Category Archives: Nurses

When will public anger over the NHS reach a political tipping point? More NHS mental health patients treated privately…

It seems we are a long way from the tipping point whilst “most” services are up and running for the articulate and coherent. NHSreality has opined that “civil unrest” is not far below the surface, but whilst the Regional Health services can hoodwink their populations, and whilst citizens (mainly healthy) can remain in denial as their elderly and mentally infirm get a “rough deal”, and whilst the media and press, including Toynbee, fail to grasp that “overt rationing” is a pragmatic necessity, post coded and covert rationing will drive more and more into private care, and result in a two tier service. Harry may have had “counselling” but I expect it was private, unlimited, and done by a fully trained psychology counsellor. In the Health service it would be limited to six sessions, provided by a Nurse Counsellor who has done an extra short course, and terminated when the allowed sessions expired.

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Polly Toynbee in the Guardian 13th April asks: When will public anger over the NHS reach a political tipping point?

here is an ebb and flow in reporting on the NHS as Trump, Syria and Brexit dominate front pages. But the pressure-cooker state of the entire service still worsens. This morning’s latest figures are just a snapshot of deterioration – but every target is missed: for A&E, ambulance response times, for treating psychosis within a week, for cancer waiting times, blocked beds and diagnostic tests.

“Demand” is rising, the government says, as if serious illness were a choice, though the pressure comes from well-predicted, rapidly increasing numbers of old, sick people: this February’s A&E figures are, as ever, better than deepest winter January, but worse than February last year, as this crisis ratchets up.

Major A&E centres are treating 81.2% of patients within four hours, against a target of 95%, which used to be hit before 2010. The government likes to blame frivolous users of A&E, but those are easily triaged to on-site GPs. Serious delays are because of very ill people needing to be admitted with no empty beds: bed occupancy is at dangerous levels, as Chris Hopson of NHS providers warns, where doctors often have to decide “one in, one out”, discharging those who still need more care too early.

Take the temperature in virtually every part of the NHS and the wonder is how the heroically overstretched staff keep the wheels on the trolley. Take this week alone: the Royal College of Physicians says 84% of doctors have to cope with staff shortages and gaps in rotas.

GPs? Two years after a government promise of 5,000 more GPs, numbers are still falling. They dropped by 400 just in the last three months of last year: as doctors find the workload unmanageable some escape abroad, take earlier retirement or become locums. Too few new doctors want the burden of running a GP partnership, so 92 practices closed last year, tipping hundreds of thousands more patients on to already overloaded neighbouring GP lists.

Today the Royal College of Nursing, traditionally most reluctant of unions to take action, starts consulting its members on whether to hold a strike ballot. But with public sector pay frozen yet again at 1%, when inflation will shortly hit 3%, nurses are departing – as are doctors – for less stressful, better-paid work. Recruitment from the EU is plummeting, as predicted…..

…This is the dismal background to the reorganisation that the head of NHS England, Simon Stevens, is attempting, almost undercover. His state-of-play review of his five-year forward plan passed hardly noticed, announcing a first tranche of England’s 44 STPs, (sustainability and transformation plans) to reconnect local services fragmented by the Lansley 2012 act.

Most observers think it the right way to go, putting the NHS and social care under a united structure with one finance hub, ending destructive and expensive competition and tendering of services. But hardly anyone thinks this can be done with no new money: every STP calls for capital for new beds and units. Virtually all involve closures and mergers stirring a local political outcry.

Jeremy Hunt, who always presented himself as the patient’s ally, rooting out poor quality, wallowing in the Labour disaster at Mid-Staffs, has fallen uncharacteristically quiet. He has nothing much to say about patient safety in A&Es or elderly patients turned out of beds too soon. Not even deaths on trolleys in A&E corridors in Worcester roused his usual righteous ire.

Concern about the NHS has risen high in recent polling: what no one knows is when public anger will reach a political tipping point. Theresa May and Philip Hammond stay iron-clad adamant: all this is NHS shroud-waving and there will be no more money. Lack of any opposition helps, but can they really tough it out where Margaret Thatcher, John Major and Tony Blair all bent in the face of NHS crises?

Chris Smyth in the Times 18th April reports: Sick children ‘denied drugs to save money’ and Spendthrift NHS regions face big cuts. This is the reality of todays health services, and which/what quality of service depends on which. post-code you live in. You cannot plan for the deficit, because the “priorities” change from year to year.

George Greenwood for BBC 18th April: More NHS mental health patients treated privately

 

Nurses consider whether to strike over low pay – if all nurses joined an agency on striking what could happen?

It takes a lot to make the nurses even think of striking. However there is a solution: they ALL join the agencies!  NHSreality believes that if this happened reality would come home to the politicians and the UK citizens. Nurses are underpaid…

James Gallagher for BBC news reports 14th April 2017: Nurses consider whether to strike over low pay

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Nurses and pharmacists to replace GPs for 1 in 4 visits

The highest risk situations in General Practice are when seeing patients without records, when complex elderly people who may have communication difficulties are seen alone, and when there is no chaperone and /or a language/communication problem. Telephone triage may weed out the most risky cases, and reserve these for the GP, notes may be available on a portable computer, but there will be a temptation for “drift” and for those untrained in diagnosis to be over extended. The risk may be more than the insurers will accept. Expect mistakes, and premiums to rise, or for even more pressure on A&E as more patients are referred …. (defensive medicine).

Chris Smyth reports 16ht Feb 2017: Nurses and pharmacists to replace GPs for 1 in 4 visits

One in four GP appointments will be conducted by pharmacists or nurses under plans to relieve pressure on family doctors.

Health chiefs in the South West have said that by 2020 they want doctors to cut their appointments by 27 per cent by drafting in other health professionals and by getting patients to manage their own conditions.

Simon Stevens, head of NHS England, has said that he wants patients across the country to be treated by pharmacists, counsellors and physiotherapist to ease the pressure on GPs. For the first time, health chiefs have now estimated how many doctors’ appointments this could avoid.

The sustainability and transformation plan for Bristol, North Somerset and South Gloucestershire has set a goal to “reduce the number of consultations conducted by GPs by up to 27 per cent through diversion of work to more appropriate multidisciplinary team members and non-clinical services”.

Health chiefs in the area said that the figure was a rough estimate that aimed to show how big a change was needed to keep pace with an older, sicker population when cash and doctors were both in short supply.

They also want to use online consultation and monitoring services to reduce surgery visits by 15 per cent by helping people to look after themselves at home.

Medical leaders have backed the plan as a way to deal with routine problems when waits for appointments are lengthening, but warned that it must not become a way to stop patients seeing a GP.

Richard Vautrey, of the British Medical Association’s GP committee, said: “Nurses, pharmacists and other healthcare professionals could play a vital role in supporting GPs to deliver care in the community.

“This is needed particularly at present as the government has so far failed completely to deliver the much-needed 5,000 new GPs they promised.”

However, he added: “While expanded teams can be beneficial, they should not be seen as a replacement for GPs, as it remains essential that patients can access a GP when they need to.”

Mr Stevens announced plans last year to hire 1,500 in-surgery pharmacists to carry out blood pressure checks, to treat for minor ailments, and conduct routine follow-ups and medicine reviews for older people.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “These highly trained healthcare professionals can provide much-needed support to GPs and our existing teams at a time when the profession is under intense resource and workforce pressures, and they will be instrumental in freeing up GPs’ time to deal with complex patients who really need the expert skills of a family doctor who considers the physical, psychological and social context during the consultation.”

A spokesman for the plan said that the figures “reflect a blended assessment of the scale of the challenge we are trying to address with changes to the way we plan, organise and deliver services both in community and in hospital. What we do want to do is to reduce demand for GP appointments.”

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Desperate NHS needs a desperate remedy – care is already rationed

if I was an overworked GP I would be tempted to go “part time” and close the doors. There are just not enough of us, and a reasonable defence mechanism is to reduce the pressure.  Philip Collins does not seem to appreciate that his local Health Service is already rationed, but covertly, and in a differential post coded manner. He has not recognised that several other countries who initially tried to imitate the 1948 model, have abandoned it. (NZ and Scandinavia). The ironic laughter with which the profession saw the Olympic Ideal portrayed in London needed to be seen by politicians. It is too late for a “turnaround” because the goodwill has gone, along with many of the staff. It has to get worse now, and a new model of care will evolve. It looks like being a two tier system with insurance or private care for those who can afford it, including emergencies. The care tsunami will overwhelm us..

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Philip Collins opines in The Times 15th Jan 2017: Desperate NHS needs a desperate remedy – If the medical profession continues to cry out for more money, the health service will have to start rationing care

When Theresa May said, at prime minister’s questions, that the Red Cross had been “irresponsible and overblown” to describe the state of the NHS as “a humanitarian crisis” she was right. The Chelsea and Westminster hospital is not Aleppo. But the Red Cross has devalued the debate more than that. It has encouraged the pretence that the crisis is sudden and government-inspired. In fact the crisis is truly chronic.

Simon Stevens, chief executive of NHS England, told a committee of MPs that the health service is under severe pressure while the prime minister, who is in danger of falling out with a civil servant she really needs, is said to believe that the crisis is no more than the typical winter discontent. An iron law of politics applies: in any political argument it is more than likely that both sides are right.

The situation is both severe and typical. The NHS will now be permanently “in crisis”. Every so often there will be a flashpoint such as the junior doctors’ strike or a winter surge. December 27, 2016 was the busiest day in the seven-decade history of the NHS; the number of elderly patients waiting on trolleys has trebled. If the prime minister is tempted to take the attitude of “Crisis, what crisis? she would be foolish. Real people are suffering, some of them fatally.

It helps nobody, though, to pretend that this is all the fault of Jeremy Hunt, the health secretary. His intentions for the NHS, despite the wild accusations of some critics, are nothing but good. The problem is much bigger than the identity of the minister or the political complexion of the government. The Office for Budget Responsibility (OBR) has calculated that unless the current productivity rate in health improves, the cost of the NHS will push the national debt to more than 200 per cent of GDP by 2060. We cannot pretend that we can keep finding enough money. As Giuseppe di Lampedusa wrote in The Leopard, “If we want things to stay as they are, things will have to change”.

The first change is to recognise that the National Health Service is not really any of those three things. Variations in quality mean the NHS is a regional service with a national logo. Second, the nature of modern illness, which depends so much on diet, means that health is looked after at home; the NHS is an illness checker and fixer. Finally, the NHS is not a single service. The current problem with A&E occurs because GPs, happy recipients of a crazy contract, are closed or there is no local minor injuries centre, which would be a much better place for many of the people in A&E. Hospitals cannot discharge the elderly because local government cuts — the falsest economy in the sorry history of austerity — have turned a poor social care service into a shameful one. The NHS is the repository of problems, not the cause….

Yet we are sickly sentimental about it. To provide health care by need rather than by ability to pay is a noble principle which should remain the centrepiece of the system. But too often it functions as a sign that warns off trespassers: “No reform here.” It’s too late for that; winter is upon us.

The NHS budget has been protected, at least relative to other services. The much bigger problem is that demand is racing ahead. The country is older than it was and getting older. In 2015 there were three times as many people aged over 85 as there were in 1990. Medical science can do more than ever before, and in a system in which people are not rationed by cost they understandably want all the care they can get. Inflation in the NHS is in the region of 7 per cent per annum, just to achieve the same results.

If we really want to defend the principle of the NHS then we have to countenance unpopular measures. The first is a campaign to close hospitals. Routine problems such as hip replacements no longer need to be done in the district hospital. Victims of heart attacks, coronaries and strokes are better treated in small specialist units. Ultrasound can now be done by GPs. Some acute care can be offered at home. The day of the all-purpose district hospital has gone.

The NHS was designed in an era when care was done to patients by doctors. That is no longer true. Two thirds of the NHS budget goes on the 15 million people in the country who have a long-term condition. Patients with dementia, diabetes, arthritis and hypertension take up half of all GP appointments, two thirds of outpatient appointments and 70 per cent of inpatient beds. Moving their treatment out of hospitals could save £4 billion a year. Most chronic care is administered by the patient him or herself. It is worrying that a 2010 Commonwealth Fund report compared seven health systems. The NHS came top for effective care and efficiency. On putting the patient in control it came bottom.

Next, politicians, especially on the left, will have to stop screaming “privatisation” at every reform. At the moment less than 8 per cent of the NHS budget is spent on private providers. Competition has lowered costs for cataract procedures, MRI and knee replacements and shortened waiting time for hip operations. If it increases capacity and quality without demanding a payment from patients, people need to get over themselves on private provision.

One person under no illusions about any of this is Simon Stevens. NHS England’s Five Year Forward Review set out a bold reform programme to replace the “factory model” of the NHS. It is obvious what will happen if reform does not follow. There will be charges. Instead of rationing by queue the NHS will begin to ration by price. The only alternative will be to define a core NHS offer that applies to all taxpayers and charge for additional treatment. None of these is a good option but this is where we will end up if critics and the profession simply cry for more money.

I shall not hold my breath. The British Medical Association is every bit as hostile to change as the RMT but much more adept at preventing it. It is posing as a friend of the NHS when it is its unwitting enemy. Whatever happens now, this will not be the winter of discontent in the NHS. That line is always misunderstood. Shakespeare meant that the discontent was coming to an end. In the NHS it has hardly started.

 

 

Three quarters of surgeries shut out patients in GP blackspots

Up to three quarters of GPs’ surgeries in some areas shut their doors to patients on weekday afternoons, according to figures highlighting the growing difficulty of seeing a doctor. Some surgeries offer appointments for only three hours a day, making it hard for patients to get a consultation. Inspectors have warned that surgeries face…

Nursing degree applications fall by a fifth – a two tier service is evolving by neglect.. State basic, and Private enhanced.

Most of the doctors feel that Nursing took the wrong course when they tried to push through the degree increments and “Agenda for change” demands in the first decade (2004) of the century. GPs as self employed businesses resisted most as our funding was not future proofed. Those who capitulated are regretting it now. Stephanie Jones-Berry reports in “Primary Health Care”.and Greg Hurst reports in The Times 17th December: Nursing degree applications fall by a fifth despite the Agenda for change”  This decline is a disaster for those of us in our sixties and seventies who hoped for the quality of nursing care our parents received. Continuous neglect, rationing of training places in medicine, and over borrowed nurses-in-training, and Agenda for change has led to government preferring to hire nurses and doctors from abroad, at cheap rates of pay, rather than train our own, with whom patients have cultural affinity and good communication.

A two tier service is evolving in Medical and Nursing care, by neglect: state basic, and private enhanced. It would be better this change was managed and overt..

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Applications for nursing degrees have fallen sharply since the government withdrew their funding via bursaries and forced students to pay for their courses with loans.

Universities said last night that applications for nursing, midwifery and allied health courses were down by about 20 per cent compared with this stage last year. In some institutions applications have halved.

Shortfalls in applications were worse in London and the southeast, among mature candidates and in specialist fields such as learning disability nursing, occupational therapy and podiatry. There are fears that some small courses may become too expensive to run if numbers dip too low.

It is too soon to judge if the fall will mean fewer student nurses starting in September next year but universities are considering contingency plans to avert a shortfall in nursing graduates, including accelerated two-year postgraduate nursing courses.

Vice-chancellors are planning a campaign with health bodies to encourage more people to train as nurses, which is likely to run well beyond the normal deadline for university course applications next month to encourage candidates to make late submissions or apply through clearing in the summer.

Some caution is needed with the figures as the Universities and Colleges Admissions Service says year-on-year comparisons are complicated this year because calendar dates mean we are two or three working days behind last year’s cycle, and university applications generally are running behind last year’s figures. But the drop in applications for nursing, midwifery and allied health subjects is twice that of other courses, according to a survey by the vice-chancellors’ body Universities UK (UUK).

Ministers claimed that ending the bursaries would create 10,000 more training places, as costs are met by students taking out loans rather than direct government funding. It would be an embarrassment if numbers fell.

Janet Davies, head of the Royal College of Nursing, said her organisation had consistently raised concerns to the government that its decision would result in a drop in applications. “Our advice fell on deaf ears. The government went ahead in gambling on the future of the nursing workforce,” she said.

Steve West, vice-chancellor of the University of the West of England and chairman of UUK’s health policy network, said that the numbers were down. “We want to ensure . . . we get the right message out that there are fantastic career opportunities in nursing.”

Vice-chancellors say that mature students are likely to find it harder to take on a student loan of £27,000 to fund their degree and worry that potential student nurses may not fully understand that they will only start repaying once they earn above £21,000.

A Department of Health spokesman said that it was too early in the application process to predict reliable trends, adding: “We are committed to increasing the number of training places for homegrown nurses, as well as making sure there are more routes into nursing including through apprenticeships.”

The RCN is concerned the effects on the future workforce will be exacerbated by Brexit and an ageing population.

To date many midwives and nurses have not been able to “demonstrate they can communicate effectively”. Communication and cultural barriers in health acknowledged. Litigation results..

In an undercapacity market who can blame the nurses or doctors? £190m is “comeuppance” for politicians. NHS nurse recruitment from EU ‘too aggressive’!

Not enough nurses or doctors? Or are we just inefficient? The situation is a disgrace and a scandal, and needs a war like atmosphere of honesty to address it…

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…

Not enough doctors – just keep lowering the bar & reducing the funding

A third of A&E doctors leaving NHS to work “in a non toxic environment” abroad

 

Tough love and honesty needed to prevent stalking and to ration health care in general..

As if morale was not low enough. Now the MDU in its advice Dec 5th: Doctors advised on dealing with ‘intrusive’ social media advances. Many “heartsink” patients have personality disorders, and the over sympathetic GP collects more than their fair share. Tough love which demands patient autonomy rather than dependence is the answer, as it is with rationing in general. Stalking can occur with nurses and other primary health team workers as well..

Katie Gibbons in The Times reports 6th December: Surgeries are a hotbed for stalkers

Doctors have been advised to tighten their privacy settings on social media and to decline gifts from patients in order to discourage unwanted advances.

Social media has made doctors “more accessible than ever” to patients, the Medical Defence Union warned. The body, which represents doctors in legal disputes, has dealt with a hundred cases in the past five years involving patients who have attempted to advance a relationship beyond the doctor’s clinic.

Beverley Ward, a medico-legal adviser at the union, said that a handful of those cases had “involved the type of stalking behaviour where a doctor may need to involve the police”.

“If [patients’ advances] are not nipped in the bud . . . things can get out of hand,” she said.

The worst results will be in poor areas with passive patients… Civil unrest could follow as “reality” hits home..

Chris Smyth reported 16th November 2016: Patient deaths rise by a fifth when nurses are replaced with assistants. The worst results will be in poor areas with passive patients… Civil unrest could follow as “reality” hits home.. The Health Services of the Uk are unsustainable as they are, and every politician knows it… but they will never admit this… Rationing staff is so tempting when they are the major expenditure, and repeated judgement comes in less than 4 years time..

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The risk of patients dying in hospital increases by a fifth for each nurse on the ward replaced by a healthcare assistant, a study has concluded.

Cutting nurses is “life-threatening” and proposals for a less-skilled class of nursing worker put patients at risk, researchers said.

Hospitals hoping to use fewer skilled staff to save money have been warned not to repeat “the Mid Staffs fallacy” and assume that patients will not suffer.

Peter Griffiths, of the University of Southampton, one of the study’s authors,….

Rosemary Bennett in The Times 17th November 2016 explains beautifully the demographics which are going to lead to Civil Unrest in the UK unless we address them. The lack of aspiration in education in the dead towns of the periphery is most worrying…

Anger at social divisions ‘carries echoes of 1930s‘

Growing public anger at the “them and us” society risks “turning ugly” as it did in Europe in the 1930s , the social mobility watchdog warned yesterday.

So-called treadmill families earning the national average of £27,000 a year are “running harder and harder but standing still”, its report said.

An unfair education system, a two-tier labour market, a regionally imbalanced economy and unaffordable housing are taking their toll, it added.

Millennials — those born in the 1980s who came of age at the turn of the century — are the first generation since the war not to start work on higher incomes than their predecessors.

Other data in its annual report show problems emerging at a younger age. Bright children from poor backgrounds still have little chance to break in to the educational fast stream, the report shows. In one year, 2010, not a single child on free school meals from the northeast got a place at Oxbridge….

Chris Smyth reports 17th November 2016: Poor home care ‘creating a living hell’, so perhaps its a good job few of the demented are voting…

Dementia sufferers are left hungry, thirsty and soiled because of “harrowing” neglect hidden behind closed doors, campaigners say.

Substandard home care is having devastating consequences for people with dementia as untrained staff struggle with everyday tasks, the Alzheimer’s Society warns. Older people have ended up in hospital, moving to a care home or even wandering into the road because of poor care that can make life a “living hell” for families, a report concludes.

Civil unrest will be inevitable… This is the future … “Super-surgeries with 50,000 patients” – take it or leave it..

What is the true story behind NICE stopping “A&E safe staffing guidance” levels? Money and fear of civil unrest…

This is just the start of civil unrest. The patients will cause a lot more problems than the doctors. Strike won’t cure sick NHS

The start of “Civil Unrest” in the Regional Health Services – as predicted by NHSreality?

GP Crisis Becoming Steadily Worse – “the public won’t tolerate complacency from a government that bears a large measure of the responsibility for this mess.” Civil Unrest to follow?

Naive and childlike Politicisation of Health – civil unrest and internal migration are possible

West Cumbria hospital changes: ‘Public unrest’ warning

Crisis – what crisis?

“Will all those that are not dying please go home!” Rationing hits the headlines..

Emergency Units (the safety net) are failing…. Wales is “bust”…

The next 50 years: is the NHS financially sustainable? Reconstruction and renewal is needed urgently….