaried

Update 31st Au9gst 2019:

Health Service Journal 30th Augu9st 2019 Managers most likely to say mental ill-health caused sick leave

Merto 25th August 2019: NHS workers’ most common reason for sick days is mental health issues and Sheffield Telegraph: Mental health problems main cause of sick days for NHS workers across England