” There is a bunker mentality in the NHS ” – Health Ombudsman. It will lead to more and more scandals..

Defensiveness and hostility pervade the health service, and despite many patient safety reviews, very little has changed or is changing. Rob Behrens tells Abi Rimmer in the BMJ. Dec 2023 I would go further. The “recurrent scandals” those more recent listed below, and going to get worse. NHSreality believes that “no fault compensation” is an essential element in the honest debate needed to create cultural change. Reckless politicians! A Wonderful exposee is in the Times. Isobel Hardnan and Aaron Davis ( See books) must be smiling…The big Q ” How to change the culture so that more family men are prepared to stand as politicians?”…
“Yet the very people who need most to tread carefully, tread most dangerously. The number of MPs who have lost their party whip now exceeds the total Lib Dem parliamentary party. Why?”..
“….I know why, (some want to be politicians) and the answer is simple. The sample is skewed. People who want to be MPs are not normal. They are not representative of the general population, but a very distinct personality type: a minority whose nature disposes them to take stupid risks.”…..
No one should let these people anywhere near a betting shop. They have only got this far by defying risk. They are, by having got this far already, gamblers. No unadventurous family man in search of security is likely to want a career in politics….”Like me, most get away with it, always have; and there were plenty such in my time. I do, though, think that the proportion of young, male risk-takers in recent parliaments has grown, especially in the Conservative Party…..” Every aspirin politician should read Isobel Hardnan and Aaron Davis books..

NHS culture change is difficult, not impossible—but essential, says health ombudsman
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2742 (Published 06 December 2023)Cite this as: BMJ 2023;383:p2742
A toxic culture of defensiveness and hostility pervades the NHS, and despite many patient safety reviews nothing has fundamentally changed, Rob Behrens tells Abi Rimmer
Early on in his career as a civil servant, Rob Behrens, now the parliamentary and health service ombudsman, was sent by the UK government to South Africa, to work on the transformation from apartheid to democracy. “People in Britain used to say what they had to do was hard. I would come back from South Africa and say, ‘You don’t know you’re born.’”
It’s an anecdote he uses when talking about culture change in the NHS. Although change might be difficult, it is not impossible, and it is something that needs to happen, says Behrens, whose role is to adjudicate independently on complaints that have not been resolved by the NHS in England and UK government departments.
“There is huge professionalism and commitment throughout the NHS. It’s been through the mill in a way that no other institution has—because of covid, strikes, and shortages of staff,” he says. “But unless we call everyone together to have a conversation about the emerging problems around the suboptimal culture in the NHS, then we will miss a big opportunity.”
Behrens was appointed to his current role in 2017, having previously worked investigating allegations of public service failure in the legal and higher education sectors. During his six years as parliamentary and health service ombudsman, a non-governmental role, he has seen many investigations and reviews into poor care in the NHS. He has, however, seen little change.
“We’ve had a lot of inquiries into leadership, distressing events, and organisational cultures but the fact is nothing has fundamentally changed,” Behrens says. “I understand that everyone has a massively busy job, that ministers, managers, and clinicians are doing the best that they can. But that doesn’t alter the fact that there are things that are fundamentally wrong that need to be tackled.”

Depressingly little learning

It’s not just his own learning that Behrens is reflecting on. He says that Bill Kirkup, a public health doctor with a specialty in obstetrics who led reviews into maternity services at the University Hospitals of Morecambe Bay NHS Foundation Trust (published in 2015) and East Kent Hospitals University NHS Foundation Trust (2022), had similar observations.12
“When he reported on East Kent, Bill Kirkup said that what depressed him was how little learning there had been from the first time he looked at these matters,” Behrens says. “Secondly, he said this is multifaceted—it’s not just about managers and clinicians, it’s about tribalism among clinicians themselves.
“Thirdly, it’s a failure to listen to patients and their families. That adds up to a toxic culture, which we need to talk about so that we get the one thing that makes an organisation effective: a disposition to learn rather than just to move on.”

Staff are victims too

As well as describing the culture in some parts of the NHS as toxic, Behrens says it is suboptimal, hostile, and defensive. “This leads to a perception that organisational reputation and professional reputation are more important than patient safety. And that is very dangerous.”
It is not just patients who suffer from such a culture, staff are victims, too, he says. “It’s not that they’re sitting there twiddling their thumbs. This is an enormously difficult climate in which to work and to tackle difficult problems.”
Medical education has a role to play in improving this culture, Behrens says, especially when it comes to relationships between doctors and patients. He has heard doctors say that their education was based on the premise that they had to stand by their decisions and not “back off just because people don’t like them.”
“First of all, that says that medical education is very important to the disposition of people, even before they get into senior positions,” Behrens says. “Secondly, it says there’s an implied arrogance that results from that education that stops communication between doctors and their patients. It’s not just about what you do in the NHS, it’s also about the education of people before they get there.”
He says there is now a “golden opportunity” to think more radically about staff development and to link it to accountability and performance. “We should be spending more on the professional development of clinicians and managers in the NHS in a way that enables them to respond to the need to change the culture of their organisation. I think that’s very important.”
Focusing on managers, Behrens stops short of calling for their regulation, but he does support calls for more accountability. “The impression that one gets is that people move from job to job as senior managers without their performance being scrutinised. That needs to be carefully looked at.”

Leaders at all levels

While it would be easy to lay the blame for cultural problems in the NHS at the door of politicians or leaders of national NHS organisations, Behrens says it is not so simple.
“You have to have leaders at all levels throughout the NHS. You can’t just say this is about ministers and trust boards, it goes right the way through. I know from the visits I have made [to organisations] that if you have a powerful, compassionate person leading a ward, for example, that makes a significant difference to the morale and the disposition of people working there.”
The power of good leadership is a point that he emphasises repeatedly. “People say culture changes from the top. Well, that’s true, but you can’t change the culture unless you have buy-in from people,” Behrens says.
He adds, “The key thing about leadership is empowering the people who work for you to do the things that need to be done. You can’t do it on your own. You can’t be a general without an army. You have to make sure that your people are with you, whether it’s at a ministerial level, at NHS England level, or at a GP surgery level.”

“Bunker-ism”

Within his own world of ombudsmen, Behrens has introduced peer review, something he thinks the NHS could benefit from. “We now have, through the International Ombudsman Institute, a group of validated reviewers who are ombudsmen in other countries who, if they are asked, come for a short period of time to review one of their sister institutions and then write a report on what they found.
“It doesn’t solve the problem, but it provides a perspective of learning and drawing on the expertise of your colleagues. I don’t always see that in the NHS because there’s an element of bunker-ism about it.”
Behrens, who is coming to the end of his time in the role, has called for a thorough, independent review of NHS leadership, accountability, and culture. He reissued this call in the wake of the case of Lucy Letby, the neonatal nurse convicted this summer of the murder of seven babies at the Countess of Chester Hospital, but he says the culture of fear and defensiveness that the case highlighted is not isolated to one organisation.
“We have to be less defensive, and we have to be more collaborative. It’s not easy, but it’s not impossible. Surely, after Chester, after [other NHS patient safety scandals] Birmingham, Bristol, Shrewsbury, East Kent, Essex, there needs to be a systemic reflection on what this means for the culture of the NHS.
“It doesn’t matter what you call it, but the thinking has to take place. The debate has to take place.”

Rachel Sylvester in the Times Aug 2023: Time to cut the blame game amid another NHS childbirth scandal – Families have to fight to get answers from a system that encourages cover-ups and is financially crippling for all sides

John Ely for the Mail Nov 2023: Scandal of the NHS ‘never-events’: Bungling hospital medics

Mithran Samuel in Community Care UK 2024: Mental health trust ignored staff concerns for years before Panorama exposed abuse, finds review – Edenfield Centre experienced unsafe staffing levels for years but reporting of concerns was “actively discouraged”, enabling abuse uncovered by BBC in 2022 to happen, concludes inquiry

Sarah O’Grady in The Express Jan 2024: NHS scandal as pensioners forced to pay for healthcare – Experts warn that thousands are now being deprived of NHS treatment they have paid tax for all their lives.

Rebecca Thomas for the Independent Jan 2024: Mental health patients ‘raped and sexually assaulted’ as NHS abuse scandal revealed

Gwyn Bevan for the BBC September 2023: Lucy Letby – another case of regulatory failure in the NHS

Becky Johnson in July 2023 for Sky news: Nottingham maternity scandal set to be biggest in NHS – as ‘disregarded’ families demand apology – More than 1,700 cases of possible harm to newborn babies and mothers are being examined in Nottingham, as the independent midwife leading the investigation said families were “simply not listened to” and were “pushed away”.

Tom Witherow in the Times March 2024: Consultant at Brighton;s scandal-hit NHS trust ‘worked privately while on call’ – Complaint raised with University Hospitals Sussex NHS Foundation Trust by a fellow surgeon who was later sacked as a troublemaker

The Guardian (Dennis Campbell) in Feb 2024: NHS nurses being investigated for ‘industrial-scale’ qualifications fraud – Scam involves more than 700 healthcare workers who used proxies to pass test in Nigeria enabling them to work in the UK

The Independent in March 2024: NHS scandal exposed as elderly patients ‘treated like animals’ on overwhelmed hospital wards – Families of elderly people have come forward to share harrowing allegations of neglect as top doctors warn these patients are suffering ‘degrading’ care well below the standards the NHS expects, Rebecca Thomas reveals

The Sunday Times 20th April Thousands dead, 40 years of cover-up: time for justice for infected blood victims – NHS doctors used haemophiliac children for reckless medical

the-long-term-for-britain-leaderlessDownload

Assisted Dying: My life, My decision

NHSreality supports My Life My decision. The fact is that we are not in a celestial world where palliative and terminal care is given by a family doctor who has known the household for years. This trusted person is nearly extinct. I will never get the standard of care that my generation of GPs gave to their patients. A lack of continuity, too few but part time and inadequately trained professionals, and a post code rationed system where 80-90% of the money has to be raised by charitable methods, means that we will be dying in a “war zone”. In a war we are happy to have anyone sew up our wounds, and give first aid. This is where we are going in palliative care in the UK. Standards will vary remendously from the asset rich suberban shires, to the impoverised and left behind coastal towns. So we need to have a choice when our time comes. If we want the system to be “cheaper” we need to maximise those dying at home. Hospices are expensive, but diamorpine is cheap.
In Which countries are these practices permitted? Assisted dying: What does the law in different countries say?

• The Netherlands, Belgium and Luxembourg permit euthanasia and assisted suicide
• Switzerland permits assisted suicide if the person assisting acts unselfishly
• Colombia permits euthanasia
• California has just joined the US states of Oregon, Washington, Vermont and Montana in permitting assisted dying

It seems quite normal to me that there should be an increase if something is new and in demand. Eventually NHSreality expects the Canadian numbers to settle down to a small fraction of the population. Those who exercise choice and autonomy in this way should not be derided or discouraged provided there is informed consent. The percentages of eligable deaths in each country might be more helpful in future. Hanna Geissler for the Express today 4th March opines “Britain ‘behind the curve’ of public opinion on assisted dying, MP says” and Times letters below 16th Feb 2024 agree.

Katharina Buchholz reports for Statista August 2022: Where Most People Die by Assisted Suicide

Back in July 2021 when the health services were beginning to implode (The Minister was Matt Hancock!) in covid, the Scottish edition printed this letter: We already have what we need to die with dignity
Sir,
Assisted suicide is being suggested to the Scottish people as a lawful way to end some people’s lives. The Sunday Times and a cross-party group of Scottish MSPs have decided to dress up assisted suicide as “dignity in dying”, a clever euphemism that suggests many people do not have dignity in death.
I have been a witness to six deaths within my family in the 61 years of my life, and all my family members had deaths that were eased with painkillers — ie, morphine — and a benzodiazepine such as diazepam to ease anxiety. They all died with dignity without resorting to suicide. I would
strongly advise the Scottish people to fight any change in the law related to assisted suicide. There are enough effective drugs, palliative care teams and good hospice facilities to assist the dying without resorting to suicide.
In my opinion it would rip many families apart, with some members agreeing with the decision to assist suicide and others disagreeing with it. John Smith, Falkirk

Assessing value of life

Michael Veitch (“MSPs must listen on assisted dying”, Letters, last week) presents the inherent value of human life as a coup de grâce against the argument for assisted dying. One can believe in the value of life but also in the idea that ultimately it is up to the individual to decide whether their life still has value to them. In which case, is there not an inherent value in a good death for those individuals with a terminal illness facing a difficult end? Allison Wroe, Edinburgh

Letters on End of life strategy 2nd March 2024: Sir, The health and social care committee is to be commended for its thorough and even-handed addressing of the complex issues involved in assisted suicide and euthanasia (“We need a national assisted dying strategy, say MPs”, Feb 29). The committee wisely decided not to recommend action towards a change in the law. As HL Mencken once observed: “For every complex problem, there’s a solution that is simple, neat and wrong.” Everyone who thinks that the case for legalising assisted suicide is self-evident should read this report.
Baroness Finlay of Llandaff
Professor of palliative medicine

Sir, Both sides want the same outcome: a dignified and peaceful death, preferably at home. But for many disabled people, the unintended consequences of change loom large. I am not convinced that legislators can safeguard against human nature. With quality domiciliary care for the sick and disabled ruinously expensive and house prices temptingly distorted, mission creep seems inevitable.
Anthony Stone
London SW19

Times letters 16th Feb 2024: MPs OUT OF STEP ON ASSISTED DYING

Gordon Macdonald, of Care Not Killing, misses the point about assisted dying (Letters, last week). He notes that MPs have voted against it, but our representatives are badly out of touch with the electorate on this subject. Politicians are providing what they feel is right for the population rather than what we want.
Glyn Edmunds, Hayling Island, Hampshire

Wrong arm of the law
Let me get this straight: the police no longer have time even to attend the scene of many burglaries, let alone investigate them; they do, though, have time to investigate the terminally ill seeking assisted dying, and their distressed relatives, at what are possibly the worst moments of their lives. Burglary laws have public support; harrying the dying does not. The police should simply refuse to investigate the latter — if necessary, citing the same lack of resources that they use in the former.
Rita Johns, Bramley, Surrey

Concerning statistics
Macdonald says in Oregon “a majority of those ending their lives cite fear of becoming a burden as a reason”. Without context, this is misleading. Oregon’s statistics show the three most frequent end-of-life concerns are loss of autonomy (91.7%), decreasing ability to participate in activities that made life enjoyable (90.5%) and loss of dignity (66.7%). This is why such claims need the proper scrutiny of an independent inquiry.
Trevor Moore, chairman, My Death, My Decision

The last thing GPs want is to strike. ..

The GPs in England are voting on whether to take strike action for the first time since the 1966 contract ( GPs will be asked to consider all options in response to the Government’s imposition of an ‘insulting’ and ‘inadequate’ contract, the BMA has warned.  ). As contractors they have negotiated their self employed working conditions with the governement of the day for decades. Over the last 3 years, despite warnings that the profession was unhappy and burnout was commonplace, the contract has been “imposed” without the consent of the profession. Is it any wonder that GPs feel uncared for and given the demand increase at nearly 2500 patients per full time GP, they are feeling militant. Like the RAAB concrete issues, GP and doctor recruitment has been coming on us for decades. Political inactivity, mainly from the current team in office, but also from the other parties, has led to a situation where “it’s too late”. Headline reporting as below does not help: although Ms Lay corrects herself in the article, most people read and listen soundbites. Its Midwives nurses, physios, as well as doctors who are in short supply. “NHS pays agency £2,000 for a midwife shift“.
Kat Lay reports: GP average salaries rise by a quarter in a decade – The record high is due to extra work during the pandemic, the doctors’ union says

GPs’ average earnings have risen 23 per cent in a decade to a record £118,100, according to figures published today by the NHS.

It comes as family doctors threaten industrial action over high workloads and what the British Medical Association calls a “disastrous” GP contract.

Public satisfaction with GP services is at record lows, with only seven in ten patients describing their overall experience with their local surgery as “good”. Rising numbers of patients report going to A&E because they cannot get appointments.

The average GP’s income before tax in England was £118,100 in the 2021/22 financial year, up from £95,700 a decade ago in 2011/12.

The record high is likely to have been affected by extra work taken on during the pandemic, the doctors’ union said.

Male GPs earned an average of £146,000, while female GPs earned an average £97,500.

Unlike most doctors, GPs are not directly employed by the NHS but operate as contractors. GP partners own a share of their practice and employ other staff, including salaried GPs.

The data shows an average pre-tax income of £68,000 for salaried GPs and £153,400 for GP contractors.

“The data released today does not reflect the current reality of GPs struggling with the continually escalating costs of running a practice,” said Dr David Wrigley, deputy chairman of the England GP committee at the BMA.

“Although these figures for average earnings are more than 18 months old, they reflect not only the temporary emergency funding that was made available to general practices to support their teams to give millions of vaccines, but in addition, payment for countless hours of additional work GPs did throughout the pandemic to try and keep up with routine patient demand on top of the vaccination programme.”

He said that since 2015 there were more than 2,000 fewer full-time, qualified GPs and each was now responsible for 2,305 patients.

Wrigley said spiralling inflation had not kicked in during the time period covered by the data, and “gives no indication of the yet-to-be-seen impact of the huge cost and staffing expenses rises GP practices have been experiencing in the current and preceding financial year”.

He said: “GPs who run their practices are responsible for all costs and risks, so they plan 12-18 months ahead to ensure they can continue to pay the bills, pay their staff and pay themselves an income at the end of the year. When their running costs rise, as they will have done in the period since today’s data was published, their income inevitably falls.”

Separate figures showed GPs and their staff had provided 1.36 million appointments per day in July this year, up from 1.24 million in July 2022. Just over two fifths were delivered on the same day they were requested.

Ruth Rankine, director of primary care at the NHS Confederation, said: “These figures once again reflect the significant efforts of GPs and their staff, who are continuing to quietly deliver for patients.

“We should not underestimate the challenges ahead with general practice playing, yet again, a key role in the delivery of the Covid vaccination programme while practice and workforce numbers continue to decline. It is imperative that the needs of primary care are considered as part of wider system planning and funding for winter.”

Is listening to patients and families too much to ask? Dont tell me – listening is rationed!

I was taught “Listen to the patient: he is telling you the dianosis!” but it seems that even this elementary skill is now fading from the curriculum. Understandably Janice Turner lets off steam with ” Drop NHS deference and shout the wards down – Shocking death of 13-year-old Martha Mills is a wake-up call to all of us who bite our tongues before god-like doctors”. Now readers might realise that they have been deluding themselves that there is a reliable medical safety net in place… Dont tell me – listening is rationed!
….. Nottingham University Hospitals Trust is implicated in the deaths or injuries of 1,700 babies. Why, before it got to this grotesque figure — a whole secondary school of children — did no one spot a pattern, order a review, assess mistakes, ask what the hell was going on? …..
Nottingham will soon join East Kent (45 needless baby deaths), Morecambe Bay (11 dead babies and one mother) and Shrewsbury and Telford (300 babies dead or brain-damaged, nine dead mothers) as trusts failing to address patterns of catastrophic failure. It is mind-blowing that the NHS in England now pays £8.2 billion in annual clinical negligence compensation for maternity care, more than double the total £3.2 billion maternity and neonatal budget. Bereaved parents campaigning for justice all echo Merope Mills: they say they fought to be heard.

Even more shocking is the institutional response after a death. Doctors close ranks, refuse to attribute blame, while hospitals try to smooth over a tragedy, as when whistleblowing consultants were told to stop emailing managers with their fears about the baby-murderer Lucy Letby, to avoid a police investigation and reputational damage. At Shrewsbury, bereaved parents reported scant compassion, just a letter asking “if you would like to come and have a chat with me about the death of your baby”. A chat……
Times letters 9th September 2023: Importance of listening to patients’ families

Sir, The harrowing circumstances of the death of 13-year-old Martha Mills (news, Sep 5; letters, Sep 6, 7 & 8) should surely be a lesson to all connected with the NHS — politicians, administrators, consultants and nurses alike.

Why in this day and age do we still have an NHS which basically runs a hospital service only from Monday to Friday? Consultants striking for larger salaries need to work as normal at weekends along with the rest of NHS staff. Illness doesn’t suddenly cease on a Saturday and Sunday.

Listening to patients’ or relatives’ concerns has never been automatic; often relatives’ concerns are regarded as interfering rather than helpful. “Martha’s rule” should be implemented across the NHS without delay.
Cath Manchester
Whittle-le-Woods, Lancs

Sir, I was taught that the first rule of paediatrics is always listen to the parents/primary carer. They usually know their child far better than you and are invariably right.
Professor Richard Grundy
Professor of paediatric neuro-oncology and cancer biology, Nottingham University

Sir, I agree with the call for patients to be given the right to a second opinion (“Martha’s Rule”, leading article, Sep 6), especially where the patient’s condition is a cause for concern. A greater use of artificial intelligence and related support systems in healthcare settings could also help. Diagnostic algorithms could be set up to process clinical data that are already routinely gathered so if particular symptoms of a clinical condition appear, or a combination of symptoms develop, the AI system would send a warning to staff to take immediate action.
Narinder Kapur
Visiting professor of neuropsychology, University College London

Sir, Every word of the articles about Martha Mills echo how I feel after the traumatic death of my dear husband, Keith, in King’s College Hospital in February. He had a supposed urine infection but died from septic shock after his health deteriorated over three weeks. He had complex health issues including mental ill health and I was his advocate, his voice. Sadly I was left feeling that I wasn’t being sufficiently consulted or listened to; on occasions I felt dismissed as an interfering wife. I could have told them of a severe chest infection last year, and they might have treated him differently.

I would like to fully support Martha’s rule in any way that would make a difference to how we as family members are taken seriously, listened to and consulted on the treatment of our seriously ill relatives.
Brenda Webb
Purley, Croydon

Sir, When I started my first paediatric job as a senior house officer in 1971 the consultant told me that if his extremely experienced ward sister was concerned about the actions of any of the junior doctors, she would contact him. One night I was sure my treatment of a diabetic child was correct and we just needed to wait. The sister telephoned the consultant who spoke to me, agreed with my assessment and the child recovered soon after. In those days the wards were run extremely well by ward sisters who, in my experience, had a very good relationship with the doctors.

I was also told that if a parent was very concerned about their child they needed to be taken seriously.
Dr Susan Colvin (ret’d GP)
London SE3

The weaponisation of the GMC by NHS managers needs to stop immediately. Workplace rights and safety in hospitals

Workplace rights and safety in hospitals – The Times letters 23rd August 2023:

Sir, The obsession with cultural equality and workplace fairness in the NHS, particularly among senior managers, has led to a workforce too frightened to raise safety concerns, because doing so would be more likely to lead to their own suspension than to any meaningful safety action. I was brought into the NHS by Jeremy Hunt, then the health secretary, to see if a sprinkling of aviation safety dust might yield a reduction in avoidable harm. Instead I found roadblocks at every step of the journey, most disappointingly from the senior leadership of NHS England. A system that is brimming with data is undermined by those who cannot countenance introducing safety systems that have been tried and successfully tested by other high-risk sectors. If seven murders and more than 10,000 avoidable deaths each year cannot change this thinking, we are indeed in a very sad place.
Keith Conradi
Former chief investigator, Healthcare Safety Investigation Branch; Farnham, Surrey

Sir, The process for identifying the cause of death where there is concern that it may be unnatural or is unknown is to refer the death to the coroner, so the key question is why the deaths that doctors could not explain were medically certified. There is a duty on medical practitioners to report the circumstances and not to limit disclosure to avoid investigation. That is essential for the pathologist to properly conduct clinico-pathological correlation and might trigger a joint paediatric forensic post mortem. The immediate question, in preventing a recurrence, is whether medical examiners across the country are acting independently of their trusts and properly notifying such cases.
Andrew Harris
Professor of coronial law, William Harvey Research Institute, Queen Marys University London

Sir, The weaponisation of the GMC by NHS managers needs to stop immediately. Those of us who work or have worked in NHS hospitals recognise only too well the toxic, bullying environment that is rife in a completely dysfunctional organisation. If the government wants the NHS to function properly it needs to ensure that the concerns of clinicians are taken seriously and that appropriate sanctions are taken against those who use these threats to intimidate staff.
Dr AJ Wilkins
Consultant psychiatrist, Taplow, Bucks

Sir, Forcible extraction of a recalcitrant prisoner into court is both undignified and panders to their demands (letters, Aug 21 & 22). Faced with such an individual, with a sotto voce aside of “mountains” and “Muhammad”, I would rise, walk down the steps to the cells, with clerk, counsel and one member of the press, pronounce sentence through the slit, and then return to court, where the public would be informed. Job done.
His Honour Barrington Black
London NW3

Sir, Although a judge has the power to order a defendant to appear in court, only reasonable force may be used, not any force. Even if a defendant were made to attend he or she could be unruly. To avoid this why not place the defendant in a cell with concealed speakers, so that they are forced to hear? A video link could be added so that the defendant could be seen but not heard.
Peter Harris
Ret’d solicitor, Anlaby, E Yorks

Shortening medical training? – no good evidence, and the current loss of “goodwill” will accelerate. Australia beckons for patients as well as doctors..

On BBC1 Sunday morning with Laura Kuensberg the listening public heard that there was an 80% increase in Private Medical Insurance purchase. No wonder, as standards fall. And as the current older generation of doctors die and retire, and with long waits even for private care, and “short trained” physicians and surgeons, more may choose to go overseas as well. Australia becons for patients as well as doctors..
Medical training and burnout in the NHS Times letters 15th April 2023:

Sir, As a physician I find the junior doctors’ strike dispiriting, but it is time that it was said that this is the culmination of an NHS management that has degraded the training experience over the past 35 years.
Junior doctors used to work very long hours but were supported by the camaraderie of a clinical “firm”, which included a consultant, senior registrar, training registrar, senior house officer and sometimes a medical student. It was hard with the long hours but we were supported and learnt from our colleagues. We had a doctors’ mess and accommodation, providing a forum to discuss work. The managers later saw this as an unwarranted privilege and scrapped the facility. The European working time directive forced a 48-hour week on the training and extra-hours payment claims caused resentment. A new shift system to address this obsession with EU rules destroyed the camaraderie and now juniors work in relative isolation. The NHS training bucket will go on leaking until someone changes what is a grotesque exploitation of goodwill.
Professor Colin Fink
Coventry

17th April: Times letters

Sir, James Kirkup raises the prospect of shortening doctor training. It is difficult to assess the value of training but important nursing research exists. The same thinking in that profession led to registered hospital nurses being increasingly replaced by less-qualified staff. A study in 2003 found that a 10 per cent increase in the proportion of nurses holding a bachelor’s degree was associated with 5 per cent lower surgical death rates. This effect was absent for less-qualified staff. Similar research is needed for medicine before any reductions in its training.
Professor Sir Denis Pereira Gray

Sir, The government and some of the public fail to realise the strength of anger of those working in the NHS. I have three junior doctors and nurses in my surgery. Goodwill has gone. For the past few years staff have been forced to work in unsafe environments, often trying to do the work of two or three people. When much of the country was on furlough, staff had their training, study leave and sometimes annual leave suspended.
We are told that our work is appreciated; people clap for us and give us patronising medals. Well if our work is valued — show us. Put your money where your mouth is.
Dr Mona Kooner
GP; London SW11

James Kirkup April 13th: If anything, junior doctors should be cheaper – BMA is using misleading statistics to argue for higher pay when what the country needs is swifter training of more medics

If deaths are as high as 500 per week, we can assume that less than speedy attention causes substantial morbidity, as well as mortality….

How those politicians have let us down – and they go privately! This problem of shortage of A&E and Urgent Care centre staff has been brewing for a decade or more. Blaming the meltdown on covid and flu is silly. By not being prepared as the boy scouts taught me, our politicians have defaulted to a manpower planning nightmare, which cannot be solved speedily. All that remains is for the people to realise the true nature of the societal emergency and demand that the whole of health care is restructured. The politicians need to be empowered to look at other systems, such as France and British Columbia. GP Doctors are paid according to “items of service” which means they are rewarded for working harder, and primary care needs change. As far as Emergency care is concerned we now need a law that all qualified doctors take their turn so that cover can be provided. Updating courses for deskilled GPs will be necessary, along with creche cover for the doctors who have children and need to do their share of shifts. The BBC today: Some A&Es in complete state of crisis, warn health chiefs It is only staff that can solve this: not money. My own personal experience from 3 years ago, along with the rejection of all learning by the Trust and the Ombudsman, supports the assertion below. If deaths are as high as 500 per week, we can assume that less than speedy attention causes substantial morbidity as well as mortality. Rhys Blakely reports 1st Jan 2023 in the Times: A&E delays ‘killing up to 500 people a week’ – Senior medic’s warning as hospitals struggle with staff shortages, surgery backlogs, flu and Covid

As many as 500 people are dying each week because of delays in emergency NHS care, a senior doctor has said.

Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), said that a bad flu season was piling pressure on to services that were already critically overstretched.

A collapse in ambulance response times, gridlock in A&E units and soaring rates of staff turnover were contributing to avoidable deaths, he said.

“We think somewhere between 300 and 500 people are dying as a consequence of delays and problems with urgent and emergency care each week,” he told Times Radio.

The comments will magnify concerns about the state of the health service as thousands more paramedics, nurses and doctors prepare to walk out over pay and conditions. A healthcare leader said yesterday that hospitals were under as much pressure as at the start of the pandemic, while a senior medic urged the government to declare a national major incident.

Ambulance staff are due to strike on January 11 and 23, while nurses will walk out on January 18 and 19. A ballot for industrial action by junior doctors in England will open on January 9.

While ministers hope that continuing industrial action will erode public support for the strikers, a crisis in emergency care could also rebound on the government. Health leaders are already confronting a rise in excess deaths, with Sir Chris Whitty warning that Britain faces a “prolonged period” of high death rates because people stayed away from the NHS during the pandemic or could not get treatment.

• Read more: Ten fast ways to improve the NHS

Whitty, the chief medical officer for England, has warned ministers that thousands of middle-aged people are dying of heart conditions because they did not get statins or blood pressure medicines in 2020 and 2021.

Hundreds more people a week are dying than normal, with the reasons not fully understood. Ambulance delays have also been cited by senior doctors as worsening the death toll.

Hit by a flu and Covid “twindemic”, dozens of hospital trusts have declared critical incidents, with record numbers of patients being treated in corridors and some departments running short of portable oxygen cylinders. The longest wait for a bed is thought to have been at Great Western Hospital, Swindon, where a patient spent 99 hours last week before a place could be found on a ward, The Sunday Times reported.

Saffron Cordery, the interim chief executive of NHS Providers, which represents hospital trusts, said: “I think we are seeing equivalent levels of pressure [to the early months of Covid].”

• Lack of GPs leads patients to DIY medicine

Dr Tim Cooksley, president of the Society for Acute Medicine, called the situation in urgent and emergency care “shocking” and urged the government to declare a national NHS major incident, enabling the four nations to manage demand across the UK.

Over the weekend, Professor Sir Stephen Powis, the NHS England national medical director, highlighted how some 12,000 beds are taken up by patients who are medically fit for discharge but who have nowhere to go because of a shortage of social care.

Boyle said that ambulance response times highlighted the stress the system was under. “Last January, the average response time for a category two ambulance call, so that’s a stroke and heart attack, was about 20 minutes. Over December, it’s been over an hour and a half and over a couple of days it’s been over two and a half hours,” he said.

The estimate of 300 to 500 deaths a week being linked to emergency care delays is based on official excess death figures, which have varied from about 1,700 a week in mid-October to about 900 in mid-November for England. The RCEM believes that between a quarter and a third of these “extra” deaths are likely to be due to problems with emergency care.

The Tory MP Tobias Ellwood said that there was not enough money in the NHS and he expected parliament to debate the issue next week.

A Department of Health and Social Care spokesperson said: “We recognise the pressures the NHS is facing following the impact of the pandemic and are working tirelessly to ensure people get the care they need, backed by up to £14.1 billion additional funding.”

This is Personal: I was let down by the health service, and the Health Ombudsman in West Wales – and there’s nothing I can do other than litigate..

NHS at risk of “complete collapse” – that was a month ago – but nothing will be done. Deliberate self-harm on a national demographic basis?

The Guardian:A&E delays causing up to 500 deaths a week, says senior medic = President of the Royal College of Emergency Medicine believes waiting times for December will be the worst he has ever seen

What is their future? Are some nurses and physiotherapists doing themselves out of a job by striking? Or will the latter simply “go private” like the dentists? Nurses may opt to be “long term locums”on much higher pay..

Scotland may have a pay deal acceptable to their staff, but this is not the case in England. Is there any clearer statement that there is no “N”HS? As the Times leader 12th December point out, what the staff are demanding is inflationary, and in some ways self destructive (Duty of care: The NHS cannot afford to yield to unaffordable pay demands by nurses. But nor can it afford to keep forking out billions every year to hire agency medical staff.) Whereas there are no diagnosticians with medico-legal cover who are not doctors, there are many people who duplicate or can replace the role of nurses outside of their emergency roles. The definition of “emergency person” as opposed to “urgent care person” is pertinent to todays news and discussions as the nurses threaten strike action. The “carers” are not striking. The Physiotherapists are joining the nurses, along with the Welsh (only) Midwives (So far). and radiographers are not striking. The doctors are not striking (yet) but some are threatening . These people do not want to strike and it goes right against their genetic make up. My local “urgent Care centre” ( See photograph below) is still thought of as an A&E but when complaints about access or care threaten litigation the definition becomes more important. See Urgent and emergency care services – NHS and read carefully. You may be none the wiser unless you are a lawyer. You might like to explore a future in 8 Emergency Room Professionals and Their Roles or (for England only – remember there is no NHS) NHS England » The 14 allied health professions; Wikipedia attempts an overall view of : Emergency medical personnel in the United Kingdom. It will be very interesting to see if an intensive care, casualty, and terminal / palliative care nurse strikes. Somehow I doubt they will. They are underpaid. They are overworked. Many are also overtrained and have moved on into management. Are some nurses doing themselves out of a job by striking? A day later the ambulance staff will strike. Are they not emergency treatment providers? £ven if the “levelling up” agenda continues it will take far toom long in today’s world. The ministers in Wales will maintain that its “none of their making” but Wales voted for a much different funding system to Scotland at devolution, which has led to free prescriptions. longer waiting lists, and poorer outcomes. An extra £20m offered today bythe chancellor is about £600 each person. This was largely used up by the increasing numbers and bureacracy in the Synod.

Times letters: Nurses’ strike and ‘unsafe’ levels of care
Monday December 05 2022
Sir, Your report “Nurses will walk out of cancer and A&E wards” (Dec 3), implying services will be left unsafe, overlooks that NHS services are already unsafe. Using Christmas Day service levels may not be a good benchmark as many Christmas Days are unsafe too. In fact, staffing levels may even improve on strike days, when every stop will be pulled out.
This government has ignored long-term solutions to staffing for years, but the one quick action that would help the situation right now would be to give a substantial pay rise to experienced staff, crucial to the service, who are leaving in droves. Thus if the only thing that brings this government to the negotiating table is the last resort of industrial action, then perhaps it is a nurse’s duty to strike, to keep patients safe — or at least safer.
Gay Lee
Retired nurse; London SW2

Sir, It is obvious that the NHS is in distress but it is equally obvious that politicians do not have solutions other than yet more promises of additional funds. Labour might make superficial changes to Tory plans but there would be no fundamental changes offering the silver bullet that is often pledged. The solution must surely lie in a non-partisan approach involving all interested parties, including NHS people from all parts of the service and social services. This would necessitate some humility from our leading politicians, a quality in short supply around Westminster, so I will not hold my breath.
Michael Norris
St Austell, Cornwall

Sir, The shortage of trained nurses in the NHS (letter, Dec 2) has been exacerbated by the increased workload at ward level. I believe that this problem has been made worse by the requirement for nurses to have a university degree. Previously they were trained on the job and in training schools in major hospitals. However, the need for a degree has put many young people off nursing as a career. It was also a mistake to abolish the grade of state-enrolled nurse; they were the bedrock of nursing on the wards. I would not get rid of the need for some to be educated to degree level but there should be two tiers of entry.
Richard Mclellan
Lochgilphead, Argyll

Sir, I read with interest of the planned strikes, principally by workers whose salaries are funded directly or indirectly by the state. I understand that a majority of these jobs enjoy an attractive index-linked pension provision, with many benefiting from employer contributions of 20-25 per cent of their salary, which most self-employed and private sector workers can only dream of. I suggest any proposed pay increase be matched with a similar reduction in the rate of employer pension contribution, say for the next five years. This would allow state sector employees to enjoy a significant increase, yet put off the day of reckoning.
John Sainsbury
Epping, Essex

Sir, You have stated that cancer patients do not know whether they will receive radiotherapy treatment during the nurses’ strike. I’m sure most patients are aware it is provided by therapeutic radiographers, not nurses, and so will not be affected. If radiographers were to strike, since radiotherapy is classed as emergency treatment, patients would still receive it.
Carole Goodwill
Retired radiographer; Cardiff

The Times 6th December: Ambulance workers’ strike: NHS staff will walk out on December 21 – follow latest
The Times view on mass strike action across Britain: Winter of Discontent – A wave of public and private sector strikes threaten to bring much of the country to a standstill. Yet giving in to union demands risks deepening the inflation challenge
On Thursday tube workers tried to bring London to a standstill with their sixth strike of the year. On November 25 — Black Friday — and again on the following Monday, Royal Mail staff will go on strike in an attempt to disrupt Christmas shopping. On November 26 it will be turn of 10,000 train drivers to start their fifth strike of the year. That same week 70,000 staff at 150 universities will embark on three days of strikes. Then, sometime before the end of the year, nurses will stage their first ever national walkout. Meanwhile, 100,000 civil servants employed in 126 public sector workplaces, ranging from the prison service to the coastguard, have just voted for strike action. Others being balloted for potential walkouts include teachers, midwives, ambulance workers, NHS staff, bus drivers and the Fire Brigades Union.
Welcome to the new winter of discontent. Britain may not have yet reached the levels of industrial strife that in 1979 saw the dead go unburied and rubbish uncollected. But more than a million public sector workers have so far been balloted over strike action, along with many hundreds of thousands in the private sector. That is likely to set in train what is shaping up to be one of the worst waves of industrial action since the one that effectively brought down Jim Callaghan’s Labour government and ushered in the era of Margaret Thatcher. There has even been talk of co-ordinated action among unions, raising the spectre of another grim episode in the history of British industrial relations: the general strike of 1926.
Of course it is inevitable that with inflation at 10.1 per cent, workers should be demanding higher pay. Wages are falling at their fastest rate in living memory. In some cases there is a case for higher pay. Falling real-terms pay for nurses in recent years has contributed to a recruitment and retention crisis that is adding to the current strains on the NHS, even if the Royal College of Nursing’s demand for a 17 per cent pay rise is unfeasible. Yet too many unions are striking not only for higher pay but also to defend outdated working practices and unaffordable pension arrangements that stand in the way of the modernisation of public service delivery or impose unwarranted costs. Pay awards that are not accompanied by steps to improve productivity risk simply fuelling inflation.
The government cannot afford such a scenario, not least because higher inflation shifts the burden of the cost of living crisis on to those with less bargaining power, typically the poorest in society. What’s more, once inflation becomes embedded it becomes even harder to shift. Yet the government’s task is complicated by Britain’s exceptionally tight labour market which, with more vacancies than people looking for work, increases workers’ bargaining power. The Bank of England has signalled that it believes a recession is needed to weaken this power. Data published yesterday showed that GDP fell by 0.2 per cent in the three months to September, suggesting that Britain is probably already in recession. The faster wages rise, the higher interest rates will have to rise and the longer and deeper the stagflationary slump.
There is no way out of this crisis that does not involve economic pain for many people. Next week the government will add to that pain with a budget designed to show how Britain will balance its books in the medium term. The more of that pain that is taken upfront, the sooner the economy is likely to bounce back from recession. Yet the government can also take steps to alleviate the pain by focusing on measures to ease the worker shortage and reduce inflationary pressures. That should include measures to reduce NHS backlogs to get the long-term sick back into work, and easing of immigration rules to grant more visas to foreign workers. The nightmare is that if the battle against inflation isn’t won this winter, the next one is likely to be even more discontented.

Daniel Keane forThe Evening Standard 13th December 2022: Physiotherapists in 18 London trusts vote to strike over pay

Emily Ferguson reports in the Independent 13th December 2022: Midwives in Wales vote to strike over pay but no walkout in England as ballot falls short – Royal College of Midwives says 88 per cent of members in England who voted backed strike action, but not enough turned out to pass threshold.

Sept 2022: Shamed. All 4 health services: “…in breach of a World Health Organisation code of practice”…… “Overseas aid in reverse” causing loss of human capital & increasing deaths overseas..

2016: Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

Lies. “Life-saving cancer diagnosis plan will slash NHS waiting times for scans!” Doctors are more and more convinced there could be a conspiracy to bring the 4 health services to a crisis.

Eleanor Hayward shows her naivity in reporting this “news” item as suggested by the ministry of health press release! The subsequent letters in the Times 17th November 2022 expose the perverse outcomes of the suggested change. Take for example “headaches” which are usually self limiting but just occasionally serious enough to need a scan. The absense of any neurological signs or asymmetry is often unclear, and the pressure from anxious patients means they often get scans. How often they need these same reassuring scans is a matter for debate. Headaches have proven such a difficult subject that the RCGP took them out of their exam! NHSreality warned citizens many times that waits could get worse, and Wales has just announced that ambulance waits outside hospital are three times longer than they were 2 years ago! This will continue….The subsequent letters in the Times 17th November (see below) say how the system could become constipated. For a start GP training does not include enough variety in specialisms, and uncertainty means more referrals and more tests. This happened with Nurse Practitioners, trained to monitor and supervise care AFTER a diagnosis has been made, but not trained to make a diagnosis. The excessive number of scans will not be read, and there is no manpower plan to provide appropriately trained doctors to read them. Eleanor Hayward in the Times 16th November 2022: Life-saving cancer diagnosis plan will slash NHS waiting times for scans
A radical NHS cancer plan will mean that tens of thousands of patients get their diagnoses earlier as GPs have been told to bypass hospital doctors and fast-track patients directly for scans.
The drive to speed up cancer care and reduce pressure on the NHS means that family doctors will now be able to refer patients with worrying symptoms straight for diagnostics such as brain MRIs, CT scans and blood tests. This will cut out hospital consultants, who at present are seen for initial consultations before patients join another waiting list for a scan.NHS England said the scheme, to be introduced nationally this month, would cut the typical waiting time between seeing a GP and getting a scan from twelve weeks to four. This will help patients start treatments earlier, improving long-term survival rates

About 67,000 cancer patients a year will benefit from the shorter waits. The earlier diagnoses are expected to save thousands of lives and help to reduce backlogs caused by the pandemic. Allowing GPs to bypass hospital specialists and book patients for scans will also free up hundreds of thousands of hospital appointments each year, so NHS staff can focus on bringing down record waiting lists of 7.1 million people.
The plan will not affect patients who present with “red flag” symptoms, such as breast lumps, who are already placed on an urgent cancer pathway to see a specialist and get tests within two weeks. The new scheme covers patients with more vague symptoms such as dizziness, persistent headaches or a loss of appetite. At present one in five of all cancer diagnoses in England — 67,000 a year — are given to patients on a non-urgent testing pathway. However, many of these patients wait months for their diagnoses, and in this time their cancer may spread and become incurable. Announcing the change at the NHS Providers conference in Liverpool, Amanda Pritchard, chief executive of the NHS, is due say today: “By sending patients straight to testing, we can catch and treat more cancers at an earlier stage, helping us to deliver on our ambitions to diagnose three quarters of cancers at stages 1 or 2, when they are easier to treat.”
The guidance will be sent to all GPs in England this month, telling them to use their clinical judgment to refer patients directly for scans and tests. Similar practices have been adopted by some local NHS trusts, but this is the first time they will be enforced nationwide. Pilot studies have shown that hospital waiting times fall when GPs can refer directly. In 2018 the Royal Free London NHS Foundation Trust showed that direct access to CT scans for suspected lung cancer meant patients waited an average of 29 days instead of 66 from referral to treatment.
Professor Martin Marshall, chairman of the Royal College of GPs, said: “GPs are already doing a good job of appropriately referring patients with suspected cancers. However, there will be patients who might not meet the criteria for rapid referral . . . in these situations, direct access to diagnostic services can be helpful.” Richard Evans, chief executive of the Society of Radiographers, said: “The opportunity for primary care clinicians to refer cases that have concerning features directly for imaging could help to achieve an earlier diagnosis for many people and this has to be a good thing.”
Experts said it was vital that NHS diagnostic hubs got more funding in tomorrow’s autumn statement. Kruti Shrotri, head of policy at Cancer Research UK, said: “With capacity being drawn from community diagnostic centres, which are still being rolled out, it’s vital that they are protected from funding cuts to ensure everyone benefits from these potentially life- saving tests.”

Times letters: Drawbacks of fast-track plan for cancer scans 17th November 2022:
Sir, As a retired radiologist, my heart sank when I read your headline “Life-saving cancer plan will slash waiting times for scans” (Nov 16). Has anyone thought to ask who will report on the additional scans that will result?
A recent report by the Royal College of Radiologists revealed a shortage of 1,699 radiologists, and that the number of radiologists per head of population is significantly lower than in comparable developed countries.
Radiology departments already struggle to cope with their workload, and subjecting them to a flood of requests for imaging on patients with more vague symptoms, most of whom will have no significant disease, will overwhelm them. As a result, waiting times for those patients who genuinely need urgent attention will rise. Once again the government is setting targets without making the necessary resources available.
Dr Bob Bury
Leeds

Sir, The plan to bypass hospital doctors and let GPs request investigations such as MRI and CT scans is misguided and will clog the system further. The number of requests will skyrocket and the yield in diagnoses will drop. GPs do not have the skill or experience to match symptoms to the best diagnostic test, if indeed any are needed. Neither do they have the expertise to interpret the report. GP training takes three years: one year in hospital practice and two in general practice. Hospital specialists train for a minimum of six years: longer in surgery and other interventional specialities.
J Meirion Thomas FRCP FRCS
London SW3

Sir, Any scheme to lessen delays for cancer treatment is to be welcomed but I query whether GPs are always qualified to diagnose the disease. My late wife’s breast lump was dismissed as “nothing to worry about” and my own skin cancer as “a fungal infection”.
Luckily, I got a second opinion.
Rupert Godfrey
Heytesbury, Wilts

Sir, The president of the Royal College of GPs (letter, Nov 15) wants to move staff and resources out of hospital “so as to work more closely with GPs”. To do that effectively, GPs would have to emulate their colleagues in hospital and cover their patients’ care seven days a week. Strangely, Dame Clare Gerada omits to mention any such commitment.
Gareth Williams MD FRCP
Emeritus professor of medicine, University of Bristol; Vellow, Glos

Sir, The experience of Professor Jonathan Beard (Nov 16) is common across the NHS acute sector. Medical professionals expect to be paid an appropriate rate but money is rarely the main motivation. Being given adequate resources and being valued for their expertise and dedication are the priorities. In the 33 years I worked for the NHS, compromises in clinical care became routine because of a lack of beds, staff and equipment. At the same time small benefits were withdrawn, eg free tea in the operating theatres and the availability of food while on call overnight. Layers of bureaucracy have been created to manage the inefficiency that do nothing to address the fundamental issue. Much more time is wasted on non-clinical matters such as finding a patient in the hospital, chasing after notes or waiting for porters. The result is a less productive, more tiring and less rewarding day at work, and difficulty in retaining skilled staff.
Dr David Goldhill
Whitstable, Kent

NHSreality posts on GP Training (and reducing standards in the training).

NHSreality posts on the shortage of radiologists date back to 2015. (My friendly source had since died).

Let’s be frank about the NHS. It has now failed. Plug the leaks first..

As long ago as 2015 Martin Powell in The International Jounal of Health Policy Management was asking: Who killed the English National Health Service? – NHSreality wonders who was the minister of denial and unreality then? (Mr Hunt). You can find out how bad the services in your Region or Post Code really are on the BBC yesterday. But this only applies to England!! Wales, which has lower standards and longer waits, is worse still and will not issue comparators for obvious reasons. There are a diminishing few “Martyrs” who give their lives to the 4 Health Services, but todays doctors and nurses want to feel cherished. They are retiring and resigning, leaving and emigrating faster than the state can replace them, Its rather like trying to heat an old building. Without adequate insulation you will lose the battle. Heat is wasted and lost in an old building, and staff and patients are wasted and lost in todays failing health systems. We need to plug the leaks – fast. Frank honesty is so rare that when and if it occurs the staff dont believe it. The situation is so bad that recruits to GP training are employed without ANY UK knowledge or experience. Exit Interviews are virtually useless or unkown. Feedback to a “learning organisation” is thus pathetic. I’m a cynic. Patients feel afraid, doctors feel gagged and politicians know they can go privately (in London – city of greatest choice and least recruitment issues) if they need to. The same is true of the constipation affecting hospital beds. The privatisation of care homes, with the cost of the majority of residents being state controlled, has been a diastrous experiment with rules of the game in favour of local authorities. The result is point surveys show consistently that 80% of occupants could leave hospital if social care, home or institutional, was available. In this case the plug is in the bath, and nobody is prepared to pull it out: the reverse of professionals retiring early!

Laura Fulcher on 15th March 2018 opines for the Kings Fund: Let’s be frank about the NHS. She later lets go about “barbaric practices”. The History of the NHS is outlined by the Health Service Journal (HSJ) in their Health Service Navigator 1948-1960 , and by the Nuffield Trust but all fail to to recognise that there is no longer an NHS. On August 19th the Morning Star said that Britain was sleepwalking towards the deth of the NHS. On July 11th Paula Redmond invited Lobby Nugent to opine in “When Work Hurts”: “The NHS as Death Mother”: A conversation with Dr Libby Nugent. This is worth a listen. It is the reality of todays NHS.

Caroline Malloy for OpenDemocracy reports 8th July 2022: Jeremy Hunt: New chancellor is the man who ruined the NHS – As the former health secretary is appointed to the Exchequer, his ministerial past puts paid to his ‘sensible’ image and today “UK is pinching 1 in 4 of its nurses from countries with desperate shortages” – Exclusive: NHS gaps are seemingly being filled ‘at the expense of poorer countries’ with larger staffing shortfalls

The Times leader today 11th November 2022: The Times view on the NHS’s worst month on record: Health Emergency – The NHS is under unprecedented pressure with dire social and economic consequences. Kicking the social care reform can down the road is not the answer
If the government is really intent on kicking the plan to cap social care costs into the long grass, as The Times reported yesterday, then no one will surely be more disappointed than Jeremy Hunt. It was only last year that the chancellor, then the chairman of the Commons health and social care select committee, was calling for a “1948 moment” to fix the crisis in social care once and for all and put the health system on a firmer footing. Boris Johnson’s plan to cap social care costs was in part an answer to that plea. As prime minister Johnson presented his plan as not only the delivery of a campaign promise but the solution to a problem that governments had been ducking for more than 20 years. The consequences of this evasion were tragically exposed by the pandemic, when inadequate social care provision undermined the resilience of the wider health system.
Of course, it is hardly surprising that the government is contemplating delaying the introduction of this plan until beyond the next election. It is preparing next week to deliver a budget which, in the words of Mr Hunt, will contain decisions of “eye-watering difficulty”. The social care plan, which would have capped the amount that anyone needed to spend on social care out of their own resources at £86,000, was unquestionably expensive. It was expected to cost the Treasury £3 billion a year. Rishi Sunak never liked the plan when he was chancellor, as he believed it subsidised wealthy homeowners. That is why he insisted that it be funded by a 1.25 per cent national insurance hike. Now that the Tories have voted to scrap this funding the plan looks even less affordable.

Nonetheless, the urgency that informed Mr Hunt’s call for a 1948 moment has only intensified in the past year. Data published yesterday showed the health system under unprecedented strain. Last month was the NHS’s worst on record across almost all metrics. There are 7.1 million people on hospital waiting lists in England, up from 4.4 million pre-pandemic. A&E services had their worst month on record, with just 69 per cent of patients seen within four hours and a record 43,792 forced to wait at least 12 hours for a bed. At least part of this crisis is due to the 13,000 people taking up hospital beds each day who do not need to be in hospital but cannot be discharged due to a lack of suitable social care.
This crisis in Britain’s health and social care system is now imposing severe social and economic costs. The number of cancer patients being seen by a specialist within two weeks of being referred has dropped to just 72.6 per cent, the lowest on record and well below the target of 93 per cent. That is bound to lead to a further deterioration in Britain’s dismal cancer survival rates. Heart attack and stroke patients are waiting more than an hour on average for an ambulance, with some dying as a result. Meanwhile Britain’s workforce is shrinking, in part due to rising numbers too sick to work. According to Andy Haldane, the former Bank of England chief economist and now chief executive of the Royal Society of Arts, worsening public health is holding back economic growth for the first time since the Industrial Revolution.
There is no quick or simple fix to any of this, and certainly not one that does not involve spending more money. The question is who pays. Britain already spends about 12 per cent of GDP on healthcare, in line with comparable wealthy countries, and health spending accounts for 35 per cent of all departmental spending. Yet the situation cannot be allowed to continue to deteriorate. Whether the extra money takes the form of higher public spending, increased council taxes, greater private contributions or new forms of insurance, the government needs to be honest about the costs and put forward a fair and viable solution. Kicking the only plan that any government has so far put forward into the long grass is not good enough.