Category Archives: Trust Board Directors

Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

If you have a stroke on your way to the hereafter, your life expectancy is short, demand for services is high, and nobody listens to you, even if you can be understood.  Dumped is the right political word. Congratulations to the reporter on his understatement however, The real word, especially with regard to intensive physiotherapy, is abandoned. Dead patients don’t vote, and those near death don’t appear to count. Commissioners have a perverse incentive to save money, richer areas can have more physio as more patients go privately, and the post-coded, covert rationing lottery continues..

Image result for stroke cartoon

Jon Ungoed-Thomas in the Sunday Times reports: Stroke survivors ‘are dumped by the NHS’

Sufferers feel abandoned after leaving hospital and face waiting up to a year for the right treatment — or paying for it themselves

Stroke survivors are being left to languish at home with a “shocking” lack of support. Many say they feel abandoned by the NHS.
Juliet Bouverie, chief executive of the Stroke Association, said a new national plan was required to help the 1.2m stroke survivors in the UK. Some have to wait up to 12 months for psychological help.
“As a stroke survivor, your life and the life of your family is turned upside down,” she said. “Many stroke survivors say they feel abandoned, as if they have dropped off a cliff. The provision in some areas is shocking.”
About 100,000 people suffer a stroke every year in the UK; it is one of the country’s leading causes of death.
Andrew Marr, the broadcaster and journalist, who suffered a stroke in January 2013, said better support for stroke survivors — many of whom are of working age — could help them return more quickly to employment. He was back at work within six months, but largely because he paid for additional physiotherapy.

Stroke survivors can wait up to four months for speech therapy and up to a year for psychological support, according to data from the Royal College of Physicians. Stroke survivors say there is insufficient physiotherapy, a treatment which would ensure the best recovery.

Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner<img class=”Media-img” src=”//www.thetimes.co.uk/imageserver/image/methode%2Fsundaytimes%2Fprod%2Fweb%2Fbin%2Ffa4fb670-698c-11e7-8ef4-9d945f972597.jpg?crop=2250%2C1500%2C-0%2C-0″ alt=”Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner”>
Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work soonerDavid Cheskin/PA

A stroke strategy, launched in 2007, outlined a 10-year plan to overhaul stroke services and has seen significant improvement in acute treatment. The Stroke Association is calling for a new action plan to build on improvements and outline a new strategy for the rehabilitation of stroke victims.

Nathan Ridgard, 40, a self-employed businessman and a father-of-two from Harrogate, North Yorkshire, suffered a stroke on New Year’s Eve 2012. After being discharged from hospital, he said he was given some leaflets by the NHS on coping with a stroke, but struggled to read them because of his poor vision.

“I just felt I had been dumped out in the world,” he said. He received some NHS physiotherapy, but also paid for private sessions to supplement them. He has since made a good recovery.

Professor Tony Rudd, National Clinical Director for stroke at NHS England, said: “The quality of care and survival rates for stroke are now at record highs. We are working with the Royal College of Physicians and others local health service leaders to improve rehabilitation care for everyone who suffers a stroke.”

Image result for stroke cartoon

 

Whistleblowing law is expanded.. but hardly applies to GPs

The Times Law Report on 26th June: More than one employer can be liable to ‘whistleblower’

The trouble is that GPs are self employed and have no whistleblowing liable employer. However, GPs are more and more “portfolio” a career doctors with some time as partner or salaried partner, some time as educator, some time as referral centre letter reader, sometimes as Out Of Hours doctor or A&E assistant.

Image result for whistleblowing doctor cartoon

Court of Appeal

Published: June 26, 2017

Day v Lewisham and Greenwich NHS Trust and Another

Before Lady Justice Gloster, Lord Justice Elias and Mr Justice Moylan

[2017] EWCA Civ 329

Judgment: May 7, 2017
For the purposes of the protection for “whistleblowers” in the workplace, a person in training might be employed by both the employer with whom he had been placed and the training body that had made the placement, if the training body had substantially determined the terms under which he worked.
The Court of Appeal so stated when allowing the appeal of the claimant, Dr C Day, against the dismissal by the Employment Appeal Tribunal (Mr Justice Langstaff) ([2016] ICR 878) of his appeal against a decision by an employment tribunal to strike out his claim against the second defendant, Health Education England, that it had subjected him to a detriment for making a protected disclosure or “whistleblowing”. The first defendant was Lewisham and Greenwich NHS Trust. Public Concern at Work intervened in the proceedings.

Part IVA of the Employment Rights Act 1996 (as inserted by section 1 of the Public Interest Disclosure Act 1998) provides, so far as relevant:
“43K(1) For the purposes of this Part ‘worker’ includes an individual who is not a worker as defined by section 230(3) but who (a) works or worked for a person in circumstances in which (i) he is or was introduced or supplied to do that work by a third person, and (ii) the terms on which he is or was engaged to do the work are or were in practice substantially determined not by him but by the person for whom he works or worked, by the third person or by both of them . . . and any reference to a worker’s contract, to employment or to a worker being employed shall be construed accordingly.
“(2)(a) For the purposes of this Part ‘employer’ includes (a) in relation to a worker falling within paragraph (a) of subsection (1), the person who substantially determines or determined the terms on which he is or was engaged . . .”

Mr James Laddie, QC and Mr Christopher Milsom for the claimant; Mr David Reade, QC and Mr Nicholas Siddall for the second defendant; Mr Thomas Linden, QC, for the intervener.

Lord Justice Elias said that Part IVA of the 1996 act, read together with sections 47B and 103A (as inserted by sections 2 and 5 of the 1998 act), protected workers who disclosed information about certain alleged wrongdoing to their employers (colloquially known as “whistleblowers”) from being subjected to victimisation or dismissal as a consequence.

The appeal concerned the proper construction of section 43K and the application of that section to a certain category of doctors operating in the health service.

The claimant was a doctor who wanted to specialise and was accepted by the body then responsible for training doctors in London to take up a post from August 2011. He entered into a training contract that the parties agreed was not a contract of employment. He was allocated to the first defendant NHS Trust. Subsequently, the training body was taken over by a training board that was part of the second defendant, Health Education England.

Trainee doctors were allocated for relatively short fixed periods to NHS trusts. They entered into contracts of employment with each trust. The claimant worked, inter alia, at the Queen Elizabeth Hospital. While there, he raised a number of concerns with both the trust and with the South London Health Education Board about what he considered to be serious staffing problems affecting the safety of patients.

He alleged that those were protected disclosures within the meaning of the legislation on whistleblowers and he asserted that he was subject to various significant detriments by the second defendant as a consequence. He took proceedings before the employment tribunal against both the trust and the second defendant, as the body responsible for the actions of the South London Board.

The second defendant denied any wrongdoing, but took a preliminary point. To bring a whistleblowing claim the claimant had to fall within the statutory definition of worker and the defendant had to be his employer. The second defendant contended that that was not the position and, accordingly, that even if the facts alleged by the claimant were true, the second defendant could not be liable in law for any acts causing him detriment.

The only question was whether the claimant was a worker within the extended definition in section 43K and the second defendant was his employer as defined in that section.

His Lordship would refer to the person for whom the individual worked as the end-user and the party introducing or supplying that worker as the introducer. It was envisaged in section 43K(1)(a)(ii) that the terms on which an individual worked might be substantially determined by both the end-user (the heath trust) and the introducer (the training body). That might be either because the introducer and the end-user determined the terms jointly, or because each determined different terms but each to a substantial extent.

The extended definition of “employer” in section 43K(2)(a) was not limited to the person who played the greater role in determining the terms of engagement. Since both introducer and end-user could in principle substantially determine the terms of engagement for the purposes of the definition of worker, there was no basis for concluding that they could not do so when it came to applying the extended definition of employer.

That would in some cases have the effect that both introducer and end- user were employers and each would then be subject to the whistleblowing provisions. Indeed, that would seem to be an inevitable conclusion if the terms were determined by the end-user and introducer acting jointly. If only one party could be the employer, it was difficult to see by what principle it would be possible to determine who that should be.

The Employment Appeal Tribunal had been wrong to find that the fact that the health trust was a section 230(3) employer precluded the training body from also having that status.

There had to be some limitation on the words of section 43K, which began by providing: “For the purposes of this Part ‘worker’ includes an individual who is not a worker as defined by section 230(3) . . .” The insertion of some such phrase as “as against a given defendant” after “includes an individual who” would allow the section to operate against one of those parties even if there was a section 230(3) relationship with the other.

Accordingly the training body could in principle fall within the scope of section 43K(2)(a), notwithstanding that the claimant had a contract with the hospital trust.

The employment tribunal had not engaged directly with the question whether the training body itself “substantially determined” the terms on which the claimant was engaged. A tribunal should not limit itself to focusing solely on the contractual terms, although no doubt the terms would be overwhelmingly contractual. The section required the tribunal to focus on what happened in practice.

When determining who substantially determined the terms of engagement, a tribunal should make the assessment on a relatively broad brush basis having regard to all the factors bearing upon the terms on which the worker was engaged to do the work.

The case would be remitted to a fresh tribunal for determination of the preliminary issue whether the training body substantially determined the terms of engagement of the claimant.

Lady Justice Gloster and Mr Justice Moylan agreed.

Solicitors: Tim Johnson Law; Hill Dickinson, Manchester; Solicitor, Public Concern at Work.

Whistleblowing in the NHS – how safe are you? (Sharmila Chowdhury 4 August 2014)

Image result for whistleblowing doctor cartoon
[PDF] Wales’ GP Heroine Whistleblower…. The Spectator reveals “How the …

NHS reality. An NHS soapbox. Speakers’ corner for the NHS …400 × 305Search by image

The Spectator reveals “How the NHS silenced a whistleblowing doctor” – No cultural change yet… | NHS reality. An NHS soapbox. Speakers’ corner for the NHS.

Reflections on the BMA conference in Bournemouth. A complete lack of trust..

Image result for BMA health cartoon

ARM 2017 in Bournemouth

The annual representative meeting (ARM) is the BMA’s main policy-making body. Around 500 doctors from across the profession and the UK gather to consider and debate key matters of interest to the medical profession.

I have never been to a BMA conference before. his conference from 25-19th June was an eye opener. The volume of business, and the number of people was daunting. Agenda items ranged from the political to the clinical. and some of us thought some issues would be best addressed by politicians. Throughout the meeting there was a complete lack of trust by doctors of government, dishonesty, and denial by politicians and administrators, and resulting anger and resentment in the body politic. This is spreading beyond the profession and the unrest following the Grenfell tower will be as nothing to the unrest as the health safety net is seen to fail.

BMA council chair Mark Porter – opening speech  – Health Service running on fumes

STPs(Stick Toffee Puddings , or Slash Trash and Privatise

Agenda Items on Monday of which I as speaking at 1:34 into the meeting

Dr Roger Burns speaks up abut West Wales. (https://pharmaphorum.com/news/millions-affected-nhs-cuts-doctors/#) in response to Motion 16 (I):

Recognises that greater medical involvement in the design and planning of health care is crucial in ensuring that improved patient services are properly designed and effectively implemented.

There were plenty of retired members present, of whom I am one. It looks as if the retired members are trusted to represent their younger and busier colleagues. What is need is a way to vote from a distance. Members need to log into the website and watch a webcam and be prepared to vote at an instant. This would allow members to check in and relate to any particular motion but ignore others.

There was a couple of motions with the implication of rationing, but without mentioning the word itself:

Motion 12 (v) “Calls for government and NHS lead bodies to have an open dialogue with the public and patients about what services the NHS should provide for the funding available, and what services should no longer be funded by the NHS.

New attendees need to be aware that they need a speedy induction if they are to take advantage of the opportunity to speak. New conference members, and those who vote against a motion are given preference. I spoke out about the reconfiguration of Wales Health Trusts. NHSreality is in favour of one NHS trust for 3 million people, and this would at least endure choice within Wales. I spoke against the motion on the grounds that it failed to mention rationing, and the need for the politicians to get on board with this concept before we can make sense of the health service, and bring the hearts and minds of the doctors on board. Sometimes “hard truths” need to be said. Napoleon did this with the French after their revolution. By offering to bring order he took away a little liberty. Lack of choice is a loss of liberty, but it may be worth it if standards of treatment for important and expensive problems rise.

All local BMA groups need to plan ahead of the ARM to present notices of motion. Clinical and social meetings are also needed, and could be combined with politics.. My suggestions to be considered for the future include:

Wales residents should be given choices within Wales. If this can only be facilitated by one Health Trust then we support this proposal.

All Wales staff should be offered exit interviews by the BMA, and if they wish, in conjunction with other organisations such as the Nurses and Midwives, and other professions. Since no credence would be given to a summarised internal HR report, external consultants should be charged with this task.

In West Wales infrastructure needs to be improved, especially for travel, but also to replace old buildings and plant.

Medical Publications should always inform the reader if the paper was rejected by another publisher. The on line information should then reveal why rejection occurred.

All Wales BMA members should be offered the option of group/mutual medical insurance

and for local debate: A decision not to build a new hospital at Whitland / Narberth in 1996 is to be regretted.

Henry Bodkin in the Telegraph 27th June: Doctors call for abortion on demand as BMA votes to decriminalise terminations for first time ever 

Ann Furedi comments for BPAS: Why UK abortion laws should be scrapped – they are 50 years out of date 

Pharmforum comments on STPs on June 28th: Millions will be affected by STP health service cuts, say doctors

Hunt stayed silent over 700,000 lost letters to patients (The Telegraph)

Crowdfunding of Wheelchairs

UK falls behind in International league of doctor numbers (BMJ)

Government using GPs as scapegoats instead of taking responsibility for crisis in NHS

Margaret McCartney: Health inequality has to be political BMJ 2017;357:j2978

 

Image result for politics of health cartoon

BMA annual meeting: GPs working at unsafe levels should issue “black alert”-style warnings, says BMA (Wales sees steep rise in “at risk” surgeries.

Frances Gibb in the Times 27th June: Medical negligence payouts ‘unaffordable’

Doctors call for national rules on OTC prescribing (BMJ 25th March)

BBC2: Hospital – How do you cost life? 

Kat Lay in the Times 12th June: NHS blocks drug to help babies with spinal muscular atrophy

London commissioning group plans to restrict cataract surgery

Oliver \moody on 26th June: NHS urged to find money for cystic fibrosis drug

Kat Lay: ‘Overworked’ GPs demand to close their surgery doors

Image result for BMA health cartoon

 

 

 

 

 

Why not implement no-fault compensation? Because it needs a longer term perspective and a PR system to get it through.

Frances Gibb reports in The Times 23rd June 2017: Medical negligence payouts ‘unaffordable’

Reforms to curb the soaring costs of medical negligence, which could see taxpayers paying out £2.6 billion a year by 2022, must go ahead, a report has urged.
The NHS spent £1.5 billion on clinical negligence claims last year, enough to train more than 6,500 doctors, the Medical Protection Society said. The not-for-profit organisation , which supports 300,000 healthcare professionals worldwide, is calling for a package of legal reforms that would strike a balance between compensation that is reasonable but also affordable.
Its proposals include a cap on future care costs which would be paid on a tariff to be agreed by an expert working party. It also wants to use national average weekly earnings to calculate damages awarded, to avoid unfairness between high and low-income earners.

and the comments are good as well. In Wales the amount set aside for future litigation/compensation is more than one year’s budget. Why not implement no-fault compensation scheme? Because it needs a longer term perspective and a PR system to get it through. Apologies would then be like confetti..

Image result for confetti cartoonand that’s not to mention apologies from our masters re both contract and staffing levels:

Image result for medical apology cartoon

Scotland (and I hope Wales will follow) has announced legislation to protect doctors if and when they apologise. Doctors in Scotland get legal protection when apologising, explains MDU

Doctors in Scotland are being given legal protection when apologising to patients, the Medical Defence Union (MDU), explained today.

The Apologies (Scotland) Act 2016, the relevant part of which comes into force on 19 June 2017, makes it clear that an apology (outside of legal proceedings) is not an admission of liability. In the new Act, an apology is defined as:

‘…any statement made by or on behalf of a person which indicates that the person is sorry about, or regrets, an act, omission or outcome and includes any part of the statement which contains an undertaking to look at the circumstances giving rise to the act, omission or outcome with a view to preventing a recurrence.’

Mr Jerard Ross, MDU medico-legal adviser, said:

‘Saying sorry to a patient when something has gone wrong is the right thing to do and is an ethical duty for doctors. The Apologies (Scotland) Act provides further reassurance to doctors that apologising is not an admission of legal liability. In the MDU’s experience, a sincere and frank apology and explanation can help restore a patient’s confidence in their doctor following an error and help to rebuild trust. This is important for a patient’s future healthcare and can help to avoid a complaint or litigation.’

Doctors have a professional duty of candour, set out in the General Medical Council’s Good medical practice which states: ‘You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress you should put matters right (if that is possible), offer an apology, explaining fully and promptly what has happened and the likely short-term and long-term effects.’

A legal duty of candour was also introduced for health and social care providers in Scotland under The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 although it has yet to be brought into force by enabling legislation. It will mean that doctors and other health and social care staff in Scotland will have to inform patients and their families when a patient has, in the reasonable opinion of an uninvolved registered health professional, died or been unintentionally or unexpectedly mentally or physically harmed as a result of their care or treatment.

Although the Apologies Act does not apply to the legal duty of candour, the Health Act itself makes it clear that ‘an apology or other step taken in accordance with the Duty of Candour…does not of itself amount to admission of negligence or breach of a statutory duty’.

The GMC has published ethical guidance on the professional duty of candour which explains in more detail what constitutes an effective apology for healthcare professionals. This includes advice that apologies should not be formulaic and that the most appropriate team member, usually the lead clinician, should consider offering a personalised apology, rather than a general expression of regret.

In Wales the amount set aside for future litigation/compensation is more than one year’s budget.

David Williamson for Walesonline 30th Dec 2016 : More than £600m allocated to pay for clinical negligence and personal injury claims against the Welsh NHS in the future

In the last financial year £74.6m was paid out and £682m has been set aside for future payments

NHS faces ‘compensation time bomb’ as clinical negligence …  GP online25 Jul 2016

520 results (0.30 seconds)

BBC News28 Nov 2016

 

Image result for medical apology cartoon

Leimyoscarcoma treatment options unfair…. in west Wales where choice is anathema.

I do not mind if something/some service is denied to everyone in the UK paying into the same mutual. What I do not like to hear is when someone in my town and post code is denied a treatment which is available in London. The National Sarcoma centre is at the Marsden, and there is a National Sarcoma Service. Unfortunately, unbeknown to the citizens and taxpayers of Pembrokeshire, until they suffer from sarcoma, is that this service is not available to them. This is what NHSreality calls COVERT rationing because one is not aware of it in advance. Net result is that money is raised, and this one patient gets “private” care. What about all the others in Wales? Local exclusion would be all very well for high volume low cost treatments, (this is not allowed) but is patently unjust for low volume high cost treatments. (allowed under the current “rules of the game”) Will the trust respond by saying they feel this is reasonable rationing? No way. They will use the words exclusion, restriction or prioritisation to justify their position. As a trust in special measures ( bankrupt and getting worse) it is not surprising they wish to save money… and the treatment may be poor value for money but this shows how unfair the situation is for those in West Wales, and it is repeated across many specialities and treatments.

Image result for unfair cartoon

BBC News reports today 23rd June 2017: Haverfordwest mum’s ‘roadblocks’ to SIRT cancer treatment

NHS Wales has been accused of “not being set up to deal with” certain types of cancer.

Anca Falconer, 36, from Pembrokeshire, was diagnosed with Leiomyosarcoma (LMS), a type of soft tissue sarcoma, just days after giving birth in 2010.

Her request for specialist treatment in England was refused.

The Welsh Health Specialised Services Committee said the success of Selective Internal Radiation Therapy (SIRT) “has not currently been established.”

Mrs Falconer, who lives in Haverfordwest, initially underwent extensive surgery and chemotherapy for her rare liver cancer, but it returned.

Her first request to the committee was rejected in 2013 on funding grounds, and her cancer consultant refused to submit another application, describing the efforts as being “futile”, and she was told she would have to find the money herself.

Fundraising efforts allowed her to receive the first round of SIRT, which involves injecting radioactive microbeads into the liver, at a cost of £10,000.

Mrs Falconer, who had been bedbound for about three months, said she felt transformed after the treatment.

“Within days I was able to stand up again. I can play with Mary and take her to school,” she said. “I had lost hope before.”

The second round of treatment costs £20,000 and is due by late August.

Mrs Falconer’s husband, Richard, 51, said NHS Wales was “not set up to deal with soft tissue sarcomas” with many of the specialist centres in England.

He added that he thought experts in Wales had “given up on his wife” four years ago and that she had received “nothing more than palliative care” and “roadblocks to all curative options that should have been on the table”.

Dr Sian Lewis, medical director for the Welsh Health Specialised Services Committee, said the “clinical effectiveness” of SIRT for the treatment of liver cancer “has not currently been established”.

She said it is only available to a limited number of patients in NHS England as part of a programme to assess its effectiveness.

The Welsh Government said NHS Wales will make a decision regarding the routine commissioning of SIRT when the results of the evaluation become available next year.

False hopes

Abertawe Bro Morgannwg University Health Board, which provided chemotherapy to Mrs Falconer, said if previous funding requests have been declined by the committee any subsequent submission has to contain “new clinical evidence”.

A statement from the health board said, while it could not comment on Mrs Falconer’s case, its “clinicians fully appreciate the distressing situation its patients are in”.

“It’s because of this they would never consider falsely getting a patient’s hopes up by resubmitting an already declined request when there is no new clinical evidence available.”

Hywel Dda University Health Board has also been asked to comment.

September 2016 – Mark Smith for Walesonline: Three Welsh health boards have been placed under additional Welsh Government scrutiny

Cardiff and Vale, ABMU and Hywel Dda are just one level short of ‘special measures’

Adrian O’Dowd in the BMJ 15th June 2017: Trusts boost ratings by engaging staff and including clinicians in management

Adrian Dowd in the BMJ 23rd June 2017 : The only way is up: the “special measures” trust that got back on its feet

Image result for unfair cartoon

 

State funded media asks the right question – at last

Hugh Pym reports for BBC news 7th June 2017: Is NHS rationing a possibility?

State funded media asks the right question – at last. Will they provide the right answer in our lifetime? The BMA is already on record as willing to debate the motion “Is NHS rationing a possibility?(Bournemouth in July) and in Wales has asked for an “honest language” in health. (and Exit interviews) More importantly, why have our intellectual elite, and the public health experts, media and politicians, failed to open the debate years ago, and continue even this week, before the  professions became disengaged and demoralised? Now that many have retired early, emigrated or changed career, it will take years to recover.

Image result for honest politician cartoon

Money, money, money – it’s a familiar background theme across the NHS in England, but the volume is increasing.

Campaign funding promises have been made but whoever forms the next government will find some challenging financial issues highlighted in their ministerial red boxes.

This week, reports of a tightening of the financial thumb screws have emerged. There is talk of rationing and, as one source told me, “unpalatable things” being contemplated by hospital managers and local health commissioners.

Under what’s been billed as a “capped expenditure process”, NHS England and the regulator NHS Improvement are telling some trusts to stick within spending limits even if that means tough decisions on the provision of non-urgent care.

The new pressure on hospitals and local health commissioning groups in England comes after some trusts overshot agreed spending targets during the last financial year.

Spending control

Since the start of this year, from the beginning of April, it has become clear that the biggest over-spenders have been unable to agree their so-called “control totals”. They have now been told to take firmer action to keep a grip on spending.

The Health Service Journal (HSJ) reported that NHS officials have contacted health managers in 14 areas of England with a series of proposals for controlling budgets. These include extending waiting times for routine procedures and treatments, downgrading certain services and limiting the number of operations carried out by the private sector for the NHS.

HSJ first revealed the tougher spending regime in April, quoting from a letter sent to those local health leaders who could not agree their budgets.

They were asked to decide “from which areas further expenditure reductions will be made”, including reviewing the range of medicines prescribed.

Interestingly, the letter and subsequent dialogue has been with both commissioners, who can limit what they are prepared to pay for, and trusts who might save money by curbing the volume of non-urgent care provided to patients.

There was a clue to this tougher approach in the update to the NHS Five Year Forward View plan, published at the end of March. The finger is pointed at those organisations which had historically substantially overspent their “fair shares of NHS funding”.

Put a lid on it

They are accused of “living off bail-outs” taken from other services. They are then told to confront “difficult choices” and if necessary “scale back spending on locally unaffordable services”.

An NHS England spokesperson said no final decisions had been made and when final choices were made locally they would need to be approved nationally. But there was no denying the fact that in some areas hospital managers and commissioners were being told to go further than before to keep a lid on spending.

The background to this is that NHS England is receiving a much smaller budget increase this year than in 2016/17 which, though originally billed as a generous “frontloaded” settlement, appeared to only just cover what the service needed. Patient demand will continue to outstrip the money available with the financial pressure even more intense this year.

Those who see the NHS as a bottomless pit always requiring more money to be poured in will call for more efficiency savings before another bailout is contemplated. Those who argue that the NHS has been underfunded for some years, with the share of national income devoted to health lagging behind other leading economies, will say the only answer is higher levels of government funding.

It’s a familiar debate and one which won’t go away after polling day.

Not enough money

The three main health think tanks, The King’sFund, Nuffield Trust and the Health Foundation, wrote a joint letter this week arguing that no political party was offering enough extra spending to cope with the demographic and demand pressures on the NHS.

They estimated that an extra £20 billion annually would be needed by 2022 over and above the most generous manifesto pledge.

The think tanks argue that failure to provide sufficient funding will result in longer waiting times for patients and a decline in levels of care.

Recent reports indicate NHS chiefs are already planning for that to happen.

Specific tax rises are short term, not enough and ignore the big issue.. Honesty.

 

Police investigate NHS waiting list ‘fiddle’

The epidemic of performance management in health has corrupted administrators, commissioners, and trust boards as well as doctors and nurses. The perverse incentives to fiddle the books are so strong that many are tempted. This is just the tip of an iceberg… Rationing differently by post-code encourages whatever behaviours can be got away with..

Image result for iceberg cartoon

Chris Smyth on June 5th reports: Police investigate NHS waiting list ‘fiddle’

Police are investigating allegations that an NHS hospital fiddled waiting times to meet targets.
NHS counterfraud agents are also looking into claims that bosses manipulated computer systems to hide the extent of long waits.
Dozens of patients are known to have been harmed, including one who suffered loss of sight, and hundreds are still waiting for surgery after more than a year.
Kettering General Hospital accepts that waiting lists were wrongly reported but insists this was an IT error rather than a deliberate cover-up. However, David Phelan, a former surgery man- ager at Kettering and now a governor of the hospital, said that officially reported waiting times were “based on a lie”.
Hospitals are told to make sure that 92 per cent of patients are given routine operations, such as hip replacements, within 18 weeks. Mr Phelan claims that bosses were so obsessed with hitting the target that they asked for databases to be programmed to exclude patients who had waited for more than a year and those who had not been in touch for six months.

He first noticed the anomalies in 2015. “They’ve bastardised the data so badly they actually don’t know what the waiting list is. They don’t know how many patients were affected,” he said.
Norman Lamb, the Lib Dem health spokesman, demanded a full inquiry. “There appears to be a rotten culture which has to be confronted,” he said.
Detectives have interviewed Mr Phelan and visited the hospital in response to the allegations but have yet to decide whether to open a formal inquiry. It is unclear whether the claims would be treated as fraud, misconduct in a public office or a data crime. “An allegation of potential misconduct at Kettering General Hospital has been made to Northamptonshire police and we are in the process of scoping that allegation,” a police spokesman said.
Fiona Wise, interim chief executive of Kettering General Hospital, said: “Naturally we will work with [the police and NHS Protect] to demonstrate how we have handled our waiting-time is- sues. The trust has openly and publicly admitted that we have had problems with our waiting-times data, systems and processes at that time and we have worked hard to address all of those issues and ensure that patients do not wait for too long. We have also categorically refuted any allegation that the trust has deliberately manipulated its waiting-list data.”