Category Archives: NHS managers

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 …

 

 

Covert and post coded randomised rationing of dementia care..

The daily mail claims there is a deliberate bureaucratic block on spending money on dementia. The implication is that these citizens, at the end of their lives, don’t matter. After all they often don’t have the mental capacity to vote, and they don’t have the life expectancy, so the combination means their votes don’t matter. The votes of their relatives do matter, but somehow relatives learn to live with this post code random rationing. It will be even more random in the other jurisdictions: these figures apply only to England.

Image result for dementia cartoon NHS

On Tuesday April 2nd the Times published: Dementia Care is not good enough across half of NHS but it was not on line (It referred to the Daily Mail):

“Dementia care is not good enough in half of NHS local healthcare groups according to official ratings.

One in three patients does not have a diagnosis with large variations across the country..

Experts have accused the government of losing focus on dementia as the number of patients continues to rise. About 850,000 Brtions have dementia… Analysis on the Daily Mail website shows  19 clinical commissioning groups that fund care locally are rated “inadequate”, and 66 as “requires improvement”. This compares with 43 rated “good” and 52 “outstanding”.

Clive Ballard, a dementia specialist at the University of Exeter, told the newspaper: “In 2012David Cameron made a commitment to takle dementia. The current figures show no subsequent progress. It feels very much like these pledges have been kicked into the long grass.”…..

In Camden (London) 91% are estimated to have a diagnosis, whereas in Cornwall on 52%…..

Fiona Carragher , of the Alzheimer’s Society, said: “It’s deeply worrying that the postcode lottery of care is continuing. People tell us they have to wait years for a diagnosis and have to fight the system to access support, advice and treatments.

“Some say their care plan is little more than a tick box exercise”.

Alistair Burns , National Clinical Director for dementia at NHS England said: “The long term plan prioritises further improvement, with GPs being given additional support to spot the tell-tale signs”.

 

December 17th 2018. Chris Smyth in the Times: Dementia patients have to move hundreds of miles for good care

A million older people live in places where most dementia beds are rated poor, forcing vulnerable patients to move hundreds of miles for decent care, The Times has learnt.

Large swathes of the country have fewer than one satisfactory dementia care home bed for every 100 people aged over 65, according to analysis. One in 14 older people has dementia and diagnoses are rising.

In Kensington and Chelsea, only 19 per cent of dementia beds assessed by inspectors have been rated good or outstanding, the lowest in the country. Campaigners have warned of a “broken system” for coping with dementia, which is the country’s biggest killer….

and in 2016: Dementia patients marooned in hospital

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Halfhearted support from Scotland. English Whistleblowers: “promises of protection are repeatedly broken”, meeting hears.

In Scotland the “whistleblower blast” is on 19th June, but there is no funding for the room Peter Gregson needs. For fundraising go here

He ends his message: “Please chuck in a few £. Then I’ll be able to afford to feed my children this month”. The petition is here

and the Scots are also looking at the Independent Contractor Model (GPs) after it has been cleaned out by understaffing and underfunding.

The health services are too proud and mean to contract out their human resources, but this is what is needed, along with a whole dose of repeated honesty, exit interviews, removal of targets, and giving the profession more powers over their own destiny..

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The BMJ opines: Whistleblowers: promises of protection are repeatedly broken, meeting hears BMJ 2019;364:l1482

There has never been a more dangerous time for frontline NHS staff to consider speaking up in defence of patients, a consultant surgeon who lost his job after reporting concerns about an avoidable death has told a meeting on whistleblowing at the Royal Society of Medicine.

All three levels of supposed protection—the NHS itself, regulators, and the law—are failing whistleblowers, Peter Duffy said.

Duffy, who reported his worries to the Care Quality Commission in 2015, won his case for unfair constructive dismissal at an employment tribunal last July. He was awarded £102 000 (€120 000; $135 000), which related to a dispute over pay, not his disclosures.

He told the meeting, opened by the RSM’s president, Simon Wessely, that he had been forced to resign from University Hospitals of Morecambe Bay NHS Foundation Trust in 2016 “for my own protection” and was “unemployed and, it seemed, unemployable.”

Since 2017 he has worked outside the NHS as a consultant surgeon at a hospital on the Isle of Man, living alone, while his wife, family, and friends still live in the Morecambe Bay area. “It really does feel like being two years into a 10 year prison sentence,” he said.

His case showed, he added, that “we have NHS promises of whistleblower protection repeatedly broken, leaders who don’t show leadership, regulators who don’t regulate, guardians who don’t hold organisations to account, and a law which simply exposes whistleblowers to more hate, threats, intimidation, and allegations.”

He said that the law failed whistleblowers in at least three critical areas. First, the whistleblower was the one on trial, not the NHS trust and managers. Second, whistleblowers were “threatened with costs if they don’t drop the case.” Finally, for success in a claim of sacking on the ground of whistleblowing the law demanded an evidential link or “smoking gun” to link the whistleblowing and the sacking. “This evidential link is an almost impossible task, particularly with the NHS conducting a scorched earth policy to evidence right from the start,” said Duffy.

He advised potential whistleblowers, “If you speak up as a group, you are infinitely more powerful. My mistake was to go it alone.”

David Nicholl, consultant neurologist with Sandwell and West Birmingham Hospitals NHS Trust, asked how far the NHS had come since the report of Robert Francis’s Freedom to Speak Up review in 2015.1 “Not very far,” he answered.

Nicholl said that one hopeful sign was that the CQC had fined Bradford Teaching Hospitals NHS Foundation Trust in January for breach of the duty of candour because it had failed to tell a family within a reasonable time that there had been delays and missed opportunities in treating their baby, who had died.2

Peter Wilmshurst, consultant cardiologist at Royal Stoke University Hospital and a whistleblower who has reported several research misconduct cases to the General Medical Council, said that there was an inequality of arms because “the individual can never match the resources of the trust.” He added, “There are no effective sanctions for those who treat whistleblowers badly.”

Several speakers and delegates called for reform of the whistleblowing legislation the Public Interest Disclosure Act, which Duffy described as “full of loopholes.”

Nicholl said, “There are fundamental problems with the legislation. If there’s anything we can do to press on that, it’s absolutely vital.”

David Walker, medical director of the Morecambe Bay trust, said in a statement, “We strongly encourage staff to come forward if they think patients may be in any way at risk, so we can investigate and learn from any mistakes. He added that the concerns raised by Duffy had been thoroughly investigated at the time and that “the employment tribunal found there was no evidence that he was ill treated or suffered a detriment for raising those concerns.”

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

Any illusions that there is still a “National” health service have been destroyed today. The news that Welsh patients will not be welcome at their normal English (Over the border) hospital has been coming for some time. See the entries from NHSreality below those for the news from various sources in Wales and Chester as well as the BBC. It is interesting how our politicians and our media collude in the fantasy that there is a “National” health service.. There is a national shortage of diagnostic skills, worse in Wales, and if the money moves with the patient, and Wales has no money….  The politicians and the media need to break their collusion of denial.. The admin cannot sanitise this..

BBC News today 5th April 2019: Countess of Chester Hospital: Funding threat in patient row

and the day before Countess of Chester Hospital says no to Wales’ patients

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June 28th 2013: Border Issues – When we will need border controls? Bevan’s “frontier” issues..

Devolution of health to Wales was a mistake? NHSreality 15th August 2015

An increase in prescription charges encourages autonomy, but only in England. It also encourages movement between different systems… In Wales we already know we are second class citizens. NHSreality 28th Feb 2019

Wales is an unsustainable state: another good reason not to leave the EU. Graphics in support… NHSreality 16th April 2016

April 1st 2016: 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?

NHS ‘postcode lottery’ denies Welsh nurse £70,000 treatment for rare stomach cancer because the hospital is across the border in England NHSreality 14th September 2014

The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change.. Dec 3rd 2015 NHSreality

Election 2015: Bevan would be ‘turning in grave’ over NHS. Welsh Health Service derided.24th April 2015 NHSreality

Disintegration? Plaid Cymru publishes proposals to recruit an extra 1,000 doctors to Welsh NHS. Meanwhile a “managed service”..

Where did Labour’s prescription for treating the Welsh go wrong?

Don’t go West – go East!. An example for us all: Welsh patients in the dark about EU treatment options

Welsh NHS ‘is a scandal’, says David Cameron. The philosophy of not aspiring to excellence, but rather to reducing inequalities

Mr madam’s approach to a national shortage of diagnostic skills is understandable, but only partly truthful.

Why are we so proud of our 4 health services pretending to be one? “NHS is way down international league for healthcare”

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In the Chester Daily Post 4th April 2019:Chester hospital refusing to accept Welsh patients – despite being just miles from border – The Countess said it had taken the decision over ‘unresolved funding issues’ but Welsh Government says move is ‘unacceptable’

Walesonline: Countess of Chester Hospital says it will no longer accept patients living in Wales.

The Wrexham.com: Countess of Chester says unresolved funding issues to blame for no longer accepting some patients in Wales

The Independent: NHS patients in England refusing to accept patients from Wales.

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