Category Archives: Trust Board Directors

Missed appointments are a distraction. In the factory model there has to be a disincentive for poor quality (and to make a claim).

Recent news on missed appointments may be confusing the public. GPs are pleased to have a little reflective and organisational and administrative time when a patients does not attend. They may already be late, and then the time is merely used to catch up. In GP land, before GPs were excused from “emergencies”, all patients had to be seen before you went home. Not so today. In Hospital land, consultants have limited numbers, and GPs have followed suite. The least popular careers in the 4 health services are, guess what, emergency medicine. Victims of a career in A&E have to contend with long and difficult shifts, overdemand, and under capacity. The mopping up which GPs used to do has moved to A&E, and with less experienced doctors seeing the patients. Missed appointments are a distraction. In any factory  model ( mutual insurance system ) there has to be a disincentive for poor quality ( and to make a claim) .. Once we ration overtly, and probably introduce co-payments, morale in all areas will improve, recruitment will be better, and the “reality” of life will sink in to the public as a whole. Phil Collins in the Times opines that “..The factory model of healthcare is no longer appropriate in a nation made healthier by the success of the first seven decades of public healthcare.” But even he shies clear of the need for autonomy, responsibility for self, and for sticks as well as carrots to encourage good health. If missed appointments cost millions, most Drs don’t really care. It’s a distraction, a side issue. Politicians have yet to arrive for their reality appointment… (see below)

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BBC News 2nd January: Missed GP appointments ‘cost NHS England £216m’

July 2nd in the Times: Attlee ‘would be shocked by abuse of NHS’ – “The prime minister who created the NHS would be horrified that patients are abusing it by missing appointments”, his granddaughter has said.

Jo Roundell Greene, the granddaughter of Clement Attlee, said that when the health service was created people were “so grateful”, but some now took the system for granted.

We have to shut hospitals to save the nhs – Phil Collins opines in the Times 4th Jan 2019…    “…Public Health England, the government’s health agency, has been highlighting the threat from diabetes which, on current trends, could take up a fifth of the whole NHS budget by 2035.”

The Times letters to the Editor 2nd and 4th Jan 2018: Missed hospital appointments and the NHS

Sir, I challenge the supposition of the chief nursing officer for England that missed clinic appointments are so costly (“Timewasting patients are costing NHS £1bn a year”, Jan 2).

When, some years ago, we looked into the problem in my orthopaedic and fracture clinics, we found that most non-attenders had recovered, or no longer needed our treatment. Most were judged to have been given precautionary appointments by less experienced junior doctors.

In some areas patients are now sent mobile phone text reminders of their appointment, with plans to supplement this with a similar email policy. This and better supervision and training of young doctors should resolve the problem for most cases.

Reappointments need be sent only to those unable to decide for themselves, such as children, or the few deemed at serious risk should they miss their checkup.
Paul Moynagh
(Retired orthopaedic consultant surgeon)

Sir, The chief nursing officer tells us that patients who fail to attend their hospital outpatient appointments are costing the NHS nearly £1 billion annually. This is almost certainly nonsense. In almost all of my 25 years as an NHS consultant in ear, nose and throat surgery (which has a heavy outpatient workload), we would evaluate the missed appointments rate regularly and increase the planned numbers per clinic accordingly. This is standard practice across the service.
Prof Antony Narula
Wargrave, Berks

Sir, I feel we are not made sufficiently aware of the costs of NHS services we use. If the cost of each medication were printed on the package we may be persuaded to use it carefully.

I was horrified to be told by the pharmacist that my bottle of medicine cost £300. I now make sure that I don’t waste a single drop.
Elizabeth Bass

Shepton Mallet, Somerset

and on 4th Jan:

MISSED APPOINTMENTS
Sir, I cannot understand how missed appointments are costing the NHS £216 million (report, Jan 2). The so-called cost of an appointment is a notional figure; if the appointment does not happen, it costs nothing at worst and saves money at best. If a patient fails to show, not only can an overworked GP catch their breath (or catch up, because they will almost certainly have got behind) but they won’t have to do expensive tests or prescribe expensive drugs. So this £216 million is fake accounting.

What might be interesting is why appointments are missed. The patients may have got better; their mother-in-law may have been admitted to hospital as an emergency; or there was no one to take them to the surgery.
Dr Andrew Bamji

Rye, E Sussex

Sir, In my experience missed appointments can be due (in part at least) to the NHS’s own systems. For example, my wife was called by her consultant’s secretary to ask why she had not attended an appointment; she replied that she had not been given an appointment (the letter, which had a second-class stamp, arrived the next morning).

My daughter has had a number of similar experiences: once the letter dropped through the letterbox 30 minutes before the appointment was due. After another appointment she was called by a secretary at the hospital, who asked why she had failed to attend. My daughter replied that she had, in fact, attended. She was then asked to relate, in detail, what the doctor had said to her.
Malcolm Hayes

Southam, Warwickshire

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Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

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Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns

Haverfordwest

Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

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The problem of non-attenders. There has to be a penalty… the denial of equal access to tertiary specialist care could be addressed by combining rural trusts, such as Hywel Dda, and Swansea.

Today in the Times 2 Letters: The good Samaritan approach that has led to a non functioning and disrespected system is the one below. The “hard cop” approach is first, and I have reversed the order that the editor chose! There has to be a penalty. In other countries there are much more financially affordable systems, and their life expectancy is little different. Putting state money into the expensive medical treatments (both in the developed & developing world) is of little benefit in extending life expectancy of the population, because we are at the top of the “gapminder” graph (real time today). Now look how the picture has changed in the last decade, since 2006. What makes populations healthy is wealth. We have enough money to afford an Irish or a Swedish style system, where there are co-payments for those earning enough, and punishments for abuse. The “hard truth” is that, without encouraging autonomy and discouraging paternalism, the health service is impossible to maintain. 

In the last two weeks the local Western Telegraph Newspaper has had two reports. One is with myself (Dr Rger Burns Illogical not tto have a hospital in Pembrokeshire, and Dr Robertson Steel, who mostly agrees with me. He wants reorganisation, but fails to address the issues around rationing and money. Dr Robertson Steel exit interview. The report is in fact a form of exit interview, and one wonders if he would have said it when employed, and kept his job. His article is titled “NHS challenges need to be faced by government”, but does not suggest how to combine a means tested social care with a free medical care, and make it work.

We already know that rural areas are being cheated when compared with cities, and now we know that life expectancy (In Scotland) is 5 years lower in the rural parts. Some of this is due to access, some to stoic people, and some to poorer education. But the denial of equal access to tertiary specialist care could be addressed by combining rural trusts, such as Hywel Dda, and Swansea. 

Notice the change in the slope of the graph (its nearly flat now(, and the lowest life expectancy (50 in the Central African republic) compared to 40 a decade earlier.

DOCTORS’ DILEMMA

Sir, In Sweden, if you fail to attend or fail to cancel an appointment with a healthcare assistant at least 24 hours beforehand, you can expect to be charged 100 SEK — or about £9. If you fail to cancel an appointment with a doctor, it’s 300 SEK. It concentrates the mind.
Michael Storey
Wokingham, Surrey

Sir, Some 25 years ago I analysed the “Did not attends” (letters, Dec 10 & 11) in my hospital outpatient clinics and a minority could be blamed on patient apathy. Many had serious other commitments but more had never received the appointment in the first place. Booking systems should write in an overbooking of 10 per cent. It’s good enough for airlines.
Dr Andrew Bamji
Rye, E Sussex

[PDF] Cancer Incidence and Cancer Mortality by Urban and Rural areas (2007) Wales

Daily Mail 12th December 2018: Living in the countryside gives you a ‘survival disadvantage’

The Times December 13th: Rural cancer patients less likely to live

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People living in rural areas are less likely to survive cancer than those in cities, according to a global review.

Researchers examining 39 studies found that 30 of them reported a “clear survival disadvantage” for rural inhabitants compared with those living in urban areas. Those living in the countryside were found to be 5 per cent less likely to survive cancer than their metropolitan counterparts.

The research by the University of Aberdeen suggested a number of reasons for the discrepancy, including transport infrastructure and distance from health facilities. As most services in developed countries are based in urban areas, it can be more time- consuming and expensive for rural people to travel for treatment, which may put them off seeking help in the first place or missing appointments.

Professor Peter Murchie, a GP and primary care cancer expert from the University of Aberdeen and the lead investigator, said: “A previous study showed the inequality faced by rural cancer dwellers in northeast Scotland and we wanted to see if this was replicated in other parts of the world.

“We found that it is indeed the case and we think the [5 per cent] statistic . . . is quite stark. The task now is to analyse why this is the case and what can be done to close this inequality gap.”

The university said that theirs was the first systematic review to consider this information on a global scale.

The team had previously found that those in the northeast of Scotland who lived more than an hour away from a treatment centre were more likely to die within the first year after a cancer diagnosis than those who lived closer.

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NHS in Scotland is “not financially sustainable,” auditors warn. Do the Scots expect a bail out?

Is the Scottish Government expecting England to bail them out? Financial responsibility comes at a price, and it looks as if Scotland is not willing to pay that price – yet. Reality has not yet hit our politicians. Health has to be rationed…. Individuals can declare bankruptcy, but not state hospitals.

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In BMA news Bryan Christie on 25th October reports: NHS in Scotland is “not financially sustainable,” auditors warn (BMJ 2018;363:k4520 )

A stark warning has been issued about the future of the health service in Scotland in a critical report that says it is not financially sustainable in its current form.

Audit Scotland has performed its annual health check on the service and found a continuing decline in performance, longer waiting times for patients, major workforce challenges, and increasing difficulty among health boards to deliver services within existing budgets.1

Only one of the eight key national performance targets was met in Scotland in 2017-18 (for patients with drug and alcohol issues to be seen within three weeks), while only three of 14 NHS boards met the 62 day target for cancer referrals. And there has been a 26% rise since 2016-17 in the number of patients waiting more than 12 weeks for inpatient or day case surgery, to a total of 16 772 in 2017-18.

Total spending came to £13.1bn in 2017-18, a fall of 0.2% in real terms on the previous year, forcing NHS boards to use one-off savings or extra support from the Scottish government to break even. In the coming years projected increases in healthcare costs are expected to outstrip any additional funding for the service.

“The NHS in Scotland is not in a financially sustainable position,” said the report. “The scale of the challenges means decisive action is required, with an urgent focus on the elements critical to ensuring the NHS is fit to meet people’s needs in the future.”

The steps the report recommends include:

  • Moving away from short term firefighting to long term fundamental change

  • Ensuring effective leadership

  • Creating a more open system to encourage an honest debate about the future of the NHS

  • Carrying out detailed workforce planning, and

  • Improving governance and the scrutiny of decision making.

Caroline Gardner, auditor general for Scotland, said, “The performance of the NHS continues to decline, while demands on the service from Scotland’s ageing population are growing. The solutions lie in changing how healthcare is accessed and delivered, but progress is too slow.”

The day before Audit Scotland’s report was released the Scottish government announced an £850m initiative over the next 30 months to shorten patients’ waiting times across Scotland. It seeks to achieve the 12 week treatment time guarantee for all inpatient or day surgery patients, which was introduced in 2012 but has never been met.

But Lewis Morrison, chair of BMA Scotland, said that this was the wrong approach. “We need to adopt a more mature, wide ranging way to assess our NHS and the care it delivers. Simply piling more political pressure on the meeting of existing targets that tell us little about the overall quality of care will do nothing to put the NHS on a sustainable footing for the long term.”

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170,000 victims, and nobody takes the blame!! Typical of a nationalised health service…

Just as we need to change the onus of proof on Agricultural products, we need to do the same with non drug medical products. The licensing of the mesh repair products is a case in point, and all 4 health systems should be ashamed of not reporting side effects and complications systemically (all together). The reporting of such problems is just one reason for a large mutual in health. Devolution means smaller numbers and lower standards. The commissioners and the Trust Boards are all to blame, but so is central government. Will any careers be finished? They should be.. Mesh is a foreign body, and as such the default is rejection, and possible infection.

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Hernia mesh complications may have affected up to 170 000 patients, investigation finds ( BMJ 2018;362:k4104 )

Up to 170 000 patients who have had hernia mesh operations in the past six years could be experiencing complications, yet NHS trusts in England have no consistent policy for treatment or follow-up with patients, an investigation by the BBC’s Victoria Derbyshire programme has found.

Around 570 0000 hernia mesh operations have taken place in England over the past six years, figures from NHS Digital show. Leading surgeons think that the complication rate is between 12% and 30%, meaning that between 68 000 and 170 000 patients could have been adversely affected in this period.

Patients who had had hernia mesh operations told the programme about being in constant pain, unable to sleep, and finding it difficult to walk or even pick up a sock. Some patients said that they felt suicidal.

The Department of Health and Social Care and the Medicines and Healthcare Products Regulatory Agency (MHRA) continue to back the use of mesh for hernia repair. The use of surgical mesh for stress urinary incontinence is under ongoing review after it was suspended in July in response to pressure from campaigners and MPs.1 Campaigners are calling for a similar review into the use of hernia mesh.

Owen Smith, a Labour MP who chairs the all party parliamentary group on surgical mesh implants, said that he feared the UK could “potentially have another scandal on our hands.”

He added that the MHRA was not doing enough to listen to the experiences of patients affected. “It reflects the flawed system we have in place,” he said. “Neither the regulators nor the manufacturers have to follow-up on problems.”

Ulrike Muschaweck, a private hernia surgeon, told the programme that she used a suture technique instead of mesh for most hernia operations, but this method was dying out because young surgeons were rarely taught it. She said that she had performed 3000 mesh removals because of chronic pain—after which only two of the patients had not gone on to become “pain-free.”

Suzy Elneil, a consultant urogynaecologist who was a leading voice in the campaign to halt the use of vaginal mesh, said that the mesh used in hernia was the same product. She estimated that treating those who have had complications with hernia mesh would cost a minimum of £25 000 (€28 000; $33 000) a patient—a similar amount to that predicted for vaginal mesh complications. This includes the removal of the mesh, a further operation to treat the hernia, and follow-up care. She said that the manufacturers should be covering the cost rather than the NHS.

The Royal College of Surgeons pointed to a 2018 study, which found that both mesh and non-mesh hernia repairs were effective for patients and were not associated with different rates of chronic pain.2

A spokesperson for the college said that “complications range dramatically from minor and correctable irritations to the more serious complications highlighted [on the] programme. Complications can also occur with non-mesh hernia repairs and by not operating on a hernia at all.”

They said that the college and regulatory authorities would continue to listen to patients’ experiences. “It remains vital that surgeons continue to make patients aware of all the possible side effects associated with performing a hernia repair,” the spokesperson said.

Kath Sansom from campaign group Sling the Mesh told the programme that a lot of the studies into complications were flawed or had short follow-up times. Quality of life questionnaires, for example, asked only about whether the hernia was fixed and not about new onset pain or other complications.

In a statement, the MHRA said: “We have not had any evidence that would lead us to alter our stance on surgical mesh for hernia repairs or other surgical procedures for which they are used. The decision to use mesh should be made between patient and clinician, recognising the benefits and risks in the context of the conditions being treated and in line with NICE guidance.”

An MHRA spokesperson added, “We encourage anyone—patient, carer, or healthcare professional—who is aware of a complication after a medical device is implanted, to report to us via the yellow card scheme, regardless of how long ago the implant was inserted.”

… following hernia repair with an Ethicon Proceed patch have resulted in a product liability lawsuit against the manufacturer
This was caused by what should have been a simple 45-minute operation to fix a hernia … of patient filed lawsuits. “For the ..

The rising trend in fraud in the UK health services.

My calculation for a population of 70 million is that this “fraud” costs us all around £16 each. The known parts are £5 loss to staff, £1 loss to patients, and £10 the professionals.  How can an organisation be run by administrators and leaders so much in the dark? We know purchasing power is reduced in smaller Health Services (Wales, Scotland and N Ireland), and now we know more about what they have been unable to correct due to the perverse incentives in the system. How many families have crutches, walking sticks and other accessories no longer needed? A small co-payment, is needed, with partial refund when returned undamaged. The managers need a breakdown at the touch of a button, of all missing items. Can you imagine a company like Screwfix or Argos not knowing what was where? Whilst the figures are not high, the rising trend shows it might become a real problem in future. 

Fraud is also a concern in other countries, especially the USA. Some comfort…

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Kat Lay reports 8th October 2018 in the Times: Fraud in the NHS could have paid for 40,000 nurses

Fraud costs the NHS £1.29 billion every year, according to the health service’s anti-corruption watchdog.

The money would be enough to pay for more than 40,000 staff nurses or buy more than 5,000 frontline ambulances, the NHS Counter Fraud Authority said in its annual report.

The organisation was established on November 1 last year. The new figure is higher than the £1.25 billion identified at its launch. The estimated total loss includes £341.7 million from fraud by patients and £94.2 million by staff.

Fraud by dentists adds up to about £126.1 million, the watchdog said, and opticians £79 million. Fraud in community pharmacies is estimated at about £111 million and in GP surgeries it is worth £88 million. People accessing NHS care in England to which they are not entitled is thought to cost the health service £35 million. The rest included fraud involving NHS pensions, bursaries and legal claims.

Simon Hughes, the authority’s interim chairman, said: “Ensuring public money pays for services the public needs and doesn’t line the pockets of criminals means we all benefit from securing NHS resources.”

Sue Frith, its interim chief executive, said: “Fraud always undermines the NHS, with every penny lost to fraud impacting on the delivery of vital patient services. If fraud is left unchecked, we believe losses will increase.”

The report said there was “no such thing as a ‘typical’ NHS fraudster”. It noted that there were barriers to tackling the issue, including a lack of understanding of the problem in many NHS services. It added: “There is also sometimes a mistaken assumption that reporting fraud casts the organisation involved in an unfavourable light.”

At the end of March there were 45 criminal investigations in progress, the report said. In July a neurology nurse from London was jailed for 16 months for fraud by false representation. Vivian Coker, 53, from Camberwell, took sick leave from August 2014 to May 2016. During this time she received pay of £32,000 from St George’s University Hospitals NHS Foundation Trust, but had also registered with two agencies and worked shifts. Coker initially denied the charges but changed her plea at Kingston crown court.

In March the authority helped to jail Andrew Taylor, a locksmith employed by Guy’s and St Thomas’ NHS Foundation Trust. He was sentenced to six years for defrauding his employer of £598,000. He had charged the NHS mark-ups of up to 1,200 per cent.

Taylor, 55, from Dulwich, was found guilty at Inner London crown court of fraud by abuse of position. Financial investigators “established that Taylor was leading a cash-rich lifestyle beyond his legitimate means, which included paying for his son to attend a private school whose fees were £1,340 a month and purchasing a brand new Mitsubishi L200 vehicle at a cost of £27,400”, the report said.

It also described the case of Paula Vasco-Knight, 53, chief executive of South Devon NHS Trust, who made fraudulent payments of more than £11,000 to her husband, Stephen. She admitted fraud by abuse of position in March 2017 and was given a 16-month prison sentence, suspended for two years, and ordered to do 250 hours of unpaid work by Exeter crown court.

The couple said that they did not have sufficient assets to repay the money but investigators found that they had access to personal pensions that could be surrendered.

The advantages of mutuality are being shunned. Purchasing power in small regions is little. Choices are disappearing.. Hammond is unlikely to help ..

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A new West Wales Hospital – an inevitable utilitarian decision. Today’s children are going to live shorter lives than their parents. Todays West Wales adults could also live shorter lives than their parents.

The decision to commit to a new hospital in West Wales has been inevitable – since the WG has no intention of combining Hywel Dda and Abertawe Bro Morgannwg (ABMU) and providing a sensible solution, a mistake is being made. Recruitment to West Wales has been poor at the best of times, and now that the rationing of medical school places over the last 30 years is coming home to roost, the Hywel Dda board have no other option. There are not enough professionals ready and willing to work in West Wales, and not enough money to fund them if there were. There is an ethical argument, from a population perspective, that rationing covertly )whereby nobody knows what is not available until they need it) is better than rationing covertly (whereby citizens know in advance what is not available in their post code). But from a liberal and individual perspective, this is unethical, as it discourages autonomy and choice. It seems some choices have to be planned for by saving money, and of course this option divides us into the haves and the have nots. Exactly what Aneurin Bevan tried to avoid. Medical professionals accept that the pace of advance of medical technology is faster than any states’ ability to pay, and that rationing is inevitable and endemic already. Politicians deny the need to ration, and until this becomes honest and overt, the hearts and minds of the caring professions will be disengaged from the politics.

It has been a “least harm for the greatest number” decision that Hywel Dda has been asked to make. It will please nobody. It will satisfy nobody. It may lead to more emergency deaths. As the population ages and the demographic suggests this will be for several decades, the problems of type 2 diabetes and dementia will become worse. The Welsh Health Service costs more per capita than the English because of poverty, and yet the WG takes more from the overall budget by top slicing. When dealing with a population as low as 3 million, this really matters and adversely affects the options in devolution. That is just one of the reasons devolution has failed.

Aberystwyth finds it even harder to attract staff, and the longer term prospects for their people are worse. Llanelli and Carmarthen citizens have speedy access to Swansea, and NHSreality, and most GPs in Pembrokeshire, feel that joining the two boards would be best. The decisions to build relatively new A&E and Renal units at Withybush in the last decade now seem very strange.

Is the fact that every county wants the new hospital the opposite of NIMBYism?

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Today’s children are going to live shorter lives than their parents. Todays West Wales adults could also live shorter lives than their parents.

…Babies of both sexes in Scotland and Wales and baby boys in Northern Ireland are even projected to live shorter lives than their parents do after average longevity dropped slightly in parts of the UK.

Experts said that the government must investigate the reasons behind the stalling of life expectancy, which some have blamed on cuts to public services.

Between 2015 and 2017 the average life expectancy remained at 79.2 years for men and 82.9 for women, the Office for National Statistics said. There were falls in Scotland and Wales for both men and women, and among men in Northern Ireland, averaging 0.1 years.

Greg Hurst September 26th in the Times: Today’s children set to live shorter lives than parents

Nicola Davis in the Guardian 25th September: Children becoming physically weaker found team who measured handgrip, arm-hangs and sit-ups in Essex children

Western Mail (Walesonline) 26th September: Hywel Dda Board in shake up decisison

May 4th 2018: The agony of Damocles sword hangs over West Wales..

The fourth option for West Wales? Do we want “soft lies and gentle indifference”, until we realise the safety net is failing for us personally?

February 2018: A bigger and bigger deficit in West Wales…… Now at £600 per head……

January 2018: The West Wales options.

West Wales Health has to have a future – somewhere in the “middle” ground… Back to 2006 and reversing the wrong decision taken then not to build a new Hospital.

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

Banal and sanitised Drakeford interview shames the local press in West Wales

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