Category Archives: Trust Board Directors

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

The NHS is at risk from a no-deal triple whammy. Winter is coming, along with a flu outbreak and a “no deal”……

The risks of Brexit to the 4 health services are in inflated costs (products are bought in US dollars), and staff (many are from overseas, mostly non-European). The triple whammy : Winter is coming, along with a flu outbreak and a “no deal”.  

Chris Hopson in the Times 26th August 2019: The NHS is at risk from a no-deal triple whammy

Whatever your views on Brexit, our key public services need to be fully prepared for no-deal, should that occur on October 31.

Foremost in our minds should be NHS hospital, ambulance, mental health and community service trusts that provide vital healthcare to a million patients every 36 hours.
How ready are they to manage a
no-deal Brexit?

The NHS has a proud tradition of performing well in a crisis. Trust leaders are used to preparing for emergencies, working closely with other public services. As you would expect, there is a huge amount of planning being done. But there are two features of a no-deal Brexit that frontline leaders believe are significant risks for the NHS.

The first, due to the timing, is an awkward potential triple whammy: a difficult winter, a flu outbreak and a no-deal. The NHS is at its busiest over winter. Emergency care performance figures, the worst in more than a decade, show how much pressure the service is under, with concern that we’re heading for a pressurised winter. Levels of flu in Australia, often a good predictor for UK winter flu, are at their highest for some years. Combine that with the prolonged negative impact of a
no-deal Brexit, should that occur, and you have an NHS chief executive’s nightmare scenario.

The second concern is how many risks are beyond the immediate control of NHS trusts and require close and effective working with other public services and, particularly, central government.

Trust leaders are very dependent on the work of others to secure 8,000 medicines and other medical devices from European supply routes. They are similarly reliant on others to ensure that the NHS can feed 120,000 patients a day and to guarantee the free flow of traffic in areas such as Kent so ambulances, patients and vital staff can reach their destination.

Trust leaders need greater support as an NHS free at the point of use for all EU citizens moves to being one where staff will, overnight, become responsible for eligibility checks. They need the government to remove obstacles and uncertainty for European staff on whom the health service is heavily dependent.

NHS leaders are working hard with other public services and Whitehall to manage these risks. But we need to recognise that this is a complex and resource-intensive task, especially when set alongside everything else an overstretched NHS is trying to do.

Chris Hopson is the chief executive of NHS Providers, which represents all English NHS hospital, ambulance, community and mental health trusts

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Hospital chief says family time would give patients a better end to life

The end of most of our lives will not be planned or expected for long. The “handover” from oncology and chemical treatment to attempt cure, and palliative and then terminal care, is not good enough. Those in charge of the former are reluctant to give up and hand over to the latter. The result is a lot of unnecessary discomfort and stress, and often in rural areas, of travelling long distances to achieve very little. The interface between these specialities would be best facilitated by a GP, preferably one with a palliative care interest. 

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Advanced directives would also be helpful, and other countries are showing us the way.

Sarah Kate Templeton on June 25th in the Times reported: Professor Marcel Levi: Dying should shun treatment and take final holiday – Hospital chief says family time would give patients a better end to life

Patients who are dying should be allowed to go on a final holiday rather than be subjected to gruelling treatment, according to the boss of one of Britain’s largest NHS trusts.

Professor Marcel Levi, a practising doctor and chief executive of University College London Hospitals, said the NHS is wasting time and money treating dying patients at the end of their lives.

He said: “I often think, ‘You would be better going on holiday with your family and you may have a little shorter but a lot better end of your life.’”

Levi, who is Dutch and was previously chairman of a leading hospital in Holland, said: “I do not find the discussion, ‘Which patients should we not treat any more at the end of their lives?’ very well developed in the UK.

“The patients do get anti-cancer treatment when the oncologist, probably the patient and his or her family know it is not going to contribute a lot and it may cause a lot of safety problems and harm.

In Holland, Levi said it is common for patients to state they have had enough treatment and do not want to go back into intensive care.

In the UK, however, he said patients are automatically continuing with treatment in the absence of an honest discussion about what is going to be achieved.

“Patients who are 85 years old do not have to expect a lot of gain from haemodialysis [kidney dialysis], but they still go there three times a week. They feel terrible on the day of dialysis, they feel terrible the day after dialysis. That is six out of seven days of the week,” he said.

“Somebody should at least discuss with them, ‘Is this useful for you? Are you really having any gain of quality of life by doing this?’

“They have a very short life expectancy and we are actually spoiling the last weeks of their lives instead of making them comfortable and them spending quality time with family and friends.”

About 43% of NHS spending goes on the over-65s, according to the Nuffield Trust healthcare charity. This age group also occupies about two-thirds of hospital beds, National Audit Office figures show. Between 10% and 20% of the NHS budget is spent on people in the last year of life, a government-commissioned palliative care funding review found.

Dr Gordon Caldwell, a consultant physician at Worthing Hospital, West Sussex, agrees that British doctors — himself included — often avoid frank discussions about letting patients die.

He said: “Often, as doctors, we hold on to hopes of marginal benefits — ‘You could live 30 days longer, perhaps to three months’ — but omit, ‘This will involve 60 days attending hospital, so you could not go to see Snowdon and Anglesey with your grandchildren.’

“We have relatives demanding, ‘Do everything, doctor.’ Those same relatives, when the patient dies, ask, ‘He didn’t suffer, did he?’ Well, if we were honest [we would say], ‘Yes, he did because you asked us to do everything.’

“I strongly suspect many patients would want less medical interference, such as tests, treatments, last-ditch attempts at chemotherapy.

“Doctors must learn to be honest about the true likely effects of their tests and treatment — a marginal benefit in a few patients at a lot of opportunity loss. A day spent having chemotherapy is a day not with the family.”

Levi said it is up to physicians to broach the subject and it is often welcomed by patients and their families.

“It is the doctors who start the discussion. It was a bit tricky when we did this [in Holland] but it actually turned out that many, many patients and their families were extremely supportive,” he said.

“There were many families of patients who died of cancer who said, ‘If I knew before this was going to happen, we would not have done this operation or this chemotherapy.’”

Professor Karol Sikora, former chief of the World Health Organisation’s cancer programme and chief medical officer of Proton Partners International, a private cancer and healthcare specialist, said there are now more than 25 cancer drugs available that cost more than £50,000 for one year’s treatment and in most cases these would prolong life for only an extra three months.

He added: “There is so much pressure to be active, driven by the pharmaceutical industry and the breakthrough mentality. Giving patients permission to let go has got a lot harder over the last decade.”

However, Baroness Finlay, a crossbench peer and palliative care consultant, believes patients must be given the options of treatments that could help them live longer.

“Sweeping judgments about a person’s quality of life are dangerous,” she said. “Anyone can refuse or cease treatment and that wish must be respected but it becomes dangerous when people are not given the options that might help them live longer and live well.”

Judith Kerr, 94, the children’s author and illustrator who wrote The Tiger Who Came to Tea, has already made her preparations. Last year she told The Sunday Times she keeps “a little piece of pink paper signed by the doctor, saying ‘Do not resuscitate’.”

She added: “Having had a good life, to go through this misery, and at great expense to everybody else — expense not only in money but in emotion.”

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Selecting doctors, and portfolio careers crossing from primary care to Hospital.

Just like Brexit, health is a complex and long term problem. Decisions on both should be taken only by experts..

The Canadians shame us with their plans for end of life care

Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

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Bradford staff: government breaking its promises….. This needs to be a nationwide rather than a local solution.

If we look at pensions as a promise of  future payment, and we assume that the English Health Service, along with the other 3 dispensations, has a “ponzi” scheme type of pension fund, then it is not surprising that Trusts and their boards of directors try to escape future commitments that they cannot fulfil. The whole of the former NHS (when we had one mutual) is funded on this basis, but by denial of the long term problems, politicians are forcing locally based solutions, inequity, and poverty in their workers old age. In effect they are breaking their promise… just as the Greeks had to …. The problem needs a nationwide solution so that the pain if felt equally. The earliest Trust sare those most likely to get away with it, and some already have. The result is post-code rationing by ethically and legally dubious means….  In any event, the whole state as well as health worker pension situation needs review….

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Unison website reports 8th July: Bradford hospital staff strike to stay in the NHS and picket lines will begin

BBC reported 14th August: Bradford Teaching Hospitals staff to strike over outsource plan

and Susie Beever of the Yorkshire Evening Post reported 1st August that there would be a two week strike over jobs 

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The History: Bradford Hospital has a track record. Simon Freemna in the Times 27th November 2004: Hospital’s rescuers charge £160,000 for the privilege

Sarah Kate-Templeton in the Times 2016: Safer births campaign: Shamed hospitals blame high stillbirth rate on the mothers

Rhys Blakeley in the Times 19th August 2019: Plea for state pension age of 75

 

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…

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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)

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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)