Category Archives: Nurses

Just a name on a rota? An adverse environment is holding back staff and affecting patients….

From rags to Richer in the Economist October 3rd describes how one man, Mr Julian Richer, who is a fan of “In Search of Excellence”, a business bestseller by Tom Peters and Robert Waterman which came out in 1982, built his business and then sold over half to his staff. Bartleby describes this as A business success story built on treating people well”.  (There are few Health Service staff surveys which can be trusted, and exit interviews are rare …. Mr Richer does staff surveys every week.).

How does he keep staff loyal? One way is to survey morale every week.

The 4 Health Services of the UK need to treat their people well, but they don’t. Politicians and Trust Board members and managers should re-read Peters and Waterman, whose motto used to be the legend above my own local trust here in West Wales. I wonder what made them abandon it?

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In the BMJ 10th October 2019 Dr Chaand Nagpaul comments on an article written for Dr Tameem, a ST6 who has had experience in Australia where juniors feel much more valued. His account in ” More than just a name on a rota” in explicit and represents what is going on nationally, in all 4 dispensations. It is the culture of the organisation which is wrong. The rules of the game, decided by politicians, don’t allow people like Mr Richer to run the business….. Excellence has been written out of the script for most on call STs in DGHs. Surviving that shift, night or day, is the name of the game.

An adverse environment is holding back staff and affecting patients, says BMA council chair Chaand Nagpaul

People become doctors because this career embodies their values. It’s a long and arduous journey and it is a commitment that extends beyond working days.

Yet many doctors find themselves in a working environment that, instead or recognising this commitment, perversely works against them. Our own survey shows that nine out of 10 doctors feel they can’t provide safe, high-quality care because of the stress and strain placed on themselves, colleagues and the wider system.

To add insult to injury, if things do go wrong, more than half of doctors fear they will be blamed for errors caused by system and capacity issues and only half of doctors would feel confident to raise concerns.

Not only does this adverse environment prevent doctors from achieving their best but it is also denying patients the full potential skills and capability of care from our medical workforce.

Given this tough – and often unfair – working environment, one would expect employers to support frontline staff and offer them gratitude, understanding and support – rather than a culture many doctors inhabit of fear, blame and isolation.

As part of our Caring, supportive, collaborative project, the BMA will continue to campaign for an NHS that has adequate resources so that doctors can do their best for patients, underpinned by a culture rooted in learning and improvement rather than blame, and which values its workforce as its strongest asset.

Find out more about the BMA’s Caring, supportive, collaborative project

There is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the

Changing a culture of fear, bullying and gagging…… Start again with local pride….

CQC …

No need to comment on the “Culture of fear”

Despite the evidence, the health services culture crisis will be ignored by those with the power to act… It’s going to get worse..

The culture of the NHS has yet to catch up with the rhetoric as this speech from the GPC leader underlines.

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

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

Clinical excellence may become impossible in state provided health care.

‘My local practice was a centre of excellence. Now we face a future of depersonalised, rationed healthcare’

All education is divisive – We must all aspire to excellence, and speak out.

Sir Bruce Keogh: “I am not interested in an NHS that aspires to mediocrity, the European average or whatever. We should set ourselves the achievable ambition of raising our cancer survival rates to match the very best in Europe.”

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Incremental neglect tips over into significant and costly malfunction, as rationing is denied but extended..

The damning statements from the finance officers show how neglect and denial have built up to a point where it will take 15 years, and the importing of many overseas nurses and doctors to even start to put our 4 health services right. Since devolution has failed in Wales it will be even harder here, where I am based. “…..Incremental neglect tips over into significant and costly malfunction, and opportunities for strategic renewal and improvement are being squandered. Many interviewees identified ways that their trusts could better manage their capital investment programme, but these were eclipsed by the near-universal call for increased funding and a relaxation of central controls. 

Iestin Williams reports for the Health Foundation 8th March 2019: Views of NHS finance officers on limited capital.  see below…

Laura Donelly on 28th May 2019 in the Telegraph reports: A doubling in rationing of cataract surgery

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3190 (Published 04 July 2017) Cite this as: BMJ 2017;358:j3190

Laura Donelly in the Telegraph 11th August 2018: Numbers “going private” for surgery soaring as NHS rationing deepens.

Nick Triggle for BBC News 4th July 2017: NHS ‘rationing leaves patients in pain’

Pressure on NHS finances drives new wave of postcode rationing https://doi.org/10.1136/bmj.j3190
(Published 04 July 2017)  BMJ 2017;358:j3190

[PDF] NHS Rationing and the Law. Warwick Heale. MA Medical Ethics. Interest in legal and ethical issues in treatment funding decisions.

Iestin Williams reports for the Health Foundation 8th March 2019: Views of NHS finance officers on limited capital.

Fixing leaky roofs, servicing ageing scanners and updating antique IT systems – the maintenance of capital infrastructure in the NHS isn’t the most enthralling of topics, and it’s generally only talked about when things start to go wrong. However, recent warnings about the lack of NHS capital investment and controls on capital spending by trusts have put this issue very much in the spotlight.

At a national level, we know that for some time now, money has been diverted towards the day-to-day costs of health care and away from capital budgets, leaving them severely squeezed. However, less is known about what this means for the trusts affected and the services they provide. We tried to find out more by speaking to finance directors at NHS trusts across England.

Squeezed to breaking point?

The trusts involved in our study were clearly feeling the financial pinch. In itself, this is nothing new. For example, taking out loans to pay for new IT systems or delaying the overhaul of outdated estates are commonplace. However, when basic maintenance work starts to be repeatedly postponed, the concerns voiced become a little more insistent. This was the tone of many of our interviews. We were struck by the prominence of the word ‘crisis’ – one not used lightly by seasoned finance personnel.

Rationing

The squeeze on budgets has necessitated tough decisions about what to fund and what not to fund, and in what order. As a result, all but the most urgent of capital plans were frequently being abandoned or at least put on hold. In many cases, considerations around efficiency and improvement have been crowded out by more immediate concerns over safety and service viability. However, while this has mitigated the short-term impacts on patients and services, finance directors frequently lamented the potential long-term harm. In short, organisations were engaged in reactive rationing, rather than proactive priority setting.

Navigating the system

Interviewees described a much-changed environment in which sources of funding they had previously used for major capital projects were increasingly unavailable. Many trusts have found themselves unable to generate revenues to pay for capital projects, and were frustrated by the central financial controls imposed upon them. Others argued that the process for applying for centrally held NHS funds, including through partnerships arrangements such as STPs, was increasingly complex and inaccessible. Opportunism – for example, in the form of asset sales and charitable fund raising – offered only a partial solution to those trusts with access to these options.

All these factors are building towards something of a ‘perfect storm’, in which incremental neglect tips over into significant and costly malfunction, and opportunities for strategic renewal and improvement are being squandered. Many interviewees identified ways that their trusts could better manage their capital investment programme, but these were eclipsed by the near-universal call for increased funding and a relaxation of central controls.

Dr Iestyn Williams (@IestynPWilliams) is a Reader in Health Policy and Management and Director of Research at the Health Services Management Centre at the University of Birmingham 

 

 

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

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

The reality that Health and Social Care are not either of them free, has not sunk in to the politicians yet. We cannot have “Everything for everyone for ever” and for free, and in their denial, both houses thus conspire to avoid the important debate that Mr Stevens called for on 4th June 2014, almost exactly 5 years ago. If Social Care is means tested, why not Health Care? 

The unedifying spectacle of two potential leaders trying to bribe 160,000 older and richer people who happen to be their members, is the reality of todays politics. No wonder so many people dont vote. We need an honest party to speak “hard truths” to the nation. NHSreality believes the first party to do this, and be understood as honest and working for the overall good of us all, fairly, will eventually win a landslide. It will also win the hearts and minds of the medical professionals….. and they are trusted, and speak to many people daily.

Our political (moron) representatives need to permit commissioners and trust boards to ration overtly, so that their citizens know what is not available. Initially this will have to be by post code, but national guidelines from NICE would help. Eventually, for those services and treatments that none of us can afford, cancer and big operations for example, there can be a National Health Service again, and for cheap and cheerful, high volume low cost services, we can have local post code rationing if we still want it…

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BBC News reports 4th July: Social care: Hunt and Johnson urged to consider NHS-style free service

Public Service Executive reports: Peers call for NHS-style free social care system and an extra £8bn to tackle funding crisis

and the Guardian today also reports the Peers asking for an extra £80m for “vulnerable elderly people”. 

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

New and higher taxes will never solve the problems of health and social care…

There is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

What principles should underpin the funding system for social care? Surely an ID card with tax status and means is now essential….

The reality of the post-code lottery and rationing of health and social care. It will just have to get worse before the “honest debate”…

A Happy Brexmas to everyone as our leaders duck health and social care funding crisis.. The media failure, and political denial can only get worse..

Nov 2016 NHSreality: NHS funding and rationing: The debate (and the denial) intensifies… It’s going to get worse..

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

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)

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Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding? If we don’t keep the gatekeeper role for GPs the system will get constipated.

A recent report in the Times (Not on line) opines “Gatekeeping by GPs called into question. This is not new, as you can see from the debate following Matthew Paris’ article in 2015. The problem is not referrals, but the 90% who do not need a referral. Allowing others, less trained in dealing with uncertainty, will lead to more referrals, longer waits and a constipated system. The useless 111 service where there has seen no reduction in GP workload is another attempt to wriggle off the hook of under capacity and poor manpower planning. In his Imperial College funded report, Geva Greenfield and others report: “Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding?”.

One solution is to make patients pay for their GPs and let them have appointments free with the nurses and paramedics. A two tier system by design. Lets see the comparisons in referral rates, expense and survival!! The result would be anarchy.. (sic) Geva Greenfield says “There is a trade-off that needs to be found between GPs serving as hgatekeepers to secondary care, and at the same time allowing patients to see a consultant when they wish”. We are trying to treat patients, and the governement are treating populations. Money matters, and the services are all rationed. (covertly)

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This is the sort of thinking “outside the box” of current opinion that we have to get to talking about openly.

On November 26th 2018 Chris Smyth reported in the Times: Bypassing GPs could help to diagnose cancer sooner

In Pulse 2015: GPs should give up their Gatekeeping Roles

Matthew Paris on June 16th 2012 reported in the Times: GPs – little more than glorified receptionists

In this age of medical specialisation, if family doctors didn’t exist we wouldn’t feel the need to invent them

Next Thursday, family doctors plan to strike. Striking doesn’t suit the profession’s humanitarian image. Interviewed, doctors’ leaders struggle to insist (on the one hand) that nobody needing medical attention will be denied it, without implying (on the other) that few will suffer if doctors aren’t there.

How much, though, would we suffer? If family doctors had not existed, would we today have found it necessary to invent them?

We pay general practitioners more than we pay airline pilots, but they are becoming glorified gatekeepers: a portal to the more specialist medical care that our health service offers in growing measure. As GPs have receptionists, so the NHS itself uses GPs as its receptionists. Are we investing too much in the citizen’s first port of call, to the detriment of investment in the specialist attention to which, to an increasing degree, surgeries are likely to end up referring the patient?……..

……..Nurse-led primary care, too, is plainly on its way and expanding fast, with (the research is clear) excellent results. Walk-in and appointment clinics are becoming more common, especially evening clinics. Sexually transmitted disease, family planning, coughs and colds, eye, ear nose and throat … in all these fields specialist practices staffed by nurses and pooled doctors, rather than personal GPs, are where we’re going.

The only question is how fast. Let’s hope next Thursday’s strike prompts us to speed this thinking up. Decades ago, at the bookshop Foyles, you had to get a little chitty from a person in a booth before you could get your purchase. One day we’ll remember the GP surgery in the same way, with the same amusement that the archaic practice lingered so long.

The response June 18th 2012:

Sir, Matthew Parris (Opinion, June 16) is not quite correct in describing GPs as “becoming glorified gatekeepers”. We have already had that role (among others) for decades.

It is true that part of this role is to refer to secondary care, but he seems to miss the corollary of this; that we also judge when not to refer, thus saving patients, and the country, the burden of over-investigation and over-treating. The internet has expanded everyone’s access to specialist knowledge, but has not, perhaps, increased our ability to apply that knowledge appropriately. We know more, but understand less.

Mr Parris also fails to acknowledge that GPs have a vital role in the other direction of travel; from specialist care to the community. In this past week I have picked up the care of patients after their discharge from heart by-pass surgery, psychiatric in-patient treatment, dermatology, gynaecology, child autism and palliative care clinics.

In addition, we need to manage patients whose symptoms and conditions cover several specialties, as well as those who have exhausted all secondary care investigation without any diagnosis being reached.

“A decent grasp of the whole thing” is exactly what GPs need.

Dr Jonathan Knight
GP, Ipswich

Sir, Matthew Parris assumes that his interaction with his GP is typical of the work that GPs do. I have been working in general practice since 1987 and my experience is very different. We spend most of our time managing long-term illness such as high blood pressure, diabetes, kidney disease and asthma. When I was in training in the 1980s these conditions were managed in hospital but are now managed mainly in primary care. Of course I do not profess to be an expert in everything so I may refer to colleagues for opinions about aspects of a patient’s care, but they are then usually discharged to my care.

Allowing less-qualified health professionals to manage patients has never been shown to be more cost effective than using GPs.

It is this system of every patient having a GP, enshrined in Bevan’s original vision for the NHS, that other health systems around the world have strived to emulate. We should not discard it lightly.

Steve Charkin
London NW3

Sir, Matthew Parris says that he believes he could refer himself appropriately to a specialist, but he is not our typical patient. GPs’ time is predominantly taken up with the very young and the elderly, particularly those with chronic, complex and multifaceted medical conditions. For these folk, it is their GP who sees the “big picture”, the context and impact on the individual and their family, while each specialist focuses in on his own area of expertise. Approximately 90 per cent of healthcare needs are met in the community, by GPs and their practice nurses, with only 10 per cent of care being hospital-based, at far greater expense. It is true that a GP’s role includes “gate keeping” access to expensive specialist opinion, but I would suggest this is essential.

As Mr Parris concedes, most GP consultations do not lead to a referral to a specialist. His vision of a future without GPs to manage the majority of our health concerns would be financially unsustainable and bewildering to many. Would a woman with lower abdominal pain and back ache refer herself to a gynaecologist, urologist, gastroenterologist, oncologist or orthopaedic surgeon? Does she need a specialist at all if it is just a urine infection? How does she know?

While a single day of industrial action will cause no more inconvenience than the extra bank holiday for the Diamond Jubilee, Mr Parris belittles our role at his peril.

Dr Isabel Cook
Reading

Sir, Before getting rid of GPs Matthew Parris might be wise to wait until he is a bit older when he may have to see more than one specialist at the same time. He will find that the treatment for one condition often aggravates another and he will then be grateful for a generalist’s opinion. He will also find it more efficient to keep seeing the same GP so that he does not have to keep repeating his past history.

Dr Richard Stott
Epsom, Surrey

Sir, As a GP I know Matthew Parris is right. A lot of what GPs do is pointless or could be done by others. So there is a simple solution: stop giving us work.

John Booth
Middlesbrough

Sir, There is overwhelming evidence that GPs deliver highly effective, cost-effective care to our patients. Moreover, we do so with the trust of our patients, and with care and kindness.

I invite Mr Parris to sit through a surgery with me at any time, where he will see first hand how GPs care for the elderly, the frail, the disadvantaged and the ill. I’m sure that afterwards his perceptions of general practice will be different.

Professor Clare Gerada
Chair of Council, Royal College of General Practitio

 

An administration with no direction, no virtue, and no future.

The ministry of health has reversed it’s intention on nurses, and selling it’s outsourcing. Both recruitment and procurement are long term problems that are impossible to solve in a shirt time horizon. However, procurement could be so much more quickly solved. Its just that its politically impossible to outsource… Part of the reason for this is the thoughtless devolution 20 or so years ago. A health mutual is stronger when it is larger, and 4 dispensations rather than one makes for inefficiencies, particularly in procurement.

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The Observer reports Sunday 2nd June: on Plan to hire thousands of foreign nurses for NHS is axed

Target was politically difficult for a government committed to reducing net migration

The Guardian initially reported 2nd June: US wants access to NHS in post-Brexit deal, says Trump ally

Before president’s visit, Woody Johnson says every area of UK economy up for discussion

and then Francis Elliott the Times the following day (June 3rd) reports Jeremy Hunt apparently reversing his successor’s intention : NHS will never be part of US trade deal, says Jeremy Hunt

Jeremy Hunt has warned Donald Trump that the NHS will remain off-limits to American companies, whoever wins the Tory leadership race to become Britain’s next prime minister.

The foreign secretary became the second candidate to rule out allowing US firms access to NHS contracts in a post-Brexit trade deal after Woody Johnson, the US ambassador to the UK, said on Sunday that the “entire economy” would have to be “on the table” in any deal.

Pressed whether that included the NHS he said: “I would think so.” Access to NHS contracts and farming standards are the two most controversial elements of any future deal. Speaking before he left Washington Mr Trump said: “[We’re] going to the UK. I think it’ll be very important. It certainly will be very interesting. There’s a lot going on in the UK. And I’m sure it’s going to work out very well for them.

“As you know, they want to do trade with the United States, and I think there’s an opportunity for a very big trade deal at some point in the near future. And we’ll see how that works out.”

Matt Hancock, the health secretary, became the first of the Tory leadership candidates to insist that the NHS was off-limits yesterday…..

Drug Procurement scandalously profligate and inadequate…

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

Procurement in the NHS – next stop the courts.

Kimberly Hackett in the Nursing Times 8th May 2019: NHS to step up nurse recruitment overseas, says leaked report

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To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

NHSreality as well as Spike told you it was going to get worse. Is it not ironic that in a country where we have depended on nurses, carers and doctors from overseas (usually less developed countries than ourselves) that we are now threatening not to allow them in, and especially not from Europe and the EEC, which means we may well get staff from less culturally affiliated countries, OR we have to export our elderly, OR we have to look after them with robotics! Personal continuity of care has died in the 4 health services, but many of us, if we can afford it, will pay for it.

In the last few weeks the shortage of GPs and poor access to the health care system applicable in your Post Code has become more evident. Rich areas like Horsham cannot attract GPs, partly because the price of property is so high, and poorer areas of the country cannot attract GPs because of the poor housing and schooling problems. Gainsborough surgery closed suddenly… (Connor Creaghan 29th May 2019 in the Lincolnshire Post)

Don’t believe it when the government says they are learning from their mistakes. They still have no “honest language” and they have no exit interviews. These are their main mistakes….

The whole idea of a mutualised health service is to care for those with the bad luck to have a serious illness or a physical / mental handicap. The latter do not often vote, and numbers don’t influence an election so they have been left behind, to the benefit of voters. Our Minister of health seems more concerned with innovation and Big Pharma than she is in boosting numbers of staff!

In a world market (English speaking) Nurses and Doctors have skills and are people who can move. The best way to keep them is to look after them, and to train a surplus.

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Meanwhile clinical acumen and skills, and organisational issues are in decline. Public health has been underinvested and now people are starting to suffer.

The cost of care is so great that we may end up exporting our elderly….

Nursing crisis extends all the time… Surgery, ICU, intensive care and now oncology and cancer care…

29th May 2019 BBC News: ‘Lessons learned’ over £24m Altrincham health hub failings

Sarah Page in the West Sussex county times 22nd Jan 2019: Shortage of GPs in Mid Sussex

and Martin Bagot on the Mirror 31st May reports that there are over half a million people who have had to change their GP.and Desperation recruitment from abroad (Philippines, India, Ireland and Australia are targets, but Bangladesh and Pakistan may be the reality)

BBC News 21st May: ‘Broken’ care system for most vulnerable

on 21st May ITV reported that there were not enough nurses and doctors to meet demand  and the implication of their report is that there won’t be in the foreseeable future.

The Government is in denial and Nicola Blackwood in a speech to the ABPI opined: “We are going to have one of the most exciting health innovation systems in the world.” It certainly will be different for those who fall foul of it…

Thank Goodness one health Trust has agreed to actually pay nursing trainees! Cornwall’s Megan Ford on 14th May in The Nursing Times.

The Yorkshire Post: Scandal of the growing wait for a GP appointment. (YP 11th May 2019)

Meka Beresford and Ollie Cole in Human Rights News report 21st March 2019: NHS staff shortages could double without radical action.

Nick Triggle admits through the BBC news 21st March that there is “No chance of training enough staff”.

BBC News 29th May: Glan Clwyd Hospital told to improve orthopaedic care by coroner

BBC News 31st May 2019: Llwynhendy TB outbreak: Family ‘disgusted’ after death

And Matthew Parris in 2018 asked “How does anyone know how to navigate the maze of our second-rate NHS: ( You can download the whole article below)

The Maze of the NHS – Matthew Parris

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

Say goodbye to continuity of care.

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