Category Archives: Trust Board Directors

NHS confusing public by using ‘gobbledygook’

In keeping with the BMA in Wales, Nick Triggle reports that “NHS confusing public by using ‘gobbledygook'” in the Times 28th March 2017.

The BMA Wales response to the Welsh Government was that we wanted “a clearer and more honest language” to be used in health. Needless to say this has not happened, and indeed NHSreality does not blame the Welsh politicians. The recommendation for “honest language”, along with “Exit Interviews” was buried deep within the BMA response ( Our health, our health service BMA response) to that part of the Green Paper , and did not appear in any bullet point summary. The rules of the game, for Commissioners (de-commissioners) will ensure that the language barrier remains. Therefore we need to change the rules. Both language and outcomes are going to get worse.. until we agree there has to be a cost.

Imagine the scene. Up and down the country, local NHS leaders are crowded into meeting rooms discussing information transfers and ambulatory care, when someone jumps up and shouts “I’ve had enough of sticky toffee puddings”.

Confused? You’re not the only one. The language being used by the health service is simply gobbledygook, says the Plain English Campaign (PEC).

Steve Jenner, the campaign’s spokesman, said the health service was riddled with “jargon” when it comes to explaining anything from the closure of hospital services to major incidents.d he even believes the NHS may be doing this on purpose.

“If you use impenetrable language it means the public has no clue what is going on. I can’t help thinking that suits the NHS sometimes,” he said.

“What this jargon is describing is very important. It should be articulated very clearly.

“We expect doctors to clearly explain themselves. It should be the same for the NHS management,” he added.

Sticky toffee puddings or important NHS plans?

STPs – dubbed sticky toffee puddings by some in the health service – are among one of the most important developments in the health service in recent years.

But you would never guess from the official name – sustainability and transformation plans.

However, the jargon goes further than that, according to the PEC. Look through most plans – there are 44 of them – and you will find some strange phrases.

Cambridgeshire and Peterborough’s documents, for example, talk about investing in “system-wide quality improvements” and developing a “shared understanding of all the interrelated issues”, while being able to learn “what it means to us as individuals and as organisations”.

Meanwhile, documents from North Central London shared the experience of one patient’s care that went wrong.

It says due to “hand-offs, inefficiencies and suboptimal advice and information transfers” the “patient’s pathway” went on for too long.

Another popular “pathway” is the ambulatory patient pathway. What does that mean? The patient can go home after being seen in hospital.

Is the NHS involved in a medieval battle?

Vanguards are a term used to describe the formation of a medieval army. But the NHS has also – ahem – deployed the term.

There are 50 vanguards that have been set up to test new ways of running services. They were created in 2015 and include schemes to get hospital doctors working in community clinics and to provide advice via video link-ups as well as the creation of super hubs in the community bringing together GPs, district nurses and council care teams.

You should not be surprised to hear evidence of what works best in the vanguard programmes will then be fed into the STP process.

But it’s not just in England where jargon can be found. Northern Ireland’s 10-year health strategy, published last autumn, promised to shift the focus from “treatment of periods of acute illness and reactive crisis approaches, towards a model underpinned by a more holistic approach to health and social care”.

Or, more simply, try to get people to live more healthily and give them better support to stop them needing hospital care.

Running hot or just busy?

Taps run hot, but so too, it seems, does the NHS. Commentators and health service managers have been using the phrase to describe just how busy hospitals and, in particular, A&Es were this winter.

It may be a bit of an odd phrase, but it is at least easier to understand than Operational Pressures Escalation Level Four.

That is the new name for a black alert – when hospitals get so busy they have to cancel non-emergency operations, divert ambulances and call in extra staff.

And guess what red alerts – the level down from black – were renamed? Yes, that’s right, Operational Pressures Escalation Level Three.

Guidance issued by NHS England last year ordered hospitals to use the new terminology when communicating with the public and media.

Not everyone obeyed. Newspaper coverage this winter was littered with reports of black and red alerts.

And what did NHS England make of this? They were unable to provide the BBC with a response.

The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

In Search of the Perfect Health System ( a new book reviewed )

The BMA response ( Our health, our health service BMA response) to that part of the Green Paper

 

 

Invidious options: to have to choose between fears is not necessary.

In Place of Fear (A Free Health Service 1952 Chapter 5 In Place of Fear), citizens are asked to choose between two fears: cancer or emergencies. Which is the greatest will be different for different individuals… As a 66 year old man my chances are greatest for Ischemic Heart Disease, but I have also had two cancers so I am at more risk of another than the average individual. As I get older I am at risk of a fracture, particularly fractured neck of femur, which in my case will be complex as I have had two hip replacements. There are strong arguments for individuals such as myself, living in a region (Wales) without choice, for moving near to a tertiary centre of excellence (teaching hospital). Does cancer care mean treatment as well as palliative and terminal care? The last two are mostly funded by charities… in the richer areas of the country. The life-years saved by A&E may be greater, but A&E deals with lower social classes who don’t vote… If the decision is left to patients we may not get the utilitarian result we need.. Hobson’s choice will of course be decided by administrators, as pithed politicians will sit on the fence. Given a choice, they must fund A&E properly (before cancers), but A&E is not where doctors compete to work… Such an invidious decision does not have to be made if we ration health care overtly. This is not as simple as the choices for an individual..

Image result for strategy health choices cartoon

Chris Smyth reports 30th March 2017: Patients must choose between A&E and cancer care, warns health chief

Patients must be told they cannot have routine operations quickly if they also want short waits for A&E, cancer care and other treatments, an NHS leader has said.

Simon Stevens, head of NHS England, is being urged to relax targets for waiting times as he prepares to lay out his reforms to the service today.

Niall Dickson, chief executive of the NHS Confederation, which represents all health service organisations, said that it was unrealistic to pretend that patients could have everything they had come to expect when money was so tight. “It’s not reasonable to say that all the current targets have to be met,” Mr Dickson told The Times.

“[Bosses] are on the one hand saying that mental health has to be a priority, elective care’s a priority, A&E’s a priority, cancer’s a priority and so on. Well, there’s got to be acknowledgement that some other things are not a priority.”

Mr Stevens is due to approve a structural upheaval of the NHS. It aims to better join up services around patients and to prevent illness. He has also signalled that he will spell out the financial pressures, threatening to resume a row with Theresa May over NHS funding.

Simon Stevens, head of NHS England, is being urged to relax targets for waiting times as he prepares to lay out his reforms to the service today.

Niall Dickson, chief executive of the NHS Confederation, which represents all health service organisations, said that it was unrealistic to pretend that patients could have everything they had come to expect when money was so tight. “It’s not reasonable to say that all the current targets have to be met,” Mr Dickson told The Times.

“[Bosses] are on the one hand saying that mental health has to be a priority, elective care’s a priority, A&E’s a priority, cancer’s a priority and so on. Well, there’s got to be acknowledgement that some other things are not a priority.”

Mr Stevens is due to approve a structural upheaval of the NHS. It aims to better join up services around patients and to prevent illness. He has also signalled that he will spell out the financial pressures, threatening to resume a row with Theresa May over NHS funding.

“If the money isn’t there you have to acknowledge that. It’s better to acknowledge that than to set up the system to fail,” Mr Dickson said. “It’s just unrealistic to expect the NHS to do everything and it’s unfair on patients and staff to pretend it can . . . It is disheartening, in any business, when a target is set that [staff] cannot deliver.”

The NHS is missing most of its main targets, including for A&E, routine operations, ambulance responses and cancer care. Jeremy Hunt, the health secretary, insisted this month that the target for 95 per cent of A&E patients to be seen within four hours must be met next year, despite January’s figure of 85.1 per cent being the worst on record.

Mr Dickson said: “If the government is absolutely set on, for example, A&E times and mental health, and I can see why they want to do that, then they should perhaps acknowledge that there are other areas where they could relax the targets a bit, which would allow the system to focus on those priority areas.”

Ministers have promised an extra £8 billion for the NHS by 2020 but Mr Dickson said that the “small amounts of additional money” fell well behind long-term average increases and left staff struggling to cope with rising demand from an ageing population.

He said that it was “absolutely right” to demand more savings but added: “We don’t think it’s reasonable to demand big financial savings on the one side, and on the other side expect no diminution of quality when demand is rising, without an admission that the NHS will have to prioritise some activities over others.”

Local health groups have been criticised for rationing services such as fertility treatments or barring the obese and smokers from surgery. Mr Dickson said that NHS England should back these decisions with “an honest admission that the service can’t do anything and that it’s reasonable to make decisions on the basis of priorities”.

•Only a quarter of people are satisfied with social care services, half as many as are satisfied with A&E, the least popular part of the NHS (Kat Lay writes). An annual report from the King’s Fund found that 63 per cent of people were satisfied with the NHS overall last year. Only 26 per cent were satisfied with local authority social care services, compared with 54 per cent who were happy with A&E

Pithed politicians collude in unsafe care, ministers told

Rationing in the NHS – The Nuffield Trust

Health professionals call for NHS Wales ‘vision’ by prospective parties. If you don’t have a choice in Wales, you can buy or game that choice….

If we go on like this the housing debt will be as nothing to the health debt in 10 years time.

Many of us start our lives with debt, usually on property, but this declines as we grow older. If we go on like we are in Health, the housing debt will be as nothing to the 4 UK Health Services debt in 10 years time.. The chancellor is rightly worried about debt, and the future looks bleak…(UK’s borrowing binge is worrying the Bank of England – Larry Elliott in the Guardian 27th March 2017) £50m for Hywel Dda board equates to approximately £156 per head today, and possibly £10,000 per head in 10 years. Expect more and more de-commissioning / covert rationing.

Image result for mountain of debt cartoon

 

Ministers refuse to bail out the Welsh Health Boards (Hywel Dda is the worst) – BBC News 28th March 2017

The boards are forecast to over spend by £146m this year.

In one case – Abertawe Bro Morgannwg University Health Board (ABMU) – the financial outlook is said to be “extremely challenging”.

The health board, which covers Swansea and Bridgend, said it was attempting to cut agency staff costs.

As well as ABMU there are overspends at Betsi Cadwaladr in north Wales, Cardiff and Vale board and Hywel Dda in mid and west Wales.

Betsi Cadwaladr’s deficit is now forecast to be £30m, Hywel Dda £49.9m, ABMU £35m and Cardiff and Vale £31m for the 2016-17 financial year.

The health boards will not face a bill to repay the money, but they will be expected to balance their books in the next financial year.

A spokesman for the Betsi Cadwaladr University Health Board said: “We have worked hard throughout the year, and worked closely with Welsh Government, to address our challenges, and we will continue to do so going forward.”

Stephen Foster, of Hywel Dda University Health Board, said: “This is not the financial situation that we would want to find ourselves in and we are putting together significant plans to turn it around.”


Analysis by BBC Wales political editor Nick Servini

These figures show a dramatic deterioration in the finances of four out of Wales’ seven health boards.

They have also prompted a hard-hitting response from the Welsh Government which, until this point, has been keen to stress how they approach problems together.

The tone resembles the approach of the man in charge of the English NHS, Jeremy Hunt, who has not been afraid of calling out heath trusts he believes are under-performing.

The Welsh Government has called for a significant improvement in the financial performance.

That will be easier said than done in the face of intense pressure on these organisations.

Walesonline and the Western Mail report 27th March 2017: Wales’ Health Secretary refused twice to guarantee that NHS services will not face cuts

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There is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible..

The Guardian has an “anonymous” opinion. I guess those close to the decision making action will know who it is. “The NHS sets leaders up to fail – and then recruits more in the same mould” on 27th March 2017.

NHSreality maintains that there is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible. There are no exit interviews of high turnover Trust Directors, and no feedback to Politicians – probably because they know they don’t want to hear it. Anonymous is one of the many disillusioned …. and a 1p hypothecated tax will change nothing. Lincolnshire will get nowhere with it’s request for suggestions because rationing overtly is excluded… Politicians with only one eye on health (the other in Brexit) will continue to be conned ….

It’s my job to support and develop senior NHS managers. And I’m deeply worried that we’re setting them up to fail – then recruiting more in the same mould.

I’m a former primary care trust director

Most of these leaders were hired to lead foundation trusts at a time when NHS providers were being encouraged to compete with other trusts for business; to invest in new services; to develop their own organisations at the expense of other providers. To make use of the freedoms granted to foundation trusts – including the ability to borrow money at commercial rates – they hired leaders with commercial, transactional and financial skills: hard-edged, competitive businesspeople who could expand their market share.

But then the environment changed. Trusts were – quite rightly – put under greater pressure to improve service quality and patient safety. And demand rose much more quickly than budgets, so the tariffs paid for trust services were cut year after year. Soon, many new services were struggling to repay the investments made in them. In a world of shrinking revenues, those skills in business growth suddenly looked out of place.

Meanwhile, health system leaders began pushing a new agenda – one built around collaboration between organisations, professionals and sectors. To protect healthcare nowadays we need people to work together, rather than to compete: the emphasis is on building services around the patients’ needs, rather than the providers’. The Sustainability and Transformation Plans and the Five Year Forward View create a need for leaders who have emotional intelligence; who are approachable and listen to their staff; who put the public’s needs above those of their trust; who can share power and responsibilities with other organisations. And in that context, the skills and approach of many NHS leaders look hopelessly outdated.

Too often, leaders are remote and isolated. Poor links between ward and board mean that board members often remain unaware of emerging problems. To deliver great care, you need your staff behind you – but we’ve spent years recruiting empire-building business leaders who have no feel for the kind of hands-on, visible leadership required.

; I now work as an executive coach, helping NHS executives to improve their skills. Many of my clients lead trusts whose leadership has been deemed “inadequate” or “requires improvement” by the Care Quality Commission – but few of them are genuinely bad leaders. The problem is that they were hired to do one job, and the requirement is now for something quite different. Yet they’re not being helped to change their approach, and when their trusts run into trouble they are being replaced with people likely to encounter exactly the same set of problems.

We end up with chief executives who find themselves receiving a lot of criticism, and being pushed out – creating huge damage to their careers and reputations. But it’s the system that’s let them down, not them letting down the system. Nobody’s given them the right advice or development or challenge, and the characteristics once seen as assets have become liabilities.

Unfortunately, trusts’ recruitment practices haven’t changed to reflect the need for a new kind of leader – so when these more commercial, transactional managers fail, trusts are too often replacing them with new figures cut from the same cloth. Many trust chairs are still stuck in an empire-building mindset; job descriptions focus on financial and operational experience; and recruiters are often cynical about the softer skills required for staff engagement and partnership working. So the trusts select new managers well-suited to facing the challenges of five years ago, and organisations head off towards a fresh set of failures.

What’s to be done? For a start, trusts need to refresh their recruitment practices – taking their cue from NHS Improvement’s new leadership framework, and shifting away from a narrow focus on technical competences towards a values-based approach. The solution is not simply to swap our existing leaders for a new set. The NHS cannot afford to lose a swath of senior managers. Many of these people could develop the skills we need, we just need to help them to do so. After all, we require doctors and nurses to refresh their skills regularly, revalidating their qualifications; and these days, the disciplines of management and leadership are changing just as fast as medical practice.

It’s hard for senior leaders and managers to reflect, train and change their approach. Most already work 60 hours a week, and seeking new skills is too often seen as a confession of weakness or incompetence. But this is a nettle we must grasp. For many of our senior leaders are ill-suited to the task in hand. If we are to serve the interests of NHS organisations, staff, leaders themselves and, above all, patients, we must reshape our leadership cadre – equipping it to understand and address the vast new financial and organisational challenges facing the NHS.

NHS faces ‘mission impossible’ to meet performance targets and budget savings, new analysis from health think-tank NHS Providers finds

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Scotland and Whistleblowing

NHSreality takes the view that since morale is so low, no internal assessment of a whistleblower is possible. Cultural change needs to come quickly, and the start of this is meaningful “exit interviews” by an independent HR company. This company should report in general publically, for a Region, but specifically, in private to Health Boards. Copies of reports should go to the Minister concerned, and should be released once they are not embarrassing to individuals concerned. Incognito exit interviews could then be possible, and done for all staff moving or leaving posts; in particular juniors. I have delayed this post for 3 months hoping there would be some good news follow up… Post will be updated if there is. Some “good news” – Hywel Dda Trust in West Wales have told the consultants that they will initiate exit interviews. At least they are recognising their importance – now they need to recognise the barriers to speaking honestly to their own HR, especially for those moving post within the Trust, but even for those at retirement. The Health Services are on fire… Interesting that the problem has been deferred to the Health and Sports committee… reminds me of “turfing”, or passing the buck in the House of God. (Sam Shemm 1978)

Update 15th March 2017 from 17th Feb 2017:

Hello, If you want to read the transcript of the Petitions Committee meeting where MSP’s quiz Edinburgh Council, Public Concern at Work (PCAW) and Unison on whistleblowing read it here and you can see the video here which last 45 minutes. The Council scheme comes over as having overcome the culture of fear around when I worked there and contrasts hugely with NHS arrangements. The Council reps pointed out that they’d had 53 reports in the 3 years since it was introduced compared to only 3 disclosures over 8 years prior. PCAW said NHS Scotland needed better arrangements but disappointingly said nothing  about the shortcomings of Scotland’s Board Champions, who can’t take or deal with reports (even though I’ve heard they think this is a problem). Unison didn’t really say anything. The next landmark will be on 2nd March when the NHS Scotland Chief Executive, Paul Gray, is called to account.

Important news – the Scotsman reported that “the Parliamentary Health Committee has commenced an enquiry to investigate how the NHS deals with whistleblowers amid concerns there is a culture of fear which discourages staff from raising patient safety issues. NHS staff are to be asked for their views as part of the inquiry launched by MSPs on Holyrood’s health and sport committee.”
More details can be found on the Parliament website “Call for written views on Inquiry into NHS Governance – Creating a culture of improvement” at http://www.parliament.scot/parliamentarybusiness/CurrentCommittees/103512.aspx The Committee is considering whether staff are managed in a fair and effective way.

 And on 5th March 2017:

Hello, The evidence submitted by the NHS Chief Executive, Paul Gray, to Petitions Committee on the 2nd March was underwhelming. The MSPs gave him an easy ride. You can view the 45 minute video here: http://www.scottishparliament.tv/20170302_public_pets?in=00:00:17&out=00:45:04 The transcription is here: http://www.parliament.scot/parliamentarybusiness/report.aspx?r=10824

I was surprised that the Chair brought up grievances at the beginning, ignoring the fact that staff only bring grievances after they feel they have been unfairly treated. Why did she not ask not ask directly for views on the petition? Indeed, it felt as if they’d rehearsed the whole discussion beforehand. There were no questions as to the efficacy of the whistleblowing champions – in having no staff-facing role, with no means to knowing how many (and when) concerns were raised.  At no point did the well-known victimised whistleblowers at Aberdeen, Forth Valley, Ayrshire & Arran and Lothian get a mention, and how they could have been better protected- and no mention of Robert Francis’s recommendations. The only point at which any MSP acknowledged they’d read any of the submissions was when Paul Gray was quizzed about the falling number of helpline calls – to which the Chief Exec answered that the “bottled-up” frustrations in 2013 had created a “spike” – and also, due to ongoing improvements, staff had less need – so there was little, on an ongoing basis, to worry about. There were no references by the MSPs to the staff survey showing fear at speaking up and no calls for it to be run again. Whilst it was acknowledged that an independent whistleblowing officer would be good, it sounded like another consultation was  likely in August – (although they already consulted on this a couple of years ago, so maybe this would be the precursor to a Parliamentary Bill).

Interestingly, the Scotsman managed to make the evidence look newsworthy- see “Health staff fear consequences of whistle-blowing, NHS Scotland chief tells MSPs” here.

Anyway, the Petitions Committee concluded that they would now refer the petition onto the Health & Sports Committee for consideration. We can only hope that they seriously consider what the petition proposes. At no stage did the Petitions Committee express a view on the petition. Sigh.

Thus my petition has followed its course. If it is to go anywhere now, that will depend if the Health Committee. Let’s hope they’ll really discuss the subject properly.

They are currently conducting an inquiry into NHS Governance – Creating a culture of improvement. Whistleblowing fits well. The call for evidence has another 9 days to go – please send something in if you can; I know a few of you have– you can do it confidentially, if you wish.

So I won’t be sending you any more “Update” emails, unless you want updates on the Health Committee’s conclusions. If you would like that, please let me know.

You can submit your evidence openly, anonymously or confidentially. But you only have until the 15th March, just four weeks, to do so. I’ll be writing in – hope any of you at the NHS (either past or present) with views will do too. This represents a real opportunity to call for change.

 

Peter Gregson wrote 4th December 2016:

The Petitions Committee considered the petition again on 24th Nov. The official (verbatim) report is here: https://shar.es/18jO8j

You can view their 6-minute deliberation on the webcast at http://www.scottishparliament.tv/Search/Index/1548bdac-8fee-42b8-8e00-d890656e9e1a – it starts 52mins 34 seconds in and runs onto 58.05. In a nutshell, the Committee now wants to hear from the Chief Exec of NHS Scotland and “representatives of whistleblower organisations”. They suggested the unions, especially Unison. The minute  of the meeting states “The Committee agreed to invite the Chief Executive of NHS Scotland and other relevant stakeholders including the City of Edinburgh Council, Public Concern at Work and trade unions, to provide oral evidence at a future meeting.”

I immediately wrote to the Chair of the Committee and the other four MSPs, suggesting that I could assist with whistleblowing organisations, individual whistleblowers (Rab Wilson, ex-nurse, of Ayrshire & Arran has offered) and asking they try again to contact the English Health trusts (there are 3 in all). No response yet.

I subsequently did some searching and found Whistleblowers UK who assist whistleblowers and give support at tribunals. They have been around a bit more than a year and their website is at http://www.wbuk.org/. They have a helpline for whistleblowers (and no – it isn’t like PCAW at all!). I spoke with their chief exec and she may be able to come up from London to the Scottish Parliament, or send in a submission.

A Scottish whistleblower has been in touch with me saying that if evidence could be taken with the webcam switched off, then they would like to attend to speak to Committee. If any of you feel the same way, please let me know and I will relay this to Johann Lamont.

If you have time, you might like to read the 10 submissions that have come in from Scottish NHS chief execs on the Parliament website here. Only one institution has been positive- the City of Edinburgh Council – and there is a negative one from Unison. A reversal of fortunes from three years ago, when each of these body’s positions were the opposite of what they are now, when I last petitioned for a hotline for local authority staff.

I urge you to read the Edinburgh Council submission that shows how their hotline actually works and the difference it makes- the link is here (I had also petitioned them too, back in 2013). I was also pleased Dr Peter Gordon wrote in – the support of clinicians is key to securing change. Finally, my comment on all the submissions was published as well (Petitioner letter of 9th Nov).

I think the Petitions Committee will revisit the petition with the NHS Chief Exec, probably in late January. I think that will be a very telling meeting – I’ll keep you posted.

 Other news- my FOI to Grampian Health Board on the costs of Professor Krukowski’s treatment has been refused again (see their response here ) so I have now submitted an appeal to the Information Commissioner.

Other news is that on 22nd Oct at their conference, the Scottish Green party adopted this motion, thanks to one of our campaigners:

The Trade Union Group conference identified that existing policy is not clear about the role of trade union representatives on boards. Experience has shown that partnership working between trade unions and management, for example on Health Boards, can be used to incorporate unions into the agenda of management. This motion is supported by SGP TUG.

 …For publicly funded bodies (such as the NHS, local authorities, education institutions, etc.), which have a distinct and particular responsibility to protect employees and those using the services they provide, such measures should include the establishment of a whistleblowing hotline, independently managed by an organisation invested with powers of investigation and disciplinary powers will provide an additional mechanism to ensure good practice is adhered to and wrongdoing is addressed.” 

Best wishes

Pete Gregson

www.kidsnotsuits.com/nhs-staff-whistleblower-hotline-parliamentary-petition/

HSJ implies Managers and Directors are now at odds with Politicians over rationing..

t seems that systematic rationing might become acceptable to managers (who run the HSJ). The Health Service Journal headline 10th March: “Exclusive: NHS England warns CCGs over ‘arbitrary rationing’” implies that whilst it is random rationing is not acceptable. What about systematic rationing? Are NHS England open to overt rationing yet? More importantly, are our politicians willing to say what will not be covered systematically (Nationally), and what would be acceptable locality rationing. This article is of interest to us all, but is only available if you subscribe… It implies that Managers and Directors are now at odds with Politicians over rationing..

NHS England has issued a warning to commissioning groups accusing some of “rationing” surgery using “arbitrary cut offs”, amid growing concern about the issue, HSJ can reveal.

 

 

 

Evidence basis is needed for all treatments – and confirmation by independent third party. Hospitals and pysicians collude to waste money.

The Crick Institute, with buildings at Mill Hill and in Central London, could be a useful tool in health rationing once rationing is overt. It’s evidence could be an additional source for NICE. However, the incentive for government keen to reduce costs is on questioning too much, and delaying, and the incentive for big Pharma is to sell more. The evidence for many drugs in common use should have been questioned more, and the alternative use of funds which might have been used on Pharma products needs more consideration. Only overt rationing can do this. Bisphosphonates such as Alendronate cost money, and it might be better spent elsewhere. The advertising and the sale pitch is on fear of fractures, and the misconception that X ray improvement of bone density correlates with less risk. Hospitals think they will reduce costs, and physicians want to do good, so they conspire/collude to waste money. Knowing this, Big Pharma is willing to pay us when it’s arm is twisted.. (Drug companies propped up NHS with £250m after cabinet’s threat)

Tom Feliden reports in the Times 1st March 2017: Osteoporosis drugs may make bones weaker

Drugs used to treat weak bones in elderly patients suffering from osteoporosis may actually make them weaker, research suggests.

Scientists at Imperial College London examined the bone structure of hip-fracture patients who had been treated with bisphosphonates.

They found evidence the drugs were linked to microscopic cracks, making bones more fragile and prone to break.

Osteoporosis affects three million people in the UK.

What is osteoporosis?

Losing bone is a normal part of the ageing process, but some people lose bone density much faster than normal. This can lead to osteoporosis and an increased risk of fractures.

Bisphosphonates – the main treatment for osteoporosis – are an extremely successful and commonly prescribed class of drugs that slow down the natural processes by which the body removes ageing or damaged bone.

But doctors have raised concerns about the number of fractures occurring among elderly patients who have been taking the drugs for a long time.

To find out why, the team led by Dr Richie Abel took samples of bone from 16 hip-fracture patients and studied them at the Diamond Light Source – the massive doughnut-shaped Syncatron or particle accelerator at the Harwell campus in south Oxfordshire.

“What we wanted to see was whether the bone from bisphosphonate patients was weaker or stronger than bone from untreated controls,” Dr Abel explained.

“Rather startlingly, we found the bone from the bisphosphonate patients was weaker. That’s a conundrum because the bone should be stronger.”

By bombarding the samples with X-rays 10 billion times brighter than the Sun, the team were able to generate images of the internal structure of the bones in unprecedented detail.

These showed microscopic cracks building up in the bones of patients treated with bisphosphonates.

Dr Abel said: “The drug is clearly working, but it also leads to the build-up of micro-cracks in the bone and that could increase the likelihood of a fracture.”

It’s a surprising result, but the study was small and the work is at an early stage.

Even so, Prof Justin Cobb, a co-author on the paper, says the discovery raises important questions about how we prescribe bisphosphonates for long-term conditions such as osteoporosis.

“There’s no hurry, but we should think about how long people are taking them for, and how we might monitor the development of these micro-cracks,” he said.

In the meantime the researchers say people should continue to take medications prescribed by their doctor.


Osteoporosis: Are you at risk?

If you answered: “Yes,” to more than one of these questions, then you may be more at risk of developing osteoporosis:

•Has anyone in your family ever been diagnosed with osteoporosis?

•Have you ever broken a bone after a minor bump or fall?

•Are you female and aged over 50?

•Do you drink more than three units of alcohol a day?

•Do you miss out on summer sunlight (through being housebound, avoiding the sun, always covering your skin or wearing sunscreen)?

•Do you miss out on doing at least 30 minutes of activity five times a week?

Source: National Osteoporosis Society

Medline Evidence on Osteoporosis

NICE pathways to Osteoporosis treatments

(Drug companies propped up NHS with £250m after cabinet’s threat)

No party is offering a credible alternative….. the future of the 4 UK Health Services may lie in social media