Category Archives: Trust Board Directors

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

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

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

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

Image result for honest politics cartoon

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

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

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

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

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

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

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

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

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

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

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

A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this. (U tube 4th June 2014)

Image result for honest politics cartoon

 

 

Dont have a stroke in Scotland. Tribalism leads to another cause of rationing.

Preventing a stroke by keeping fit, not getting diabetes, and keeping the blood pressure down is all very well. But it means that we still have strokes, only older. The cost of looking after a stroke victim is long term, and beyond the time horizon of our politicians. On the other hand, treating strokes early fairly and universally will cost money, and in the immediate future. By saving the lives of stroke patients there should be a long term saving on health and social care costs, and a patient may well succumb to a different illness eventually.

If you think treatment and support is bad in Scotland, its even worse in Wales! Regional rationing, some of it from tribal causes…

Helen Puttick on June 12th reports from Scotland: Stroke patients miss out on vital treatment as doctors prolong row

Infighting between hospital doctors threatens to block access to a life-changing treatment for stroke patients in Scotland, it has been claimed.

Relationships among specialists in Glasgow have soured to the point that psychologists are needed to improve workplace culture, a report concludes.

They were expected to help introduce a new treatment, thrombectomy, which can spare stroke patients lifelong disability by swiftly removing blood clots from the brain. NHS England is spending £100 million implementing the procedure, but plans to introduce it in Scotland have not been published.

The only Scottish hospital to have performed the procedure was Edinburgh’s Western General, but it was never a routine service and last year was withdrawn because of a lack of specialist staff and funding. About 600 patients could benefit from the procedure, but in 2017 it was performed 13 times.

It is understood that personality clashes between doctors and prolonged periods of sickness have resulted in disruption in Glasgow. A report, obtained by The Times via a freedom of information request, has revealed that a history of tension has made it difficult to attract and retain specialists, known as interventional neuroradiologists (INR).

It says: “Poor collaboration and discord have impacted on recruitment into the INR service in Glasgow and could compromise introduction of a thrombectomy service. Ongoing monitoring of behaviours in the Glasgow service is required and appropriate mentoring/coaching put in place to enable the service to move forward.”

Jane-Claire Judson, chief executive at the charity Chest Heart & Stroke Scotland, said: “People who have missed out on a thrombectomy in Scotland will be angry at this news. Any discord and delay must stop; everyone needs to work together to put stroke patients and their families first.”

Insiders have expressed frustration at the time it is taking to develop thrombectomy services in Scotland.

The report says: “At the present time, in common with many parts of the UK, there is not capacity within the current consultant interventional radiology workforce within Scotland to provide a mechanical thrombectomy service. However, there is ongoing engagement with national bodies to determine if other specialty consultants can be trained in this technique.”

A spokesman for NHS Greater Glasgow and Clyde said: “Staffing issues, skills shortages and relationships have been at the core of the challenges facing the service. The aim of these actions is to provide enhanced clinical leadership, effective teamwork, collaboration and communications and this is already having a positive impact.

“Our recruitment process is progressing and we are optimistic of recruiting a third consultant very soon.”

Eight-hour A&E waits on the rise
Hundreds of patients have been stuck waiting in Scottish emergency departments for more than eight hours with long delays hitting the highest level for the time of year since records began (Helen Puttick writes).

The latest figures show that 313 patients queued for over eight hours in the week to June 2, with 75 stuck for 12 hours or more.

The proportion of patients seen within the Scottish government’s target time of four hours has dropped to 88 per cent, the lowest figure for early June since weekly data was first released in 2015.

Edinburgh Royal Infirmary, where 63 patients spent more than eight hours before being admitted or discharged, had some of the worst delays.

The figures released by NHS Scotland yesterday also showed that there were long waits at Wishaw General and Hairmyres hospitals, which are both in Lanarkshire.

Waiting times tend to drop in the warmer summer months.

August 14th Eric Sinclair comments in letters:

Sir, As a stroke survivor, I was angered and depressed to read that thrombectomy for stroke patients in Scotland is to be further delayed, not just by Scottish government bureaucracy but by the workplace culture among Glasgow clinicians (“Stroke patients miss out on vital treatment as doctors prolong row”, Scotland edition, Jun 12). The cabinet secretary for health promised action on thrombectomy by May this year. This has not happened.

Now, apparently, the workplace culture among some clinicians is preventing progress. This is nothing short of scandalous. Thrombectomy is a procedure that every year could avoid the unnecessary blighting of hundreds of lives by severe disability. It has the potential to save the NHS and social care millions of pounds. It is being invested in heavily in the rest of the UK and around the world, yet there seems no apparent urgency by the Scottish government to make this procedure available to Scottish patients who suffer a stroke.
Eric Sinclair

Aboyne, Aberdeenshire

ITV News 18th June: Charity warns of “desperate need for support” for stroke survivors in Wales

 

Everyone as an opinion on their Health Service. Enoch Powell saw through its weaknesses in 1976.

The small book by Enoch Powell “Medicine and Politics 1975 and after” (his period was 3 years as Health Minister) should be obligatory reading for all doctors. He could less politely have said that the Emperor has no clothes. . Read a review by retired BMJ Editor Richard Smith. 

He tells us that of course the health care is rationed, and that this is deliberate but covert. He (page 37) discusses some methods of rationing, but since his day we have invented many more than the waiting lists and waiting times that he refers to.

Parkinson’s Law of Hospital Beds (page 43) “asserts that the number of patients always tends to equality with the number of beds available for them to lie in”. But he was not aware that clever administrators can use trolleys, but not count them as beds. Therefore more and new covert rationing….

Finally I wish to quote his last word on rationing:

“It is unfortunate that the nature and value of rationing by waiting and by ineligability in the NHS are not recognised, at least by the professions (and by implication the rest of the country). For these are the features that make it possible to avoid invidious discrimination in administering the service and, at the same time, secure a certain rational allocation of priorities. Instead, these features are treated as evidence of “inadequacy” and as blemishes that it lies within the power of politicians to remove, given the will.”

Richard Smith non-medical blogs on Enoch Powell’s book – The best book ever written about the politics of the NHS

The Socialist Health Association also summarises the book (A large part or almost all – I failed to spot omissions)

Is it wrong to earn a living or make a profit out of health related services? Does it matter if the profit goes overseas if the provider is more efficient than our own?

In a factually truthful account of how we have tried to exclude inefficiencies, improve purchasing and delivery, Ian Birrell points out that we have outsourced many services. Many firms, including both domestic, and foreign ones based overseas, make profits from “patients’ misery”. All healthcare for curative services has an element of pain or misery, and once extended to prevention becomes part of the “worried well” psyche prevalent in our affluent society. Anyone would think it was wrong to earn a living or make a profit out of health related services. Does it matter if the profit goes overseas if the provider is more efficient than our own? Should the longer term implications of delegating more and more to overseas businesses be discussed?

Image result for healthy profit a bad word cartoon

Ian Birrell in the Times asks 4th June 2019: Worried about US healthcare giants? They’re already here.

The response could not have been clearer when Woody Johnson, US ambassador to Britain, suggested that American firms would want access to the NHS in any post-Brexit trade deal. “The NHS is not for sale,” thundered the health secretary, Matt Hancock. “The NHS as a publicly run, publicly owned institution is part of our DNA,” added his predecessor, Jeremy Hunt, now foreign secretary.

This was a predictable response as political rivals seized on the ambassador’s “terrifying” comments, especially when both men are engaged in a leadership battle. But it is also untrue. Lucrative chunks of the NHS have already been handed to rapacious American healthcare giants with disastrous consequences. And this pair of posturing politicians have done little to thwart them.

Image result for profit a bad word cartoon

Remember Winterbourne View, where the BBC exposed abuse of patients with autism and learning disabilities in a secure hospital unit eight years ago? The response was unequivocal: such people should not be held in these places since community care tends to be cheaper, kinder and more effective. Yet efforts to end such abusive detention failed. For as the NHS pulled out, private firms muscled in on contracts worth up to £14,000 a week, while many staff continue to be paid little more than minimum wage and there is no real accountability.

More than 2,200 such patients remain trapped in assessment and treatment units and the proportion in privately run beds rose from a fifth to more than half in a decade. Acadia, a Tennessee healthcare firm, spent £1.3 billion on the Priory Group, which takes £720 million annually from taxpayers. Universal Health Services, another US firm, recently snapped up psychiatric services including Danshell, owner of a Durham hospital that just featured in another Panorama exposé of abuse. Its UK operations are run by Cygnet Health Care, which having tweeted it was “shocked and deeply saddened by the allegations” nonetheless boasts in its latest accounts of revenues from 220 NHS purchasing bodies and profits surging to £40.4 million.

It is shameful that our fellow citizens can still be stuffed in places where they are subjected to solitary confinement, violent restraint, hatch feeding and forced sedation. The legacy is damaged minds, devastated families, sometimes even death. This scandal offers frightening insight into wider failures in psychiatric services. It is taking place in secretive units — scores of them owned by American firms and funded by the state.

The private sector is not solely to blame. But instead of posing as valiant guardians of the NHS, how much better if we could trust a health secretary to protect patients from foreign firms making profits from their misery.

Image result for profit a bad word cartoon

Melting down….We are all getting what we deserve. Without honesty to ration overtly the system will only get worse.

The profession has been warning the different UK governments and Health Administrators for decades that there would not be enough trained doctors, nurses and attached staff. Now that this is actually happening, what are the thoughts of NHSreality? You get what you deserve in a first past the post short time horizon system? You get what you deserve if you don’t do exit interviews, and destroy teams? You get what you deserve if the access is so poor that citizens are pushed into private care? But even if we had trained too many doctors etc, we would still have a system with unlimited demand, limited resources, and no disincentive to make a claim (other than prescription charges, travel and parking). We need exit interviews urgently, and in West Wales the threat of Hospital closure and of poor Out of Hours coverage is so bad that many people may choose to leave the area…..

Image result for meltdown hospital cartoon

The Nuffield Trust gives some background and insight into how we have got to this point, but without referencing rationing. The trust reports the worst April on record…

The paediatricians in Wales are over-working, but this is partly because of the shortage of GPs. They find that it is easier to refer many problems than to see them again and support in the community.

The radiologists are worried that their vast workload leads to mistakes (mainly of omission).

Nick Triggle for the BBC reports: GP pressure: Numbers show first sustained drop for 50 years

Its not just patients who are charged: Trainee doctors on call at night are often charged for sleeping!

In a world market the Irish Times reports that there are plenty of opportunities in the UK, but you will have to work “HARD”.

Image result for meltdown hospital cartoon

Perhaps Pembrokeshire will be the first area to “go private” and abandon the health service?

Do we need an Aspberger’s Teenager to tell it as it is…?

A GP in Bristol explains for Gulf News

A GP in Pembroke explains for those who don’t know that “the hours stink”.

 

The revolving door of health service managers….. mismanagement is nothiong less than neglect.

The mismanagement of the 4 health services that used to be the “National Health Service” amounts to nothing less than neglect.

We medics all know managers who move on quickly. Being fast on your feet is essential in a  service where nothing is addressed long term. Recruitment is a nightmare of under capacity, female bias, and the resultant manpower disaster means we need to recruit from overseas for decades. NHS looks abroad for thousands of nurses – Health chiefs admit failing to plan for elderly care

We jaundiced GPs and Consultants can only assume that these managers have no exit interviews, and that nobody wants to hear what they have to say any more than the professionals.

Chris Smyth reports 7th May 2019 in the Times: NHS register to stop ‘revolving door’

A professional register of NHS managers and a values test for senior leaders are being planned to stop a “revolving door” for failed bosses.

A health service scarred by bullying and stress “needs to be a better place to work”, an interim workforce plan concedes. Although the NHS acknowledges that unexpected pension tax bills are forcing doctors to retire early and work fewer shifts, plans to tackle that issue have been removed from a final version.

The NHS interim people plan makes the starkest acknowledgement yet that staff are leaving the health service because they are overworked, with increases in bullying, harassment and abuse all reported recently.

The plan promises staff that they can expect support on work-life balance, whistleblowing protection and equal opportunities. Specific details are yet to be decided but the plan pledges that more jobs should be part-time or term-time only.

The plan lays out how the management culture of the NHS had to change to “root out bullying and harassment” with an admission that all staff will have experienced a dysfunctional working environment at some point.

“It cannot be right that there are no agreed competencies for holding senior positions in the NHS or that we hold so little information about the skills, qualification or career history of our leaders,” the plan states.

“A series of reports over the last decade have all highlighted a ‘revolving door’ culture where leaders are quietly moved elsewhere in the NHS, facilitated by ‘vanilla’ references,” the plan continues. “These practices must end.”

A government-ordered review has previously recommended a set of core skills for managers. The NHS has now pledged to draw up “an explicit set of competencies, values and behaviours required in different senior leadership roles”. This could include, for example, honesty and protecting patient safety.

Ministers have previously promised a central database of directors’ qualifications. The NHS has now pledged to “develop options to create a registration scheme for NHS managers similar to those used in other healthcare professions and in finance”. It is unclear whether such registration would be compulsory. The plan concedes: “The lack of a transparent, fair and consistent process for the appraisal of senior leaders has contributed substantially to the challenges we face today.”

The plans do not address higher pension taxes for top earners, which are forcing many consultants to retire early or turn down extra shifts to avoid bills for tens of thousands of pounds.

Mistakes due to overwork are manslaughter. Not enough sickness and absenteeism? Nobody blames the management and politicians… “Wise doctors will retreat from the front line now?”

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

This mismanagement of the NHS amounts to neglect

Image result for revolving door cartoon

No Out of Hours service for taxpayers in Pembrokeshire. Be prepared to camp wherever you are sent…

As readers know there is no NHS, and in Pembrokeshire citizens who pay their taxes have no  GP Out of Hours Service/ Doctors on Call – in Pembrokeshire County …  

If you are elderly, or have young children, it looks as if you will have to camp in Casualty, and even that is poorly staffed, incompletely covered, and failing. NHS 111 is an appalling service. Confidence is failing, and private care will have to step in when the demand for it occurs. If there are deaths this might be sooner rather than later.

ITV news reports that for the second week running “GP shortages mean Out of Hours closures. 5th April 2019.

and prior to this, on 29th March: Out of Hours GP service closed again at Withybush Hospital this weekend.

For those who don’t know the area, the nearest (and also failing) DGH is 35 miles and many agricultural vehicle obstructions away, in Carmarthen. The situation is akin to the loss of services in Chester, except this is worse: it is access to emergency care rather than cold planned care that has been rationed out by successive administrations (of all colour).

The service in West Wales is now an official failure… but nobody is admitting their complicity in this disaster. The Post Code lottery is worse for distant and remote places. We are expecting a decision on a new hospital… 

Image result for camping hospital

GP shortages this weekend mean that out of hours services in Carmarthenshire and Pembrokeshire will be closed intermittently. 5th April ITV News 

Hywel Dda University Health Board says they are continuing efforts to fill the shifts but expect the following disruptions:

  • Withybush General Hospital – closed 12am to 8am on Sunday.
  • Prince Philip Hospital – closed 2pm on Saturday until 8am on Sunday.
  • Glangwili General Hospital – closed from 10:30pm on Saturday to 8am on Sunday.

Analysis by Health Reporter James Crichton-Smith:

The fact that Hywel Dda is struggling to fill its GP out of hours rota is not a new one.

Health boards across Wales regularly have gaps in GP out of hours cover and Hywel Dda has previously warned of a shortfall at weekends, like it has this afternoon.

Read more:

Staffing problems and poor morale affecting GP out of hours

Health Board has had no doctor available overnight

The cause is a simple, and familiar, one. There simply aren’t enough GPs in Wales.

Efforts are ongoing to try and change this. The Welsh Government has its Train. Work. Live. campaign – and it has been getting results.

But training new GPs and attracting them to Wales takes time. The challenges are in the here and now.

August 2013:A series of intellectually and ideologically bancrupt administrations has led us to a GP recruitment crisis.

April 2019: GP suicides: LMCs call for action to reduce “appalling” numbers

March 2016: Top GP warns of threat to NHS as BMA calls emergency conference

August 2014: Recruitment rationing: GP magazine calls on political parties to support general practice

Image result for camping hospital