Category Archives: NHS managers

The “Economist” acknowledges health rationing, but does not recognise that it is covert…. More and more anger to come.

How long will the UK citizens put up with untruths? How long will it take for the proper debate to begin? The Economist recognises rationing, Enoch Powell in “A new look at Medicine and Politics” recognised rationing in 1966. We cannot go on without knowing what (for us) will be unavailable. It is surely a human right to be able to plan for your own health, your family’s health, your death, and illnesses. No wonder citizens are getting more and more angry..

If we want to win the cooperation and hearts and minds of medical staff we need to find out the truth about what they think. BMA conferences full of retired and burnt out doctors may reject the “long term plan” but there is no link with the doctors at the coal face.

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Not only is devolution a failure (certainly in Wales) but the 4 different systems allow different language of obfuscation, different methods of rationing, and outcomes. The anger will be the same.

The East Anglian daily Times shows how angry and dissatisfied the citizens are becoming. If you multiply the figures up over 200 health staff are attacked daily in the UK.

NHS GPs Economist 0619 Whats up Doc June 2019

Enoch Powell 4 Supply and Demand – Rationing  Minister of health for 3 years 2nd Edition 1974

Toni Hazell 28th June in GP mag: Here are two potential problems with primary care networks.  Huge hurry, and who takes responsibility?

Andrew Papworth reports 30th June 2019 in the East ANglian Times : “NHS staff aren’t punchbags”: Shock as six workers a day attacked in Suffolk by patients.

BMA ARM: Doctors spurn NHS long term plan

NHS patients ‘face more treatment rationing since coalition restructuring’

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

Image result for angry patient cartoon

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Is it wrong to earn a living or make a profit out of health related services? Does it matter if the profit goes overseas if the provider is more efficient than our own?

In a factually truthful account of how we have tried to exclude inefficiencies, improve purchasing and delivery, Ian Birrell points out that we have outsourced many services. Many firms, including both domestic, and foreign ones based overseas, make profits from “patients’ misery”. All healthcare for curative services has an element of pain or misery, and once extended to prevention becomes part of the “worried well” psyche prevalent in our affluent society. Anyone would think it was wrong to earn a living or make a profit out of health related services. Does it matter if the profit goes overseas if the provider is more efficient than our own? Should the longer term implications of delegating more and more to overseas businesses be discussed?

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Ian Birrell in the Times asks 4th June 2019: Worried about US healthcare giants? They’re already here.

The response could not have been clearer when Woody Johnson, US ambassador to Britain, suggested that American firms would want access to the NHS in any post-Brexit trade deal. “The NHS is not for sale,” thundered the health secretary, Matt Hancock. “The NHS as a publicly run, publicly owned institution is part of our DNA,” added his predecessor, Jeremy Hunt, now foreign secretary.

This was a predictable response as political rivals seized on the ambassador’s “terrifying” comments, especially when both men are engaged in a leadership battle. But it is also untrue. Lucrative chunks of the NHS have already been handed to rapacious American healthcare giants with disastrous consequences. And this pair of posturing politicians have done little to thwart them.

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Remember Winterbourne View, where the BBC exposed abuse of patients with autism and learning disabilities in a secure hospital unit eight years ago? The response was unequivocal: such people should not be held in these places since community care tends to be cheaper, kinder and more effective. Yet efforts to end such abusive detention failed. For as the NHS pulled out, private firms muscled in on contracts worth up to £14,000 a week, while many staff continue to be paid little more than minimum wage and there is no real accountability.

More than 2,200 such patients remain trapped in assessment and treatment units and the proportion in privately run beds rose from a fifth to more than half in a decade. Acadia, a Tennessee healthcare firm, spent £1.3 billion on the Priory Group, which takes £720 million annually from taxpayers. Universal Health Services, another US firm, recently snapped up psychiatric services including Danshell, owner of a Durham hospital that just featured in another Panorama exposé of abuse. Its UK operations are run by Cygnet Health Care, which having tweeted it was “shocked and deeply saddened by the allegations” nonetheless boasts in its latest accounts of revenues from 220 NHS purchasing bodies and profits surging to £40.4 million.

It is shameful that our fellow citizens can still be stuffed in places where they are subjected to solitary confinement, violent restraint, hatch feeding and forced sedation. The legacy is damaged minds, devastated families, sometimes even death. This scandal offers frightening insight into wider failures in psychiatric services. It is taking place in secretive units — scores of them owned by American firms and funded by the state.

The private sector is not solely to blame. But instead of posing as valiant guardians of the NHS, how much better if we could trust a health secretary to protect patients from foreign firms making profits from their misery.

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

The profession has been warning the different UK governments and Health Administrators for decades that there would not be enough trained doctors, nurses and attached staff. Now that this is actually happening, what are the thoughts of NHSreality? You get what you deserve in a first past the post short time horizon system? You get what you deserve if you don’t do exit interviews, and destroy teams? You get what you deserve if the access is so poor that citizens are pushed into private care? But even if we had trained too many doctors etc, we would still have a system with unlimited demand, limited resources, and no disincentive to make a claim (other than prescription charges, travel and parking). We need exit interviews urgently, and in West Wales the threat of Hospital closure and of poor Out of Hours coverage is so bad that many people may choose to leave the area…..

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The Nuffield Trust gives some background and insight into how we have got to this point, but without referencing rationing. The trust reports the worst April on record…

The paediatricians in Wales are over-working, but this is partly because of the shortage of GPs. They find that it is easier to refer many problems than to see them again and support in the community.

The radiologists are worried that their vast workload leads to mistakes (mainly of omission).

Nick Triggle for the BBC reports: GP pressure: Numbers show first sustained drop for 50 years

Its not just patients who are charged: Trainee doctors on call at night are often charged for sleeping!

In a world market the Irish Times reports that there are plenty of opportunities in the UK, but you will have to work “HARD”.

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Perhaps Pembrokeshire will be the first area to “go private” and abandon the health service?

Do we need an Aspberger’s Teenager to tell it as it is…?

A GP in Bristol explains for Gulf News

A GP in Pembroke explains for those who don’t know that “the hours stink”.

 

The revolving door of health service managers….. mismanagement is nothiong less than neglect.

The mismanagement of the 4 health services that used to be the “National Health Service” amounts to nothing less than neglect.

We medics all know managers who move on quickly. Being fast on your feet is essential in a  service where nothing is addressed long term. Recruitment is a nightmare of under capacity, female bias, and the resultant manpower disaster means we need to recruit from overseas for decades. NHS looks abroad for thousands of nurses – Health chiefs admit failing to plan for elderly care

We jaundiced GPs and Consultants can only assume that these managers have no exit interviews, and that nobody wants to hear what they have to say any more than the professionals.

Chris Smyth reports 7th May 2019 in the Times: NHS register to stop ‘revolving door’

A professional register of NHS managers and a values test for senior leaders are being planned to stop a “revolving door” for failed bosses.

A health service scarred by bullying and stress “needs to be a better place to work”, an interim workforce plan concedes. Although the NHS acknowledges that unexpected pension tax bills are forcing doctors to retire early and work fewer shifts, plans to tackle that issue have been removed from a final version.

The NHS interim people plan makes the starkest acknowledgement yet that staff are leaving the health service because they are overworked, with increases in bullying, harassment and abuse all reported recently.

The plan promises staff that they can expect support on work-life balance, whistleblowing protection and equal opportunities. Specific details are yet to be decided but the plan pledges that more jobs should be part-time or term-time only.

The plan lays out how the management culture of the NHS had to change to “root out bullying and harassment” with an admission that all staff will have experienced a dysfunctional working environment at some point.

“It cannot be right that there are no agreed competencies for holding senior positions in the NHS or that we hold so little information about the skills, qualification or career history of our leaders,” the plan states.

“A series of reports over the last decade have all highlighted a ‘revolving door’ culture where leaders are quietly moved elsewhere in the NHS, facilitated by ‘vanilla’ references,” the plan continues. “These practices must end.”

A government-ordered review has previously recommended a set of core skills for managers. The NHS has now pledged to draw up “an explicit set of competencies, values and behaviours required in different senior leadership roles”. This could include, for example, honesty and protecting patient safety.

Ministers have previously promised a central database of directors’ qualifications. The NHS has now pledged to “develop options to create a registration scheme for NHS managers similar to those used in other healthcare professions and in finance”. It is unclear whether such registration would be compulsory. The plan concedes: “The lack of a transparent, fair and consistent process for the appraisal of senior leaders has contributed substantially to the challenges we face today.”

The plans do not address higher pension taxes for top earners, which are forcing many consultants to retire early or turn down extra shifts to avoid bills for tens of thousands of pounds.

Mistakes due to overwork are manslaughter. Not enough sickness and absenteeism? Nobody blames the management and politicians… “Wise doctors will retreat from the front line now?”

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

This mismanagement of the NHS amounts to neglect

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The service quality is falling, and staff are leaving

Across the four health services staff are demoralised and leaving. Bullying is endemic, and Scotland and its midwives are at least is trying to address this more actively.  Staff numbers are at their lowest, and Brexit will only make this worse. Most pregnancies are now to women over 30, and such a large proportion are “high risk” that midwifery led units are probably destined for extinction…. The NHS England site mouths platitudes like “participation is important”… for NHS staff, but those employed no longer believe it.

Bullying and Maternity Care Plans in Scotland (Nursing Times 15th April)

Laura Donnelly in in the Telegraph 27th March 2019: The number of NHS staff quitting over long hours trebles in the last 6 years.

Jane Dalton reports for the Independent today : One in four wards has dangerously low numbers of nurses..

Meka Beresford and Oli Cole report in RightsInfo: NHS Staff Shortages Could Double Without ‘Radical Action’

The NHS in England could be short of 70,000 nurses and 7,000 GPs within five years unless urgent action is taken to address a growing staffing crisis, according to analysis by three leading health think tanks.

A report by The Nuffield Trust, Health Foundation and King’s Fund warns that existing nursing shortages could double and the shortfall of family doctors treble, without radical action.

The analysis says that urgent measures must be adopted in a new NHS workforce strategy to prevent the shortages from worsening, with a combination of international recruitment, student grants and innovation needed…..

The NHSExecutive website reports 8th April: Widening pay gap between private and NHS staff ‘risks damaging the health service beyond repair’

No Out of Hours service for taxpayers in Pembrokeshire. Be prepared to camp wherever you are sent…

As readers know there is no NHS, and in Pembrokeshire citizens who pay their taxes have no  GP Out of Hours Service/ Doctors on Call – in Pembrokeshire County …  

If you are elderly, or have young children, it looks as if you will have to camp in Casualty, and even that is poorly staffed, incompletely covered, and failing. NHS 111 is an appalling service. Confidence is failing, and private care will have to step in when the demand for it occurs. If there are deaths this might be sooner rather than later.

ITV news reports that for the second week running “GP shortages mean Out of Hours closures. 5th April 2019.

and prior to this, on 29th March: Out of Hours GP service closed again at Withybush Hospital this weekend.

For those who don’t know the area, the nearest (and also failing) DGH is 35 miles and many agricultural vehicle obstructions away, in Carmarthen. The situation is akin to the loss of services in Chester, except this is worse: it is access to emergency care rather than cold planned care that has been rationed out by successive administrations (of all colour).

The service in West Wales is now an official failure… but nobody is admitting their complicity in this disaster. The Post Code lottery is worse for distant and remote places. We are expecting a decision on a new hospital… 

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GP shortages this weekend mean that out of hours services in Carmarthenshire and Pembrokeshire will be closed intermittently. 5th April ITV News 

Hywel Dda University Health Board says they are continuing efforts to fill the shifts but expect the following disruptions:

  • Withybush General Hospital – closed 12am to 8am on Sunday.
  • Prince Philip Hospital – closed 2pm on Saturday until 8am on Sunday.
  • Glangwili General Hospital – closed from 10:30pm on Saturday to 8am on Sunday.

Analysis by Health Reporter James Crichton-Smith:

The fact that Hywel Dda is struggling to fill its GP out of hours rota is not a new one.

Health boards across Wales regularly have gaps in GP out of hours cover and Hywel Dda has previously warned of a shortfall at weekends, like it has this afternoon.

Read more:

Staffing problems and poor morale affecting GP out of hours

Health Board has had no doctor available overnight

The cause is a simple, and familiar, one. There simply aren’t enough GPs in Wales.

Efforts are ongoing to try and change this. The Welsh Government has its Train. Work. Live. campaign – and it has been getting results.

But training new GPs and attracting them to Wales takes time. The challenges are in the here and now.

August 2013:A series of intellectually and ideologically bancrupt administrations has led us to a GP recruitment crisis.

April 2019: GP suicides: LMCs call for action to reduce “appalling” numbers

March 2016: Top GP warns of threat to NHS as BMA calls emergency conference

August 2014: Recruitment rationing: GP magazine calls on political parties to support general practice

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You can’t get no satisfaction – and its going to get worse….

The 4 health services need money, especially if they are “free at the point of access”, and cradle to grave, without reference to means etc. Unfortunately we in the profession know this is unsustainable and hence the problems at Chester – refusing Welsh Patients. The money moves with the patient all around the 4 Health Services, so no wonder the commissioners refuse second opinions from outside their trust (These are the only ones that matter), and refuse inter trust transfers and referrals whenever possible. Just like in Dentistry, private services are going to thrive, whether GP advertising is banned or not… Cutting referrals means more private care.. 

The fines for long waiting lists have to be more than the cost of extra contractual referrals! Commissioners will coolly calculate the difference and lives will not be considered. 

We shame Aneurin Bevan’s ideal and even Stephen Hawking realised this.

Nick Triggle for BBC news 7th March reports: Satisfaction with NHS ‘hits 11-year low’

and this is particularly true in the Walsh border area around Chester.#

The Chester Chronicle reports: Satisfaction with NHS “at lowest since 2007”.

Public satisfaction with the NHS has fallen to its lowest level in more than a decade, despite the Government’s announcement of a funding boost, new research suggests.

Just over half of people (53%) in 2018 said they were very or quite satisfied with the way the health service is run, the British Social Attitudes (BSA) survey found.

This is down three percentage points from 2017 and the lowest proportion since 2007, according to analysis by the King’s Fund and Nuffield Trust.

In 2016, 63% of people were satisfied, compared to 65% in 2014.

Satisfaction with how the NHS is run is at its lowest since 2007 (PA Graphics)

 

(PA Graphics)

Ruth Robertson, senior fellow at the King’s Fund, said she was “surprised” by the results of the survey, in the year the NHS celebrated its 70th anniversary and was promised an additional £20.5 billion per year.

“We didn’t see this ‘birthday bounce’ that you might have expected in satisfaction,” she said.

The survey of almost 3,000 people in England, Scotland and Wales was carried out between July and October, after the funding announcement.

The main reasons people gave for being dissatisfied with the NHS overall were long waits for GP and hospital appointments (53%), not enough staff (52%), a lack of funding (49%) and money being wasted (33%).

More than two-thirds (71%) of those who were satisfied with the health service said it was because of the high quality of care, while 62% said it was the fact it is free at the point of use.

Older people were happier with how the NHS is run than younger people, with 61% of those aged 65 and over satisfied compared to 51% of those aged 18 to 64.

“Despite the outpouring of public affection around the NHS’s 70th birthday and the Prime Minister’s ‘gift’ of a funding boost, public satisfaction with how the NHS is run now stands at its lowest level in over a decade,” Ms Robertson said:

“In the short term at least, the promise of more money doesn’t appear to buy satisfaction.

“The public identified long-standing issues such as staff shortages and waiting times amongst the main reasons for their dissatisfaction and cash alone will not solve these.”

Satisfaction with GPs has hit its lowest level since the survey began (PA Graphics)

Satisfaction with GPs has also dropped two percentage points to 63%, the lowest level since the survey was first carried out in 1983.

Professor John Appleby, director of research and chief economist at The Nuffield Trust, said: “This may reflect continued strain on general practice, with mounting workloads and staff shortages and the evidence shows that people are finding it harder to get appointments than before.

“The NHS long-term plan expects even more of general practice – these problems will need to be addressed quickly if that vision is to be made possible.”

The analysts cautioned that there may be a “lag” before the money pledged by Theresa May has an impact on satisfaction levels.

However Ms Robertson added: “Two of the factors that people are telling us are big drivers of their dissatisfaction – waiting times and a lack of staff – are things that aren’t actually addressed in the long-term plan.

“We are waiting for the workforce strategy to come out to deal with the crisis we’ve got around workforce, and a review of waiting times as well.”

A spokesman for the NHS said: “For the third year in a row, public satisfaction with the quality of NHS care has improved and satisfaction with inpatient services is now at its highest level since 1993, however the results as a whole understandably reflect a health service still under pressure.

“The Long Term Plan sets out an effective blueprint for making the NHS fit for the future as funding comes on stream and does so on the back of the public’s enduring support for NHS services, with increasing satisfaction scores in the survey for both outpatients and inpatients.”

The Health Service is no longer National, and there is blatant finacial rationing because Wales has not paid up!

April 5th Chester Chronicle: English health trust accused of using Welsh patients as ‘bargaining …

BMJ 3rd April: David Oliver: The revolving door to the NHS lobby

The Guardian 31st Jan 2019: NHS England to ban GPs from advertising private services

The Herald Scotland 1st April: Margaret Taylor: It’s unforgivable for MPs to fiddle while our NHS burns

26th March 2019: CCGs continue to offer cash rewards for GPs to cut referrals

The Independent 15th February 2019: Tens of thousands of cancer patients left waiting months to start …